Health of Children

| |Healthy minds | | |Promoting emotional health and well-being in schools | | | | Contents Executive summary1 Key findings4 Recommendations6The role of schools in providing for pupils with mental health difficulties7 Whole-school approaches to promoting good mental health10 Recognising and providing for individual needs17 Working in partnership with other agencies17 Relationships with parents24 Informal arrangements27 Provision through professional referral31 Notes34 Further information35 Publications35 Websites36 Executive summary This report examines the vital role played by schools in promoting the emotional well-being of their pupils.It analyses practice based on evidence gathered from visits by Her Majesty’s Inspectors (HMI) to 72 schools and reports on the impact of the guidance provided to schools four years ago by the Department of Education and Skills (DfES) and the National Healthy Schools Standards (NHSS), agreed in 1999. [1],[2] Both clarify the importance of goo d provision to ensure that schools meet the needs of pupils with mental health difficulties. Schools’ lack of knowledge of the DfES guidance results from a missed opportunity to improve the quality of provision for pupils with mental health difficulties.The large number of schools visited for this survey who were not working towards meeting the NHSS is of serious concern. Only just over half of them were aware that such standards existed. Of these, only a very small minority of schools were working towards or had met the criteria for providing for pupils’ emotional health and well-being. One barrier was the low level of awareness of the importance of the issue. It is unsurprising, therefore, that training for staff on mental health difficulties was found to be needed in three quarters of the schools.Most training tended to focus on strategies for managing pupils’ behaviour rather than on promoting positive approaches to relationships and resolving conflicts. Des pite such a lack of awareness in schools of mental health issues, there was good practice in one third of the schools in the survey, including: †¢ an ethos which valued and respected individuals †¢ a serious approach to bullying and pupils’ difficulties with relationships, and swift resolution of problems †¢ good arrangements for listening carefully to pupils’ views †¢ the involvement of parents in identifying problems and making provision for their children.Good joint working between health services, social services and schools was at the heart of effective planning and provision for individual pupils. Although multi-agency working was becoming better established within local education authorities, it was unsatisfactory in a quarter of the schools. Schools, parents and pupils were not always aware of how they might gain access to services. The best arrangements included regular meetings attended by a range of professionals, where work was coordinat ed, referrals made and difficulties followed up.Health services, social services and schools used different terms to describe mental health difficulties. The lack of a common language added to difficulties in recognising and meeting pupils’ needs. Schools identified about one in twenty pupils with mental health problems, although the Department of Health suggests a figure nearer one in ten. Arrangements for pupils to refer themselves for support and help were popular with them, as well as effective. This was particularly so where a pupil was struggling emotionally but where the school had not noticed changes in the pupil’s behaviour.Mentoring and support from peers was also very effective at providing a listening ear and opportunities for positive friendships. The report concludes that schools should make the promotion of pupils’ emotional health and well-being a priority and ensure all staff are aware of the guidance available. Key findings were nearly all prim ary or special schools and pupil referral units (PRUs). Secondary schools found it most difficult to make arrangements for multi-agency working a priority and they rarely took the lead in improving this aspect of their work.The lack of common language between education, health and social services professionals contributed to the difficulties in establishing good partnership working. Recommendations Local authorities and other agencies should: †¢ ensure that services for pupils with mental health difficulties are co-ordinated effectively within their area and that access to services is clear to schools, parents, children, young people and other service users †¢ commission, where appropriate, the services of voluntary organisations. Schools and other settings should: use the DfES national guidance on mental health difficulties to develop clear procedures, that are known and used by all staff, for identifying and supporting pupils †¢ ensure that issues concerning mental health are tackled successfully, either through the National Healthy School Standard (NHSS) programme or the PSHE curriculum †¢ establish arrangements for preventing bullying and promoting positive relationships and monitor their effectiveness †¢ work together to ensure that the DfES guidance is disseminated to all staff.The role of schools in providing for pupils with mental health difficulties 1. Many services play an important role in promoting pupils’ emotional health and well-being, including health services, social services, voluntary organisations, early years provision and schools. However, the notion of mental health difficulties carried a considerable stigma for many pupils and their parents. This, together with the need to attend a clinic, created difficulties for Child and Mental Health Services (CAMHS) in working with young people and their parents.A few pupils in the survey said that they did not wish to attend clinics for their appointments and did no t want to be labelled as mentally ill. Schools, therefore, play an important role in supporting children and young people in this area. 2. Guidance provided by the DfES in 2001 aimed to help teachers and others, working alongside mental health professionals, to promote children’s mental health and to intervene effectively. [3] It provides a useful description of the nature of pupils with mental health difficulties and a thorough overview of the issues relating to joint working between health services, social ervices and education. It suggests helpful strategies for schools to use. Few schools, however, were aware of the guidance which should have provided a good opportunity to improve the quality of provision for pupils with mental health difficulties. 3. A survey referred to in the DfES guidance indicated that about 10% of pupils experience clinically defined mental health difficulties. The schools visited, however, identified only between 4% and 6% of pupils overall with so me form of mental health difficulty, indicating some under-identification.This might go some way to explaining why schools struggle to manage the behaviour and attendance of some pupils, if they are not correctly identifying their difficulties and providing for them. 4. The 1999 Mental Health Foundation publication Bright futures defined children who are mentally healthy as able to: †¢ develop psychologically, emotionally, intellectually and spiritually †¢ initiate, develop and sustain mutually satisfying personal relationships †¢ use and enjoy solitude †¢ become aware of others and empathise with them †¢ play and learn develop a sense of right and wrong †¢ resolve (face) problems and setbacks and learn from them. [4] 5. Health services, social services and schools all use different terms to describe pupils and their conditions. There are many definitions of the term ‘mental health difficulty’ ranging from the highly categorised, commonly u sed by many health services, to those based on more descriptive terms which are prevalent in schools and other educational settings. 6. ‘Mental health’ and ‘mental health difficulties’ are more commonly used terms within health and social care.Schools and local authorities are increasingly using the term ‘emotional health and well-being’ in relation to both the care they take of pupils and the curriculum they provide. 7. The lack of shared definitions and understanding of mental health problems, however, makes it difficult for schools to identify and discuss these pupils. In a small proportion of primary schools, boys were pinpointed as more likely to exhibit mental health difficulties, but most schools reported no pattern. Some secondary schools identified more girls who were depressed, self-harming or who had eating disorders.However, no real gender differences were apparent and boys and girls were equally likely to have mental health problem s which were evident in school. Whole-school approaches to promoting good mental health 8. The best schools promoted good emotional health and well-being by valuing and respecting every individual. In the schools visited, those which embodied a value system that embraced all children identified fewer children with mental health problems. These schools promoted many and varied opportunities for pupils to share their thoughts and feelings.They used the curriculum to develop pupils’ listening skills and an understanding of other people’s points of view: this culture permeated school life. Case study A primary school in a disadvantaged area had a caring and supportive ethos in which the personal development and emotional well-being of pupils was very effectively promoted. There was a strong emphasis on developing all pupils’ self-esteem and ensuring that they had the language and opportunities to express their feelings and emotional needs.The school council and staf f were concerned that some pupils did not have friends to play with at break time. Very good initiatives, including ‘Playground Buddies’ and a ‘Friendship Area’, were introduced in response to these concerns. The school worked very hard to build up and maintain supportive relationships with parents and guardians, who felt that the school was a very safe and caring place for the children. The whole staff, including teachers, teaching assistants, administrative staff, catering staff, the site manager and cleaning staff contributed to this whole-school thos. 9. Pupils interviewed for the survey identified a lack of friendships and bullying as reasons for emotional difficulties in school. In all the schools with good arrangements for promoting health and well-being, bullying was not tolerated at any level. Pupils were able to discuss any incidents where they felt bullied and matters were discussed sensitively and resolved speedily. In these schools the pupils s pecifically commented that they were happy at school because they could talk to an adult if they had problems and know that action would be taken. 10.All schools taught a programme of personal, social and health education (PSHE). Nearly all primary and special schools discussed some elements of anger management, conflict resolution, bullying and friendship difficulties through such programmes. The provision was always at least satisfactory, and was good in over half of all schools visited. 11. Very few of the schools, however, tackled mental health difficulties specifically. These were missed opportunities to promote pupils’ general emotional well-being, particularly so in secondary schools where there were generally fewer opportunities to explore such issues.Only a third of the secondary schools visited taught PSHE programmes which included topics such as bereavement, stress and bullying. 12. The Primary National Strategy has provided training and curriculum materials for sc hools which focus on the social and emotional aspects of learning. At the heart of the materials is the belief that positive behaviour requires an active, whole-school approach to developing children's social, emotional and behavioural skills within a community that promotes the emotional well-being of all its members.A few of the schools visited were involved in the pilot stage of this work to very good effect. These schools were teaching pupils how to understand their own feelings and those of others, persevere when things became difficult, resolve conflict and manage worries. Staff found the training helpful and were in a good position to ensure their pupils learned how to take responsibility for their relationships and their learning. Following successful piloting, the Social and Emotional Aspects of Learning (SEAL) curriculum resource was made available to all primary schools in June 2005. [5]Case study A Year 5 class explored what it felt like to join a new group. Pupils talke d freely about their own experiences of joining clubs, moving to a new school and trying to make new friends. They used a good range of vocabulary to describe the feelings associated with newness and change, ranging from ‘scared’ and ‘excited’ to ‘apprehensive’ and ‘excluded’. Groups then planned what they would put in a welcome pack for a newcomer to their school. They gave careful thought to the kinds of information that would be helpful and to the ways in which they, as individuals, could be supportive. 3. No similar national programme was observed in secondary schools although one is currently being developed. Overall, secondary schools were less successful than primary and special schools at tackling issues of emotional health and well-being through whole-school initiatives. 14. In over half of the secondary schools visited, behaviour policies created stress or tensions for pupils. For example, in one school, exclusion was a c ommon response to difficult behaviour; as a result, the pupils felt under-valued.Schools made only very limited efforts to provide a suitable curriculum to meet these pupils’ emotional and learning needs. In one learning support centre within a school, pupils were taught by unskilled staff in poor surroundings which contributed to their low self-esteem. In a PRU, Year 11 pupils involved in a transition programme jointly run with the youth offending team reported that they were sent home on study leave two months before their official leaving date, even though they were not taking any formal examinations. They felt unwanted and this has had a negative effect on their self esteem, behaviour and attendance. 5. A significant minority of the secondary schools found ways to promote emotional well-being through their behaviour policies. For example, one large secondary school was developing ways to ensure that older pupils remained engaged with their school, even though they were so on to leave. A group of Year 11 pupils received two days’ training to develop skills of listening and helping pupils to find their own solutions to problems. The pupils subsequently provided a non-threatening opportunity for pupils who were experiencing difficulties to confide in someone and share their problems.The trained listeners received an external accreditation award for completing their training. 16. One barrier to improving provision for pupils’ emotional well-being was the low level of awareness amongst staff of its importance. Hardly any schools were aware of the comprehensive guidance issued by the DfES in 2001. [6] Even fewer schools had provided any staff training to raise awareness of the issues and the strategies described in the guidance. 17. Training for staff on mental health difficulties was unsatisfactory in just over a third of the schools visited and good in only just under a quarter.Most training tended to focus on managing pupils’ behavi our rather than on promoting a positive approach to relationships and resolving conflicts. However, a few secondary mainstream and special schools were developing an approach to conflict resolution based on ‘restorative justice’. This ensured that, where there were conflicts, all points of view were aired and discussed. The pupils valued this: they felt they could ‘have their say’ and that their views were respected. The training programme for staff was effective: teachers and support staff felt able to implement the programme successfully. 8. The National Healthy Schools Standard (NHSS) is at the core of the government’s healthy schools programme. [7] It was introduced in October 1999 to support the teaching of PSHE and citizenship in schools and to provide schools with practical ways to create a safe and productive learning environment and minimise potential health risks. One of its eight key areas of activity is emotional health and well-being (in cluding bullying). Of serious concern, however, was the large number of schools in the survey who were not working towards meeting the standard. Only just over a half were ware that the NHSS existed and, of these, only a very small minority were working towards or had met the criteria for emotional health and well-being in their school. 19. Small schools often had informal but effective arrangements for recording and discussing concerns about pupils’ well-being. Staff quickly perceived changes in pupils’ behaviour, demeanour or progress. An important feature of these effective schools was the quality of the communication between staff, for example between class teachers, teaching assistants and the special educational needs co-ordinator.Recognising and providing for individual needs Working in partnership with other agencies 20. All schools and LEAs recognised the importance of working well with professionals from the health and social services. Joint working with thes e other agencies was crucial in planning and providing for pupils’ individual needs. The challenge, however, for professionals from a range of disciplines was to achieve a common understanding of the problems of pupils with mental health difficulties. The following case study shows the benefits of effective joint working. Case studyA counsellor in a secondary school was working with a pupil who had referred herself for support. The pupil’s mother did not know this. A mental health worker from CAMHS, who worked in a local clinic, was also working with the pupil and approached the counsellor to see if they could work together with the pupil and parent. The counsellor discussed this with the pupil who gave permission for her mother to be contacted. Both professionals became engaged in supporting the parent and child. The consistent approach agreed between the adults ensured more straightforward discussions and properly agreed resolutions to problems. 1. Many of the local authorities visited were in a period of reorganisation as they set up Children’s Services to meet the requirements of the Children Act 2004. Practice is beginning to develop to establish the joint planning and working at the heart of this legislation. For example, one LEA was developing multi-agency patch teams and common referral procedures were being considered. Despite this, the survey showed that there was a long way to go to ensure that the legislative intentions result in better practice in schools. 22.Partnerships with external services were unsatisfactory in nearly a quarter of the schools visited and significant improvements were required in two thirds of them. Only a few of the secondary schools had good arrangements for multi-agency working. Relationships between schools and social services were particularly variable. 23. Unsatisfactory relationships between schools and other agencies were typified by: †¢ the unavailability of social workers, even for urgent c ases †¢ schools’ inflexibilities in approaching the planning of programmes to meet the needs of some of their pupils †¢ frequent staff changes long waiting lists for referrals †¢ reliance on personal informal contacts rather than agreed systems †¢ issues relating to geographical boundaries which remain unresolved. In the third of schools where multi-agency work was good, all the agencies had found ways of resolving such difficulties. 24. The most effective strategies which promoted good joint working included regular, frequent meetings attended by all agencies. Pupils’ needs were discussed and plans agreed and recorded. Case study A Vulnerable Students’ Panel effectively identified students xperiencing emotional health difficulties and provided appropriate multi-agency support for them. The panel met monthly and included representatives from a range of agencies. It was chaired by a deputy headteacher and a psychiatric nurse who was the manage r of the school support centre. All school staff were informed confidentially about the students who had been discussed and this dissemination aided further identification. Decisions made by the panel ensured that agencies were deployed to work most effectively in their areas of greatest competence and avoided unnecessary duplication of effort.Importantly, the school and agency representatives were charged with taking action and reporting back on its success at the next meeting. In this way each organisation was accountable to the panel. 25. Identifying one person to be responsible for co-ordinating and liaising with health and social services helped communication and ensured important information about pupils was disseminated effectively. 26. In a few LEAs, networks of professionals working in the same area met regularly to share effective strategies.They learnt about each other’s working practices and this promoted a shared understanding of issues. There was good practice i n schools where a wide range of professionals including counsellors, therapists, social workers and psychologists were employed by the school. Case study A primary school had formal procedures for logging concerns about a child’s academic, personal, social or emotional development. A nurture group also provided a way of identifying pupils who might have mental health difficulties. The school used short-term charitable funding to employ a family officer.She maintained close links with families identified as being in crisis and was therefore easily able to identify pupils at risk of developing difficulties in their emotional health and well-being. This approach encouraged partnership working so that parents referred their child to the family officer, headteacher or special educational needs coordinator if they had concerns. 27. Regular visits by other professionals helped schools to identify pupils who might be experiencing mental health difficulties. Case study The headteacher attended the school’s breakfast club every day and a mental health worker attended once a week.The club provided an effective method of identification through direct observation of children and regular communication with parents. 28. Sometimes other agencies initiated the joint working and the schools grasped the opportunity to participate. Case study A consultant paediatrician at a local hospital initiated collaboration amongst different schools to promote emotional literacy amongst pupils. The initiative was inspired by an attempt to deal with bullying, cited as a problem by many children who attended the hospital.The project, now in its fourth year, involved pupils from a primary school, special school, high school and the local tuition service. The project’s activities were based on posters which depicted problems faced by pupils. They were encouraged to develop listening skills, understand the perspective of others and to negotiate and compromise. Hospital staff encouraged the use of a common language by colleagues and the project fostered strong links between the health and education services. The result was fewer individual referrals to the hospital. Pupils who experienced bullying were usually referred directly to the project for support. 9. The pupils who were least mentally well were those who were withdrawn or depressed and who were underachieving as a result. Schools commonly identified pupils whose attendance was unsatisfactory and who did not participate fully in school life. Typically, these pupils had few or no friends and were isolated in the play ground. However, they presented few challenges to teachers and, too often, their problems were not followed up. Few schools saw non-attendance, lateness or falling behind in course work and homework as indicative of deeper problems. 30.Schools relied too much on informal methods to identify vulnerable pupils. Primary schools, particularly, insisted that they were able to identify such pupils easily because they knew their pupils very well. 31. Only a minority of the secondary schools used information from pupils’ previous schools to help recognise those who might experience mental health difficulties. Relationships with parents 32. A key to effective identification and provision lay in schools’ relationships with parents. Links with parents and other agencies were closest in the early years.Home visits, where parents could talk openly about their concerns and their children’s behaviour, and initiatives such as parenting classes, supported the identification of any problems or difficulties. As pupils grew older, schools found it harder to sustain such relationships, although there were examples of very good practice in primary, secondary and special schools. The main characteristics of good practice were: †¢ home visits by teachers and other support staff †¢ training for parents in developing healthy minds †¢ parental support gr oups †¢ regular meetings and telephone contact co-ordination with other agencies so that parents had to attend only one meeting. 33. Parental support groups were particularly common in the schools visited. In the following case study, the support groups were run by a local CAMHS team based in the school. The workers were able to talk to teachers while they were in the school and to ensure that information about individual pupils was discussed with them when appropriate. Case study A group of six parents met for ten two-hour sessions. The aim of the group was to help parents enjoy rather than simply manage their children.Parents learned how to play games and stimulate their children, thus strengthening their relationship. They particularly appreciated the opportunity to share their concerns with other parents who understood the problems. One parent reported, ‘You realise you’re not on your own; you don’t feel so bad’. The project was in its infancy, bu t there were signs that it was helping parents to develop confidence and to help each other do better. 34. Difficulties in working with parents stemmed from: †¢ late diagnosis of a pupil’s problems †¢ uncoordinated support from a range of agencies poor information provided for parents about whom to contact †¢ inadequate account taken of parents’ childcare arrangements, so that they sometimes had difficulties in attending meetings †¢ negative feedback to parents about their children †¢ parents’ perceptions that the school had ‘given up’ on their child. One parent observed, ‘Nobody ever said what was available; you had to find out for yourself or hear it from someone else’. 35. Most, but not all, of the pupils identified with mental health difficulties also had emotional, social and behavioural difficulties (EBSD).Some had more than one such difficulty. Ofsted has reported recently on the provision for these pupil s and its effectiveness. [8] This report focuses on the provision required for pupils who do not necessarily have special educational needs but who require additional emotional support to succeed at school. Informal arrangements 36. Half the schools in the survey operated self-referral or drop-in schemes run by peer counsellors, youth and community workers, school nurses, in-school counsellors and those from voluntary organisations.These arrangements enabled the pupils to identify themselves and seek the help they wanted and needed. Case study A secondary school appointed a health practitioner who dealt with a wide range of issues: developing self-esteem, anger management, relaxation and stress management. Pupils were able to make their own appointments and the work was completely confidential. She also did some teaching. This made her more accessible and reduced the stigma for pupils of ‘knocking at the door’. 37. A very small minority of primary schools offered pupils opportunities for self-referral to staff.In these schools, pupils could draw or write about themselves in a ‘reflections book’ or a ‘feelings book’, make use of a ‘bullying box’, and write or talk directly to the headteacher or the PSHE co-ordinator. Pupils who had such opportunities reported that this was supportive and gave them confidence. A Year 6 pupil said of her ‘reflections book’: ‘It helps me to have a confidential conversation with my teacher about things that are worrying me. ’ 38. A programme of education about values also helped pupils to talk freely and openly about their feelings.Each pupil was given a book in which they could write or draw a picture about the things that had made them happy or sad. Teachers monitored the books regularly to ensure that a pupil’s personal difficulties were identified early; they were powerful additions in a school where the ethos was already strongly supportive of pupils’ emotional well-being. 39. Clubs and after-school activities also enabled schools to support vulnerable pupils in a way which reduced the stigma of referrals. 40. In one primary school, 50 pupils regularly attended the ‘happy/sad’ club, where they talked about positive or negative experiences that concerned them.Clear ground rules had been established, which were understood by pupils, such as respecting what had been discussed and not gossiping. Pupils could put a photograph in a scrapbook of people that were special to them. The teacher usually led a short, directed session based on an appropriate text and provided an opportunity for meditation and reflection. The high number attending reduced the possibility of negative labelling and pupils had good opportunities to share their thoughts and feelings openly with their peers. 1. Pupils often commented that they particularly valued opportunities to talk and be listened to. The extent to which pupils with m ental health difficulties have problems in making and sustaining friendships may explain, to some extent, the success of peer support schemes. 42. Nearly half the primary schools visited had effective initiatives which were based on pupils helping each other to resolve difficulties. One school focused on socially isolated pupils by appointing ‘playground angels’.The ‘angels’ had weekly meetings with a teacher and were also represented on the school council. Pupils involved in these activities felt that they helped them to show responsibility towards younger children and to develop into mature and sensible people. 43. Others schools focused on the difficult point of transition between primary and secondary school. Pupils who struggled to make friends were considered by a few primary schools to be particularly at risk of experiencing problems. These schools developed a range of peer support programmes, as in the following example: Case studyA group of Year 4 pupils were considered to be at risk of difficulties on transition and the school decided to make provision in collaboration with the local secondary school. Year 8 pupils were invited to apply for posts of pupil mentors. They were interviewed and successful applicants were trained. Over two years, the primary pupils visited the secondary school at least once each half term for lessons, lunchtimes and social activities. On each occasion they were met by their individual mentor and had time to discuss issues with them. Primary pupils really enjoyed the programme.They were very clear how the transitional programme had helped them to prepare for secondary education. 44. Two thirds of the secondary schools visited had good peer counselling, support and mediation systems. Peer mentors who had themselves experienced difficulties in the past commented on how much they valued helping younger pupils who were also experiencing problems. The most successful schemes provided thorough training f or the pupils offering the support, as well as careful monitoring from the teachers responsible for it. Provision through professional referral 45. Referral systems differed widely.In one area, the consultant psychiatrists responded to requests for information about pupils; the service accepted referrals from any involved professional. More commonly, however, panels of professionals considered referrals. The latter arrangement had some advantages in that there was discussion and agreement on the type of intervention which was most likely to succeed. However, this arrangement also tended to create delays in responding to pupils’ needs. 46. Not all professionals were clear about how referrals should be made, and who ought to make them, for particular types of provision.This lack of clarity meant that pupils who might have benefited from services were not given access to them since the school was unaware that it could make such a referral. 47. Schools and pupil referral units (P RUs) did not always receive an equitable service from other agencies, especially where education, social services and health services had not agreed how resources should be allocated and work prioritised. It was common to find that a CAMHS worker was based in a school in one part of a local authority, while, in the same authority, another school had to make referrals to a panel.The schools were unaware of why these differences existed. 48. The most common types of provision were: †¢ counselling †¢ family work †¢ mentoring and support workers who visited the pupils regularly and provided advocacy and support through discussion and activities †¢ a modified curriculum and timetable †¢ nurture groups and sanctuary space. 49. This provision was largely effective when it was matched well to the assessment of the pupils’ needs. However not all schools were able to attract the additional resources required to provide these types of opportunities.Larger school s had more funding to be able to establish support centres specifically for pupils with mental health problems. 50. Local and national voluntary organisations played an important role in working with schools and local authorities to provide services for children and young people with mental health difficulties, and they were often represented on local CAMHS strategy groups. In some local authorities, partnerships with voluntary organisations provided helpful services for schools and parents, such as counselling and family therapy.Voluntary groups were often better at monitoring and evaluating the impact of their work since they depended on such evidence to attract further funding. Case study In one local authority a charity had been working in some schools for five years. For an annual fee, the school received a large amount of support from the charity which provided an art therapist and a dance instructor who worked with pupils identified by the school and provided counsellors, sup ervised by team leaders, from the charity. NotesThis survey is based on the findings of a survey of 72 settings in eight local authorities. The settings and almost all the authorities were selected randomly to represent a mixture of shire and unitary authorities. One authority was chosen because of known good work in the area of mental health. Her Majesty’s Inspectors (HMI) visited early years settings, primary and secondary schools, pupil referral units, hospital schools and settings, maintained and independent schools for pupils with EBSD and learning difficulties, and specialist provision for pupils who had been bullied.HMI observed lessons and other activities, scrutinised policies and records and held discussions with 269 pupils and 115 parents. Discussions were also held with a range of local authority staff, headteachers and senior managers, teachers, teaching assistants, learning mentors, and representatives of voluntary organisations. They also met CAMHS regional dev elopment workers. Further information Publications Promoting children’s mental health within early years and school settings, (DfEE 0121/2001), DfEE, 2001. SEN and disability: towards inclusive schools (HMI 2276), Ofsted, 2004.Managing challenging behaviour (HMI 2363), Ofsted, 2005. Mental Health and Social Exclusion, Social Exclusion Unit Report, Office of the Deputy Prime Minister, 2004. http://www. socialexclusionunit. gov. uk/downloaddoc. asp? id=134 Promoting social, emotional and behavioural skills in primary schools, Primary National Strategy, DfES, 2004. Developing emotional health and well-being: a whole-school approach to improving behaviour and attendance, Key Stage 3 National Strategy, DfES, 2004. Behaviour and attendance toolkits, Key Stage 3 National Strategy, DfES, 2005. http://www. standards. fes. gov. uk/keystage3/respub/ba_toolu Promoting emotional health and well-being through the national healthy school standard (NHSS), NHS Health Development Agency, 2004. http://www. hda-online. org. uk/Documents/promoting_health_wellbeing. pdf Guidance on new ways of working for psychiatrists in a multi-disciplinary and multi-agency context: national steering group interim report, NIMHE, CWP, Royal College of Psychiatrists and Department of Health, 2004. http://www. dh. gov. uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4087352=01RXVr Effective joint working between child and adolescent mental health services (CAMHS) and schools, Research report no. 412, Bridget Pettitt, Mental Health Foundation, DfES, 2003. Websites www. dfes. gov. uk/mentalhealth DfES Mental Health www. rcpsych. ac. uk Royal College of Psychiatrists www. socialexclusionunit. gov. uk Mental health and social exclusion www. standards. dfes. gov. uk/primary DfES guidance on developing children’s social, emotional and behavioural skills www. teachernet. gov. uk/management/atoz/n/nhss/ National Heal thy Schools Standard ———————– 1] Promoting children’s mental health within early years and school settings (DfES 0121/2001), DfES, 2001. [2]Promoting emotional health and well-being through the national healthy school standard (NHSS), NHS Health Development Agency, 2004. [3] Promoting children’s health within early years and school settings, DfES, 2001. [4] Bright futures: promoting children and young people’s mental health, Mental Health Foundation, 1999. [5] The SEAL resource box can be ordered from Prolog, Tel. 0845 602 2260, [email  protected] uk. com (ref: DFES 0110 – 2005 KIT), or viewed and ordered from the Teachernet website: www. eachernet. gov. uk/seal. [6] Promoting children’s mental health within the early years and school settings, DfES, 2001. [7] The NHSS is funded jointly by the DfES and the Department of Health, hosted by the Health Development Agency (HDA). It forms part of the government’s drive to reduce health inequalities, promote social inclusion and raise educational standards through school improvement. [8] Managing challenging behaviour (HMI 2363), Ofsted, 2005. ———————– Primary and SecondaryJuly 2005 HMI 2457 ———————–

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The purpose of this assignment is to assist you in refining problem-solving capabilities that organizations already possess for use in business ethics applications. This paper uses a structured, objective format sometimes called a system of inquiry. This assignment is a systematic formalized inquiry into or examination of the code of ethics of an organization and its effects to achieve a specific level of ethical behavior in employees, management, and executives. Each business should have a framework for ensuring ethical behavior. The structure, format, and scope of codes vary depending on the company’s business. An oil company’s code, for example, would probably have different criteria and emphases than a healthcare provider’s code of ethics. Sometimes, codes of ethics are called by other names, such as an employee code of conduct. A code of ethics, though, should be differentiated from standard good operating practices. Evaluation and analysis includes problem solving and behavior in assessing organizational ethics along with decision-making processes. In this case, you are evaluating your own company’s code of ethics, or that of another company if your employer does not have a code of ethics. Write a 1,200- to 1,400-word paper, one not using question-and-answer format, discussing your organization’s code of ethics in detail. Perform the following steps: Â · Obtain a copy of your employer’s code of ethics or find an example on the Internet from a major corporation, such as Shell Oil Company’s Statement of Ethics. This is the document upon which to base your inquiry. Â · Write a general information paragraph on the company, including its mission statement. Â · Determine the type of ethical system used by the firm and reasons or examples upon which you based your decisions. Ethical systems include ends-driven, relativistic, entitlement, and duty-driven (legal or religious) ethics. Â · Identify and discuss how the code of ethics is used. Include several paragraphs on each use: one for employees, one for management, one for the board of directors, and so forth. Some of this information comes from the company’s code of ethics. Others may be available through an Internet search. Consider the following: o Why it is used—the general or special circumstances o How it is used o When it is used Note. You may not be able to find all the information. In that case, state this fact and indicate which sources were examined with no results. Â · Why might the organization need to modify their existing code of ethics? Consider how you might modify the code if you were the new CEO and how you would implement the changes. Â · What possible reactions to the code are to be expected from employees and managers? What effects does the organizational culture have on the acceptance of the code? Â · What is the effect of the code on the organization? Â · Summarize the results of your systematic analysis or inquiry into the code of ethics of this organization.

Essay on The Great Pyramids - 1941 Words

The Great Pyramids Throughout the thousands of years that the Great Pyramid has been standing, there have been many myths and legends that sprung up. Among them was a landing site for alien spacecraft, a spacecraft itself, or the means to predict the future. This report is going to explain the actual reason the Great Pyramid of Giza exists, how and why it has existed for so long, and the story of its construction. The builder of the Great Pyramid does not get enough credit for his unbelievable achievement. Khufu (Also known as Cheops) was pharaoh for 24 years, 20 of which were occupied by the construction of the pyramid. The Greeks of the period called him Cheops but his original Egyptian name was Khufu. Despite building†¦show more content†¦Until the 19th century it was the tallest building in the world and, at the age of 4,500 years, it is the only one of the famous Seven Wonders of the Ancient World that still stands. It is the Great Pyramid of Khufu, at Giza, Egypt. Some of the earliest history of the Pyramid comes from a Greek traveler named Herodotus of Halicanassus. He visited Egypt around 450 BC and included a description of the Great Pyramid in a history book he wrote. Herodotus was told by his Egyptian guides that it took twenty-years for a force of 100,000 oppressed slaves to build the pyramid. Stones were lifted into position by the use of immense machines. The purpose of the structure, according to Herodotuss sources, was as a tomb for the Pharaoh Khufu (whom the Greeks referred to as Cheops). Most of what Herodotus tells us is probably false. Scientists calculate that fewer men and fewer years were needed than Herodotus suggests. It also seems unlikely that slaves or complicated machines were needed for the pyramid construction. It isnt surprising that the Greek historian got it wrong. By the time he visited the site the great pyramid was already 20 centuries old, and much of the truth about it was shrouded in the mists of history. Certainly the idea that it was a tomb for a Pharaoh, though, seems in line with Egyptian practices. For many centuries before and afterShow MoreRelatedThe Great Pyramid Of Giza930 Words   |  4 Pagesfeats of architecture ever assembled, The Great Pyramid. Located approximately 5 miles west of the Nile River near the city of Cairo, Egypt, The Great Pyramid is part of a larger complex called the Giza Necropolis, which also houses the Great Sphinx, and two smaller pyramids. It is said to have been built by the enslaved citizens of Khufu, second ruler of the 4th dynasty, and son of Snefru. Although archaeologists have since disproved that theory. The pyramids are said to have been built to house theRead MoreThe Great Pyramid Of Giza1382 Words   |  6 Pagespaper will examine the Great Pyramid of Giza during the Fourth Dynasty, the period in which it was built. My purpose for this topic is to not only educate myself further in the humanities of Ancient Egypt but to also get a better understanding of how the art relates to the people and their lives, I will do so by examining how and when The Great Pyramid of Giza and the surrounding pyramids were built, then how the culture of the people at the time influenced the making of the pyramid, and finally I willRead MoreThe Great Pyramid Of Giza Essay1704 Words   |  7 PagesThe Great Pyramid of Giza is one of the seven wonders of the ancient world. It is located at El Giza, Egypt. This pyramid was built for the pharaoh Khufu in around 2560 B.C. and was intended to last an eternity. Also, this pyramid was the tallest structure in the world for nearly 3800 years with a height of more than 481 feet. This pyramid is a great tribute to engineering and decades-long labor by tens of thousands of workers. It was estimated that the pyramids were built by 100,000 workersRead MoreThe Great Pyramid Of Giza Essay1147 Words   |  5 PagesThe â€Å"Great Pyramid of Giza† is situated in the Giza Necropolis which borders the largest city in Egypt – Giza. It is also identified by two other names; the Pyramid of â€Å"Cheops† or â€Å"Khufu†. The Great Pyramid stands as the largest and oldest among the Giza Necropolis pyramids. Furthermore, it is listed among the Seven Wonders of the Ancient World, holding the record of being the oldest in that list. The magnificence of the pyramid’s structure is an attraction that has grabbed the attention of severalRead MoreThe Great Pyramid Of Giza859 Words   |  4 Pages The Great Pyramid of Giza, is one of the oldest and sole surviving wonders of the Ancient World, has attracted the interest of many people such as tourists, philosophers, and travelers for hundreds of years. The pyramids interest has centered on the question of whether the ancient Egyptian people created and or possessed certain mathematical concepts and rules in the pyramids for the proportions and measurements. The Great Pyramid’s elevation encodes three of the most important constants in createdRead More The Great Pyramid Essay1399 Words   |  6 Pages Outline  Ã‚  Ã‚  Ã‚  Ã‚   Thesis Statement: The Great Pyramid is a mystery to the modern age, even though its purpose, uses, history, and condition have challenged explorers for centuries it will always be considered one of the greatest wonders of the world. 1.  Ã‚  Ã‚  Ã‚  Ã‚  Why was the Great Pyramid built? A.  Ã‚  Ã‚  Ã‚  Ã‚  Who built the Great Pyramid? B.  Ã‚  Ã‚  Ã‚  Ã‚  Why was it built? C.  Ã‚  Ã‚  Ã‚  Ã‚  Comparative theories. 2.  Ã‚  Ã‚  Ã‚  Ã‚  What was the Great Pyramid used for? A.  Ã‚  Ã‚  Ã‚  Ã‚  Religious uses. B.  Ã‚  Ã‚  Ã‚  Ã‚  Astronomical uses. C.  Ã‚  Ã‚  Ã‚  Ã‚  EnvironmentalRead MoreThe Great Pyramid Of Giza1138 Words   |  5 Pagesbuilt. The Pyramids! We find these mysterious, immense, and fascinating structures throughout the world. We gaze at them in wonder and ask ourselves: who built them? How were they built? what were they used for? and, when were they built? The Great Pyramid of Giza is the oldest and largest of the three pyramids in the Giza pyramid complex bordering what is now El Giza, Egypt. It is the oldest of the Seven Wonders of the Ancient World, and the only one to remain largely intact. The pyramids purpose hasRead MoreThe Great Pyramid of Giza Essay679 Words   |  3 PagesThe Great Pyramid of Giza Who built the Great Pyramid? The Great Pyramid was built by the Egyptian pharaoh Khufu. Khufuwas born in 2589 BC - 2566 BC. His real name was Khnum-khuf meaning the god Khnum is his protection. Khufuwas the son of another great pyramid builder, King Sneferu. Khufus mothers name was Hetepheres. Khufuwas the second king in the 4th dynasty. The Greeks referred Khufu as Cheops When and Where was the Great Pyramid built? The GreatRead MoreThe Great Pyramid Essay examples1438 Words   |  6 PagesStatement: The Great Pyramid is a mystery to the modern age, even though its purpose; uses, history, and condition have challenged explorers for centuries it will always be considered one of the greatest wonders of the world. 1. Why was the Great Pyramid built? A. Who built the Great Pyramid? B. Why was it built? C. Comparative theories. 2. What was the Great Pyramid used for? A. Religious uses. B. Astronomical uses. C. Environmental uses. 3. How was the Great Pyramid built? A. WorkersRead MoreEssay on The Great Pyramid of Giza1176 Words   |  5 PagesThe Great Pyramid of Giza is also recognized as the Pyramid of Khufu, Khufus Pyramid and Pyramid of Cheops. It is the most significant and earliest structure in the world. This pyramid is the oldest of the three pyramids standing on the Giza Necropolis. It is also the largest of them all (Larry, 2000). This great pyramid is located on the northern edge of the Giza Plateau, which is 25 km outskirts, southwest of Cairo, Egypt. It is the only remaining standing monument of the Seven Wonders of the

Biblical And Mythological Allusions Of Moby Dick - 851 Words

Moby-Dick is Herman Melville’s masterpiece, a purposeful novel that acts both as a documentary of a sea voyage but also a philosophical allusion on life as a whole. Moby-Dick is far beyond its time in reference to its use of allusion within its text. In this novel, Herman Melville frequently uses biblical and mythological allusions. With these strategic allusions, the reader is able to begin to understand the topics of discussion within the book and is also exposed to the wisdom and potential knowledge Melville possesses. Melville uses many Biblical and mythological references in the form of character stories, which I found beneficial in helping interpret the texts meaning (Howard, 27). This paper will discuss the Biblical and Mythological allusions that Melville’s use in Moby-Dick in the hopes to develop a deeper understanding of the issues Melville was hoping to address. An Allusion is a brief and indirect reference to a well-known person, place, thing, cultural, hist orical, or literary work (Delahunty, 24). As Described by Andrew Delahunty in the Oxford Dictionary of Reference and Allusion, allusions form a colorful extension to the English language, drawing on our collective knowledge of literature, mythology, and the Bible to help us connect and interpret literature (26). Though an allusion is used to reference something significant, it does not describe in detail the person or thing to which it is referring too. Writers often use allusions as just a passing commentShow MoreRelatedEssay on The Death of Identity in DeLillos White Noise2934 Words   |  12 Pageslie within Orest Mercators name. Orest may take his first name from Orestes, the son of Agamemnon and Clytemnestra, who avenged his fathers death by killing his mother and her lover. The Classical allusion repositions Orest as a mythological origin who blends both Greek myth and Biblical allusions (by returning to Eden and confronting the serpent) with his indeterminate lineage. The binary extends to the quasi-palindromic nature of his name, beginning and ending with or. This is different

Essay on Censorship in Schools is not Justifiable - 959 Words

Censorship in School is Not Justifiable Walt Whitman once said, â€Å"The dirtiest book of all is the expurgated book.† Between the years 2000 and 2009 a total of 3200 books were challenged in school libraries in an attempt to expurgate, or censor, the content in books provided to students. Today the trend of censorship continues as popular novels such as The Hunger Games, The Fault in Our Stars, and Captain Underpants are censored from schools across the nation (Challenges by Reason).Censorship in regards to literature refers to the examination and suppressing of a book because of objectionable material. The process of censorship in school libraries often begins with an outspoken parent, teacher, student, or administrator and ends in the†¦show more content†¦Heinrich Heine states, â€Å"Wherever they burn books they will also, in the end, burn human beings.† Restricting the discussion of new and controversial ideas rather than tolerating and acknowledging the presence of new and controversial ideas is causing more pain than it is worth in the school setting. The idea of censoring reality from school libraries is unreasoned, yet that is exactly what pro-censorship individuals advocate. The discussion and knowledge of new, controversial, and necessary ideas among students is restricted due to censorship. Censorship in school libraries allows teachers, administrators, peers and their parents to decide what a student may or may not read based on their opinion. Opinion is variable between different groups of people within the school; therefore, a single person or a small group of people cannot be trusted to make decisions on the behalf of a larger group. Kekla Magoon argues, â€Å"That no one person can be trusted to censor material, individuals can choose to be exposed to.† Expurgation, banning, and abridgement of books are not allowing students to learn how to guard themselves from topics they do not personally believe in. Students would benefit much more if they practiced self-censorship rather than depending on adults to make decisions for them. AShow MoreRelated The Controversy Around Banning Books Essay852 Words   |  4 Pages The subject of censorship is a very controversial one, especially the banning of books. Many people believe they must protect themselves and others from the quot;evilsquot; of many classic books and works of art because they can be deemed quot;indecentquot; in one way or another. Many believe that this is absurd and censorship in its current form is a violation of our First Amendment right to free speech. Personally, I align myself with the latter, however I do feel there are occasions whereRead MoreThe Controversy Around Banning Books889 Words   |  4 Pagessubject of censorship is a very controversial one, especially the banning of books. Many people believe they must protect themselves and others from the evils of many classic books and works of art because they can be deemed indecent in one way or another. Many believe that this is absurd and censorship in its current form is a violation of our First Amendment right to free speech. Personally, I align myself with the latter, however I do feel there are occasions where censorship is justifiable. TheRead MoreThe Importance Of Media Censorship1013 Words   |  5 Pagesis n ot only justifiable but essential the public is provided with immediate, accurate and uncensored information. Media censorship has become a greater deal now than it ever was in centuries, because of globalization and the increasing interdependence among other nations has made censorship more harm than any good. Censorship often prevents other perspectives and point of views from being presented and in censorship or censored media and not everyones voices hurt.Media censorship limits a personsRead MoreOn January 1, 2016, The Institute Of Contemporary History1736 Words   |  7 Pageshad to contend with a lot of criticism due to their strong censorship of Mein Kampf. According to one commentator, letting people read the book and make their mind meditate upon its content could do more to fight fascism rather than strict censorship (Horn). Unfortunately, not many governments view censorship in this light. In the current digital age, it is extremely hard to completely block the distribution of any book. In fact, censorship often raises the curiosity of the public, leading to an evenRead MoreFahrenheit 451 By F. Montag1378 Words   |  6 PagesThe expression of ideas is an irrefutable facet of human nature that cannot be stripped away due to the fact that it does not conform to the expectations of society. This idea of censorship impedes the freedom and expression of individuals and dilutes the presence of divergent cultures and beliefs. It is ubiquitous in different forms of media, including books and technology, which leads to the perceived protection from dangerous notions or exposure to outside ideas. As a result of these fears andRead MoreCreationism vs. Evolution Essay1170 Words   |  5 Pagesthe scientific research grew and developed into theories like the Big Bang and evolution, though primarily in places where such progress was tolerated. The state of Tennessee in 1925 was not such a place. In the town of Dayton in Tennessee, a high school biology teacher was found to be in violation of a recently passed law, the Butler Act, because he taught the theory of evolution in his classroom. The debate that ensued has yet to be resolved, what with the modification of creationism into the theoryRead More Media Violence Essay1860 Words   |  8 Pagesmurders and 100,000 other acts of violence on television by the time he or she has completed sixth grade. In further studies it was determined that by the time that same child graduates from high school he or she will have spent 22,000 hours watching television, twice as many hours as he or she has spent in school (Bru no 124). In a study by the Centers for Disease Control, published by the JAMA (Journal of the American Medical Association), it was shown that homicide rates had doubled between the introductionRead MoreViolence in Entertainment and Its Effect on Society Essay1985 Words   |  8 Pagesmurders and 100,000 other acts of violence on television by the time he or she has completed sixth grade. In further studies it was determined that by the time that same child graduates from high school he or she will have spent 22,000 hours watching television, twice as many hours as he or she has spent in school (Bruno 124).brbrIn a study by the Centers for Disease Control, published by the JAMA (Journal of the American Medical Association), it was shown that homicide rates had doubled between theRead More The Ethics of Internet Filtering in China Essay3623 Words   |  15 Pages Introduction Based upon the aforementioned acts of government intervention of web filtering and censorship by the Chinese government, if anything even remotely resemble that kind of censoring were to take place in the United States, there would be an outcry of unprecedented proportion. Based upon the Western values of freedom, such an invasive form of web filtering which amounts to censorship would certainly be deemed an act of immorality by the government. However, before we immediate jumpRead MoreAnalysis Of Aunt Chip And The Great Triple Creek Dam Affair1896 Words   |  8 Pages  In most present-day societies, people have the freedom to read and think what they wish without censorship or restrictions. It is these very freedoms that allow the people of a society to explore the works of others and later accept them or criticize them with the thoughts that belong uniquely to them. Should a society lose the freedom of doing such things, could prove to be dangerous by tipping the scales of power where it would be unfavorable to a significant portion of the population. People

Efficiency and Safety of Vaccination-Free-Samples for Students

Question: Discuss about the Efficiency and safety of vaccination in the pediatric population. Answer: Introduction: There are various different reasons behind the onset of medical adversities; however, the communicable diseases pose the most threatening of the medical adversities that pose the biggest and most critical to overcome challenge. There is a vast variety of different communicable diseases, and most of them contribute to the increasing mortality rates and co-morbidity in different age groups, although it has to be mentioned that the most of the detrimental impact of the communicable diseases is imparted on the health and wellbeing of the children. The annual rates of the pediatric mortality rate due to different communicable diseases are extremely high in this particular sector, and that is the reason the vaccination activity is the most emphasized for the pediatric populations (Al-Salem et al. 2012). The vaccines can be defined as one of the greatest achievements of the medical science and health care in general that has effectively revolutionized the heath care delivery when it comes to the communicable disease outbreaks. Now it has to be mentioned that the roles that vaccination has played is great; when considering the communicable outbreaks that have been endemic and epidemic scale in the absence of any sound intervention strategy like smallpox, polio, measles, rubella, and many more; and almost all of the mentioned communicable diseases outbreaks have the highest risk of targeting the pediatric populations. Hence, in order to implement a preventative strategy that can effectively decrease the alarmingly increasing mortality rates in the pediatric and neonatal population the vaccination procedure has a global emphasis on the pediatric population, and the strategy has been effective as well (Baggs et al. 2011). Although it has to be understood in this context that the vaccinat ion procedures have a lot of risks associated as well and if a strong safety and efficiency protocol in place, there can be many severe consequences that can potentially threaten the health and wellbeing of the children receiving the vaccination. This assignment will attempt to explore the need for safety and efficacy in vaccination and the procedures in place in the pediatric population emphasizing on the Saudi Arabian demographic context. Need For Safety and Efficiency: According to the Black et al. (2010), the vaccination procedure is designed and implemented in the hopes of providing mostly the children population, with a few adult vaccination exceptions, in order to provide acquired immunity against a few selective communicable infections. There are different types of vaccines that provide differential immunity and the type and dosage of the vaccination depends on the need of the recipient as per the age group that the individual must have. However, regardless of the type of vaccination pr the dosage of the vaccination that is being administered, the procedure must follow a meticulous and detailed safety protocol for the vaccines to be effective and avoid any chances of contamination and infection (Buttery et al. 2011). It has to be mentioned in this context that the safety procedures that are implemented for the vaccination procedures are multi- dimensional, and the safety and efficiency checking procedures are carried out in both the manufacturing- licensing phase and while in the health care facility as well. There are different authorative bodies that direct control and monitor the safety and efficacy of the different vaccines and dosage specifications and the centre for disease control and prevention or the CDC can be considered the most effective one. It has to be mentioned that the safety and efficacy of the vaccines are a serious concern in the public health scenario as there are many adverse effects that are associated will ill- controlled vaccination procedure implemented to the children. One prime example of the adverse effect of overwhelming impact of too many vaccines with too much dosage has a possible impact on development of autism and similar developmental disorders in the pediatric population. Hence, the efficiency and the relevance of the vaccines are meticulously checked and evaluated before it is even released in the market by the authorative bodies. However only checking the efficiency is nowhere near enough as the most of the threat to the children when it comes to faulty vaccination procedure is the safety protocol implemented in the vaccine administration procedure in the health care facility (Gee et al. 2011). According of a recent statistics the phenomenon of safe immunization process can be considered still a massive concern for the developing countries. There are major concerns that the emerging nations are facing when it comes to safe and effective immunization procedure, they are, right vaccine composition, handling, scheduling and administering the vaccines or injections, and the surveillance and evaluation of the vaccines being administered to the pediatric patients. Along with that, it has to be mentioned in this context that the safe waste disposal during the vaccine administration procedure, according to a recent statistics there are closely 1 billion injections administered annually on the patients for the immunization procedure. And along with that the unsafe injection administration is a regular event that occurs routinely in the developing nations and leads to many health adversities for the patient population. Hence, it can be mentioned here that the developing countries, ho wever very little are attempting the need for safe and effective monitoring on the vaccine administration procedure (Glanz et al. 2011). Safety practices in vaccine administration in Saudi Arabia: The country under emphasis in the vaccine administration safety review assignment is Saudi Arabia, and it has to be mentioned in this context that the nation has successfully achieve tremendous accomplishments in the sector for basic immunization coverage. In addition, the country has been able to successfully achieve the same by the means of a series of structured vaccination programs carried out in a well controlled a connected network of primary health care centres (Lee et al. 2011). However, there has been a brewing consensus regarding the safety of the programs both in design and implementation procedure mostly due to the lack of effective surveillance framework or program in the remote areas. In a pilot study, the incidence of adverse effects after immunization has been studies after the different vaccination programs that have been carried out on children aged 6 and lower. And hence it has to be mentioned in this context that in case of the DTP vaccination, which is the most c ommon and most abundantly administered vaccine in the pediatric populations can be the fact that the rate for adverse effects after immunization or AEFI are alarmingly high in the remote and rural areas. The incidence rate of the AEFI depended heavily upon the age of the child, vaccine preparation, clinical setting involved and the dosage schedule of the vaccination involved (Memish et al. 2013). It has to be mentioned in this context that the increase in the rte of adverse events after immunization is intricately linked with the different factors and the most of the adverse events occurred in the children during the first twenty four to forty eight hours of the vaccine administration. Despite the regular vaccination safety administration procedures the statistics of adverse events associated with the different kinds of adverse events associated with the vaccination process in Saudi Arabia is more than 90%. Elaborating more, close to more than 80% of the adverse events were discovered to be local reactions after the vaccine administration and along with that systemic reactions were reported soon after in the recipients in the 79% of the recipients. Fever has been discovered as the most crucial adverse event associated with the faulty and unsafe vaccination procedure closely followed by systemic reactions like vomiting, hypotonicity and irritation. Along with that, few of the studies focusing on the vaccination safety scenario of Saudi Arabia has also revealed the prevalence of behavioral reactions after the vaccination and the percentage of these long term reactions are almost more than 40%. There it can be concluded based on the statistical data represented above that the safety situation of vaccination procedure is in dire need of reform and the condition is worsening in case of the remote and rural areas (Al-Qatari 2010). Challenges and recommendations: In order to address the alarming condition of the vaccination safety and efficacy monitoring and implementation in the Saudi Arabia, it is crucial to discover all the different challenges associated with this situation. Now elaborating on the challenges it is also extremely important to explore and evaluate all the contributing factors associated with this situation so that a interventional strategy can be designed that can address all the challenges and successfully overcome the said challenges. First and foremost, it has to be mentioned that the most of the incidence rate in the pediatric population of AEFI has been reported in the remote areas where the health care delivery is limited and there is a significant lack of any surveillance and monitoring body overlooking the safety protocol compliance in the above mentioned demographic. it has to be mentioned in this context that the compliance rate to the vaccination safety procedures in place for Saudi Arabia primary health care fac ilities in the urban areas are much higher than what is observed in the rural or remote areas (Al-Qatari 2010). Hence, two of the most important contributing factors behind the present alarming condition are the lack of compliance rate and any surveillance or monitoring body in the remote areas overlooking the lack of compliance and care quality. Another very important factor that has been discovered in this context is the lack of knowledge and training in the existing staff in the remote areas in regards to the new and effective vaccination safety or safe vaccine administration activities that is being utilized globally. According to the Rehmani and Memon (2010), the most of training procedure and professional development programs are held in the urbanized clinical settings and hence the already understaffed facilities in the remote areas do not get the opportunity to adapt to the innovative safety techniques and protocols and hence the rate of ADFI keeps escalating. Lastly, the la ck of effective government initiative cannot be ignored in this discussion as well. It has to be mentioned that the lack of infrastructure in the rural areas are another grave contributing factor behind the escalating issue. A few recommendations that the Saudi Arabian health care authorities can atke into consideration in order to improve the present situation are: First and foremost, there is need for a strong and strict surveillance framework that will overlook the safety handling and administration procedure of the vaccines, and along with that, care needs to be taken to ensure that the remote areas are being regularly monitored as well for compliance to the protocols in place (Tse et al. 2012). Secondly, the lack of skills and training in the existing nursing staff also needs to be taken into consideration along with the low staffing situation in the primary health care facilities in the rural areas when compared to the urbanized regions (Weber et al. 2013). Training and professional development program involving the global authorities, executed in all the remote areas will eventually help the health care staff acquire better competence in handling and administering vaccines safely and effectively (Yih et al. 2011). Lastly, there is need for effective and collective efforts being invested from both the national government and the global health acre improvement authorities so that staffing and infrastructure of these regions can be improved and the children are no longer in risk for vaccine safety related health adversity (Yousif et al. 2013). Conclusion: On a concluding note, it has to be mentioned that there are various concerns and issues with the safety and efficiency maintenance of the vaccinations that are being implemented in the pediatric population. In addition, the most of the adverse situation is in case of the developing nations. This assignment effectively discussed the challenges and issues prevalent in this are taking the assistance of the Saudi Arabian context, although the scenario is very similar in all pf the developing nations. Hence, there is need for a more effective and innovative surveillance and monitoring coupled with adequate staffing and training, which can attempt to address the concerns that are prevalent in this issue as discussed. And with co-operative and collaborative efforts invested from all kinds of national and global authorities, these challenges can be hoped to be overcome. References: Al-Qatari, G., 2010. Vaccination Practice in Saudi Arabia: Is It Safe?. Al-Salem, A.H., Kothari, M.R., AlHani, H.M., Oquaish, M.M., Khogeer, S.S. and Desouky, M.S., 2012. Safety of intradermal Bacillus Calmette-Guerin vaccine for neonates in Eastern Saudi Arabia.Saudi medical journal,33(2), pp.172-176. Baggs, J., Gee, J., Lewis, E., Fowler, G., Benson, P., Lieu, T., Naleway, A., Klein, N.P., Baxter, R., Belongia, E. and Glanz, J., 2011. The Vaccine Safety Datalink: a model for monitoring immunization safety.Pediatrics,127(Supplement 1), pp.S45-S53. Black, S., Eskola, J., Siegrist, C.A., Halsey, N., MacDonald, N., Law, B., Miller, E., Andrews, N., Stowe, J., Salmon, D. and Vannice, K., 2010. Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines.The Lancet,374(9707), pp.2115-2122. Buttery, J.P., Danchin, M.H., Lee, K.J., Carlin, J.B., McIntyre, P.B., Elliott, E.J., Booy, R., Bines, J.E. and PAEDS/APSU Study Group, 2011. Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia.Vaccine,29(16), pp.3061-3066. Gee, J., Naleway, A., Shui, I., Baggs, J., Yin, R., Li, R., Kulldorff, M., Lewis, E., Fireman, B., Daley, M.F. and Klein, N.P., 2011. Monitoring the safety of quadrivalent human papillomavirus vaccine: findings from the Vaccine Safety Datalink.Vaccine,29(46), pp.8279-8284. Glanz, J.M., Newcomer, S.R., Hambidge, S.J., Daley, M.F., Narwaney, K.J., Xu, S., Lee, G.M., Baggs, J., Klein, N.P., Nordin, J.D. and Naleway, A.L., 2011. Safety of trivalent inactivated influenza vaccine in children aged 24 to 59 months in the vaccine safety datalink.Archives of pediatrics adolescent medicine,165(8), pp.749-755. Lee, G.M., Greene, S.K., Weintraub, E.S., Baggs, J., Kulldorff, M., Fireman, B.H., Baxter, R., Jacobsen, S.J., Irving, S., Daley, M.F. and Yin, R., 2011. H1N1 and seasonal influenza vaccine safety in the vaccine safety datalink project.American journal of preventive medicine,41(2), pp.121-128. Memish, Z., Al Hakeem, R., Al Neel, O., Danis, K., Jasir, A. and Eibach, D., 2013. 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We Wear The Mask Essay Example For Students

We Wear The Mask Essay Analysis of ?We Wear the Mask?In one of Paul Lawrence Dunbars most famous poems ?We Wear the Mask,? he describes the harsh reality of the black race in America and how they hide their grief, sadness, and broken hearts under a mask for a survival strategy towards whites. ?We wear the mask that grins and lies,It hides our cheeks and shades our eyes,This debt we pay to human guile;With torn and bleeding hearts we smile,And mouth with myriad subtleties.?In the first verse, the mask is taken off. The ?We? of the poem describes the black community that lives a double life, the masked and the unmasked. Dunbar included the word ?mask? in his poem because historically it was a false deceptive role-playing that was acceptable for a survival strategy by blacks and it maintained a sense of empowerment in a racial society. The word ?lies? is a simple word but the mask not only lies to the whites, but to the person who is wearing the mask that start to live by it. Dunbar uses the word ?mouth? as a verb, which intensifies our expressive genuine facial features that never lies. In life, the mask is the concealment of those features that reveal tears that give quality to a smile. The masks when worn is always smiling but underneath are the torn and broken heart of o nes soul and ?this debt we pay to human guile.? The debt that the black community is paying dearly by wearing the mask everyday for the cunning white race with ?myriad subtleties?, the black race that wants to speak out and be heard. We will write a custom essay on We Wear The Mask specifically for you for only $16.38 $13.9/page Order now ?Why should the world be otherwise,In counting all our tears and sighs?Nay, let them only see us, whileWe wear the mask.?The second verse, the mask is replaced. The word ?overwise?, Dunbar recognizes that the black people knew too much for their own good. They knew that if they were to speak out that they would be condemned for knowing too much in which they struggled for equality from the white race and peace within. In the last three lines of the second verse emphasis their hurt when they are not around the white race and how they are trapped under the mask. We smile, but, O great Christ, our cries To thee from tortured souls arise. We sing, but oh the clay is vileBeneath our feet, and long the mile;But let the world dream otherwise,We wear the mask!In the words ?We smile?, it shows that they wear their smiling mask everyday with tortured souls beneath and that they pray to Christ to find peace in the awful world they live in. The words ?clay is vile? sets the setting for slavery on a plantation in the south where clay is popular. The plantation is where they worked and lived. Which did whites that treated blacks with disgust own. The words ?world dream otherwise,? says that the otherwise will turn their head the other way and think differently. Some of them will die with their mask on and never realizing the truth or some will wake up without the mask and reveal the truth that it is wrong. In Paul Lawrence Dunbars poem, he links it to the black race and uses extended metaphor to have a penetrating insight to the reality of the frowned upon race in America, that struggles for equality and peace within a racial s ociety. 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