A Report on Kingfisher Airlines Essay

Overview of Airlines industry in India The aviation industry in India is one of those sectors that saw a constant pace of growth among the other industries in the world over the past many years. The open sky policy of the government has helped a lot of overseas players entering the aviation market in India. From then, it has only been growing in terms of players and the number of aircrafts. At present, private airlines account for around 75% portion of the domestic aviation market. The 9th largest aviation market in the world is India. Taking the help of the statistics from the Ministry of Civil Aviation, approximately 29.8 million passengers traveled to/from India in 2008, showing a surge of 30% from 2007. The prediction stated that international passengers will touch 50 million by 2015. More opportunities in the aviation industry in India are likely to make way for about 69 foreign airlines from 49 countries. Growth of aviation industry in India The Indian Civil Aviation market grew at a CAGR of 18%, being valued round US$ 5.6 billion in 2008. Further statistics revealed that the air traffic in August 2009 was a double digit figure. The domestic airliners flew 3.67 million passengers in August 2009, as against 2.92 million in the corresponding period of 2007, up by 26%. The Centre for Asia Pacific Aviation (CAPA) has estimated that the domestic traffic will go up by 25% to 30% till 2010 along with a surge in the international traffic by 15%. There would be more than 100 million passengers by 2010. Then again by 2020, Indian airports will in all probability handle over 100 million passengers every year. The investment plans to the tune of US$ 9 billion has been made by the Aviation Ministry for modernizing the existing airports by 2010. In terms of domestic passengers’ volume, US have always been the leader with followers in the league like China, Japan and India. The number of domestic flights went up by 69% from 2005 to 2008, with the domestic aviation sector growing at 9-10%. Vision â€Å"The Kingfisher Airlines family will consistently deliver a safe, value-based and enjoyable travel experience to all our guests.† Mission   Ã¢â‚¬Å"Kingfisher Airlines will have ‘Fly the Good Times’ approach and this will reflect in the experience we will offer to passengers Introduction Kingfisher Airlines Limited is an airline group based in India Its head office is in Andheri (East), Mumbai and Registered Office in UB City, Bangalore. Kingfisher Airlines, through its parent company United Breweries Group, has a 50% stake in low-cost carrier Kingfisher Red. The airline has been facing financial issues for many years. Until December 2011, Kingfisher Airlines had the second largest share in India’s domestic air travel market. However due to a severe financial crisis faced by the airline at the beginning of 2012, it has the lowest market share since April 2012.The airline has temporarily shut down its operations when on October 20, 2012 the DGCA suspended its flying license. This suspension had been due to failure to give an effective response to the show-cause notice issued by DGCA. However, The airline had locked out its employees for several days before this suspension. On 25 October 2012, the employees agreed to return to work. Strategic Management â€Å"Strategic management is an ongoing process that assesses the business and the industries in which the company is involved; assesses its competitors and sets goals and strategies to meet all existing and potential competitors; and then reassesses each strategy annually or quarterly [i.e. regularly] to determine how it has been implemented and whether it has succeeded or needs replacement by a new strategy to meet changed circumstances, new technology, new competitors, a new economic environment., or a new social, financial, or political environment.† (Lamb, 1984) The systematic analysis of the factors associated with customers and competitors(the external environment) and the organization itself(the internal environment) to provide the basis for maintaining optimum management practices. The objective of strategic management is to achieve better alignment of corporate policies and strategic priorities. Sociological Today’s air traveler is like any other consumer looking for value for money. Disposable incomes are on the rise and the consumer is willing to spend more for quality and brands. Air travel is no more about transporting passengers. It is more about the flying experience. People like travelling in planes. ‘Kingfisher airlines’ has a very good social image. Being a five star airlines, customers want to travel with Kingfisher. Also, the brand charges a premium price that is why only upper Socio Economic Class people prefer Kingfisher airlines. The lifestyle of the people is improving. Luxury is becoming necessary. They are ready to pay more for luxury services. Kingfisher has a strong advantage here. So, we can conclude that sociological conditions are favouring Kingfisher airlines. Technological People are becoming more and more tech-savvy. Kingfisher does provide a TV at the back of the seat. That means every commuter has his own TV. Apart from that, Kingfisher also has facilities such as e-booking. Now, commuters can even book the tickets by mobiles. So, it can be stated that Kingfisher’s image and sales are driven by technology too. Economic Figures indicate that purchasing power of Indians is increasing. People look for more options now, even luxury goods. Bank Credit is easily available in case of travelling. Economic slowdown is one of the major factor which is affecting the sales of aviation industry. In INDIA there is a mixed economy so private organization easily perform their tasks within any given economic system of course, organization are influenced by a variety of economic features over which they have little independent control, such as inflation, interest rates and recession Another important input to the enterprise is the nature of government fiscal and policies. Ecological One important factor is that how natural factor affects the aviation industry as whole. The most important factor is the stability of the weather. The timings of the flight are highly affected by shifts in weather. Also, it can be noticed that a highly unstable weather is directly proportional to the added costs to the company. For example, if there is a delay in the flight, the company has to provide facility for accommodations of commuters. In India, weather is quite stable in most of the time during the year. Thus, aviation is a profitable business in India, if we consider ecological factor. Political The political environment is stable. In India, government changes after 5 years. Also, it is a democratic country. Kingfisher has an added advantage over here that the owner of Kingfisher, Vijay Mallya has very good political network. That means even political environment favours Kingfisher airlines. Legal Aviation fuel prices in India are regulated by government. So the competition for price becomes quite still. All the companies in the industry have to pay the same amount for fuel. Now companies can increase or decrease the prices depending on the services they provide. A premium service provider, of course, would charge the prices for its services. Ethical Indians are highly ethical people. They always make a trade off between what is right and what is wrong before they make any purchase decision. For example, if a company says that 50% of their contributions will go for the charity, then Indians are more likely to buy products or services of that company. Kingfisher airline gives value for the money. It is India’s only five star airline service provider. Hence, considered ethical. Porter’s 5 Forces for Kingfisher Airlines Threats from competitors: The level of threat from the domestic competitors is very high. Competitors like Jet Airways, Indian are some of the old well established players in the market which prove to be strong competitors for the emerging Kingfisher Airlines Threats from new entrants: The level of threat from new entrants is quite low such as Virgin Atlantic, Qantas. The major players in the Indian aviation industry form an obstacle to foreign airlines and moreover Indian flyers prefer to have an Indian experience on the flight. Threats of substitutes: The introduction of high speed trains, high tech buses and other means of transport has given more options to people to travel. Aviation in India is booming and with the entry of several new players in the market competition has stiffened. In such a scenario it is imperative for any airline to build its brand and have a focused marketing strategy in place Bargaining power of suppliers: The bargaining power of suppliers is medium. For example, Airbus and Boeing are the major aircraft manufacturers and there aren’t many aircraft manufacturers other than these two, this confines Kingfisher’s options therefore the bargaining power of Airbus or Boeing increases. In case of other suppliers such as caters the bargaining power of the suppliers is low therefore Kingfisher has many other options of caters to contract to. Bargaining power of customers: The bargaining power of the customers is low since kingfisher is designed to meet the total comfort and value for money; therefore customers aren’t reluctant to pay a little more sum to gain this experience. Competition Analysis Kingfisher’s only strong obstacle proves to be Jet Airways, since Jet has control on both ends of the market and secondly it has penetrated into the international market as well. Benchmarking against Jet Airways, Kingfisher Airlines has acquired Air Deccan which was one of the most profitable low cost airlines, hence kingfisher too has entered in the lower end of the market but bearing in mind that they haven’t changed the name â€Å"Deccan† to â€Å"Kingfisher Airlines† so that the brand doesn’t lower. Kingfisher is still testing the lower end of the market with Deccan. Kingfisher is also going to start non-stop flights to US so as to foray into the international market.

Love and Dedication in The Old Man and the Sea

There are two unique relationships that are touched upon in the novella The Old Man and the Sea by Ernest Hemingway.   The first relationship is the friendship and love that occurs between the old man, Santiago and his young companion, Manolin.   They have bonded over the years in a unique father-son relationship.   The other significant relationship that the story emphasizes is the one between Santiago and the fish.   It is apparent the strong love that Santiago feels for his adversary. Through these two relationships, Santiago displays his love and dedication. The endurance of love is displayed through the relationship of Santiago and his friend, Manolin.   Their relationship has seen both ups and downs, but through it all, Manolin has stood by the old fisherman.   In the beginning of the novella, we learn that Manolin’s family has forced him to work on a different fishing boat to gain more profit.   Despite this, he still visits his old employer and helps him take care of himself and his boat.   By bringing him food and water, he is displaying his genuine feelings for Santiago.   The reader sees in the final scenes, how deep this love and affection runs.   Manolin weeps for his friend as if he has suffered the loss of the marlin as well. These feelings that Manolin has built up has been the result of the companionship that they have shared through the years.   Santiago was the one who taught Manolin how to fish and has been his friend for many years.   Santiago has become a father figure for Manolin since he did not have that type of relationship with his own father.   Santiago has been able to give the boy friendship along with feelings of self-worth.   The boy feels that Santiago is the greatest fisherman: â€Å"There are many good fishermen and some great ones. But there is only one you† (Hemingway 23).   This strong bond enables Manolin to empathize when Santiago loses his great prize. Santiago has a great love for his only friend.   Without Manolin, he would be alone and he is grateful to have the boy in his life. He no longer dreamed of storms, nor of women, nor of great occurrences, nor of great fish, nor fights, nor contests of strength, nor of his wife. He only dreamed of places now and of the lions on the beach. They played like young cats in the dusk and he loved them as he loved the boy. (Hemingway 25) The reader is revealed Santiago’s strong affection for his companion when he is alone on the boat.   When the struggle between Santiago and the marlin ensues, he wishes that Manolin was there with him.   As he's towed by the fish, the old man says: â€Å"I wish I had the boy† (Hemingway 45).  Ã‚   Santiago is very appreciative of Manolin and enjoys sharing stories with him. They talk of baseball and he relays tales of the time that he spent in Africa.   The way that the boy looks up to the old man makes him feel significant.   He feels as though he has something to teach the boy and the boy respects the skills of the man. The boy is the one bright spot in Santiago’s return from his battle with the fish.   He is content with the fact that he has defeated such a creature and is able to return to see his friend again before he joins his great fish for eternity. Santiago has a strong dedication to fishing.   In the beginning of the tale, we learn that the man has gone eighty-four days without catching a single fish.   However, he does not give up hope that his luck will change and that he will begin catching fish again.   He has dedicated his life to fishing and will not stop because he has had a run of bad luck.   Hemingway remarks â€Å"Everything about him was old except his eyes and they were the same color as the sea and were cheerful and undefeated† (Hemingway 10).   He does not wish to rely on luck, but would rather have faith in his skill as a fisherman. He has dedicated his life to fishing and has it down to an exact science.   He focuses all his energies on fishing: â€Å"Now is the time to think of only one thing. That which I was born for† (Hemingway 40).   This is why he makes such a formidable opponent for the marlin.   He knows the signs of a large fish and looks for them when he sets out on the water.   Furthermore, once he defeats the fish, he has the skill and ability to lash the great fish to the side of his skiff and set out for home. Despite the battle between the marlin and the old man, it is obvious that the man feels a great amount of love and respect for the creature.   He is impressed by its greatness and realizes that regardless of his determination, it is very likely that the fish will win the battle between them. You are killing me, fish, the old man thought. But you have a right to. Never have I seen a greater, or more beautiful, or a calmer or more noble thing than you, brother. Come on and kill me. I do not care who kills who. (Hemingway 92) The way that Santiago regards the fish displays the great love that he feels for nature and the creatures on this earth.   Even as the battle continues on and he is weakened, he still does not feel any hatred for the fish.   As he says, â€Å"Fish, I love you and respect you very much. But I will kill you dead before this day ends† (Hemingway 54).   Even after he has defeated the fish, he does not let go of the love he feels for such a magnificent animal.   When sharks attack and take most of his prize, he feels as though he has sinned by taking such a wondrous creature’s life.   He experiences a profound sense of regret and sorrow. â€Å"They must have taken a quarter of him, and of the best meat. I wish it were a dream and that I had never hooked him. I am sorry about it, fish† (Hemingway 103).   This love provokes him to vow to fight the sharks and protect the fish as best as he could, even if it means his own death. Santiago’s love and dedication to both Manolin and the fish is an integral part of The Old Man and the Sea.   These relationships turn an otherwise tragic novel, into a tale of hope.   The boy and the old man are dedicated to each other and the reader has faith that through this love, Santiago will be able to overcome the devastating loss of his prize.   Manolin vows to never leave him again and dismisses the expectations placed upon him by his family.   The ending can be considered triumphant because through Santiago’s dedication, he was able to defeat the fish and still be able to return home to his beloved friend. WORKS CITED Hemingway, Ernest.   The Old Man and the Sea.   New York: Scribner, 1995.

Ateneo Entrance Exam Essay

Hazel Grace Lancaster (The Fault in Our Stars by John Green) This little line from one of my favorite books helped me start my journey of self-discovery. Before, I really did consider myself as someone very inexorability. To the world, I'm Just an average girl that nobody will ever notice. Maybe never will be noticed in an extraordinary way, but I'm determined to make my mark. But flirt things first, I had to discover myself and define who I really am. My first moment of self-discovery began, actually, when first developed my love for books.And that moment happened way, way back when I was still a young child. Nothing made me happier than going to National, Power Books or Fully Booked to go see what new storybook, magazine or novel was available. To this day going book shopping, an activity most people my age would find as agonizingly boring, is an opportunity to expand my knowledge and vocabulary. The only thing I need to improve on right now Is, admittedly, my book choices. My Dad constantly reminds me to move onto more young adult publications and cut back on the children's novels. Books are my flirt great love.Through them, I can go on fantastic adventures that become almost real in my imagination. I also relate to the characters In terms of their personalities and the things they do In the story. From the protagonist, antagonist and all the other characters in between, I can find someone or even something I can relate to in a book. My current favorite books are The Fault in Our Stars by John Green, where I have learned a great many deal of new words such as hamster, thyroidal, prototypical, narcissistic, bacchanalia and so many other terms that were once too sophisticated or me to understand until I looked them up In the dictionary.The Fault In our stars is a heartwarming and yet also heartbreaking love story of two young cancer-stricken teenagers who find their own little infinity together within their limited number of days. I'd tell you more but I would n't want to spoil the entire novel. Second in my favorites list would have to be The Book Thief by Markus Sake. Here, I saw World War II and the horrors of the Holocaust through a young girl like myself, who was unable to read and write until she was given to a foster family in Germany. Lies Impinge then later befriends Max Vandenberg, a Jewish man who hides in her family basement to escape the Nazis.Again, I will not spoil this great work and you will have to read it yourself. This book really strikes me as something that can really make us all question our humanity. As almost all of us know, the Holocaust in World War II was the most horrifying genocide in the entire world. Millions of men, women and children all executed Just because of their religion. If you ask me, Doll Hitler must have been both insane and blind. Did he not know that in World War l, approximately 96,000 Jewish soldiers fought for Germany? It pains me to think that Hitler did not remember that.The Book Thief is most definitely one of those war novels that will have you questioning mankind's humanity. As for a favorite book series, I would have to say that the How to Train Your Dragon series by British author Caressed Jewell. I admit, it's a children's books series but I really enjoy reading the 1 OFF imagination. In fact, this beloved series has been turned into two films and a TV show. But I'll tell you all about it later. Indeed, through reading books of all kinds I eave discovered things about myself I didn't even know were there. I discovered that I have a talent for writing and storytelling.And I have grown to love these two hobbies, which I hope that I can turn into a Job by becoming a writer or a Journalist when I grow up. Aside from reading, I have also experienced being in academic contests in my school where I have begun to define myself as an intellectual. One of those contests is the Essay Writing Contest the school has every year. I never really win any prizes for my composit ions but it's always so much fun to compete. Through essay writing contests, my writing ability is steadily honed and constantly improved with every essay I write.So part of my Journey of self-discovery has been accomplished through the means of books and writing. The other part is, honestly, what Vive been recently obsessing about. â€Å"Everything we know about you guys†¦ Is wrong! † – Hiccup Horrendous Haddock Ill (How to Train Your Dragon Movie) That line from an animated movie by Trademarks Animation has always been embedded in my memory. The first part of this essay focused on my love for books and how reading and writing eave helped me discover who I am in terms of what I can do in this world. This part will now focus on who I truly am as a person.How to Train Your Dragon is a 2010 animated film directed by Dean Edibles and Chris Sanders under Trademarks Animation. Its story revolves around a young Viking teenager named Hiccup (Yeah, I know. The name is pre tty unusual. ) who lives in the fictional dragon fighting island of Beer. In Beer, fighting dragons is as necessary as breathing air to live. However, Hiccup is the runt of the village and is physically unable to fight dragons and cannot vive up to his father's expectations. Incidentally, his father, Stoics the Vast, is the tribe chief.But when Hiccup creates an invention that shoots down an ultra rare dragon species known as the Night Fury and attempts to slay it, the young Viking then finds himself unable to do so. This then leads to him freeing it and establishing a forbidden friendship with the dragon, whom he names Toothless. In Hiccup world, befriending a dragon is the highest act of treason. And yet in the end, Hiccup and Toothless' amazingly strong bond enables them to change the relationship between he dragons and Vikings of Beer. Yes, it is an animated movie. But it is not strictly for kids only.I had a real moment of self-discovery and self-definition when I watched this at my best friend's recommendation. And I was immediately awestruck by the movie on so many levels. The detail on the animation was superb, the lighting was perfect, the music score was Just phenomenally beautiful. But what really touched my heart was the story. I really relate to Hiccup. He is left-handed, physically not in the best of shape, intelligent and extremely different from the rest of his peers. L, myself, am also left- ended, physically weak, mentally strong and†¦ Different.I often look at my friends and other people and I can't help but sometimes feel that I'm Just too different. I don't like all the things everyone else likes and sometimes I don't even understand current trends and stick to the things I know. Like Hiccup, I am different. And also like Hiccup, I have embraced my difference. Thanks to this film (and its TV series and sequel) I have figured out who I am as a person. Everyone discovers a new trend and they all zone. And when someone tries to change me , I steadfastly refuse to do so. I am an individual. And I am proud of it.I'm different from everyone else and that's okay. Truth be told, we're all different. We're Just scared to show the world our individualistic. That's why I try hard to stay true to myself and make sure nobody and nothing turns me into something I am not. But I also remind myself to keep an open mind and broaden my horizons. When I experience new things, it helps me discover more interesting characteristics that help define myself as a person. And that's exactly what Hiccup does. He accepts his individuality and tries to do things nobody has ever tried before.Throughout the film, TV series and sequel, Hiccup stayed true to himself and didn't allow anyone to change him. If you must know, I have recently watched How to Train Your Dragon 2 and had another great moment of realization. In the second film, Hiccup is now a young adult and is currently trying to find himself. This is exactly what I'm doing right now, e ven as I write this. I apologize if this essay may seem haphazardly constructed. I must admit, my writing style does tend to confuse some people. But that's essentially how I have defined myself as a person, through books, writing and argons.And to tell you the truth, self-discovery and defining yourself as a person never stops. As the years go by, you will have more experiences, more moments that help you realize that there's more to you than meets the eye. For me, I'm still pretty young so I still have a long way to go until I can complete my personal definition. In case some of you may not fully know me yet, allow me to tell you once again who I am. I am an individual with a love for writing, making stories, reading books, obsessed with dragons. And basically, I am different. And I am proud to be different.

Written Assignment Essay Example | Topics and Well Written Essays - 1500 words

Written Assignment - Essay Example In the present scenario, globalisation, expatriation and advent of technologies have changed business operations and market conditions to a large extent. In this context, organisational behaviour plays an important role, as it assists in evaluating, controlling and forecasting the changing perception of workforce of organizations. It ensures that an effective workplace is maintained within an organisation, so that employees are able to conduct their operations in accordance with desired business objectives successfully3. Presently, the business scenario and market conditions have changed due to globalization and technological advancement. In addition, the emerging concept of expatriation has also changed the internal organisational environment to a large extent. The aforementioned factors are identified to be accountable for changes in organizational cultures. Individual from varied cultural background, ethnic groups and sex among others are working together in an organisation due to expatriation. The involvement of individuals representing different culture and having different belief has raised the trend of changing workforce in an organisation. In this context, organizational culture and organizational behaviour are recognised to be interrelated and equally important for organizations. Organizational culture includes vision, mission, values, assumptions, beliefs. Organizational culture is an important consideration for the overall performance of an organisation and it is regarded as the backbone of an organization. Workforce is the main asset of any organization. Subsequently, changing workforce is identified to influence organisational behaviour to a certain extent. Every organisation follows certain rules and regulation in its workplace to conduct operations in a coordinated and systematic manner. In this context, changing workforce may

Ethical Theories & Stakeholders Essay Example | Topics and Well Written Essays - 1750 words

Ethical Theories & Stakeholders - Essay Example An organization exists in the society, for the society and cannot have an existence independent of the society. Moreover, the organization has responsibility towards all the stakeholders that are directly or indirectly affected by the conduct of the organization or the employees (Joyce, 2005). Problem statement Top management involvement is essential to build a strong ethical culture within an organization (Clement, 2006). The issues before Veronica are to ascertain if the company policy permits action against such issues. Besides, as a director, she has responsibility towards the stakeholders. She is also morally bound by duty to act in the interest of the maximum number of people. If the demands of the shareholders, stakeholders, consumers and the investors are not met, it can adversely affect the brand image, customer retention, and overall business (Robinson, 2002). Ethical theories & Stakeholders The stakeholders The stakeholder theory holds that managers are obliged to serve al l those who have a â€Å"stake† in the firm (Marcoux, 2000). Initially the stakeholders included the Big Five – the employees, the owner or the shareholders, the customers, suppliers and the community in which the firm operated. The other twin stakeholders include the government (who has the responsibility to ensure that the firm complies with all regulations) and the competitors (who keep the company conscious of the developments and help avoid unethical business practices. The purpose of the firm itself is to serve and coordinate the interests of all the stakeholders (Joyce, 2005). Great Builds is a multinational engineering company and has to ensure that the interest of all the stakeholders is taken care of. Employees are the greatest stakeholders as they constitute the firm and contribute to the firm. Employees have the fundamental right to liberty and safety within the workplace (Greenwood & Cleri, 2005). Customers are only interested in reliable supply of goods a nd services but more recently they have become conscious of dealing with ethical firms. The suppliers demand timely payments and long-term relationships and the community expects safety and security. In the case of Great Builds the most affected by unethical practices would be the employees, the customers and the shareholders. The competitors could be positively affected if the performance of Great Builds suffers as a result of the CEO’s behaviour. Categorical Imperative According to Immanuel Kant duties cannot be associated with self-interest or rewards and payoffs (Carrigan, Maronova & Szmigin, 2006). Moral requirements are based on a standard of rationality known as â€Å"Categorical Imperative†. However, chances are these standards are desire-based on instrumental principles of rationality (Stanford, 2004). The moral philosophy goes beyond that of a human slave to passions. Kant emphasizes that there is a self-governing reason in each individual which guides the pe rson in a rationale decision-making process. There has to be motivation by duty or motivation by respect for law that governs actions. Thus, Kant states that the fundamental principle of our moral duties is a categorical imperative. The word imperative urges us to act in a particular way. The Categorical Imperative is derived from two maxims – objectivity and respect for all persons (Kitcher, 2004). The maxim of objectivity states that the act is right if

Ethical Aspects Essay Example | Topics and Well Written Essays - 1000 words

Ethical Aspects - Essay Example It is important that ethical aspects are included so that the body of evidence that is available to policy makers reflects the diversity of the population. The essay will analyse this case study with a view to determining the value of the research to the participants and investigators, as well as assessing the validity and precision of the study. For any research studies to go ahead, investigators have got to ensure that the study is valuable to the current body of knowledge and to the participants. Research has to contribute to improving the health and wellbeing, and in this case study, it sought to determine the links between suicidal tendencies and low cholesterol levels. The information derived from this research study would be valuable to participants, as they would be aware of factors that could be detrimental to their health. This information is also valuable to the patient population as it is thought to be specific to patients with Para suicidal tendencies. This research found that those patients with low cholesterol levels were more likely to develop suicidal tendencies than the control groups. To further enhance the value, the study had to be designed in such a way that would reduce bias; which could have been introduced through age-related disorders such as dementia, anorexia, etc. Bias can also be introduced if the sample group is homogeneous, which is there is a significant proportion of males to females; however, the investigators have made sure each group has an equal split. Validity and precision The research sought to determine if there was any difference in cholesterol levels between the patient groups examined, and if there was an association between cholesterol level and measures of suicidal tendencies, impulsivity and depression. The study results and analysis revealed a significant difference in mean cholesterol levels between the three groups with the parasuicide group having the lowest levels and the psychiatric controls having the highest. This clearly satisfies the first aim of this research, and cholesterol, non-planning and motor sub scale scores of self reported impulsivity were significantly inversely related, which supports the second hypotheses. The validity and precision of these results could have been influenced by bias and other conditions, however, the investigators have taken a number of steps that would have reduced the probability of this occurrence. One method of ensuring validity and precision is to select an appropriate sample size, sample method and make sure the confidence intervals are appropriate for the study. The sample method of selecting three groups provides a population spread and accounts for the various psychological conditions that exist. For example, normal controls will be different to psychiatric controls and this ensures the generalisation of the study results. Efforts have also been made to ensure the gender split is equal in all three groups, as the study found that there are some differences between the sexes. The psychiatric controls also served to remove any bias that may have been or could be attached to the participants in the parasuicidal/DSH group. The age range was a potential source of bias, however the inclusion criteria was necessary as over 65s could present with symptoms that are asymptomatic of parasuicidal/DSH as a result of

Employers Duty of Care Essay Example | Topics and Well Written Essays - 1000 words

Employers Duty of Care - Essay Example However, Jake could seek the car owners’ permission to provide the basic checking services for extra charge that would provide revenue for the shop and would not necessarily cause unnecessary work slowdown for those car owners who opted not to avail of these extra services. In so doing, Jake would still be complying with the duties expected from his scope of employment and still adhere to the priorities set by Herman, his manager.2. Explain whether or not Herman is responsible for Jake’s injury.  As employer, Herman is responsible for Jake’s injury primarily since the injury was sustained while doing the responsibilities expected of him in the service department. According to U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA), â€Å"employers are responsible for providing a safe and healthful workplace† (OSHA Law and Regulations, n.d., p. 1). The injuries sustained by Jake form part of OSHA’s regulations that co ver autobody repair and refinishing where injuries that were identified include â€Å"being struck by an object, struck against an object, and caught in an object, equipment, or material† (Smith, 2007). In this regard, it is within the responsibility of Herman, as employer, to ensure that the workplace is safe and that employees, including Jake, are accorded with the appropriate medical attention for injuries sustained within the work setting and in complying with his identified responsibilities.... According to U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA), â€Å"employers are responsible for providing a safe and healthful workplace† (OSHA Law and Regulations, n.d., p. 1). The injuries sustained by Jake form part of OSHA’s regulations that cover autobody repair and refinishing where injuries that were identified include â€Å"being struck by an object, struck against an object, and caught in an object, equipment, or material† (Smith, 2007). In this regard, it is within the responsibility of Herman, as employer, to ensure that the workplace is safe and that employees, including Jake, are accorded with the appropriate medical attention for injuries sustained within the work setting and in complying with his identified responsibilities. Herman should duly comply with OSHA reportorial requirements, as needed. 3. Explain whether or not Jake should be paid the overtime. The payment of overtime is governed by the Fair Labor Standards Act (FLSA) issued by the U.S. Dept. of Labor. The law specified that â€Å"it requires employers to pay covered employees who are not otherwise exempt at least the federal minimum wage and overtime pay of one-and-one-half-times the regular rate of pay† (U.S. Department of Labor, n.d., par. 1). Jake’s responsibilities, despite the noted promotion to service manager, remained the same as a service personnel. In this regard, he should be paid the overtime. As disclosed in the law for exemptions in the availment of overtime pay, â€Å"to qualify for exemption, employees generally must meet certain tests regarding their job duties and be paid on a salary basis at not less than $455 per week. Job titles do

Suppliers Relationship at Pfizer Essay Example | Topics and Well Written Essays - 2000 words

Suppliers Relationship at Pfizer - Essay Example As of 3rd quarter of 2010, the company reported its total revenue of $16.2 billion despite the economic recession in some parts of the world (Pfizer, 2010 c). This figure is 39% more than the total revenue of Pfizer during the 3rd quarter of 2009. (See Table I – Comparison between Pfizer’s 3rd Quarter Revenue between 2009 and 2010 below) In the past, majority of the purchasers are searching for a wide-range of sources of raw materials provided that the supplier can offer the company the lowest market price for the same product (Gadde and Hakansson 1993, pp. 165 – 166). Today, purchasers are after the need to develop a long-term collaborative relationship with its suppliers in order to avail cheaper high quality raw materials (Chobra and Meindl 2001; Araujo, Dubois and Gadde 1999; Bensaou 1999). In relation to the business growth of Pfizer, this report wide-range of will discuss about the importance and ways on how to properly manage the supply side of raw materia ls by establishing a good relationship with its suppliers. Aside from discussing the different degrees of involvement in which Pfizer can establish good relationship with its suppliers, this report will discuss some strategies that will enable Pfizer maintain a strong and long lasting relationship with its accredited suppliers. Supplier relationship management has been a common practice in supply chain management of multinational companies like Pfizer. As explained by Wisner, Tan and Leong (2009, p. 95).

Executive Remuneration Essay Example | Topics and Well Written Essays - 2000 words

Executive Remuneration - Essay Example These debates on the director’s compensation has been seen in most countries more notably the Royal Bank case involving Stephen Hester and this has led to most companies developing their own measures and procedures to be followed in the remuneration of executives to avoid much pressure from the government and the public interest. The perception that Hester received much remuneration package while the shareholders were rewarded lowly in terms of their performance contribution to the company has raised much debate. According to Lee (2002), the level of executive’s compensation has continued to raise much heat to the public. Therefore the much interest from the public, state regulators, and the media have seen most companies taking more time and paying a lot of attention to investigate, documenting and announcing executive remuneration. In order to cool down the much heated debate, public limited companies should implement the following practices and legal procedures. Coming Up With A Compensation Committee Once a company has a specialized committee that knows her functions is a better way to ensure that the committee has time and devotion to attend matters related to the executive compensation. The compensation committee usually operates within certain regulated legal authority, and resolution that is written by the full board of directors. The legal restrictions are put in place to avoid much conflict between the board and the executive staff over the amount of compensation.

English Essay Example | Topics and Well Written Essays - 2000 words

English - Essay Example Generally, when a writer produces a work, it comes in market in its original form and then it is presented to any other entity with its right and license to translate it to other languages to get it a place on international level. Such translations get feedback comprising of appreciations and loopholes both by the people having command on both original and translated languages which helps later to consider the drawbacks and produce better translations in future (Kovac, M., and Wischenbart, R., 2012). Translation of books into English language was not always appreciated as in Australia many authors did not like the Australian stories translated into English with so many changes in the text and wanted the youth to read original version of the stories (Nick Earls, ABC Premium News, 15 July 2009 i Allington, D., 2012). African writers also prefer to write in their own language and want Africa to be the centre of their literature. By doing this they do not aim to refuse the English stream rather they only wish to see things from African perspective. Ngugi is of the view that the Oral Tradition is important but it cannot replace the Modern African Literature. To remain loyal to the literature is to stick to the history and assimilate and embrace the traditional thoughts and so not losing the roots (Ngugi, 1986, p. 94-5). In the clip we observe South African writers’ reasons behind choosing language as a medium of their writing. Hambidge prefers to write in Afrikaans as it is connected to her identity. Moreover, she can express her thoughts and emotions in her own language in the best possible way. Magona and Ndebele see Afrikaans as the language of oppressed nation. Ndebele opts English for her writings as it is a language of opportunity and fame for its being international language Magona, though, prefers to write in English but she feels that she cannot write like Jane Austen and it involves both conscious and unconscious factors which shape thought language (U214, DVD 3, Clip 20.1, ‘Choosing to write in English’). While translating a language into English, problems may arise at lexical level. There may not be an alternative word available and a set of words express the meanings so it lengthen the sentence. For example in Russian language there is no separate word for ‘cloud’ rather there are words for different kinds of clouds so it makes the translator to interpret the kind of clouds relying on the context and present a different expression from the original sentence. This does not mean that Russian language is richer than English and provide finer details regarding vocabulary. In some other cases, Russian language has no separate word for ‘arm’ or ‘hand’ rather there is a single word ‘ruka’, so every time the translator encounters this word, he faces difficulty in interpreting that whether the writer is talking about ‘arm’ or ‘hand’. These pro blems are solved by using other words such as ‘fist’, ‘palm’ or ‘from shoulder to fist or wrist’ but it results in comparatively longer sentence. So, such lexical gaps between languages make it difficult to create a perfect translation (Cook, G., 2012). Cook observes the difficulties that become a challenge while translating other languages into English. Referring to the translation of the Chinese film ‘

Library Research Assignment Scenario Essay Example | Topics and Well Written Essays - 1250 words

Library Research Assignment Scenario - Essay Example Secondly, individual currency leads to reduced price transparency. This poses a challenge to many firms as they find it difficult to compare the prices of goods, services and resources across various regions. This happens due to the distorting effects of exchange rate variations. Moreover, such firms are vulnerable to uncertainty caused by exchange rate fluctuations. This happens as such firm’s tries to invest in other countries with different currency. This leads to decreased investment and inefficiency in business activities. Additionally, individual currency leads to increased costs to industries because such firms will have to buy foreign exchange in their trade activities. This makes such firms unable to compete with other large trading blocs. Furthermore, this form of currency leads to reduced foreign investment (Schadler, 2005). On the other hand, individual currency has an edge to the nation. First, individual currency is more reliable as compared to integration. This helps in maintaining the exchange rate stability in the country. This prompted the UK and Italy to leave the ERM in 1990 as they found the process ineffective (Anchors, n.d.). Secondly, individual currency offers some stability. This is as compared to integration where there exist rigidities. ... In addition, an individual country is essential in maintaining sovereignty. This helps a country to control the actions of its central bank (Stoa, 2008). This also helps the government in controlling its policies and,therefore, able to pursue policies beneficial to its economic and that of its firms. A rich history exists towards the development of a single currency in Europe. Currently, the euro has become part of seventeen member states of the European Union (EU). However, other member states are required to join the union in the future. The first appeal to the achievement of the European currency began before the market crash of 1929 (Europa, 2011). However, this was not realized due to prevailing economic conditions. The other attempt was after the end of Second World War. In Europe, three treaties bringing all six signatory states (Germany, Belgium, France, Italy, Luxembourg and the Netherlands) laid a foundation (Europa, 2011). The treaties led to the establishment of European Coal and Steel Community, European Economic Community, and European Atomic Energy Community. Besides, another summit in Hague defined a new objective of European integration. A task was formed to come up with various suggestions. The taskforce submitted a report in 1971 envisaging full economic and monetary union in the next ten years (Europa, 2011). Some of the recommendations were not adopted, but there was approval to the introduction of EMU in some steps. The first stage involved the narrowing of currency fluctuations margins with no further commitment. However, the US decision to float the dollar posed the challenge on the parities of the European currencies and hence the project was abandoned (Europa, 2011). Other attempts also faced the same challenge. However,

Enrollment System Essay Example for Free

Enrollment System Essay Enrollment is the focus of the Compfuturist that would lessen the institution’s difficulties in their Information System processing, solve data problems and an easier access of the establishment’s information. Every enrollment, 80-100 enrollees come for the dates of admission having a maximum of 30 for each level, in present time classrooms are consist of 15 students. An easier recording of files and a database to save documents will lessen the space being occupied by the records of the students. A faster transaction, easier ways for inputting datum and a convenient ways for saving files are offered for the use of the establishment by the enrolment system. The commonly used advertisements of schools are brochures, leaflets, banners and calling cards; the group also offers a website that will be used to improve its approach to people. The website would be a help for parents about the notice or updates of events and gatherings, it would also be a way to know the history of the institution and the contact details of the establishment. The incomplete requirements are the main problems during the enrollment, one of which is the student information, some of the information needed is not filled up and some are important to the school records. In the Pre-School it is required for them to have the copy of their birth certificate, two (2) copies of a 22 photo and an interview with the Pastor or Principal. For the grade-schoolers a photocopy of the birth certificate, the form 138, a certificate of Good Moral Character for transferee and an interview with the Pastor or Principal. Due to the uninformed people about the requirements needed some are not brought and are filed to be uncompleted forms. Each student has a folder that contains his or her information about the birth certificates, previous records from the earlier institution he or she attended, the quality point average for each year and also the permits signed by the parents. Enrollment takes time and effort from the parents, students and also from the teachers; every step of an enrolment, a teacher is assigned to instruct a parent or guardian what to do and where to go next. The slow process of enrolment makes the parents furious and makes the job even harder for the teachers for them to rush, that sometimes some records are not being filed or are not properly assigned. Missing documents are also a cause of problem for the institution, it might be placed to another folder or the parent forgot about it. A school’s updates about events and gatherings are the problems for teachers and parents. Students forget to tell their guardians or forgot to give the letter accustomed by their advisers. The result of the forgotten events cause students not to wear the proper attire, parents does not attend meetings and gatherings, students are thought to be absent for specific happenings and also parents become indignant about the unknown proceedings. Project Framework The Compfuturist Group offers the instituion. a system and a website that would shoulder the difficulties of the institution. The school appoints teachers to handle the student information during the enrollment. Software that is specially made only for Mabalacat Christian Academy and a website that would help the advertisement of the school increase. The system can only be open by an authorized member or the principal of the institution. Passwords and accounts would be made for the privacy policy made by the institution to safeguard each student’s information and background. The Student Information Sheet or Form would consist of the basic details about his or her family, previous schools the child attended, number of siblings, if there were awards he or she got from previous levels, address, contact number of the parent or guardian and more information that are to be filled by the guardian. An option will be given to the parent or guardian if the transaction of payment would be a full payment or a partial payment every quarter and a choice to have it paid through cash or cheque. A database would be given with a maximum capacity of 300 and a number of 50 students per level. A website would be provided for the institution that would only be used for the use of the school’s advertisement, featuring the facilities of the establishment, faculty members, and history of the school and updates of happenings. The page would be the source of parents to be updated to the school’s events; when, where and what to wear. Specific events require students to wear a garment requested by the institution for uniformity. The page can also be a source and guide for parents and guardians to know the details and history about the school. Contact details would be posted and an added detail of the page is that if parents are working abroad they could send the uncompleted requirement to the email of the school with attachment of the requirements. The Facebook page of the institution is also posted to the website and could be directed to the page created by the faculty members of the school. Statement of Objective Website and Enrollment System is a program extended to Mabalacat Christian Academy, a program that would make the transactions of requirements and documents, and also help about the school’s reputation about the improvement of its ways. It could solve the problems of the school since it started; the system only solves the problem of the school paperworks and will lessen the space of the documented files. The System is a program that would make the process of filing student information faster and easier to save for the school. The enrollment system’s purpose is to give a database for the files of students, a maximum of 300 files for the whole institution and an easier way of searching student files. A transaction that would make the access of information system easier for the authorized people, a faster accessibility in information provided and an improved process; the admission and acceptance of enrolees would be faster for the completion of forms would not be difficult for teachers to save and keep. The Website will inform the parents of the situations, cancellation of classes, school events, PTA meeting schedules, examination dates and payment dues. An account will be given to the principal or school head to access the student accounts and website if changes are to be made, the account given to the principal can also be used to check the number of students enrolled and to what level they are assigned to Importance of the Study The Compfuturist created a system only from Pre-School to Elementary levels and for an institution with one section per level, the system subjects only to the enrollment, saving and filing of documents and the postage of contact details of the institution. The use of the program is to lessen the burden of alphabetizing envelopes for each level and student, it also makes the search of a student file faster compared to the manual based of searching through metal drawers. A database that would show and save documents for specific purposes and privacy of files will be kept and safe from others to see. Only the Principal and the appointed faculty or member of the institution could access the information system of the database provided by the system. The institution would benefit from the free system that could be used for years and less updates of program would be given for the system is only for the use of Mabalacat Christian Academy. Parents and students would also benefit from it because information given from the old students will not be inputted again but be moved to the folder that consists of the level he or she is. The editing and adding of details is convenient even to those people who are not good in using computers. Less stressing and easier to use, is the way that the program or system offers to its benefactors. Radio buttons, scroll bars and more features of the program and website would be given to lessen the difficulty that some encounters in web pages and softwares. A free ten (10) months of maintenance is given for the institution and would make things better compared to the existing manual system.

Effectiveness of Support for Children in Homeless Families

Effectiveness of Support for Children in Homeless Families The whole issue of parents and children in need is a vast, complex and ethically challenging one. This review is specifically charged with an examination of those issues which impinge upon the stresses and strains that are experienced by parents of children in need. A superficial examination of these issues that are involved in this particular area would suggest that there are a number of â€Å"sub-texts â€Å"which can all give rise to this particular situation. Firstly, to have child in need is clearly a stressful situation for any parent.(Meltzer H et al. 1999) This can clearly be purely a financial concern and a reflection of the fact that the whole family is in financial hardship, perhaps due to the economic situation or perhaps due to the actions of the parents themselves. Equally the need of the child can be a result of anon-financial need, so we should also consider the child who is in some way handicapped, ill, emotionally disturbed or perhaps in need in some other way. This produces another type of stress on the parent, and these stresses are typically longer lasting and, in general, less easily rectified than a purely financial consideration of need. (Hall D1996). It is part of the basic ethos of the welfare state that it should look after its less able and disadvantaged members. (Welsh Office 1997).Parents of children in need will often qualify in this definition. We shall therefore examine the various aspects of this problem. Literature Review Effectiveness of family support for children in homeless families We will make a start by considering one type of child in need. The first paper that we will consider is that of Prof. Vostanis (Vostanis2002), which looks at the mental health problems that are faced by deprived children and their families together with the effectiveness of the resources that are available to them. It is a well written and well researched paper, if rather complex and confusing in places. We will consider this paper in some detail as it provides an excellent overview of the whole area. The paper starts with a rather useful definition for our purposes. It qualifies the deprived child, initially in terms of a homeless family, that being : A family of any number of adults with dependent children who are statutorily accepted by local authorities (housing departments) in teak, and are usually accommodated for a brief period in voluntary agency, local authority or housing association hostels. This period of temporary accommodation can vary enormously depending on the time of year and the area considered, and can range from a few days to perhaps several months. The target in Greater London is currently storehouse homeless families within 4-6 weeks. In London particularly, the homeless families can be placed in Bed Breakfast accommodation.(D of H 1998) In this respect, the immediate family support mechanisms do appear tube in place. Vostranis however, goes on to make the observation that despite the fact that the definition of the homeless family is rather broad, it does not cover all of the potential children in need, as those children and their carers who have lost their homes but have managed to live with relatives, on the streets or perhaps live as travellers, are not covered by the statutory obligation to provide housing. The official figures therefore, he observes, are generally an underestimate of the true situation. The official figures for the homeless families are put (in this paper) at 140,000. (Vostanis Cumella, 1999) The authors give us further information in that many families will become homeless again within one year of rehousing and the typical family seen is the single mother and at least two children who are generally under the age of 11 yrs. They also observe that the typical father and adolescent child tend to be placed in homeless centres. (Doff H 1995) In exploration of the particular topic that we are considering, the authors give us the situations that typically have given rise to the degree of parental stress that may have led to the homelessness. They point to the fact that a homeless family is usually homeless for different reasons to the single homeless adult. Vostanis (et al 1997)is quoted as showing that 50% of the cases studied were homeless as direct result of domestic violence and 25% as a result of harassment from neighbours. The authors observe that the numbers in this category(and therefore the problems), are rising. (Welsh Office 1999). There are a number of section to this paper which are not directly referable to our considerations. We shall therefore direct our attention purely to those parts that have a direct bearing on the subject. One particularly useful and analytical part of the paper is the section that details the characteristics and needs of the target group. This is a very detailed section, but it makes the point that the children in need in this group are particularly heterogeneous, generally all with multiple and inter-related needs. Homelessness is seldom a one off event. This particular observation, (say the authors),is crucially important for the development and provision of services. Most families have histories of previous chronic adversities that constitute risk factors for both children and parents (Bassuk et al,1997). Such events include family conflict, violence and breakdown; limited or absent networks for family and social support; recurring moves; poverty; and unemployment. Mothers are more likely to have suffered abuse in their own childhood and adult life and children have increased rates of placement on the at-risk child protection register, because of neglect, physical and/or sexual abuse. If we specifically consider the health needs of this population, the authors categorise them thus: The children are more likely to have a history of low birthweight, anaemia, dental decay and delayed immunisations, to be of lower stature and have a greater degree of nutritional stress. They are also more likely to suffer accidents, injuries and burns. (BPA 1999) Some studies have found that child health problems increase with the duration of homelessness, although this finding is not consistent. Substantial proportion of homeless children have delayed development compared with the general population of children of a similar chronological age. This includes both specific developmental delays, such as in receptive and expressive language and visual, motor and reading skills, as well as general skills and educational status (Webbet al. 2001). It is for this reason specifically, that it has proved extremely difficult to assess the effectiveness of the family support services because of the multivariate nature of the problems that are presented. The authors point to the fact that one of the prime determinants of the degree of support available, is the actual access that the families have to these services. Many sources (viz. Wilkinson R 1996), equate the poor health of the disadvantaged primarily with the lack of access to services. One immediate difficulty is the current registration system in the UK. In order to be seen in the primary healthcare team setting, one must be registered with a named doctor. In the majority of cases that we are dealing with here, they have moved area and registration is probably not high on their list of priorities. One can argue that there is the access to the A E departments of the local hospitals but there is virtually no continuity here and they arena geared up to provide anything other than immediate treatment. (HallD 1996). This fact restricts their access to primary healthcare team procedures such as immunisations and other preventative medicine health clinics.(Lissauer et al, 1993) . By the same token these groups also have restricted access to the social services, whether they be the access teams, the family teams or the family support units and other agencies. The authors also point to other more disruptive trends in this group such as an inability to attend a particular school for fear of being tracked by an abusive partner. It follows that these children do not have a stable social support of a school. They are denied such factors as peer groups, routines and challenges which are both important protective and developmental factors. (Shankleman J et al2000). The summation of all of these factors, and others, is that the effectiveness of the family support services is greatly reduced by the mobility and the transient nature of the family unit. Quite apart from the difficulties outlined above relating to the problems of access to avenues of help open to the child in need and their families there are the problems engendered by the fact that social service departments indifferent areas of the country may not have immediate access to the previous records giving rise to many potential, and real, problems with continuity of care. This problem is brought into more immediate focus when one considers the increased frequency of child protection registrations in this particular group. (Hall D et al 1998). One specific analysis of the family support services of this particular group comes in the form of the psychiatric services. In the context of the title of this piece, it demonstrates how these particular services,(but not these alone), are failing to deal with the totality of the problem. All of the aspects that we have outlined so far are conspiring to dilute the effectiveness of the services provided. The fact that they are a mobile population with no fixed address means that some of the services may choose to invoke this as a reason for not making provision for them, particularly if resources are stretched. If more resources are given, then they are typically preferentially targeted at the single adult homeless population where the need is arguably greater. The authors of this paper point to the fact that this may not actually be true as some studies have shown that homeless single mothers and their children have a 49% psychopathy rate and only an 11% contact with the support services. (Cumella et al, 1998). The impact of this fact on the children can only be imagined. To an extent however, it can be quantified as the authors cite other studies which show a 30% need rating for children, (they do not actually define exactly what their perceived level of need was), contrasted with a 3% contact rate for children and adolescents in this area. (viz. Power S et al. 1995). Suggestions for improvement Putting these considerations together, the authors outline a set of proposals which are designed to help improve the access to some of the essential services. The model that they propose could, if successful and with a degree of modification, prove suitable for adaptation to other areas of the family support services. It is not appropriate to discuss this model in detail, but suffice it to say that it has tiered structure so that the degree of distress and need is titrated against the degree of input generated. One of the reasons that we have selected this particular paper to present in this context is for its last section. It proposes a â€Å"family support services model† which has been developed and pioneered in the Leicester area. In the context of our review, it is worth considering in some detail. A service provided through a family support team (four family support assistants).This is designed to detect a range of problems at the time of crisis; manage a degree of mental health problems (behavioural and emotional); provide parenting-training; support and train housing(hostel) staff; co-ordinate the work of different agencies; and provide some continuity after rehousing by ensuring intake by appropriate local services. The family workers are based at the main hostel for homeless children and families. Other, predominantly voluntary, services have established alternative posts, such as advocates and key workers. Whatever the title of the post, it is essential that the post-holder has some experience and on-going training in mental health and child protection, so that he or she can hold a substantial case-load, rather than merely mediate between already limited services. The family support workers have direct access to the local child and adult mental health services, whose staff provide weekly outreach clinics. Their role is to work with the family support workers another agencies, assess selected children and families, and provide treatment for more severe problems or disorders such as depression, self-harm and PTSD. A weekly inter-agency liaison meeting at the main hostel is attended by a health visitor, representatives of the local domestic violence service and Sure Start, There are also close, regular links with education welfare and social services. The aim is to effectively utilise specialist skills by discussing family situations from all perspectives at the liaison meeting. A bimonthly steering group, led by the housing department, involves senior managers representing these agencies, as well as the education and social services departments and the voluntary sector, and they oversee and co-ordinate the service. This appears to be something of an exemplar in relation to services provided elsewhere. The paper does not provide any element of costing sin this area neither does it provide any figures in relation to its success rates, contact rates or overall effectiveness. In conclusion this paper is an extremely well written and authoritative overview of the situation relating to the stresses of the homeless parent with children and the effectiveness (or lack of it) in its ability to reduce the stresses experienced by the homeless children in need and their parents. It proposes remedies but sadly it does not evaluate the effectiveness of those remedies. The effectiveness of the support services on families of children with psychiatric morbidity In order to address these shortcomings we can consider another paper by Tickler (et al 2000). This looks at a similar outreach set up which has been designed to capture the families of children in need who might otherwise slip through the net. This paper is written from different perspective and specifically analyses the effectiveness of these services as they pertain to an entry cohort of 40 families. This particular study was set up after preliminary work was done in the Birmingham area with 114 homeless families and this study defined the needs of the families but did not quantify their support systems.(Vostanis et al 1998). This paper set out to identify and measure the support systems available and their effectiveness as far as the families were concerned. The stresses encountered were partly reflected by the incidence of psychiatric morbidity. The mothers in the group were found to have over 50% more morbidity than a matched control group. The children in the group were found to have â€Å"histories of abuse, living in care, being on the at-risk protection register, delayed communication and higher reported mental health problems.† Allot which adds to the general background stress levels. (Kerouac S etal. 1996). This particular study found that despite the psychiatric morbidity in the children, (estimated to be about 30%), and the psychiatric morbidity in the parents, (estimated at about 50%), only 3%of the children and 10% of the parents had had any significant contactor support from the social services. In this respect, this paper is very useful to our purpose as it quantifies the levels of intervention and access to healthcare resources that this particular group has. By any appreciation, it would be considered woefully inadequate in any society that calls itself civilised. In the terms of the title of this piece, the effectiveness of the family support services is minimal. Suggestions for improvement Like the last paper discussed, this one also considered how best to tackle the problem, and this one is of much greater value to us, as it specifies a response, or intervention, to the problem in much the same way as the Vostranis 2002 paper did, but it makes the same measurements as it did prior to the intervention, and therefore allows us an insight into the actual effectiveness of the intervention. The way this particular study worked was to assess the problem (as it has been presented above), devise an intervention strategy and then to measure its effect. This particular study goes to great lengths to actively involve all the appropriate agencies that could help the situation by having a central assessment station that acted as liaison between all of the other resources. In brief, it actively involved liaison with the following: Education, social services, child protection, local mental health services, voluntary and community organisations to facilitate there-integration of the family into the community, and particularly their engagement with local services following rehousing; and training of staff of homeless centres in the understanding, recognition and management of mental illness in children and parents. This is essential, as hostel staff often work in isolation and have little knowledge of the potential severity and consequences of mental health problems in children. It was hoped that, by doing this, it would maximise the impact that the limited resources had on reducing the levels of morbidity and stress in the families of the children in need. Results The post intervention results were, by any estimate, impressive considering the historical difficulty of working with this particular group (OHara M 1995). 40 families (including 122 children) were studied in detail. The paper gives a detailed breakdown of the ethnic and demographic breakdown of the group. By far the biggest group were single mothers and children (72%) The results showed that the majority of referrals were seen between1-3 times (55%), with a further 22% being seen 4-6 times. It is reflection of the difficulty in engaging this type of family in need that over 25% did not actually keep their appointments despite the obvious potential benefits that could have been utilised. The authors investigated this group further and ascertained that a common reason for nonattendance was the perception that the psychological welfare of the children was not actually the main concern. The families perceived that their primary needs were rehousing and financial stability. Other priorities identified were that physical health was a greater priority than mental health. The authors also identify another common failing in the social services provision, and that is the general lack of regular contact. They cite the situation where some families cope well initially, apparently glad to have escaped an abusive or violent home situation, but a prolonged stay in a hostel or temporary accommodation may soon precipitate a bout of depression in the parents and behavioural problems in the children of such parents. (Brooks RM et al 1998). They suggest that regular re-visiting of families who have been in temporary accommodation for any significant length of time should be mandatory. This paper takes a very practical overview by pointing out that workability of the system is, to a large extent, dependent on the goodwill of a number of committed professionals. The authors state that this has to be nurtured and they call for sufficient funding must be given to enable this particular model to be extended to a National level. Thus far in the review we have considered the effectiveness of the service provision in the support of the families of the children in need in one specific target grouping, those who are stressed by virtue of the fact that they are homeless. We will now consider the literature on a different kind of family stress, and that is when a parent dies. This leaves the children with a considerable amount of potential emotional â€Å"baggage† and the surviving parent with an enormous amount of stress. (Webb E 1998). Effectiveness of support services in the case of parental bereavement An excellent paper by Downey (et al 1999) tackles this particular problem with both sensitivity and also considerable rigour. It is a long and complex paper, but the overall aims and objectives are clear from the outset. The structure of the paper is a prospective case study which aims to assess whether the degree of distress suffered by a family during a time of bereavement is in any way linked to the degree of service provision that is utilised. The base line for this study is set out in its first two paragraphs. Parentally bereaved children and surviving parents showed a greater than predicted level of psychiatric morbidity. Boys had greater levels of demonstrable morbidity than did girls, but bereaved mothers showed more morbidity than did bereaved fathers. Children were more likely to show signs of behavioural disturbance when the surviving parent manifested some kind of psychiatric disorder. (Kranzler EM et al 1990). The authors point to the fact that their study shows that the service provision is statistically related to a number of (arguably unexpected[Fristad MA et al 1993]) factors namely: The age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death. Paradoxically the level of service provision was not found to be statistically significantly related to either the parental wishes or the degree of the psychiatric disturbance in either the parent orchid. (Sanchez L et al 1994) The service provision did have some statistical relationships but that was only found to be the manner of the parental death and the actual age of the child at the time. The authors therefore are able to identify a mismatch between the perceived need for support and the actual service provision made. Part of that mismatch is found to be due to the inability of the social services and other related agencies to take a dispassionate overview. Elsewhere in the paper the authors suggest that there are other factors that add to this inequality and they include lack of resources and a lack of specificity in identifying children at greatest risk.(Harrington R 1996) The authors examine other literature to back up their initial precept that bereaved children have greater levels of morbidity. They cite many other papers who have found distress manifesting in the form of â€Å"anxiety, depression, withdrawal, sleep disturbance, and aggression.†(Worden JW et al. 1996) and also psychological problems in later life(Harris T et al. 1996). In terms of study structure, the authors point to methodological problems with other papers in the area including a common failing of either having a standardised measure or no matched control group(Mohammed D et al 2003). They also point to the fact that this is probably the first UK study to investigate the subject using a properly representative sample and certainly the first to investigate whether service provision is actually related to the degree of the problems experienced. The entry cohort involved nearly 550 families with 94 having children in the target range (2-18). With certain exclusions (such as two families where one parent had murdered the other etc.) and no respondents, the final cohort was reduced to 45 families and one target child was randomly selected from each family. It has to be noted that the comparatively large number of on-respondents may have introduced a large element of bias, insofar as it is possible that the families most in need of support were those who were most distressed by the death of a family member and these could have been the very ones who chose not to participate. (Morton V et al2003) The authors make no comment on this particular fact. The authors should be commended for a particularly ingenious control measure for the children. They were matched by asking their schoolteacher to complete an inventory of disturbed behaviour on the next child in the school register after the target child. A large part of the paper is taken up with methodological issues which ( apart from the comments above) cannot be faulted. Results In terms of being children in need, 60% of children were found to have â€Å"significant behavioural abnormalities† with 28% having scores above the 95th centile. In terms of specific service support provision, 82% of parents identified a perceived need for support by virtue of the behaviour of their children. Only 49% of these actually received it in any degree. Perhaps the most surprising statistic to come out of this study waste fact that of the parents who were offered support 44% were in the group who asked for it and 56% were in the group who didn’t want it. The levels of support offered were independent of the degree of behavioural disturbance in the child. Suggestions for improvement As with the majority of papers that we have either presented here or read in preparation for this review, the authors call for a more rationally targeted approach to the utilisation of limited resources. The study also provides us with a very pertinent comment which many experienced healthcare professionals will empathise with, (Black D1996), and that is: Practitioners should also be aware that child disturbance may reflect undetected psychological distress in the surviving parent. While not suggesting that this is a reflection of Munchausen’s syndrome by proxy, the comment is a valid reflection of the fact that parental distress may be well hidden from people outside of the family and may only present as a manifestation of the child’s behaviour. (Feldman Met al. 1994) The conclusions that can be drawn from this study are that there is considerable gap in the support offered ( quite apart form the effectiveness of that support) in this area of obvious stress for both parents and children. (Black D 1998). This study goes some way to quantifying the level of support actually given in these circumstances. Effectiveness of support in families where there is domestic violence We have considered the role of the effectiveness and indeed, even the existence, of adequate support services for the children in need and their parents in a number of different social circumstances. The next paper that we wish to present is an excellent review of the support that is given to another specific sub-group and that is women and children who suffer from domestic violence. Webb and her group (etal 2001) considered the problem in considerable (and commendable) depth The study itself had an entry cohort of nearly 150 children and their mothers who were resident in a number of hostels and women’s refuges that had been the victims of family violence at some stage in the recent past. The study subjected the cohort to a battery of tests designed to assess their physical, emotional and psychological health, and then quantified their access to, and support gained from, the primary healthcare teams and other social service-based support agencies. This study is presented in a long and sometimes difficult tread format. Much of the presentation is (understandably) taken up with statistical, ethical and methodological matters – all of which appear to be largely of excellent quality and the result of careful consideration. Results The results make for interesting and, (in the context of this review), very relevant reading. Perhaps one of the more original findings was that nearly 60% of the child health data held by the various refuges was factually incorrect. This clearly has grave implications for studies that base their evidence base on that data set(Berwick D 2005). Of great implication for the social services support mechanisms was the finding that 76% of the mothers in the study expressed concerns about the health of their children. Once they had left the refuge there was significant loss to the follow up systems as 15% were untraceable and25% returned to the home of the original perpetrator. The study documents the fact that this particular group had both high level of need for support and also a poor level of access to appropriate services. In the study conclusions, the authors make the pertinent comment that the time spent in the refuge offers a â€Å"window of opportunity† for the family support services to make contact and to review health and child developmental status. This is not a demographically small group. In the UK, over 35,000children and a parent, are recorded as passing through the refuges each year, with at least a similar number also being referred to other types of safe accommodation. Such measures are clearly not undertaken lightly with the average woman only entering a refuge after an average of 28separate assaults. One can only speculate at the long term effects that this can have on both the mother and the children. Suggestions for improvement In common with the other papers reviewed, this paper also calls for greater levels of support for the families concerned as, by inference, the current levels of effectiveness of the family support services is clearly inadequate. Conclusions This review has specifically presented a number of papers which have been chosen from a much larger number that have been accessed and assessed, because of the fact that each has a particularly important issue or factor in its construction or results. The issue that we have set out to evaluate is the effectiveness of the family support services which are specifically aimed at reducing the stress levels for the parents of children in need. Almost without exception, all of the papers that have been accessed (quite apart from those presented) have demonstrated the fact that the levels of support from the statutory bodies is â€Å"less than optimum† and in some cases it can only be described as â€Å"dire†. Another factor that is a common finding, is that, given the fact that any welfare system is, by its very nature, a rationed system, the provision of the services that are provided is seldom targeted at the groups that need it the most. One can cite the Tickler (et al 2000)and Downey (et al 1999) papers in particular as demonstrating that substantial proportion of the resources mobilised are actually being directed to groups that are either not requesting support or who demonstrably need it less than other sectors of the community. Some of the papers (actually a small proportion) make positive suggestions about the models for redirecting and targeting support. Sadly, the majority do little more than call for â€Å"more research to be done on the issue†. In overview, we would have to conclude that the evidence suggests that the effectiveness of the family support services in reducing stress and poverty for the parents of children in need is poor at best and certainly capable of considerable improvement. References Bassuk, E., Buckner, J., Weiner, L., et al (1997) Homelessness in female-headed families: childhood and adult risk and protective factors. American Journal of Public Health, 87, 241–248 1997 Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Black D. 1996 Childhood bereavement: distress and long term sequelae can be lessened by early intervention. BMJ 1996; 312: 1496 Black D. 1998 Coping with loss: bereavement in childhood. BMJ 1998; 316: 931-933 BPA 1999 British Paediatric Association. Outcome measures for child health. London: Royal College of Paediatric Effectiveness of Support for Children in Homeless Families Effectiveness of Support for Children in Homeless Families The whole issue of parents and children in need is a vast, complex and ethically challenging one. This review is specifically charged with an examination of those issues which impinge upon the stresses and strains that are experienced by parents of children in need. A superficial examination of these issues that are involved in this particular area would suggest that there are a number of â€Å"sub-texts â€Å"which can all give rise to this particular situation. Firstly, to have child in need is clearly a stressful situation for any parent.(Meltzer H et al. 1999) This can clearly be purely a financial concern and a reflection of the fact that the whole family is in financial hardship, perhaps due to the economic situation or perhaps due to the actions of the parents themselves. Equally the need of the child can be a result of anon-financial need, so we should also consider the child who is in some way handicapped, ill, emotionally disturbed or perhaps in need in some other way. This produces another type of stress on the parent, and these stresses are typically longer lasting and, in general, less easily rectified than a purely financial consideration of need. (Hall D1996). It is part of the basic ethos of the welfare state that it should look after its less able and disadvantaged members. (Welsh Office 1997).Parents of children in need will often qualify in this definition. We shall therefore examine the various aspects of this problem. Literature Review Effectiveness of family support for children in homeless families We will make a start by considering one type of child in need. The first paper that we will consider is that of Prof. Vostanis (Vostanis2002), which looks at the mental health problems that are faced by deprived children and their families together with the effectiveness of the resources that are available to them. It is a well written and well researched paper, if rather complex and confusing in places. We will consider this paper in some detail as it provides an excellent overview of the whole area. The paper starts with a rather useful definition for our purposes. It qualifies the deprived child, initially in terms of a homeless family, that being : A family of any number of adults with dependent children who are statutorily accepted by local authorities (housing departments) in teak, and are usually accommodated for a brief period in voluntary agency, local authority or housing association hostels. This period of temporary accommodation can vary enormously depending on the time of year and the area considered, and can range from a few days to perhaps several months. The target in Greater London is currently storehouse homeless families within 4-6 weeks. In London particularly, the homeless families can be placed in Bed Breakfast accommodation.(D of H 1998) In this respect, the immediate family support mechanisms do appear tube in place. Vostranis however, goes on to make the observation that despite the fact that the definition of the homeless family is rather broad, it does not cover all of the potential children in need, as those children and their carers who have lost their homes but have managed to live with relatives, on the streets or perhaps live as travellers, are not covered by the statutory obligation to provide housing. The official figures therefore, he observes, are generally an underestimate of the true situation. The official figures for the homeless families are put (in this paper) at 140,000. (Vostanis Cumella, 1999) The authors give us further information in that many families will become homeless again within one year of rehousing and the typical family seen is the single mother and at least two children who are generally under the age of 11 yrs. They also observe that the typical father and adolescent child tend to be placed in homeless centres. (Doff H 1995) In exploration of the particular topic that we are considering, the authors give us the situations that typically have given rise to the degree of parental stress that may have led to the homelessness. They point to the fact that a homeless family is usually homeless for different reasons to the single homeless adult. Vostanis (et al 1997)is quoted as showing that 50% of the cases studied were homeless as direct result of domestic violence and 25% as a result of harassment from neighbours. The authors observe that the numbers in this category(and therefore the problems), are rising. (Welsh Office 1999). There are a number of section to this paper which are not directly referable to our considerations. We shall therefore direct our attention purely to those parts that have a direct bearing on the subject. One particularly useful and analytical part of the paper is the section that details the characteristics and needs of the target group. This is a very detailed section, but it makes the point that the children in need in this group are particularly heterogeneous, generally all with multiple and inter-related needs. Homelessness is seldom a one off event. This particular observation, (say the authors),is crucially important for the development and provision of services. Most families have histories of previous chronic adversities that constitute risk factors for both children and parents (Bassuk et al,1997). Such events include family conflict, violence and breakdown; limited or absent networks for family and social support; recurring moves; poverty; and unemployment. Mothers are more likely to have suffered abuse in their own childhood and adult life and children have increased rates of placement on the at-risk child protection register, because of neglect, physical and/or sexual abuse. If we specifically consider the health needs of this population, the authors categorise them thus: The children are more likely to have a history of low birthweight, anaemia, dental decay and delayed immunisations, to be of lower stature and have a greater degree of nutritional stress. They are also more likely to suffer accidents, injuries and burns. (BPA 1999) Some studies have found that child health problems increase with the duration of homelessness, although this finding is not consistent. Substantial proportion of homeless children have delayed development compared with the general population of children of a similar chronological age. This includes both specific developmental delays, such as in receptive and expressive language and visual, motor and reading skills, as well as general skills and educational status (Webbet al. 2001). It is for this reason specifically, that it has proved extremely difficult to assess the effectiveness of the family support services because of the multivariate nature of the problems that are presented. The authors point to the fact that one of the prime determinants of the degree of support available, is the actual access that the families have to these services. Many sources (viz. Wilkinson R 1996), equate the poor health of the disadvantaged primarily with the lack of access to services. One immediate difficulty is the current registration system in the UK. In order to be seen in the primary healthcare team setting, one must be registered with a named doctor. In the majority of cases that we are dealing with here, they have moved area and registration is probably not high on their list of priorities. One can argue that there is the access to the A E departments of the local hospitals but there is virtually no continuity here and they arena geared up to provide anything other than immediate treatment. (HallD 1996). This fact restricts their access to primary healthcare team procedures such as immunisations and other preventative medicine health clinics.(Lissauer et al, 1993) . By the same token these groups also have restricted access to the social services, whether they be the access teams, the family teams or the family support units and other agencies. The authors also point to other more disruptive trends in this group such as an inability to attend a particular school for fear of being tracked by an abusive partner. It follows that these children do not have a stable social support of a school. They are denied such factors as peer groups, routines and challenges which are both important protective and developmental factors. (Shankleman J et al2000). The summation of all of these factors, and others, is that the effectiveness of the family support services is greatly reduced by the mobility and the transient nature of the family unit. Quite apart from the difficulties outlined above relating to the problems of access to avenues of help open to the child in need and their families there are the problems engendered by the fact that social service departments indifferent areas of the country may not have immediate access to the previous records giving rise to many potential, and real, problems with continuity of care. This problem is brought into more immediate focus when one considers the increased frequency of child protection registrations in this particular group. (Hall D et al 1998). One specific analysis of the family support services of this particular group comes in the form of the psychiatric services. In the context of the title of this piece, it demonstrates how these particular services,(but not these alone), are failing to deal with the totality of the problem. All of the aspects that we have outlined so far are conspiring to dilute the effectiveness of the services provided. The fact that they are a mobile population with no fixed address means that some of the services may choose to invoke this as a reason for not making provision for them, particularly if resources are stretched. If more resources are given, then they are typically preferentially targeted at the single adult homeless population where the need is arguably greater. The authors of this paper point to the fact that this may not actually be true as some studies have shown that homeless single mothers and their children have a 49% psychopathy rate and only an 11% contact with the support services. (Cumella et al, 1998). The impact of this fact on the children can only be imagined. To an extent however, it can be quantified as the authors cite other studies which show a 30% need rating for children, (they do not actually define exactly what their perceived level of need was), contrasted with a 3% contact rate for children and adolescents in this area. (viz. Power S et al. 1995). Suggestions for improvement Putting these considerations together, the authors outline a set of proposals which are designed to help improve the access to some of the essential services. The model that they propose could, if successful and with a degree of modification, prove suitable for adaptation to other areas of the family support services. It is not appropriate to discuss this model in detail, but suffice it to say that it has tiered structure so that the degree of distress and need is titrated against the degree of input generated. One of the reasons that we have selected this particular paper to present in this context is for its last section. It proposes a â€Å"family support services model† which has been developed and pioneered in the Leicester area. In the context of our review, it is worth considering in some detail. A service provided through a family support team (four family support assistants).This is designed to detect a range of problems at the time of crisis; manage a degree of mental health problems (behavioural and emotional); provide parenting-training; support and train housing(hostel) staff; co-ordinate the work of different agencies; and provide some continuity after rehousing by ensuring intake by appropriate local services. The family workers are based at the main hostel for homeless children and families. Other, predominantly voluntary, services have established alternative posts, such as advocates and key workers. Whatever the title of the post, it is essential that the post-holder has some experience and on-going training in mental health and child protection, so that he or she can hold a substantial case-load, rather than merely mediate between already limited services. The family support workers have direct access to the local child and adult mental health services, whose staff provide weekly outreach clinics. Their role is to work with the family support workers another agencies, assess selected children and families, and provide treatment for more severe problems or disorders such as depression, self-harm and PTSD. A weekly inter-agency liaison meeting at the main hostel is attended by a health visitor, representatives of the local domestic violence service and Sure Start, There are also close, regular links with education welfare and social services. The aim is to effectively utilise specialist skills by discussing family situations from all perspectives at the liaison meeting. A bimonthly steering group, led by the housing department, involves senior managers representing these agencies, as well as the education and social services departments and the voluntary sector, and they oversee and co-ordinate the service. This appears to be something of an exemplar in relation to services provided elsewhere. The paper does not provide any element of costing sin this area neither does it provide any figures in relation to its success rates, contact rates or overall effectiveness. In conclusion this paper is an extremely well written and authoritative overview of the situation relating to the stresses of the homeless parent with children and the effectiveness (or lack of it) in its ability to reduce the stresses experienced by the homeless children in need and their parents. It proposes remedies but sadly it does not evaluate the effectiveness of those remedies. The effectiveness of the support services on families of children with psychiatric morbidity In order to address these shortcomings we can consider another paper by Tickler (et al 2000). This looks at a similar outreach set up which has been designed to capture the families of children in need who might otherwise slip through the net. This paper is written from different perspective and specifically analyses the effectiveness of these services as they pertain to an entry cohort of 40 families. This particular study was set up after preliminary work was done in the Birmingham area with 114 homeless families and this study defined the needs of the families but did not quantify their support systems.(Vostanis et al 1998). This paper set out to identify and measure the support systems available and their effectiveness as far as the families were concerned. The stresses encountered were partly reflected by the incidence of psychiatric morbidity. The mothers in the group were found to have over 50% more morbidity than a matched control group. The children in the group were found to have â€Å"histories of abuse, living in care, being on the at-risk protection register, delayed communication and higher reported mental health problems.† Allot which adds to the general background stress levels. (Kerouac S etal. 1996). This particular study found that despite the psychiatric morbidity in the children, (estimated to be about 30%), and the psychiatric morbidity in the parents, (estimated at about 50%), only 3%of the children and 10% of the parents had had any significant contactor support from the social services. In this respect, this paper is very useful to our purpose as it quantifies the levels of intervention and access to healthcare resources that this particular group has. By any appreciation, it would be considered woefully inadequate in any society that calls itself civilised. In the terms of the title of this piece, the effectiveness of the family support services is minimal. Suggestions for improvement Like the last paper discussed, this one also considered how best to tackle the problem, and this one is of much greater value to us, as it specifies a response, or intervention, to the problem in much the same way as the Vostranis 2002 paper did, but it makes the same measurements as it did prior to the intervention, and therefore allows us an insight into the actual effectiveness of the intervention. The way this particular study worked was to assess the problem (as it has been presented above), devise an intervention strategy and then to measure its effect. This particular study goes to great lengths to actively involve all the appropriate agencies that could help the situation by having a central assessment station that acted as liaison between all of the other resources. In brief, it actively involved liaison with the following: Education, social services, child protection, local mental health services, voluntary and community organisations to facilitate there-integration of the family into the community, and particularly their engagement with local services following rehousing; and training of staff of homeless centres in the understanding, recognition and management of mental illness in children and parents. This is essential, as hostel staff often work in isolation and have little knowledge of the potential severity and consequences of mental health problems in children. It was hoped that, by doing this, it would maximise the impact that the limited resources had on reducing the levels of morbidity and stress in the families of the children in need. Results The post intervention results were, by any estimate, impressive considering the historical difficulty of working with this particular group (OHara M 1995). 40 families (including 122 children) were studied in detail. The paper gives a detailed breakdown of the ethnic and demographic breakdown of the group. By far the biggest group were single mothers and children (72%) The results showed that the majority of referrals were seen between1-3 times (55%), with a further 22% being seen 4-6 times. It is reflection of the difficulty in engaging this type of family in need that over 25% did not actually keep their appointments despite the obvious potential benefits that could have been utilised. The authors investigated this group further and ascertained that a common reason for nonattendance was the perception that the psychological welfare of the children was not actually the main concern. The families perceived that their primary needs were rehousing and financial stability. Other priorities identified were that physical health was a greater priority than mental health. The authors also identify another common failing in the social services provision, and that is the general lack of regular contact. They cite the situation where some families cope well initially, apparently glad to have escaped an abusive or violent home situation, but a prolonged stay in a hostel or temporary accommodation may soon precipitate a bout of depression in the parents and behavioural problems in the children of such parents. (Brooks RM et al 1998). They suggest that regular re-visiting of families who have been in temporary accommodation for any significant length of time should be mandatory. This paper takes a very practical overview by pointing out that workability of the system is, to a large extent, dependent on the goodwill of a number of committed professionals. The authors state that this has to be nurtured and they call for sufficient funding must be given to enable this particular model to be extended to a National level. Thus far in the review we have considered the effectiveness of the service provision in the support of the families of the children in need in one specific target grouping, those who are stressed by virtue of the fact that they are homeless. We will now consider the literature on a different kind of family stress, and that is when a parent dies. This leaves the children with a considerable amount of potential emotional â€Å"baggage† and the surviving parent with an enormous amount of stress. (Webb E 1998). Effectiveness of support services in the case of parental bereavement An excellent paper by Downey (et al 1999) tackles this particular problem with both sensitivity and also considerable rigour. It is a long and complex paper, but the overall aims and objectives are clear from the outset. The structure of the paper is a prospective case study which aims to assess whether the degree of distress suffered by a family during a time of bereavement is in any way linked to the degree of service provision that is utilised. The base line for this study is set out in its first two paragraphs. Parentally bereaved children and surviving parents showed a greater than predicted level of psychiatric morbidity. Boys had greater levels of demonstrable morbidity than did girls, but bereaved mothers showed more morbidity than did bereaved fathers. Children were more likely to show signs of behavioural disturbance when the surviving parent manifested some kind of psychiatric disorder. (Kranzler EM et al 1990). The authors point to the fact that their study shows that the service provision is statistically related to a number of (arguably unexpected[Fristad MA et al 1993]) factors namely: The age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death. Paradoxically the level of service provision was not found to be statistically significantly related to either the parental wishes or the degree of the psychiatric disturbance in either the parent orchid. (Sanchez L et al 1994) The service provision did have some statistical relationships but that was only found to be the manner of the parental death and the actual age of the child at the time. The authors therefore are able to identify a mismatch between the perceived need for support and the actual service provision made. Part of that mismatch is found to be due to the inability of the social services and other related agencies to take a dispassionate overview. Elsewhere in the paper the authors suggest that there are other factors that add to this inequality and they include lack of resources and a lack of specificity in identifying children at greatest risk.(Harrington R 1996) The authors examine other literature to back up their initial precept that bereaved children have greater levels of morbidity. They cite many other papers who have found distress manifesting in the form of â€Å"anxiety, depression, withdrawal, sleep disturbance, and aggression.†(Worden JW et al. 1996) and also psychological problems in later life(Harris T et al. 1996). In terms of study structure, the authors point to methodological problems with other papers in the area including a common failing of either having a standardised measure or no matched control group(Mohammed D et al 2003). They also point to the fact that this is probably the first UK study to investigate the subject using a properly representative sample and certainly the first to investigate whether service provision is actually related to the degree of the problems experienced. The entry cohort involved nearly 550 families with 94 having children in the target range (2-18). With certain exclusions (such as two families where one parent had murdered the other etc.) and no respondents, the final cohort was reduced to 45 families and one target child was randomly selected from each family. It has to be noted that the comparatively large number of on-respondents may have introduced a large element of bias, insofar as it is possible that the families most in need of support were those who were most distressed by the death of a family member and these could have been the very ones who chose not to participate. (Morton V et al2003) The authors make no comment on this particular fact. The authors should be commended for a particularly ingenious control measure for the children. They were matched by asking their schoolteacher to complete an inventory of disturbed behaviour on the next child in the school register after the target child. A large part of the paper is taken up with methodological issues which ( apart from the comments above) cannot be faulted. Results In terms of being children in need, 60% of children were found to have â€Å"significant behavioural abnormalities† with 28% having scores above the 95th centile. In terms of specific service support provision, 82% of parents identified a perceived need for support by virtue of the behaviour of their children. Only 49% of these actually received it in any degree. Perhaps the most surprising statistic to come out of this study waste fact that of the parents who were offered support 44% were in the group who asked for it and 56% were in the group who didn’t want it. The levels of support offered were independent of the degree of behavioural disturbance in the child. Suggestions for improvement As with the majority of papers that we have either presented here or read in preparation for this review, the authors call for a more rationally targeted approach to the utilisation of limited resources. The study also provides us with a very pertinent comment which many experienced healthcare professionals will empathise with, (Black D1996), and that is: Practitioners should also be aware that child disturbance may reflect undetected psychological distress in the surviving parent. While not suggesting that this is a reflection of Munchausen’s syndrome by proxy, the comment is a valid reflection of the fact that parental distress may be well hidden from people outside of the family and may only present as a manifestation of the child’s behaviour. (Feldman Met al. 1994) The conclusions that can be drawn from this study are that there is considerable gap in the support offered ( quite apart form the effectiveness of that support) in this area of obvious stress for both parents and children. (Black D 1998). This study goes some way to quantifying the level of support actually given in these circumstances. Effectiveness of support in families where there is domestic violence We have considered the role of the effectiveness and indeed, even the existence, of adequate support services for the children in need and their parents in a number of different social circumstances. The next paper that we wish to present is an excellent review of the support that is given to another specific sub-group and that is women and children who suffer from domestic violence. Webb and her group (etal 2001) considered the problem in considerable (and commendable) depth The study itself had an entry cohort of nearly 150 children and their mothers who were resident in a number of hostels and women’s refuges that had been the victims of family violence at some stage in the recent past. The study subjected the cohort to a battery of tests designed to assess their physical, emotional and psychological health, and then quantified their access to, and support gained from, the primary healthcare teams and other social service-based support agencies. This study is presented in a long and sometimes difficult tread format. Much of the presentation is (understandably) taken up with statistical, ethical and methodological matters – all of which appear to be largely of excellent quality and the result of careful consideration. Results The results make for interesting and, (in the context of this review), very relevant reading. Perhaps one of the more original findings was that nearly 60% of the child health data held by the various refuges was factually incorrect. This clearly has grave implications for studies that base their evidence base on that data set(Berwick D 2005). Of great implication for the social services support mechanisms was the finding that 76% of the mothers in the study expressed concerns about the health of their children. Once they had left the refuge there was significant loss to the follow up systems as 15% were untraceable and25% returned to the home of the original perpetrator. The study documents the fact that this particular group had both high level of need for support and also a poor level of access to appropriate services. In the study conclusions, the authors make the pertinent comment that the time spent in the refuge offers a â€Å"window of opportunity† for the family support services to make contact and to review health and child developmental status. This is not a demographically small group. In the UK, over 35,000children and a parent, are recorded as passing through the refuges each year, with at least a similar number also being referred to other types of safe accommodation. Such measures are clearly not undertaken lightly with the average woman only entering a refuge after an average of 28separate assaults. One can only speculate at the long term effects that this can have on both the mother and the children. Suggestions for improvement In common with the other papers reviewed, this paper also calls for greater levels of support for the families concerned as, by inference, the current levels of effectiveness of the family support services is clearly inadequate. Conclusions This review has specifically presented a number of papers which have been chosen from a much larger number that have been accessed and assessed, because of the fact that each has a particularly important issue or factor in its construction or results. The issue that we have set out to evaluate is the effectiveness of the family support services which are specifically aimed at reducing the stress levels for the parents of children in need. Almost without exception, all of the papers that have been accessed (quite apart from those presented) have demonstrated the fact that the levels of support from the statutory bodies is â€Å"less than optimum† and in some cases it can only be described as â€Å"dire†. Another factor that is a common finding, is that, given the fact that any welfare system is, by its very nature, a rationed system, the provision of the services that are provided is seldom targeted at the groups that need it the most. One can cite the Tickler (et al 2000)and Downey (et al 1999) papers in particular as demonstrating that substantial proportion of the resources mobilised are actually being directed to groups that are either not requesting support or who demonstrably need it less than other sectors of the community. Some of the papers (actually a small proportion) make positive suggestions about the models for redirecting and targeting support. Sadly, the majority do little more than call for â€Å"more research to be done on the issue†. In overview, we would have to conclude that the evidence suggests that the effectiveness of the family support services in reducing stress and poverty for the parents of children in need is poor at best and certainly capable of considerable improvement. References Bassuk, E., Buckner, J., Weiner, L., et al (1997) Homelessness in female-headed families: childhood and adult risk and protective factors. American Journal of Public Health, 87, 241–248 1997 Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Black D. 1996 Childhood bereavement: distress and long term sequelae can be lessened by early intervention. BMJ 1996; 312: 1496 Black D. 1998 Coping with loss: bereavement in childhood. BMJ 1998; 316: 931-933 BPA 1999 British Paediatric Association. Outcome measures for child health. London: Royal College of Paediatric