ADVERSE CHILDHOOD EXPERIENCES, POST-TRAUMATIC STRESS DISORDER (PTSD) AND MENTAL HEALTH

ADVERSE CHILDHOOD EXPERIENCES, POST TRAUMATIC STRESS DISORDER (PTSD) AND MENTAL HEALTH

Introduction

Trauma is any occurrence, usually not any ordinary that harms the spirit, self and body. It covers a wide range of experiences that are hurtful, including the traumas that has emotional, mental, sexual and physical realm of our being (Blackburn et al 2012p.18). There are different forms of traumas that regularly occur and these are called Adverse Childhood Experiences (ACE). According to Felitti et al (1998p.249), the largest study of Adverse Childhood Experiences (ACE) ever done to examine the economic, social and medical effects of Adverse Childhood Experiences over the lifespan of children. The number of participants in the study was 18,000. Mendelsohn et al (2011p.77) pointed out the components of Adverse Childhood Experiences. These include the childhood emotional, sexual and physical abuse and neglect. Similarly, another component is a child growing up with substance abuse, domestic violence, crime or even parental loss.

From the study conducted by Felitti et al (1998p.246), the study findings reveal that Adverse Childhood experiences in life affect adults in different ways. To begin, the burden of the disease and the costs of medical care to the adult, Adverse Childhood Experiences affect adults in wellbeing, increases the suicide rates and depression. Moreover, drug abuse and alcoholism is common to adults who are affected by Adverse Childhood Experiences. Other effects on adults include disability and job performance and finally effect on the subsequent generations.

According to Schiraldi (2000 p.102), Adverse Childhood Experiences are linked to the ten most death causes in United States. The top ten risk factors include a history of sexually transmitted diseases, over fifty sexual partners, injected drug use, illicit drug use, alcoholism, suicide attempts, depression, physical inactivity, severe obesity and smoking.

According to Thomas (2008 p.113), if the trauma is accepted by the people as real and the survivors or victims experiences is validated and its expression supported its short term effects also referred to as  acute traumatic stress, can be processed, expressed, metabolized or ameliorated in a healthy way so that no or few lasting detrimental effects eventually remain. However, if traumatic experience reality is invalidated or denied by the victim, important or by close others such as family, assisting professionals, friends, and then the individual may not be able to completely heal from the traumatic adverse effects. If the trauma persists, with no support and validation in expressing its related pain, it may grow into Post Traumatic Stress Disorder (PTSD), that Van (1998p.97) believe is the main disorder among the trauma survivors who are unrecovered.

To get healed from trauma, the person who has experience trauma has to be able to mourn the related pain. To mourn, the individual must remember well enough the trauma and accurately name it. Whitfield (1997p.331) pointed out that remembering and mourning a trauma of the past may be difficult since there exist many roadblocks compared to the others. For instance, many people refuse to believe that a parent or a relative could or would neglect or abuse their own child or a relative child. Perhaps this forms the basis for the plethora of support and disbelief in the court systems and the media n favor of the accused charged with abusing or molesting their child or the ones close to them. Brandyberry et al (1998p.271) observed that it is common knowledge that over 90% of the people who abuse a child knows well the child before abusing them, and most of them are related to the children.

Blackburn et al (2012p.56) observed the psychological sequelea or the pathological results of Adverse Childhood Experiences. The symptoms of Post Traumatic Stress Disorder (PSTD) or DSM IV include traumatic event exposure, are experiencing, hyper arousal, numbing/avoidance and functional impairments. Similarly the complex Post Traumatic Stress Disorder or the extreme stress disorders include; alterations in affective arousal regulations, alterations in consciousness and attention, somatisation, characterological changes that are chronic and finally systems of meaning alterations.

Felitti et al (1998p.109) observed that in addition to Post Traumatic Stress Disorder, early life trauma is linked with impaired self awareness, sense of self and significant disturbance in regulation of emotion and interpersonal functioning. The prevalence of Post Traumatic Stress Disorder related to trauma of early life can be gauged by the study by Felitti et al (1998p.109). the DSM-IV field trials Post Traumatic Stress Disorder identified the Post Traumatic Stress Disorder prevalence in a clinical sample and combined community as 77% for sexual abuse on children and 45% for physical abuse of children and 85% for people with sexual and physical abuse (Mendelsohn et al 2011p.87).Moreover, in the mental healthcare settings, the prevalence of childhood abuse reported a rate ranging from 35% to 50%, depending on the service (Mendelsohn et al 2011p.89).

The factors increasing a person’s vulnerability to Post Traumatic Stress Disorder include the female gender, genetic vulnerability, psychiatric illness history such as anxiety and depression, repeated or prolonged exposure to trauma, poor social system of support and childhood trauma. However, the protective factors against Post Traumatic Stress Disorder as observed by Schiraldi (2000p.329) include; the early care givers of a child which play a very crucial role in buffering the child against the stressful situations impact, and more importantly, assist build resilience against adverse experiences in the future. Additionally, the presence of early attachments that are secure is a protective factor.

The neurobiology of Post Traumatic Stress Disorder related to early life trauma is explained in studies by Thomas (2008 p.137). The study shows that Post Traumatic Stress Disorder involves both emotional under modulation and emotional over modulation in a bid to restrict emotional experiences that are unwanted. The emotional under modulation includes hyper arousal, re-experiencing, anger and fear states. However emotional over modulation includes analgesia, numbing and states of dissociation.

Van (1998p.24) asserted that the interpersonal dysfunction includes; sensitivity to criticism, social isolation, revicimization such as domestic violence, physical assaults and adult rape, difficulty in standing for oneself, functioning problems and child rearing difficulties. The social emotions are elicited by social interactions and also involve language, social intentionality and meaning. However, the non social emotions according to Blackburn et al (2012p.226) emerge as a result of a posing stimulus to direct physiological relevance such as fleeing, fighting and food.

In analyzing the self reflection and sense of self in Post Traumatic Stress Disorder related to trauma of early life, Felitti et al (1998p.252) asserted that sense of self is the ability to make a reflection upon oneself. This requires a sense of self that is robust, which has been given a description as a schemata collection regarding the ability of a person, attitudes and traits that guides people’s behaviors, social interactions and choices

The study conducted by Mendelsohn et al (2011p.67) found out that the second most common adverse child experience or trauma was the overt sexual abuse on children, reported in 22% out of the 9508 of the medically evaluated adults. Furthermore, Schiraldi (2000 p.73) observed that for the past few years, a number of their accused molesters of children have cried of false memory when finally their victims recovered and revealed their adverse child experiences to others. According to Thomas (2008 p.186), child molesters usually try to silence by violence or threats their victims, and this could be an explanation why some of the victim never talk to others about their adverse experienced to others. May be Post Traumatic Stress Disorder is likely to be their main disorder, and traumatic amnesia in people with Post Traumatic Stress Disorder is common, no matter what their core trauma was.

From clinical observation of the trauma survivors, they tend to possess many disorders or diseases at a higher prevalence compared to the general population. These conditions and disorders include addictions, dissociative disorders, suicide attempts, depression, somatizatin, borderline personality disorder, Post Traumatic Stress Disorder, psychosis, self harming behaviors, prostitution, violent behaviors and pedophilia. Hence, the trauma survivors are frequent among the general medical populations as well as psychological and psychiatric outpatient and inpatient practices and clinics Van (1998p.104).

These diagnoses and the determination of the potential causal connection to the trauma of the child require skillful taking of history, and dealing with painful materials for the patient to disclose to the clinician. Whitfield (1997p.375) asserted that it is time for the public health and the general medical communities to directly begin to address the occurrences of adverse child experiences in combination to their long term effects instead of relegating the duty to the social services, psychologists, psychiatrists and trauma specialists whose number is too small compared to the huge number of survivors of trauma.

According to Brandyberry et al (1998p.296), the unrecovered survivors of trauma tend to exhibit behavior of high risk such as excessive risk taking, alcohol, tobacco and other drugs. By engaging in these behaviors of high risk, the trauma survivor, the trauma survivor is not acting antisocially or crazy, but rather re enacting aspects unconsciously of their original trauma for them to master it and eventually heal from it hopefully.

The study by Blackburn et al (2012p.32) provide more circumstantial and direct evidence that a substantial portion of the psychological and medical illnesses may be trauma based in large part. This implies that the health professionals allowing people to work to name, identify and mourn of their past traumas have a likelihood of contributing to their ability to heal from some of the diseases, problems and disorders that are associated with trauma. These lessen the impact of these associated problems and illnesses, and the final higher costs of not treating them in t5hos manner.

Mendelsohn et al (2011p.47) have also shown that some of the common organic diseases often trace their origins not from merely childhood, but in the unprocessed childhood traumatic emotional experiences. The manner in which these grief that are unhealed translates into organic diseases forms the large part of the results of the different behavioral coping mechanisms employed to gain some relief such as drugs, smoking, promiscuity, excess drinking, overeating, violence and toxic relationships. Mendelsohn  et al (2011p.53) elaborated that these mechanisms of self medication usually work to a certain degree for some time, and their risks also seems too remote, that they are actually seductive when the relief need is acute. It is not a surprising that Adverse Childhood Experiences have long term psychological effects that are prominent. Decades later, what is unexpected is an association of the adverse childhood experiences with the common organic diseases.

Over the past decades, the twelve step self help recovery fellowships at the grass root like Al-Anon, AA, Co-Dependence Anonymous and Adult Children of Alcoholics have noticed some of the Adverse Childhood Experiences and several of their connections. These effective but inexpensive groups have form part of the recovery movements during the 1980’s and the 90’s. Most of their members have also utilized the use of bibliotherapy in the form of selected books for self help that simplify some of the more principles of recovery and psychology which are effective. Some examples of such organizations include American Coalition for Abuse Awareness (ACAA), American Professional Society on the Abuse of Children (APSAC), One Voice, and The International Society for the Study of Dissociation (ISSD), The Sidran Foundation in Baltimore, the National Centre for Prosecution of Child Abuse and The International Society for Traumatic Stress Studies (ISTSS)(Schiraldi 2000p.343).

The AA twelve steps, now being used by over 100 other self help groups and fellowships have added a dimension of spirituality to the recovery. The spirituality in this scenario is defined as having to do with the relationships with self and universe in deeper dimensions.

These self help grass root fellowships and other aids for recovery have also assisted many healthcare professionals, many of whom posses a personal history of more or one Adverse Childhood Experiences or traumas, in working a program that is effective of their own recovery. By doing that way, they have surpassed the more conventional medicine, psychology and psychiatry limitations with success. These health professionals who are now recovered are able in turn to offer their clients and patients a wide range of therapeutic choices to use in their work of recovery. By doing so, they are improving and expanding the care standard for most of their patients (Thomas 2008p.142).

In the prevention of the Adverse Childhood Experiences from afflicting people, Van (1998p.89) suggested that the problem can only be limited by people’s own creativity. For example, the organizations of health professionals should consider addressing the mental and physical health of their professional members, as well as their recovery from the effects of any Adverse Childhood Experiences that is harmful. Similarly, other journals should encourage and give consideration to more clinical and basic research on trauma for publication. Alternatively, healthcare organizations and managed companies for care should pay for long term and short term appropriate treatment of the adverse effects of Adverse Childhood Experiences in survivors of trauma, which in the long run will save them money. Moreover, each training program for professionals of health should have information on trauma effects, such as child abuse or other Adverse Childhood Experiences, how to ask them about, and what to do with a trauma patient who has experienced it.

Another suggestion as elaborated by Whitfield (1997 p.542) include stopping treating children as though they are the property. People should treat children with love and compassion, and not with fear or shame. More parenting programs that are effective have been in existence for many years. These skills should be incorporated and be taught in the schools. Brandyberry  et al (1998p.107) noted that some communities have seen excellent results in child neglect and abuse elimination by establishing centers for parenting that visit weekly every new parent and child for the first two years. The training of every professionals of health should include Adverse Childhood Experiences recognition and techniques to treat and manage their long term effects.

Another suggestion proposed is giving more political and monetary support to organizations that work in child abuse prevention, such as councils of child abuse and services of child protection. Therefore, people should look to the selected state and national organizations for guidance and training. Lastly, people should support groups such as the Healthy Families America and Alliance for Children which are creatively working to improve child rearing and parenting and child maltreatment prevention (Blackburn et al 2012p.117). The federal organizations could also double their funding and efforts for health improvement and children well being.

The treatment that targets symptoms of Post Traumatic Stress Disorder, emotion, self dysregulation and interpersonal is elaborated by Felitti et al (1998p.255). Training skills in interpersonal and affective regulation plus exposure treatment prolonged specifically developed for Post Traumatic Stress Disorder related to child abuse. Furthermore, skills training in emotion, self and interpersonal regulation plus and exposure that is prolonged, has been shown to reduce impairment that are related to childhood abuse Post Traumatic Stress Disorder and its associated interpersonal, emotion and self dysregulation.

Conclusion

In conclusion, in all generations, the current generation is the first in history to understand and recognize the child abuse and neglect ravages and begin to do something tangible about it. Moreover, this is the first generation to start healing the people psychologically and physically from the harmful effects of Adverse Childhood Experiences. Through trial and error and several researches and publications and subsequent dissemination to the wider public, the people can apply constructively the knowledge and skills to the children. Some suggestions have been that if one generation can be raised of healthy children, humanity can go far in eradication of war, social violence and many other worldly problems. Through research, humanity can develop significant new knowledge that when executed, promise to foster the future generations of healthy adults, children and societies.

The following articles give more information on adverse childhood experiences, post traumatic stress disorder and mental health

  1. Blackburn Knight, R., & Falstein, M. (2012) A Man’s Recovery from Traumatic Childhood Abuse The Insiders. Hoboken, Taylor and Francis. Retrieved from http://www.UCM.eblib.com/patron/FullRecord.aspx?p=1047009.

In intimate and candid words, the author elaborates his courageous and long fight to overcome the sadistic ravages of child abuse. The author makes the reader see, feel and hear its horrors, unvarnished and raw. Instructive to both victims and therapists, the content gives techniques and hope to the healing people. Accompanied by long years of research on dissociation literature, the author tried many different approaches to treatment. He finally uncovers “the insiders” through hypnoanalytic procedures, the unconscious ego that represented the memories of his betrayal at childhood. This literature is good for therapists and many others who are seeking to heal and understand the child abuse horrors.

  1. Felitti Vj, Anda Rf, Nordenberg D, Williamson Df, Spitz Am, Edwards V, Koss Mp, & Marks Js. (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 14, 245-58.

This article repot on different common trauma forms that regularly occur in different countries. They call these traumas as the Adverse Childhood Experiences (ACEs)

  1. Mendelsohn, M., Herman, J. L., Schatzow, E., Coco, M., Kallivayalil, D., & Levitan, J. (2011) The trauma recovery group: a guide for practitioners. New York, Guilford Press.

Written with an expert, it offers practical guidance for therapists. The book presents a group treatment approach that is based on evidence for interpersonal trauma survivors. This treatment that is limited to time is designed patients that has achieved basic stability and safety in the present life, and is ready to work more on enduring ways that trauma has affected their relationship and self perception.

  1. Schiraldi, G. R. (2000) The post-traumatic stress disorder sourcebook a guide to healing, recovery, and growth. Los Angeles, Calif, Lowell House. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=23967.

The book explains that trauma manifest in many forms, from surviving a disaster or witnessing a very violent crime with the effects of rape, abuse, alcoholism or combat. The deep emotional wounds may look as if they will not heal. The book offers remarkable wide range of management and treatment alternatives and techniques. This shows the survivors that growth and recover is the other side of pain

  1. Van Der Kolk, B. A. (1998) Trauma and memory. Psychiatry and Clinical Neurosciences. 52, S52-S64.

Taking a deep examination at the most recent memory research on traumatic events, the book has sate of the art data covering the controversial areas of the repressed memory. The author and other contributors integrated multi disciplinary findings into a coherent treatment proposal, and social and legal practices and policies.

  1. Thomas, P. (2008) Post traumatic stress disorder. Farmington Hills, MI, Lucent Books.
  1. Whitfield, C. I. M. (1997) Traumatic amnesia: The evolution of our understanding from a clinical and legal perspective. Sexual Addiction & Compulsivity. 4, 107-135.
  2. Brandyberry Lj, & Macnair-Semands Rr. (1998) Examining the validity and reliability of childhood abuse scales: putting The Courage To Heal to the test. Child Abuse & Neglect. 22, 1253-63.

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Situation Analysis for Starbucks Company

Situation Analysis for Starbucks Company

Company and Product Overview

Starbucks Company is a multinational company is a marketer, roaster and retailer of coffee that operates in over 60 countries. There are four segments of the company which it operates: Middle East, Europe, Africa, Asia pacific and the channel development. The company purchases coffees and roasts before selling them, along with the handcrafted tea, coffee and other beverages in addition to different fresh food items. These are done in their stores that are operated by the company. Furthermore, Starbucks Company sells a variety of tea and coffee products. The company also licenses its trademarks through channels like the licensed stores, national accounts for food service and groceries (Bussing-Burks, 2009).

Starbucks Company has been the most successful company in the industry of coffee in the few decades that has passed. The company uses aggressive strategies for expansion to push out most of its competitors. It has focused on forming a dense stores network around United States, while opening up other new locations around the globe. Michelli (2007) pointed out that currently Starbucks is the leading coffee market retail selling coffee at a premium price to maximize their profitability.

Read also: Starbucks Corporation marketing mix

According to Sica (n.d), Starbucks Company surpassed the major competitor, Wendy and Burger king to become number three restaurant by posting $9.07 billion in sales last year. The company is also projected to gain in as one of the day parts of restaurant that is fast growing for breakfast. The estimated media budget of the company is a fraction of the total expenditure of other top chains in the industry. Bussing-Burks (2009) indicated that Starbucks company spend $94.4 million on media compared to the media expenditure of MacDonald of about $887.8million in 2010 in united States only.

The major competitors of Starbucks Company include Caribou coffee, MacDonald’s and Dunkins donuts. When comparing Dunkin donuts verses Starbucks, Americans who are hard working prefer Dunkin donuts taste over Starbucks. Dunkin donuts launched in 2009 a $100 million advertisement campaign that ran through the radios, outdoor and print advertising, in store purchase points, sports marketing, online advertisements and special events (Michelli, 2007).

In comparing MacDonald verses the Starbucks, MacDonald has heavily marketed its MaCafé coffee drinks for breakfast for the past two years. Additionally, they have continually introduced new drinks for non coffee and coffee products such as the frappes and smoothies. Sica (n.d) pointed out that MacDonald antagonized Starbucks in their TV adverts just like the Dunkin donuts. Moreover, MacDonald uses also signage and billboards, sponsor sports events at large scales.

In comparing Caribou coffee verses Starbucks, Bussing-Burks (2009) observed that in 2008, Caribou coffee spent about $2 million in advertising. Moreover, the visitor demographics analysis shows that Caribou coffee could be having a more online success if they applied the same tactics as Starbucks. Additionally, analysis shows Caribou coffee is preferred by young adults between 18-34 years. This represents 32% compared to 42 % that is attracted by Starbucks.

Situation Analysis

The second most traded commodity globally is coffee. United States of America is the largest coffee importer in the world. Coffee demand is price inelastic; this implies that when the prices of coffee rise, coffee consumption is not reduced.

Starbucks according to Michelli (2007) is the worlds most recognizable and powerful high quality brands that are unique. The market share of Starbucks is 32.6% with over 11,500 coffee stores in United States. The SWOT analysis of Starbucks is according Sica (n.d) to include:

Strength:

  1. Is the best and the biggest coffee shop in the industry
  2. Has a natural edge over other competitors who are less known in that customers associate it with popular experience and high quality
  3. With its widespread locations, it reaches larger market
  4. Drive through store
  5. Large demographic spread of its new products prevents new entrants and ensure large exposure

Weakness

  1. The whole business is in coffee industry only while its competitors like the Dunkin donuts have invested in other industries
  2. Strong presence in home market, United States, hence oversaturation of their market
  3. High price
  4. Competition from other brands that are low priced

Opportunities

  1. New opportunities for international markets
  2. New products
  3. Organic drinks
  4. Health drinks
  5. Energy drinks
  6. More bottled drinks
  7. Kid focused drinks
  8. Forming of partnerships with other companies of coffee

Threats

  1. New entry into market
  2. Stiff competition from McDonalds when they upgraded in 2006
  3. Smaller coffee houses that are privately owned
  4. Anti- Starbucks groups
  5. Image threat

 

References

Bussing-Burks, M. (2009). Starbucks. Santa Barbara, Calif: Greenwood Press.

Michelli, J. A. (2007). The Starbucks experience: 5 principles for turning ordinary into extraordinary. New York: McGraw-Hill.

Sica, Danielle. (n.d.). Starbucks Corporation: a strategy capstone. (Starbucks Corporation: a strategy capstone.

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Aerobic fitness classes Business proposal

Smart Aerobic Freelancers Business proposal

 Introduction

The xxx company is seeking proposals from businesses to offer services in provision of aerobic fitness classes and other fitness exercises to their company. “Smart Aerobic Freelancers” Company seeks to provide services to the xxx company by providing aerobic classes to and other fitness programs to their employees to improve their health and fitness conditions.  The health problems due to sedentary lifestyle and physical inactivity in the xxx company have seen the emergence of non communicable diseases among the employees of Xxx Company. These diseases range from hypertension, diabetes, high blood pressure, overweight, obesity, arthritis, and other cardiovascular diseases. Furthermore, the health problems due to sedentary lifestyles has also seen an increase in rate of absenteeism, low productivity, increase in sick leaves and high employee insurance costs..

Our successful comparative venture bid to do fitness management of the employees of xxx company in low costs, under the partnership between the Xxx Company and “Smart Aerobic Freelancers” company. This sets off the health management program that is expanded to attract the families of the employees to be more productive and healthy. Furthermore, this will continue to rebuild the company and improve the health and fitness conditions of the employees of Xxx Company.

Moreover, the “Smart Aerobic Freelancers” Company meet all of the requirements prescribed by the Registrar of companies in the republic of Kenya, in order to qualify to sign or conduct any official business that is binding. The “Smart Aerobic Freelancers” company will create a section for scheduled aerobic dance training structured to train the employees to improve their cardiovascular activities to satisfy the objective of the xxxx company.

Furthermore, the “Smart Aerobic Freelancers” company will be able to make contracts with the xxx company to train other subsidiary branches spread within Nairobi city, that also lack health and fitness intervention programs. The aerobic program within xxx company will also enable the Company, effectively and independently, to manage different aerobic classes that currently are not in existence.

The plan

  • Project activities

Establishing a new program for health and fitness management will allow “Smart Aerobic Freelancers” Company to expand and improve the Company’s fast paced health and fitness agenda for two years efficiently, responsibly and effectively. The new program for health and fitness will formulate a reliable mechanism, that quickly respond to the rising health insurance costs of xxx company, and manage the xxx Company’s health action plans of the management through the joint venture.

The “Smart Aerobic Freelancers” Company will use the xxx company’s funds to form a a new health and fitness program that will forge company and employee partnerships to manage the emerging non communicable diseases in xxx company. The funding by xxx company will improve greatly delivery of services, by the competent management to more than yyyyyyy employees of xxx company in the central and subsidiary branches in different parts of the country.

  • Budget
INCOME   EXPENDITURE  
SOURCES AMOUNT (Ksh) USES AMOUNT ($)
Revenue   General operating support  
Government grants and contracts 300,000 Salaries and the fringe  benefits 700,000
Banks and foundations 100,000 Insurance and taxes 600,000
Earned income 2,000,000 consultants 200,000
Fundraising _____ In kind expenses 100,000
Donations 400,000 Supplies and Equipment 500,000
In kind support 200,000 Savings 90,000
TOTAL 3,000,000 TOTAL 3,000,000

 

 

  • Programs and accomplishments

Every month, “Smart Aerobic Freelancers” Company, does help many people on a freelance basis in numerous health and fitness programs to prevent and manage the non communicable diseases. Step by step, the company has established a wide range of loyal clients that seeks our services on a freelance basis.

The current portfolio of freelance health and fitness service delivery represents the whole ladder of health and fitness,, ranging from aerobics, weight training, fitness consultation and advice on nutrition. The Company’s tremendous growth over the past few months attests to the proficiency.

The Company provides services to different caliber of people about health and fitness ranging from the physically handicapped, the elderly, men, women and kids. Today, there are different freelance programs that cater for the elderly, the youth, women and kids.

  • Plan for measuring the expected results

The Company will measure the success of the health and fitness programs by many programs and initiatives which the “Smart Aerobic Freelancers” Company has developed and implemented for the two years, and which will  significantly impact the quality health and fitness practice in the xxx company.

The Company will also submit a report of the projects upon completion, funded by  xx company under the human resource department. The “Smart Aerobic Freelancers” Company will also keep complete, accurate and detailed records of expenditures made under the company’s management, and actively participate in the evaluation of the activities of the projects during the course of the year.

The Company will also provide, upon request, an audited financial statement of the expenditure and income related to the income and expenditure by a qualified public accountant who is self sufficient as documentation that the money from the xxx company is spent on the provided purposes. Furthermore, evaluation of the “Smart Aerobic Freelancers” Company overall effectiveness is measured by satisfaction of the employees of xxx company, and the level of services that are provided and successful.

Conclusion

The xxx company which “Smart Aerobic Freelancers” Company serve is a a company that deals with yyyyyy and has yyyyyynumber of employees. The need of healthy and fit employees is a matter of great importance that xxx company has identified and need to be addressed

“Smart Aerobic Freelancers” Company is a recognized champion in freelance provider of health and fitness services in the industry.  A contract from the xxx company will provide “Smart Aerobic Freelancers”  Company the opportunity to form the partnership with the xxx company to, effectively run a health and fitness program for xxx company Furthermore, it will continue to improve, preserve and dignify the xxx company’s fabric.

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Affirmative action

Affirmative action

Introduction
            Affirmative action are policies that institutions engage actively in for them to improve on the opportunities for groups that have been historically excluded in the society. In the recent past, educational institutions have been under pressure to eliminate or reduce any form of discriminatory actions (Carolyn, 2000). In most cases, affirmative action policies have been employed to comply with the requirements of the law. However, research shows that the affirmative actions have not completely neutralized the acts of discrimination.

Globally, the supreme courts have crowned lengthy legal campaigns to eliminate educational institutions segregation. However, most educational institutions are, today, committed to offering equal opportunities to all persons in the institutions irrespective of color, race, nationality, religion, age, sex and educational orientation. Affirmative action is the product of 1960s civil rights movement that was intended to permit equal opportunities in institutions for the disabled community.

Affirmative Action Debate

Affirmative action is a debate process than a policy admission. Recently, universities and colleges have reached out to unrepresented groups and sought their applications. As a result of affirmative action, the universities and colleges have doubled their admission of the representatives of minority persons. Studies show by Datcher & Garman (1993) indicated that institutions that abolished affirmative action policies have seen a decline of 61% of disabled student representation in the educational institutions. They insist that affirmative action is instrumental for socioeconomic educational developments. Moreover, students who benefited from affirmative action policies have reported positive lifestyle. Honestly, they have received better jobs with pleasant incentives. For this reason, they have sustained a better life because of the opportunity they were offered.

Diversity in the educational institutions permits learning advantages for every student inclusive of their intellectual and personal developments. People exist in the global society with multiple cultures, therefore, for everyone to be prosperous; the educational stakeholders must effectively work together with a diverse society surrounding them. The affirmative action policies are instrumental for compensation of the economic, racial and social harassments. Normally, the persons who enjoy high social and economic status receive numerous opportunities than the people from lower economic and social backgrounds.

The supports of the affirmative action are of the opinion that certain ethnic or racial groups have limitations in access of education. Ideally, this might be because they are in the brackets of lower income and hence not exposed to resources navigating on the educational institutions than their counterparts from higher social and economic class.

Globally, affirmative action advocates are in support of the competition between the students based on their merit. However, they argue that the affirmative action is crucial for the compensation of the economic disparities. Although some opponents of affirmative action points out that the policy has led to division of the society along ethnic, economic, gender and nationality lines, the supports coherently argue that affirmative action incites the tensions that results from racism because the policy raises racial consciousness

Conclusion

The controversy surrounding the policy of affirmative action in the educational sectors are related to the perceptions of the public. Evidently, there is a lack of proper execution of the policy navigating on affirmative action (Hwok, 2012). This has led to variations in its actualization and an inadequate uniformity resulting in ideological clashes on the affirmative action nature. Additionally, the implementation of the policy has been downplayed by many critics of affirmative action. These argument clashes have resulted into contention against and for affirmative action. In a nutshell, affirmative action policies should be supported in educational institutions for the students to receive better equal chances irrespective of their socioeconomic significances.

References

Managing multiculturalism and diversity in the library: Principles and issues for administrators [Special topic]. (January 01, 1999). Journal of Library Administration, 27.

Datcher, L., & Garman, D. (January 01, 1993). Affirmative action in higher education. The American Economic Review (evanston), 83, 2, 99-103.

Carolyn, N., & Jane, M. (January 01, 2000). The impact of affirmative action legislation on women working in higher education in Australia: progress or procrastination?. Women in Management Review, 15, 8, 404-414.

Hwok-Aun, L. (January 01, 2012). Affirmative action in Malaysia: Education and emplyment outcomes since the 1990s. Journal of Contemporary Asia, 42, 2, 230-254.

Archibong, U., & Adejumo, O. (May 01, 2013). Affirmative Action in South Africa: Are We Creating New Casualties?. Journal of Psychological Issues in Organizational Culture, 3, 14-27.

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Affordable Care Act

Affordable Care Act

The sponsors of the affordable care act and how it effects the practice of community health nursing

The affordable care act was a crafted bill by the house of representative of United States in 2009 November. The bill got support from the administration of Obama. The 111 congress ensured that the enactment of the reforms in the health care system of United Sates (United States, 2012).

The act will not take its full effect up to the year 2014, but its impact is big in the health care system and particularly in the field of nursing. According to (Schmidt, 2011), the law is already creating new opportunities in the area of nursing:

  1. High demand of advanced practice nurses

The countrywide shortage of nurses inspired the program for advanced education for expansion of nursing, a component in the affordable care act to set aside $30 million for academic training program for certified nurse midwives and nurses practitioners (United States, 2010).

The funds were for payment for living and housing expenses so the students and their instructors. Nather (2010) asserted that potential income loss and shortage of instructors during training deterred many practitioners from pursuing advanced certificates, and the law is now funding it.

  1. Many nurses will operate outside the hospital setting

The pilot project of the law to move the chronically ill out of the hospitals to communities will cut more costs. Moreover, many private insurers are doing thee same. Soon, the outpatient care will look more attractive to the providers hence the need for the ambulatory nurses.

  1. Short supply of nurses

The mandate of the law to insurance companies will bring more than ever more patients to the health care system. Therefore, there will be short supply of the nurses. This will give the nurses more choices where d the type of work they do (State Bar of California, 2012).

  1. Providers are admitting older patients

A key component of the law is the financial incentives for health care providers attending Medicare patients, increasing demand for generic nurses. Schmidt (2011) pointed out that with the aging population and more financial incentives for the nurses, hospitals need hospice and geriatric nurses.

  1. New specialty

The program of pay for performance under the act aims to improve the care quality by giving compensation to the providers based n the outcomes of the patients, and not the amount of service. The program needs following of the complex clinical measures, hence creating more work as noted by United States et al (2012). Meanwhile, workload increase will lead to more opportunities for the nurses, and emergence of a new nursing specialty.

Reasons for the introduction of the change

  1. Consumer rights and protection

The act created a new bill of rights to patients that protects citizens from abusive practices such as exploitation by insurance companies. Furthermore, it ended the discrimination from the insurance companies who discriminated conditions such as diabetes, asthma on children. Moreover, the law ended the care limit which some patients in the past with chronic illness like cancer ran out of insurance cover due to the dollar limit imposed by their insurance companies (United States, 2010).

  1. Affordable coverage

The new law will help in lowering costs through new market place and tax credits where insurers will need to compete for you. The law will further bring down cost of healthcare by ensuring your money is spent wisely.

  1. Better care access

By providing more choices for health insurance, it improves better care access. The insurers by law are required to cover many recommended preventive services like high blood pressure, diabetes and cancer. Young adults who cannot get coverage stay under the plans of their parents and the rates are also affordable (Nather, 2010).

  1. Strengthening Medicare

The law will strengthen it by fighting fraud, adding more benefits and improving patients care. According to State Bar of California (2012), cost of drugs will be lowered and free preventive services will be offered. Furthermore, while lowering costs, they provide choices.

Impact of the new law on consumers

Since its introduction, the law has increased the premiums of the healthcare market hence increasing the cost of healthcare such as the Medicaid and Medicare. Moreover, it affects individuals on the costs of its implementation. Lastly, the law has impacts on the small business on its policy implications on the mandate of the employer, the meager tax credit and the 50- employee threshold (Schmidt, 2011).

Analysis of public statements

Governor Nathan Deal of Georgia in a live interview openly disowned the law and stated his intentions of not expanding Medicaid. The reason being his government cannot afford it. This shows how the implementation and the realization of the law fully might be difficult (United States et al, 2012).

References

United States., Washington (State)., & Washington State Library. (2012). Affordable Care Act: Medicaid expansion 2014 : implementation plan. Olympia, Wash.: Washington State Health Care Authority.

United States. (2010). The Affordable Care Act: Protecting consumers and putting patients back in charge of their care. Washington, DC: U.S. Dept. of Labor, Employee Benefits Security Administration.

State Bar of California. (2012). Navigating your path through the Affordable Care Act. San Francisco, Calif.: State Bar of California.

Nather, D. (2010). The new health care system: Everything you need to know. New York, NY: Thomas Dunne Books.

Schmidt, P. L. (2011). Medicare and the Patient Protection and Affordable Care Act. Hauppauge, N.Y: Nova Science Publisher’s.

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