Hower House Essay Example

Hower House Essay Hower House is a Victorian Second Empire Italianate Mansion; it was built in 1871 by architect Jacob Snyder.The home belonged originally to John Henry Hower and his wife Susan.The house was occupied by the Howers and there descendants until 1793 when it was donated to the University of Akron by Grace Hower Crawford.The time that was represented by the Hower House was 1871 to around 1973.Some facts I learned were that the fireplaces in the Hower House are actually stone and just appear to be marble or wood.The fireplace that looked like it was wood was very interesting because its impossible to have actually wooden fireplace because it would catch fire.In the era of the Hower House a persons wealth was dependant on how many rooms there house had in it.The Hower House has 28 rooms.Most houses of the era didnt have a closet in the bedrooms because the government counted closets as rooms and taxed people if they had them.The Hower House has a closet in every bedroom because the family wa s rich enough to afford such amenities.I also learned what an actual Griffin is (and not just someone who goes to Buchtel).A Griffin was a gargoyle like creature that was half eagle and half lion.The house had statues of Griffins that were used as table legs and such.Another fact I learned was that most of the furniture and a decorative pieces in Hower House came from places outside the U.S.The Howers loved to travel and collect goods from all over the globe.My guide also showed me a steep set of stairs that led to the top of the towers.She claimed that on a clear day you could see Cleveland but also added that she never went to the top of the Tower because she wasnt allowed.I thought that was interesting because I knew the house was big but I didnt think it was that big. I learned that people who lived at during this time did basically the same things we do but it was

Total Quality Management †William Edwards Deming

Total Quality Management – William Edwards Deming Free Online Research Papers In this paper I will talk about the management and leadership roles and tasks in relation to Total Quality Management. Total quality management represents, within the past two decades, one of the most reflective changes in the mode companies are now being managed. According to Biech (1994), â€Å"Quality improvement (TQM) are a customer-focused, quality-centered, fact-based, team driven, senior management-led process to achieve an organizations strategic imperative through continuous process improvement† (pp. 1-2). The benefits associated with TQM include higher quality, lower cost products and services that align with customer demands (Zbaracki, 1998). The capability of a company to answer to the needs of its customers measures the overall success of that company. Many organizations may ask the question, what is quality? As Hick (1998) explains, â€Å"quality is meeting or exceeding the needs and expectations of the customer† (p.1). What exactly are the expectations of the customers? It is now the responsibility of the organization to define those needs. Perhaps Biech (1994) provides a simpler picture, â€Å"Quality is the measure of satisfaction that occurs between a customer and supplier that only they can defi ne. In other words, quality is what the customer says it is† (p.25). Yet according to Perigord (1987), â€Å"Total quality means that all participants in a company are involved regardless of their position in the hierarchy† (p.7). Basically making it seem impossible for quality to be successful if all members are not sharing in the same vision and/or goals. Edwards Deming is well known for the introduction of the concept involving quality management. After World War II, Deming gained exclusive recognition throughout Japan, which later flourished to his homeland. During the early 50’s, Deming was invited to Japan to helper in he recovery of Japan’s economy. Going through a period of economic hardship and declines, the Japanese Union of Scientists and Engineers (JUSE) called on Deming’s expertise. In 1980, Deming introduced 14 key factors behind this idea of quality management. Gitlow (1994) notes the following as 14 points discussed in Deming’s work, â€Å"Out of the Crisis†. After Deming’s success with his Japanese counter partners, many North American manufacturers began to focus in on the Japanese strategies. The Japanese not only adopted Deming’s ideas for manufacturing, but also expanded them to include administrative and service industries. The implementation of quality concepts began to increase along with the techniques that focused in on employee motivation, measurement, and rewards (Hick, 1998). During the eighties, quality improvement had yet again changed names and was referred to as Total Quality Management (TQM). Hick (1998) also explains that the continuous improvement process should â€Å"be driven from the top, but implemented from the bottom† (p.2). Next customer focus, which involves the identification of who the customers are. When companies consider process improvements, they must know the people who will be using their products or services. Hick (1998) explains, â€Å"the starting point for quality improvement is to determine the customer needs† (p.3). As Allen (2001) also notes, â€Å"customer satisfaction is the hallmark of an effective TQM program† (p.5). It is wise for managers to encourage employee-customer exposure to effectively gain understanding of customer needs (Allen, 2001). Walter Shewhart developed the PDCA (Plan-Do-Check-Act) cycle, which provides a methodology for process improvements. Many organizations may use this cycle upon the realization of the need for process improvements. The PDCA cycle is also known as Deming’s cycle because Deming used this methodology to explain the concepts of continuous process improvements. This cycle consists of four important steps The first one is to plan, which is used to determine the processes needing improvement, setting a target, and making all the key players in the effort; the second one is to do what involves the implementation; the third one is to check, which included comparing the pre and post improvement data. This step is also used to determine if the post improvement efforts have corrected the original problem; and the last one is to act, which involves continuous monitoring of that particular process and moving on in areas that need further improvements (Biech, 1994). Including flow charts, or ganizations can also use cause and effect diagrams, run charts, and control charts as basic measuring tools. The main concept behind Deming’s quality theory was the creation of techniques and procedures for process control (Hick, 1998). The theory was expressed as the responsibility of the organization as a whole. In implementing such a major change, leaders must acknowledge their employees fear of the unknown. As Biech (1994) notes, â€Å"Everyone will need to be coached, encouraged, prodded, and protected as they try on new skills and behaviors† (p.138). Biech (1994) also notes several points important for leaders to acknowledge: customer-designed approach for the organization, strong, visible, leadership and commitment from all levels of management, clear vision consistently being communicated at all levels, active participation of the best people regardless of position and experience, willingness to grow as the need arises, and discipline to give the TQM implementation effort time to succeed. There are common reasons why some companies fail at implementing TQM. There are also common ways companies can prepare for the TQM tackle. Companies can start by focusing in on the previous listed points. Throughout many notes from TQM researchers, TQM can be successful if given direct and undivided attention. As Perigord (1994) notes, â€Å"Doing it right the first time means meeting the commitment that has been made†(p.107). It’s the overall desire of the company that drives TQM home. If TQM is enviable, it’s potential, it’s achievable, it becomes everybody’s job, and it becomes victorious. References Allen, R. (2001, May). Aligning Reward Practices in Support of Total Quality Management. Business Horizons. Retrieved Aug 13, 2007 from the World Wide Web: findarticles.com/cf_0/m1038/3_44/75645904/print.jhtml Biech, E. (1994). TQM For Training. New York: McGraw-Hill. Gitlow, H. S., Gitlow, S. J. (1994). Total Quality Management In Action. New Jersey: Prentice-Hall. Hick, M. (1998). Quality Management. Mike Hicks Eagle. Retrieved Aug 13, 2007 from the World Wide Web: eagle.ca/~mikehick/quality.html Perigord, M. (1987). Achieving Total Quality Management: A Program For Action. Maryland: Productivity Press. Zbarack, M. J. (1998). The Rhetoric and Reality of Total Quality Management. Administrative Science Quarterly. Retrieved Sep 13, 2007 from the World Wide Web: findarticles.com/cf_0/m4035/3_43/53392848/print.jhtml Research Papers on Total Quality Management - William Edwards DemingThe Project Managment Office SystemBionic Assembly System: A New Concept of SelfAnalysis of Ebay Expanding into AsiaDefinition of Export QuotasMarketing of Lifeboy Soap A Unilever ProductOpen Architechture a white paperPETSTEL analysis of IndiaInfluences of Socio-Economic Status of Married MalesIncorporating Risk and Uncertainty Factor in CapitalResearch Process Part One

An Examination of the Varieties of Capitalism and its Application in Essay

An Examination of the Varieties of Capitalism and its Application in USA, Sweden and Germany - Essay Example â€Å"Where social democracy is strong, the public firm was unstable and weak, and unable to dominate without difficulty; where social democracy is weak, ownership diffusion of the large firms could reign if other economic and institutional conditions prevailed...† (Roe, [Political] 21) In this definition, Roe seem to identify that nations that have strong traditions of social democracy like Germany have inefficiencies in their public institutions and structures. This include bureaucracy and some elements of inefficiency which plagues nations with strong public sector issues. However, in traditional capitalist states, dominant economic institutions and powerful corporate entities emerge to fill the gap and determine the distribution of wealth in the economy. Roe goes on to illustrate this point by examining the American model of capitalism into detail (Capital para1). He begins by recognizing that America differs from all socialist states because there is less intervention by the government. This leaves a strong vacuum for some kind of a 'moderator' to determine the distribution of income in the economy. Roe (Capital para 3) identifies that the American economy is strongly influenced by corporate entities. He goes on to state that America's laws put more power in the hands of the managers and directors of these corporate entities. This means that shareholders do not have a strong reason to push for capital oriented decisions that will solely be in the interest of their stocks and investments. This means that the people charged with governance are the actual controllers of power in America. The state's intervention is weak whilst the shareholders, who have the true capitalist interest are also kept in check by corporate governance laws which favor the managers and directors. Employees do not have much rights because these managers can hire and fire. Elsewhere in Northern Europe and Central Europe, the strength of the state is boosted because many state in stitutions act as moderators in the corporate world (Soskice 51). This means that the state has some kind of power to intervene in the distribution of wealth. Secondly, the states in these European nations have established strong negotiation systems that ensure that stakeholders like workers and shareholders negotiate to come to a consensus. This is very pronounced in Sweden. It is also quite dominant in Germany. However, what is common to all these capitalist systems is that there is debate and consensus building in all these jurisdictions. The parties involved in these debates determine the differences. On a further analysis of the American system, Roe (Capital 75) states that â€Å"for capital markets to function, political institutions must support capitalism in general and capitalism of financial markets in particular†. This means that the state must moderate in the various debates and interests of the capital markets and some elements of the society. He states that poli tical economy shapes the capital markets by economic, political and legal institutions. This creates a mechanism where the corporate entities shape policy and policy shapes the corporate entities. In a practical analysis of what happens in America, Roe (Political 104) states that capitalism in America is made up of interest groups that converge in the form of corporate entities. Thus, the Republicans and Democrats make promises based on what

Modern Theatre Essay Example | Topics and Well Written Essays - 2000 words

Modern Theatre - Essay Example By the same token, evolutionist historians have also privileged those plays which most nearly conform to this overarching narrative about the demise f melodrama and the all-conquering triumph f realism. Tom Robertson's cup-and-saucer dramas and the cordial 'goodheartedness' (Jenkins 1991) f Arthur Wing Pinero's farcical protagonists, for example, represent two important staging posts on this Whiggish journey. In passing, it's interesting to note an unacknowledged separation f theatrical spheres in these arguments. Although it is women who are usually portrayed as the heroes f managerial reform, slowly transforming dirty, communal playhouses into elegant, comfortable, quasidomestic arenas, the credit for dramatic reform has invariably been attributed to male playwrights. Several consequences arise from this evolutionist history. First, the 'rise f realism' thesis portrays the theatre f the late 1880s and 1890s as a beacon f dramatic light, at the end f the dark tunnel f institutional decadence and theatrical unrespectability. Not only does this entail a strategic and rather narrow selection f the theatrical record, but, at least as importantly, fin-de-siecle drama and theatrical institutions have acquired the status f self-fulfilling prophecies. In other words, the theatre f the 1890s tends to be valued in direct proportion to its difference from -- and satirical critiques of-Victorian drama rather than in terms f its intricate and complex relationships to earlier conventions and dramatic traditions. Michael Baker's The Rise f the Victorian Actor (1978) and Anthony Jenkins' history, The Making f Victorian Drama (1991) are two influential and distinguished examples f this evolutionist approach. Baker's work traces the gradual emergence f acting as a profession in the nineteenth century. In general, he writes, 'the actor f 1830 was a social and artistic outcast and the theatre an outlawed sector f private enterprise'; (Baker 1978) by the 1880s, however, the actor had finally 'arrived' in Victorian society. The rise f journalism and the new status f the man f letters contributed to the creation f new middlebrow audiences, whilst the emergence f a mass market leisure industry helped to provide a solid framework for the gentrification f the acting profession. For Anthony Jenkins, Victorian theatre can be construed in terms f the eventual liberation f drama from the tyranny f a popular, unthinking public. 'The attempt to rescue British Drama from the theatre's rowdy spectacle', he declares at the opening f his first chapter (pointedly entitled, 'Breaking through the darkness'), 'began a few months before Princess Victoria became Queen'. In Victoria's reign, Jenkins locates the gradual emergence f a 'serious' drama whose genealogy can be traced in the plays f Edward Bulwer Lytton, Tom Robertson, William Gilbert, and Henry Arthur Jones; its apex is represented by George Bernard Shaw's final conversion f the Victorian theatre's 'sideshow' into a momentous 'sacred

Ethical, Legal and Professional Duties of Nurses

Ethical, Legal and Professional Duties of Nurses Introduction: Nurses are subject to a large number of ethical, legal and professional duties which are so many to be discussed in this essay so that is why only main important ethical and legal duties will be discussed in this essay. According to the scenario, these main ethical and legal duties will be respect of patients autonomy and the duty of care which is given to all the patients. These duties are professional and legal in New Zealand and even all over the world which when breached can lead to legal implications. These duties are ethical duties as well because ethical considerations arise when these duties are breached, considerations such as when can these duties be contemplated, so there for these duties are ethical duties as well. In this essay, the whole critical discussion will be about the professional, ethical and legal issues that arise according to the given scenario. According to nursing council of New Zealand, nursing profession is bounded by its own code of ethics. Ethics is defined as the branch of philosophy that addresses questions about morality, that is, concepts such as good and evil, right and wrong, justice, virtue, etc. In this critical discussion, Autonomy will be the main aspect, autonomy of patient and judgement of health professional in betterment of the patient. The competencies and codes related to the above scenario according to nurse perspective are that the nurses should act ethically maintaining the standards of practice and nurses should respect the rights of the clients. These codes used in this scenario actually mean that a nurse should acknowledge and allows the individuality of a person, should act in a culturally safe manner, should use knowledge and skills for the benefit of the patients, nurse is responsible for maintain standards in her professional practice and should practice in her own scope of practice. A registered nurse is actually defined as the person who uses nursing knowledge and critical nursing judgement to assess health needs of a patient so that the best health care can be provided and advises people to self manage their health. In this scenario, the patient states the pain score as 8/10 after three hours of having morphine and the doctor thinks the patient has become dependent on morphine. Being a nurse one should ask the patent to wait for another hour so that he can have another dose of morphine and then nurse should assess if the patient is actually dependent on morphine or he is actually in pain. As a nurse, she needs to have courage, honesty and should maintain the advocacy role. In this scenario, it is very critical to decide that if the patient has become dependent on morphine or is it the doctor who thinks the patient has become dependent, being a registered nurse; one should maintain the autonomy of the patient keeping the standards of health care provided to the patient. Autonomy refers to the human capacity for self-determination and independence (Journal of clinical oncology:2001). Autonomy has two aspects, one from the nurses view and another one from patients perspective, so n this essay we will discuss autonomy issues from perspectives of nurse and the patient. In this case Mr. S is making constant requests for having 40mgs of morphine which is prescribed to him every 4hours PRN. He also states that the morphine is not actually relieving his pain and after three hours of having morphine he asks for another dose. Doctors think that the patient has become dependent on morphine so the doctors prescribe him for a placebo of normal saline instead. There is a case study which is concerning about issues in autonomy of patients which is mainly focused on nurses perception of patients autonomy and category of regaining autonomy in patients. The autonomy of patients is usually affected by circumstances such as family, health care provider, community etc. It is believed that the autonomy issue can only be resolved by a team effort, which can include processes of health education, self management etc (Proot et al: 2002). The main point of concern in this scenario is that the patient is given a placebo instead of the morphine, so that the patient would not ask for morphine again and again. The justification for giving placebos is that in the judgement of the giver, the act is beneficial to the patient (Rumbold. G, 1999). This point has both positive and negative impacts on the patient and on the health practitioners and the nurses. This is also according to Health Practitioners Competence Assurance Act 2003 that the patient should be safe.The Health Practitioners Competence Assurance Act 2003 provides a framework for the regulation of health practitioners in order to protect the public where there is a risk of harm from the practice of the profession (Ministry of health: 2010). The positive point is that if the patient has become dependent on the morphine, which is not good according to the patients health, which is why prescribing a placebo would be a better alternative for patients health. This is t he good point of this scenario according to the nurses perspective as the nurse would always work for the better health of the patient which can only become positive results for them instead of them being dependent on any medication. There is another positive point according to the nurse perspective which could be a main concern that the patient is demanding morphine repeatedly to make him feel satisfied and relieved from pain, but according to the nurses assessment, the patient feels satisfied and relieved mentally but that is not true, actually the patient has become mentally stuck that morphine s the only medication which can heal his pain. So, giving him placebo is a better option. There are some negative points as well. According to the New Zealand legislation, this action of nurses comes against The Human Rights Act 1993, which states that every individual has a right to know the truth. In this scenario, the patient is unknown of the fact that he has been administered for a saline instead of morphine. According to a nurse, the biggest ethical, legal and the professional issue here is autonomy of the patient. Autonomy is a very powerful aspect of ethical framework of almost all over the world. Autonomy is a concept found in moral, political, and bioethical philosophy (Autonomy: 2010, July). In these contexts, it refers to the capacity of a patient to make an informed decision. In moral and political philosophy, autonomy is often used as the basis for determining moral responsibility for ones actions (Autonomy: 2010, July). Autonomy means to respect rights of others to determine a course of action. So in this scenario, according to the right of autonomy based on standards of ethics, nurses should respect the patients decision and should respect of what they want. Health professionals have no right to deny patients decision. Nurses should respect patients decisions and their autonomy to develop a trustworthy and professional relationship. According to this scenario, the patients auto nomy should be respected as the patient states the pain score of 8/10 after three hours of having morphine. Mr. S has a right to decide if the morphine is relieving his pain or not and the health professionals are meant to respect his decision as patient is the person who is suffering from a very severe pain. Nurses should provide proper education to the patient and should inform about the consequences of having morphine repeatedly so that the patient can chose the best possible intervention for him. The patient also has the right to have the informed consent about any medication which is prescribed to him. If he is given an unknown medication without his consent, it comes against legal issues and can cause legal implications. In Mr. S case, if placebo of saline instead of morphine is administered to the patient without his consent, then he has the right of action to say that the medication was given to him without the consent and it can make legal implications. So, before prescribing or administering any medication to the patient, doctors or nurses should have full consent of the patient. Therefore informed consent is an ethical, legal and a professional duty of nurses and even every health professional. Consent is very effective in abiding ethical and legal duties. Sometimes, according to a nurse, it can be effective for a patient not being informed about the medication, to get positive outcomes for patients health. It is effective according to the nurse, but it is actually enabling patients decision and his condition. In some cases if a patient is unable to express what he wants, only then a nurse can decide what is best for the patient but a person like Mr. S, who can state his condition must be informed of the placebo of saline. The nurse has a duty to prevent the patient from anything worse happening to the patient but if the patient is not mentally ill, he/ she should have full right to take any decision for them. If the patient says that morphine is not relieving his pain it means that it is not really working for him. It is not good to say that the patient has become dependent on morphine. For example, if nurse administer Mr. S a placebo of saline instead of morphine, his pain can go worst which is not good for the patient and it is not the best practice of a nurse. The New Zealand legislation says that a person has a right to be informed and a right to have freedom. It is under Human Right Act of 1993 which when applied ensures that a person has a right to decide what they want without any interference of any other person. In this act there is a point of having informed medical treatment and a person has right to chose if they want the treatment or not. Ethical issues and changes in society are responsible for nurse-client relationship. The role of the nurse is to maintain clients autonomy, maintain and improve health and promote a professional relationship of trust. The key ethical principles of respect for persons, autonomy, beneficence, nonmaleficence, justice, and veracity should be inclusive in the models of the provider-patient relationship (Margret. M, 1998, para. 1 ). There are some contracts in nurse-client relationship which are boundaries, confidentiality and therapeutic nurse behaviours. Therapeutic nurse behaviours are self awareness, being genuine, respectful, culturally safe, responsible and ethical practice. These are the things which are expected from a nurse by a client and the society. All these contracts are applicable internationally. Nurses being culturally safe with clients have become the nursing practice more powerful. This concept of cultural safety was first introduced from New Zealand and is now used all over the world. Cultural safety is to keep own culture in mind and respecting others culture and practicing in the same manner. Conclusion In this essay, we looked at the case of Mr. S who is in severe pain and is in need of another dose of morphine. He states pain score of 8/10 and doctors think that the patient is dependent on morphine which he would never realise that is healing his pain or not. Mr. S condition successfully states the ethical, legal and professional issues that surrounds nurses and patients autonomy as patients need of morphine would be conveyed by the nurse to the doctor. Here patients condition has been critically discussed and the main influence is on patients autonomy and informed consent of the patient. Nurses roles and the code of ethics have also been discussed in the essay.

The dam human race

The Damned Human Race Mark Twain stated that he has been studying the traits and dispositions of animals and contrasting them with that of man. Be he ashamed to report that his findings are humiliating and that the Darwinian theory of the Ascent of Man from the lower animals should be called the Descent of Man from the higher animal. Twain did many â€Å"experiments† and spent much time observing his subjects. Twain first talks about how man is ravenous. An English Earl organized a buffalo slaughter.He and his party killed 72 buffalo and only ate the meat off of part of one. He tried the same hype of experiment with an anaconda where he put seven calves into a cage with an anaconda. The anaconda only ate one and then left the rest alone. Twain thinks that this shows that the Earl is descended from the anaconda rather than the other way around and that the Earl had lost something in the transition. He also points out that people will keep accumulating money, even if they have m ore than they can spend in a lifetime.Squirrels, birds, and bees also collect things, but even when given an opportunity by twain to collect more than their winter's supply, they would not do it. This led Twain to the conclusion that people are also materialistic and miserly. His other experiments also recognized many bad human traits such as revenge, offensiveness, vulgarity, obscenity, war, slavery, Patriotism, and religion. Twain believes that the defect In humans Is the moral sense which both distinguishes and creates evil at the same time.Twain essay can be Interpreted In many ways because of its symbolism and Irony. Personally I feel that Twain's essay Is entirely truthful. Even If Twain was meaning to be Ironic I think that he made a lot of good points on the negative aspect of human emotion and life. He provides many situations that are both possible and likely to happen I think this essay Is very affective at portraying Twain's view of the world because It Includes both rea listic and relevant experiments, and historical evidence. This realism adds a certain truth to the piece that Is hard to Ignore.Because of this I feel that this piece Is a very strong eye opener to any people living In the dark. It provides useful knowledge about what Is going on Inside many human heads to some degree. It may even tell you about yourself, but then again If you are suffering from these traits then you will most likely not know because you are already so used to doing these things that they are ingrained Into your mind. By reading this I got a very good Interpretation of humans, which I have never thought about before. He dam human race By staff believes that the defect in humans is the moral sense which both distinguishes and creates evil at the same time. Twain essay can be interpreted in many ways because of its symbolism and irony. Personally I feel that Twain's essay is entirely truthful. Even if Twain was meaning to be ironic I think that he made a lot of good p oints on both possible and likely to happen I think this essay is very affective at portraying Twain's view of the world because it includes both realistic and relevant experiments, and historical evidence.This realism adds a certain truth to the piece that is hard to ignore. Because of this I feel that this piece is a very strong eye opener to any people living in the dark. It provides useful knowledge about what is going on inside many human heads to some degree. It may even tell you about yourself, but then again if already so used to doing these things that they are ingrained into your mind. By reading this I got a very good interpretation of humans, which I have never thought

Mental and Behavioral Health Services Essay

While the future of Mental and Behavioral Health Services continue to strive through many striving goals to develop continuous practices, treatments, evaluations, policies, and research, advancements are taking place to better the future of this program and its outreach to the people. Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.1 When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translated to 57.7 million people.2 Even though mental disorders are common in the population, the main load of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who are suffering from a serious mental illness.1 In addition, mental disorders are the leading cause of disability in the U.S. and Canada.3 Many people suffer from mo re than one mental disorder at a given time. Roughly, 45 percent of those with any mental disorder meet the criteria for being strongly related to having 2 or more disorders.1 Awareness of having a disorder is very uncommon in the U.S. DEFINED & FUTURE PROBLEMS Behavioral health is a state of mental/emotional being and/or choices and actions that affect wellness. Substance abuse and misuse are one set of behavioral health problems. Others include, but are not limited to, serious psychological distress, suicide, and mental illness (4. SAMHSA, 2011). Many of these problems are far-reaching and take a toll on individuals, their families and communities, and the broader society. Research allows us to get a better picture of what the future looks like and what people need to be continuing to do and improve on. By looking over research, statistics predict that by 2020, mental and substance use disorders will exceed all physical diseases as a major cause of disability worldwide. The annual total estimated societal cost of substance abuse in the United States is $510.8 billion, with an estimated 23.5 million Americans aged 12 and older needing treatment for substance use. Along with that, every year almost 5,000 people under the age of 21 die as a result of underage drinking and more than 34,000 Americans die every year as a result of suicide, almost one every 15 minutes. Also, Half of all lifetime cases of mental and substance use disorders begin by age 14 and three-fourths by age 24—in 2008, an estimated 9.8 million adults in the U.S. had a serious mental illness. The health and wellness of individuals in America are jeopardized and the unnecessary costs to society flow across America’s communities, schools, businesses, prisons & jails, and healthcare delivery systems. Many programs and services are working together to minimize the impact of substance abuse and mental illnesses on America’s communities. Many practitioners have a very deep understanding approach to behavioral health and perceive prevention as part of an overall continuum of care. The Behavioral Health Continuum of Care Model helps us recognize that there are multiple opportunities for addressing behavioral health problems and disorders based on the Mental Health Intervention Spectrum, first introduced in a 1994 Institute of Medicine report, the model includes these components: ( It is important to keep in mind that interventions do not always fit neatly into one category or another) * Promotion: These strategies are designed to create environments and conditions that support behavioral health and the ability of individuals to withstand challenges. Promotion strategies also reinforce the entire continuum of behavioral health services. * Prevention: Delivered prior to the onset of a disorder, these interventions are intended to prevent or reduce the risk of developing a behavioral health problem, such as underage alcohol use, prescription drug misuse and abuse, and illicit drug use. * Treatment: These services are for people diagnosed with a substance use or other behavioral health disorder. * Maintenance: These services support individuals’ compliance with long-term treatment and aftercare. Two strategies for promoting the more important and most effective openings in having access to mental and behavioral health services include providing education to reach the public, and the prevention and early intervention matters intertwining with the Continuum model components of treatment and maintenance. 7 The New Freedom Commission Report and Surgeon General’s Report both emphasized the importance of changing public attitudes to eliminate the stigma associated with mental illness. Advocates for the mentally ill identify stigma and discrimination as major impediments to treatment. Stigma prevents individuals from acknowledging these conditions and erodes public confidence that mental disorders are treatable. A plurality of Americans believe that mental illnesses are just like any other illness; however, 25 percent of survey respondents would not welcome into their neighborhoods facilities that treat or house people with mental illnesses, suggesting that some level of lingering stigma persists.8 Sixty-one percent of Americans think that people with schizophrenia are likely to be dangerous to others9 despite research suggesting that these individuals are rarely violent.10 With that being said, the media plays a large role in shaping how the youth think and behave from many of the messages kids receive from television, music, magazines, billboards, and the Internet use. However, the media can be used to encourage positive behaviors as well. Four evidence based communication and education prevention approaches are through public education, social marketing, media advocacy, and media literacy that can be used to â€Å"influence community norms, increase public awareness, and attract community support for a variety of prevention issues† (SAMHSA). Public education is usually the most common strategy and is an effective way to show support to the development and success of programs and increase awareness about new or existing laws, publicizing a community based program, and reinforce instruction taught in schools or community based organizations. Through social marketing, practitioners use advertising philosophies to change social norms and promote healthy behaviors. Social marketing campaigns do more than just provide information and tries to convince people to adopt a new behavior by showing them a benefit they will receive in return.11 Social marketing campaigns are being used in a variety of social services and public health settings. Media advocacy involves shaping the way social issues are discussed in the media to build support for changes in public policy. By working directly with local newspapers, television, and radio to change both the amount of coverage the media provide and the content of that coverage, media advocates hope to influence the way people talk and think about a social or public policy12. Media literacy is a newer communications strategy aimed at teaching young people critical-viewing skills. Media literacy programs teach kids how to analyze and understand the media messages they encounter so they can better understand what they’re really being asked to do and think. Inferences about a program effectiveness relies on three things: (1) measures of key constructs, such as risk and protective factors or processes, symptoms, disorders, or other outcomes, and program implementation, fidelity, or participation; (2) a study design that determines which participants are being examined, how and when they will be assessed, and what interventions they will receive; and (3) statistical analyses that model how those given an intervention differ on outcomes compared with those in a comparison condition 19 In the past, practitioners and researchers saw substance abuse prevention different from the prevention of other behavioral health problems. But evidence indicates that the populations are significantly affected by these overlapping problems as well as factors that contribute to these problems. Therefore, improvements in one area usually have direct impacts on the other. According to the Substance Abuse and National Health Services Administration, not all people or populations are at the same risk of developing behavioral health problems. Many young people have more than one behavioral disorder. These disorders can interact and contribute to the presence of other disorders. Besides extensive research documenting strong relations between multiple problems, it’s not always clear what leads to what. Mental and physical health is also connected. Good mental health often contributes to good physical health. In the same way, the presence of mental health disorders, including substance abuse and dependence, is often associated with physical health disorders as well (O’Connell, 2009). One major advancement that has been recently made is from The Substance Abuse and Mental Health Services Administration, adding a new search feature to its National Registry of Evidence-based Programs and Practices (NREPP) Web site. The feature allows users to identify NREPP interventions that have been evaluated in comparative effectiveness research studies. Both the Obama Administration and the U.S. Congress have championed additional investments in comparative effectiveness research to enhance public understanding about which healthcare interventions are most effective in different circumstances and with different patients. The new NREPP feature can provide added information for States and communities seeking to determine which mental health and substance abuse prevention and treatment interventions may best address their needs. The Surgeon General’s notes that â€Å"effective interventions help people to understand that mental disorders are not character flaws but are legitimate illnesses that respond to specific treatments, just as other health conditions respond to medical interventions.† (7) The two major influences that are targeted upon are risk and protective factors. According to SAMHSAs levels of risk and interventions, some risk factors are causal; others act as â€Å"proxies†, or markers of an underlying problem. Some risk and protective factors, such as gender and ethnicity, are fixed, meaning they don’t change over time. Other risk and protective factors are considered variable: these can change over time. Variable risk factors include income level, peer group, and employment status. Many factors influence a person’s likeliness to develop a substance abuse or related behavioral health problem. Effective prevention focuses on reducing those risk factors, and str engthening those protective factors, that are most closely related to the problem being addressed. Taken into consideration that preventive interventions are most effective when they are appropriately matched to their target population’s level of risk, The Institute of Medicine defines three broad types of prevention interventions, universal, selective, and indicated. Universal preventive interventions take the broadest approach, targeting â€Å"the general public or a whole population that has not been identified on the basis of individual risk† (O’Connell, 2009). Universal prevention interventions might target schools, whole communities, or workplaces. Selective preventive interventions target â€Å"individuals or a population sub-group whose risk of developing mental disorders [or substance abuse disorders] is significantly higher than average†, prior to the diagnosis of a disorder (5. O’Connell, 2009). Selective interventions target biological, psychological, or social risk factors that are more prominent among high-risk groups than among the wider population. Indicated preventive interventions target â€Å"high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing mental, emotional, or behavioral disorder† prior to the diagnosis of a disorder (6. IOM, 2009). Interventions focus on the immediate risk and protective factors present in the environments surrounding individuals. A more harsher or serious way of approaching prevention is through policy adoption and enforcement. Policy can be broadly defined as â€Å"standards for behavior that are formalized to some degree (that is, written) and embodied in rules, regulations, and procedures.†13 In order to work, these standards must reflect the accepted norms and intentions of a particular community. There are six major types of policy SAMHSA uses to prevent alcohol and other drug use through economic policies, restrictions on access and availability, restrictions on location and density, deterrence, restricting use, and limiting the marketing of alcohol products. Policy can be an effective prevention strategy—as long as the laws and regulations you put in place are consistent with community norms and beliefs about the â€Å"rightness† or â€Å"wrongness† of the behavior you want to legislate14. â€Å"The key to effective enforcement is visibility: People need to see that substance use prevention is a community priority and that violations of related laws and regulations will not be tolerated.† 6 Strategies that we use today for Enforcement are through surveillance, community policing, having incentives, and penalties, fines, and detentions. There have been many areas of progress in preventive intervention research since the 1994 Institute of Medicine (IOM) report Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. Experimental research has greatly improved mainly due to the advances in the methodological approaches applied to intervention research. For a range of outcomes, while the different types of intervention research has increased, so has the number of studies providing economic analyses in the costs and benefits of these interventions. As the 2001 U.S. Surgeon General’s report on children’s mental health indicated, there is a current need for improved and expanded mental health services for children and adolescents (15). There is a greater need for greater access to a variety of mental health services for children including both medication for emotional or behavioral difficulties and treatments other than medication. Recent research studies have documented the increased use of psychotropic medications (16). Less is known, though, about the use of nonmedication treatments for the emotional and behavioral difficulties of U.S. children. These treatments may include community-based services such as behavioral and family therapy provided by mental health professionals in clinic and office settings and school-based services such as assessments of mental health problems, individual counseling, and crisis intervention services for students (17,18). With the information collected by the mental health service questions in the National Health Interview Survey (NHIS), it will be possible to monitor future trends in the use of both medication and other treatments for the emotional and behavioral difficulties of children. Recommended changes by the Surgeon General include: †¢ improve geographic access; †¢ integrate mental health and primary care; †¢ ensure language access; †¢ coordinate and integrate mental health services for high-need populations. (U.S. Department of Health and Human Services, 2001) 1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27. 2. U.S. Census Bureau Population Estimates by Demographic Characteristics. Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST2004-02) Source: Population Division, U.S. Census Bureau Release Date: June 9, 2005. http://www.census.gov/popest/national/asrh/ 3. The World Health Organization. The global burden of disease: 2004 update, Table A2: Burden of disease in DALYs by cause, sex and income group in WHO regions, estimates for 2004. Geneva, Switzerland: WHO, 2008. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf. 4. Substance Abuse and Mental Health Services Administration. (2011). Leading change: A plan for SAMHSA’s roles and actions 2011-2014. Rockville, MD: SAMHSA. 5. O’Connell, M. E., Boat, T., & Warner, K. E. (Eds.). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. National Research Council and Institute of Medicine of the National Academies. Washington, D.C.: The National Academies Press. 6. Compton, M. T. (2009). Clinical Manual of Prevention in Mental Health (1st ed.). American Psychiatric Publishing, Inc. 7.. U.S. DHHS. 1999. Mental Health: A Report of the Surgeon General. 8. Pescosolido, B. et al. 2000.Americans’ Views of Mental Health and Illness at the Century’s End: Continuity and Change. Public Report on the MacArthur Mental Health Module, 1996 General Social Survey. Bloomington, Indiana. 9. Steadman, H.J. et al. 1998.Violence by People Discharged from Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods. Archives of General Psychiatry 55 (5): 393–401. 10. Borinstein,A.B. 1992. Public Attitudes Toward Persons with Mental Illness. Health Affairs 11 (3): 186–96. 11. Kotler, P. and Roberto, E. (1989). Social marketing: Strategies for changing pubic behavior. New York: Free Press. 12. Wallack, L., Dorfman, L., Jernigan, D., and Themba, M. (1993). Media advocacy and public health: Power for prevention. Newbury Park, CA: Sage Publications. 13. Bruner, C. and Chavez, M. (1996). Getting to the grassroots: Neighborhood organizing and mobilization. Des Moines, IA: NCSI Clearinghouse. CSAP Community Partnerships (unpublished document). 14. Bruner, C. (1991). Thinking collaboratively: Ten questions and answers to help policy makers improve children’s services. Washington, DC: Education and Human Services Consortium 15. U.S. Public Health Service. Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda. Washington, DC: Department of Health and Human Services. 2000. 16. Martin A, Leslie D. Trends in psychotropic medication costs for children and adolescents, 1997–2000. Arch Pediatr Adolesc Med. 157:997–1004. 2003. 17. Steele RG, Roberts MC (Eds.). Handbook of mental health services for children, adolescents, and families. New York: Springer, 2005. 18. Foster S, Rollefson M, Doksum T, Noonan D, Robinson G, Teich J. School Mental Health Services in the United States, 2002–2003. DHHS Pub. No. (SMA) 05–4068. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. 2005 19. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions, Institute of Medicine, National Research Council. â€Å"10 Advances in Prevention Methodology.† Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: The National Academies Press, 2009.