Causes of Social, Emotional and Behavioural Difficulties

Causes of Social, Emotional and Behavioural Difficulties Understanding the cause of an individuals social, emotional and behavioural difficulties is essential before you can make a successful intervention. Critically assess this assertion in the light of an activity you have undertaken as part of this module. Introduction Delinquents, moral imbeciles and maladjusted children are just some of the labels historically attributed to individuals presenting the difficulties later termed as emotional and behavioural difficulties (Ministry of Education 1995). In this essay the importance of understanding the causes of an individuals social, emotional and behavioural difficulties (SEBD) is explored in relation to whether this understanding is critical for the implementation of successful interventions. This essay primarily considers individuals within the UK educational system which covers children/young people between the ages of 4 and 16. In the study and education of individuals with SEBD there seems to be a lack of uniformity in how the label is interpreted and applied; the descriptors and definitions of SEBD will therefore be considered along with current trends in the number of school age individuals diagnosed as SEBD in order to give context to this area of discussion. Another key area of disparity is the theoretical perspective adopted when assessing and treating an individual with SEBD. The theoretical perspectives each present a different approach to aetiology and interventions, these will be considered in relation to importance of cause in the basis of each and how they lead to interventions. The key argument will then focus on the importance of understanding cause and examine evidence from published literature, research and policies to support this followed by discussion of why understanding cause may not be essential in order to implement successful interventions. The overall aim is to ascertain whether interventions are mainly based on consideration of the aetiology of behaviour and whether there is evidence to indicate their success. Indeed Harden (2003) concluded that there was insufficient evidence for strategy effectiveness in behavioural difficulties. The subject of cause and interventions was discussed with fellow professionals in a web based discussion (Vygotsky, Skinner and Montessori discussion group October 2010 November 2010) and reference will be made to the two fictional case studies which formed the basis of these virtual discussions. In the first a boy, Ronnie, no information was given on his background so the focus was on the observed disruptive behaviour in school and the teacher believing he has SEBD. In the second an 11 year old girl, Vicki, far more detail was given including her recent transfer to secondary school; above average reading skills, parents separated and with new partners, the possibility of epilepsy, refusal to do homework and getting into trouble at school. These discussions elicited a range of views on aetiology, the need for information possibly relating to cause and the nature of assessment and interventions. In general the contributing professionals showed a desire to have more information about each child and to interpret the impact of background factors on the difficulties being observed although there was little acknowledgement of why this information was needed (Farrugia, 2010). What is understood by social, emotional and behaviour difficulties (SEBD)? One of the overriding issues in the field of SEBD is the ambiguity in understanding and identification of individuals who may have social, emotional and behavioural difficulties with those who have less severe discipline problems (Evan, Harden, Thomas 2004). This introduces the first difficulty as the decision to classify an individual as having SEBD is with the person who identifies some aspect of behaviour as problematic and is reliant on that persons constructs. Government publications have provided several descriptions of which two are considered in this essay. In Circular 9/94 (DfE 1994) Emotional and Behavioural Difficulty (EBD) is described as being between: behaviour which challenges the teacher but is within normal, albeit unacceptable, bounds and that which is indicative of serious mental illness. The distinction between normal but stressed behaviour, emotional and behavioural difficulties arising from mental illness is important because each needs to be treated differently. (p.4) The definition focuses on the behavioural aspect rather than emotional and indicates it is a problem for the teachers thereby restricting the difficulties to educational settings. Interpretation of what may be considered unacceptable is therefore likely to result in inconsistent identification of the types of children teachers identify as having EBD (Soles, Bloom, Heath, Karagiannakis 2008). In The Special Educational Needs (SEN) Code of Practice (2001), the definition was amended to incorporate social difficulties and so expanded to social, emotional and behavioural difficulties (SEBD), the code defines those with social, emotional and behavioural difficulties (SEBD) as: Children and young people who demonstrate features of emotional and behavioural difficulties, who are withdrawn or isolated, disruptive and disturbing, hyperactive and lack concentration; those with immature social skills; and those presenting challenging behaviours arising from other complex special needs ( Paragraph 7:60) This description describes a range of characteristics associated with this disorder and recognises that such behaviours can evolve from other special educational needs. This presents a broader spectrum of behaviours linked with emotional and social difficulties and remains open to the personal interpretation of those interacting with such children. The lack of clarity of the descriptors could be linked to the increasing number of children diagnosed as having SEBD being recorded in English schools. In 2008 149,040 children had a need of EBD on school action plus or statemented at primary, secondary and special state funded schools, this was an increase of 6.98% year on year (DCSF 2008), EBD represented the second highest need after moderate learning difficulties. This could be due to an actual increase in the number of children experiencing difficulties or to the wider interpretation of the definition leading to more children being recorded with this difficulty who might otherwise hav e remained at a school action stage. Whichever the reason, it is apparent that increasing number of children within the UK education system are being identified as having a need of SEBD and this in turn has led to increasing focus on interventions in particular for behavioural difficulties as seen in the recent white paper (DfE 2010). The descriptions given in Circular 9/94 (DfE 1994) and the SEN Code of Practice (2001) make no direct reference to aetiology or the necessity to acknowledge this although The SEN Code of Practise (2001) recognises that SEBD may have co-morbidity with other biological or medical conditions (7.52, 7.53, 7.58) and links with mental health (10.27) yet guidance for specific assessment and interventions is not detailed. This could be seen as indicative of the lack of unity on the understanding of causes and interventions for those with SEBD. Which theoretical perspective of cause of SEBD? In 1829 a 20 year poet wrote these lines: From childhoods hour I have not been As others were-I have not seen As others saw-I could not bring My passions from a common spring- From the same source I have not taken My sorrow-I could not awaken My heart to joy at the same tone- And all I lovd-I lovd alone (from Alone by Edgar Allen Poe 1829) The poet was Edgar Allen Poe. Poe was taken into foster care at the age of 3 following the death of his parents and at the age of 6 his foster family moved to London. Poe was said to be talented academically yet a difficult character (Poe Museum n.d.); the poem Alone suggests a troubled child who considers himself to be different. In todays educational climate he may well have been identified as a child with SEBD. Would an understanding of his early life have been important in development of successful interventions? From a behavioural perspective it could be suggested that only his observable difficult behaviour was of importance and thus treatable. The causes could not be speculated upon as they could not be scientifically measured. Bowlby, from a psychodynamic approach might have disagreed; Poes early childhood experiences, most notably the death of his parents and being taken into foster care, may have suppressed his inner desires and drives leading to internal conflicts. Bowlby might have been interested in the repression of Poes feelings following the death of his parents (Bowlby 1988). An ecosystemic perspective may have considered the effects of the changes of the family systems and the move to a different society in England as impacting on his interactions with the systems around him. In a same vein, the web based discussions of Ronnie and Vicki (Vygotsky, Skinner and Montessori discussion group October 2010 November 2010) led to similar questions. In the case of Vicki, fellow professionals mostly concurred on the adoption of an ecosystemic perspective for assessment based on the information given concerning the breakdown of the systems in her life; some believed that a psychodynamic approach to establish her unconscious processes and a biological perspective to examine the possible epilepsy should also be considered. However, the intervention strategies proposed were based on a humanistic approach rather than linked to the diagnostic perspectives. As noted earlier for the Ronnie discussion there appears little acknowledgement of why the information was needed and how information may link to interventions. In the case of Ronnie, discussions indicated that more information on areas such as his family background, his learning difficulties, incidences of observed be haviour at school and the relationships within his family would be valuable in order to make a more informed recommendation for intervention strategies. This desire for more information showed an amalgamation of perspectives including social learning, psychodynamic and behavioural. Most interesting is that fellow professionals adopted a behavioural approach to interventions in the absence of further information about Ronnie. It could be that this was within the realms of their experience of available strategies in education. The question of which theoretical understanding of cause is the correct one cannot be fully answered. Professionals in the field of educational research tend to support a particular perspective; there are differences of opinion between psychological, medical and sociological perspectives, this is further compounded by newer perspectives such as eco-systemic and humanist which have evolved from earlier theories. As Visser (2000) notes most do acknowledge that it is a mixture of perspectives which can provide insights into understanding and explaining that behaviour. (p.33). The trend for which cause can be seen in the changing descriptors given for SEBD as noted previously (DfE 1994 SEN Code of Practice 2001) and also in approaches to behavioural difficulties adopted by schools. The trend towards a behavioural psychology approach of operant conditioning and behaviour modification as a strategy for treating children with SEBD has been seen since 1975 (Cooper 1999). Children are seen a s making a choice not to behave and through use of behavioural approaches such as consequence and reward they can be taught to want to behave so a new behaviour is learnt (Greene 2008). From this perspective, aetiology is not a considered factor and emphasis is on implementing a system of rewards and consequences which aim to reduce unacceptable behaviour and encourage a re-learning of acceptable behaviour. The blanket approach of many behavioural policies, in part dictated to schools through government directives, suggest that policy makers and educationalists do not consider there is a need to understand causes of SEBD. Behaviour is assumed to be within the control of the child and the school is assumed to be able to influence and change the behaviour. Recent years have seen a change in approach with prominence given to systemic approaches taking into account the interaction of systems and environments surrounding the child as key factors impacting on their social, emotional and behavioural difficulties (Evans, Harden and Thomas 2004). From this perspective there is a need to understand cause in terms of the environments of the individual. This was evident in the web based discussion on Vicki (Vygotsky, Skinner and Montessori November 2010) where contributors were mostly united in adoption of an ecosystemic approach and attributed the cause of the difficulties to disruption in Vickis home and school life. Understanding the cause of the SEBD is essential before making a successful intervention. In the previous section a number of theoretical approaches to identifying cause were examined and it is concluded that there are difficulties in finding consensus on one approach and one understanding of cause. Despite the difference of opinions of the likely origins of the SEBD, there is widespread support of the need for understanding the cause. Visser (2005) is opposed to a prescriptive approach to dealing with behavioural difficulties and thus supports the case for recognising that each child with SEBD may have a different cause of SEBD although he previously acknowledged that there are still gaps in understanding of both causes and of approaches used in children with EBD (Visser 2002). Others in this field also advocate the benefits to teachers having understanding of pupils with SEBD; Cole, Visser and Daniels (1999) in a paper examining effective EBD practices in mainstream schools promote the need for school staff to understand the complex causation and the varied aetiology of EBD in order to be able to match apposite interventions. Another way of considering cause is to examine underlying difficulties which may be causing SEBD, not from a theoretical perspective but from a possible medical or other difficulty so the behaviour is not directly linked to a psychological or systemic root but rather from some other difficulty which leads to the behaviour emerging as a symptom. Cross (2004) believes that a relationship exists between communication difficulties and emotional and behavioural difficulties. Communication difficulties may arise from biological causes such as Pervasive Development Disorder, Attention Deficit Hyperactivity Disorder or from environmental factors such as child abuse and neglect, or from learning difficulties. Cross maintains that whatever the origin, it is the communication difficulty which must be addressed as a priority as weak communication skills can have a negative impact on a childs ability to interact and socialise, this can aggravate emotional and behavioural difficulties. In this sen se the observed behavioural difficulties could be masking underlying communication difficulties which, if not treated, will not improve the behaviour. In the web discussion on Ronnie (Vygotsky, Skinner and Montessori discussion group October 2010) fellow professionals concurred that a link was likely between his possible learning difficulties and his behavioural difficulties and that this should form a key part of any interventions. In his book, Lost At School, Greene (2008) maintains that teachers cannot know what to do with challenging behaviour unless the reasons for it are understood, referring to these reasons as lagging skills; those skills which are lacking irrespective of diagnosis. Staff need to identify and understand the skill lacking as this is pivotal to implementing a successful intervention. Greene (2008) lists many lagging skills, including difficulties with maintaining focus, considering likely outcomes, managing emotional responses, which professionals may attribute to a range of disorders such as learning difficulties, autistic spectrum disorder, cognitive difficulties, or anxiety. It is identification of the specific lagging skills which are of more importance than the actual diagnosis as the diagnostic label does not in itself indicate which skills are lacking. Emphasis should therefore be on identifying the specific aspects which are lacking; the lack of a skill alongside an environment whi ch demands these skills is the trigger to there being a problem (Greene 2008). This is in line with an ecological perspective as the behaviour is an outcome of the lagging skill conflicting with the environment. Support for the importance of understanding aetiology is also found in educational guidance; the School Discipline and Pupil Behaviour Policies (DCSF 2010) advises that it is essential to ensure correct assessment of possible reasons for children not behaving appropriately and acknowledges that behavioural difficulties may be caused by learning difficulties, environmental factors or other cognitive, social or emotional difficulties (paras 3.9.29 -3.9.33); yet a subsequent subheading is Pupils who can behave but choose not to (p.58). This takes the school back to the descriptors of SEBD and places interpretation back in a subjective framework where the school has to distinguish between the former and the latter. In much the same way as seen in the SEN Code of Practice (2001) there is a lack of clarity in how cause should be identified and how this knowledge should guide interventions. A recent report entitled Not Present and Not Correct (Evans, 2010) examined the efficacy of fixed term exclusions in curing behavioural problems. The report concluded this was not an effective strategy based on the number of fixed term exclusions having increased by 5.4% since 2003-4. Persistent disruptive behaviour was the reason for the majority of fixed term exclusions (23.3%) and permanent exclusions (29.6%) in 2008-9. These numbers have not shown significant change year on year indicating that current interventions are not effective. The report recommends that a trigger is needed to prompt a needs assessment where fixed-term exclusions are used continually. Yet, in the SEN Code of Practice (2001) this trigger should be happening for pupils who do not respond to standard behaviour management strategies or individualised behaviour management programme moving them to a School Action Plus stage. This could suggest that either appropriate referrals are not taking place or, if they ar e, the resulting interventions are not successful. If the latter is the case then it may indicate that either causes are not being considered or, if considered, are not leading to successful interventions. The American based Assertive Discipline approach to managing behaviour in schools is rooted in a behavioural perspective. A study by Jones and Smith (2004) concluded that the this approach was effective in improving minor mis-behaviour and led to overall benefits for teaching and learning in the school at the centre of the study; yet, a small but significant group did not benefit from the approach. This group may therefore have required further personalised assessment of the cause of their SEBD with individual strategies being put in place. This lends support to the necessity of understanding cause in those specific situations where the standard strategies employed in mainstream schools are not resolving social, emotional or behavioural difficulties. It also suggests that the importance of cause is not essential at initial stages of identification of behavioural difficulties, but may need to be understood if current intervention strategies are not achieving the desired outcome. A key factor in identifying the cause of the SEBD lies in the choice of the perspective adopted. As seen in the web based discussions for Vicki (Vygotsky, Skinner and Montessori November 2010) causes could be attributed to several aspects of the individuals life. Depending on the approach taken, the diagnosis and intervention will vary which means that successful intervention cannot be guaranteed. Overall, whilst there is much debate and research on causality and at the same time growing emphasis on the rise in behavioural difficulties in the classroom, classroom based research for children with SEBD tends not to link theory to identification, policy and effective interventions (Maras and Kutnick 1999). Understanding the cause of the SEBD is not essential before making a successful intervention. All perspectives consider cause to some extent although a behavioural approach is founded mainly on observed behaviour. There is little research advocating that identifying cause is not essential or important in terms of implementing interventions. The argument against the value of understanding cause is mainly one of whether knowing the cause can actually lead to a specific and effective intervention. Whilst Visser (2002) advocates the importance of understanding cause, it has proved difficult to find evidence which gives clear guidance for a link between cause and effective intervention strategies. In discussing the Individual, Medical or Deficit Model (IMD), Macleod and Munn (2004) suggest that the implication of causation should be rejected which is the reverse of the consideration of disabilities with a bio-medical root. This view is based on the belief that the biggest difficulty in identifying cause is the lack of agreement in what SEBD actually is, as seen in the earlier disc ussion on the interpretations of definitions. It could be argued that focus should be on strategies and not on cause as interpretations of the cause are too subjective. The web based discussions on Ronnie and Vicki, despite consisting of differing views for diagnosis and cause, saw a commonality in the recommendations for a multi agency approach. This is also seen in Diagram 8 model (Cole, Visser and Daniels1999) in which consultation with the Local Education Authority (LEA) and relevant agencies, such as Child and Adolescent Mental Health Services (CAMHS), is seen as an important factor in schools which are successful in the inclusion of children with SEBD. Whilst Visser (2005) has been cited earlier as an advocate of the need to understand aetiology, in a talk based on a term he encountered in his professional work, eternal verities, he looked at factors which may be universal in implementation of successful interventions for SEBD (Visser, 2002). Understanding cause of the SEBD was not a factor given which lends support to the view that, whilst understanding cause may be desirable and informative, there are more important factors necessary for suc cessful intervention. Only a third of secondary schools were deemed as effective in meeting the needs of pupils with SEBD (Ofsted 2004), which suggests that focus should be on identifying effective strategies. Research carried out by Evans, Harden, Thomas (2004) concluded that there was a limited evidence base of recommended strategies which were effective for children with EBD and they recommended a focus for more strategic commissioning of future primary research (p.8). In the case of Ronnie (Vygotsky, Skinner and Montessori discussion group October 2010), there was a quest to know more from those assessing the situation. Was it not enough that his behaviour was disruptive and so class room based behavioural strategies should be put in place to make Ronnie learn appropriate behaviour? The answer in this case seems to lie in the understanding of cause. If Ronnie had a learning difficulty, there was support for this being addressed first/or in conjunction with the behaviour interventions. If it then emerged that Ronnie was having problems at home, such as parental conflict or neglect, this may have required another form of intervention. In the case of Vicki (Vygotsky, Skinner and Montessori discussion group November 2010) there was more information on her background situation; this meant some probable causes could be explored which could then lead to a range of possible interventions. Having more information still led to a discussion on which perspect ive may be more applicable and in fact the interventions proposed were mostly similar to those for Ronnie. Although the participants suggestions for interventions for Ronnie tended to be school based whereas those discussed for Vicki were both within school and outside with a wider multi agency approach. Professionals such as teachers, educational psychologists, CAHMS practitioners and behaviour support specialists will all bring their own approaches to the SEBD table. It could be that attempts to understand the cause through a multi-agency strategy may lead to disjointed and confusing interventions at worst and a prolonged period of assessments and treatments at best, neither of which presents an ideal situation for a child (Rayner 1999). The range of interpretations, social constructs and perspectives makes a case for a scientific approach to developing interventions for children with SEBD. The aetiology is acknowledged but it is the present symptomatic patterns which are the key to successful interventions. Conclusion Is it essential to understand the cause of an individuals social, emotional and behavioural difficulties making a successful intervention? In seeking an answer to this question, much of the published research advocates the need to establish the cause of SEBD before implementing intervention thereby assuming the intervention will be more successful. The difficulty in this belief is twofold; firstly the definition of what constitutes social, emotional and behaviour difficulties and in particular at what point the severity requires specific interventions and secondly, which perspectives should be adopted to correctly identify the cause(s) and thus which interventions are most suitable. With the definition of SEBD including a wide range of characteristics, it seems most likely that there is also a wide range of causes and thus a wide range of interventions. Most evidence supports the desire to investigate and define the cause; this is also reflected in government and SEN policy and guidelines. Yet evidence to support the importance of this in securing successful intervention is sparse. Overall, whilst the need to understand the cause seems to be supported in research and advocated in government guidelines, the interventions put in place within educational settings are predominantly based on a behavioural approach where it is the observable behaviour which is addressed, measured and evaluated; this is where an anomaly exists. Over time, more responsibility and accountability has been awarded to schools and local authorities for children with SEN including SEBD. This in itself appears to have reduced the focus on understanding cause as schools have to manage this responsibility alongside government directives for improving behaviour in schools. With increasing emphasis on schools primary accountability being for student achievement in academic terms and the move to reduce the number of statements, there is likely to be less emphasis on aetiology in favour of interventions based on controlling children with SEBD certainly in mainstream education. The current governments support of academies may also magnify this as the removal of local authority involvement means that schools can decide whether there is economic value in seeking input from agencies that may have more concern with aetiology. It may be that there are other factors necessary in implementing successful strategies aside from understanding cause such as the necessity for a positive ethos within the school itself (Cole, Visser, Daniels 1999). It is concluded that understanding the cause of an individuals SEBD is part of the equation for successful intervention but unless the adults responsible acknowledge the cause and seek to promote appropriate and differentiated solutions which can be proven to be successful, then understanding on its own is not sufficient.

Marketing Techniques Essay

The main thing behind marketing in a business is finding the customer’s needs and produce the product/ services to satisfy their needs, this way the customer can choose what they would want included in their product/ service. A business that follows this rule is market-orientated. There is alternatives orientation for businesses, these are; The production concept: This is where the business produces in large quantities and distribute in bulk, this is so the customer/ business get the products cheaper as they will be bulk buying. A business that would do this is Walkers. They make thousands of packets and then sells them to large business such as Tesco, Tesco would be able to buy it for cheaper as they will be buying in a very large amount as they can stock allot of products. However charity shops will sell their products and with the entire surplus they send it off to the charity. An example of this is Oxfam, they will sell their products to the public and with all the surplus is sent off to the project they are currently on. The sales concept: Businesses need to know how to sell their products/ services. If they don’t know how to the business is likely to fail but if a business knows how to sell its goods/ sieves then it is likely to be successful. A type of sales technique is hard selling nor Tesco or Oxfam hard sell but businesses such as Anglian, Everest and Safestyle are usually hard sellers trying to get you to buy double glazing. As you can see some of the sales reps in these businesses have lied about the business just so they can close sales with people on the spot. The marketing Concept: Marketing concept is different to sales and production as it has to take every step with keeping customers in mind as marketing is based around customer’s needs and wishes. An example for this is Tesco they do this with their Tesco Club card every time you shop you swipe your card and the system knows what the customer purchased, so to bring back the customer they will mail you some vouchers which then makes the customer want to come back into the store and shop again. Another business that uses marketing is Curry’s when you purchase something the sales assistant take down your home address so if they have any offers which are similar to what you bought will send you letter informing you about any offers. Marketing definitions: Basic definition of marketing is meeting customer needs and wants profitably. Marketing consists of identifying, anticipating and satisfying customer requirements profitably. Objectives: Private sector The objectives for a private sector business are to maximise profits and expand all over the world. An example for a private sector business is Tesco. They have businesses in the UK and in America called Fresh & Easy. In the screen shot you can see Tesco’s objectives. Public sector The objectives for a public sector business are to provide quality service for the public. An example for this is the NHS as they provide health care for everyone. In the screenshot you can see NHS’s objectives. Voluntary sector The voluntary sector businesses objectives are to raise money for good causes. An example of this is Oxfam they aid anyone to donate any goods so they can sell them and send the money they produce from the goods they sell given to the public to projects they are currently on. As you can see this is one of Oxfam’s shops where they sell goods that have been donated by the public. Organisational objective This is a target for the whole business no matter how big it is. A good example of this is Tesco, Tesco’s objective may be to increase market share to 51%. Marketing objective This is how you are going to achieve it e.g. increase Tesco value products Tesco can produce their own products such as Ben & Jerry ice-cream they can produce a Tesco value version as some people may not be able to afford  £4 ice-cream so the people can buy the alternative which would help Tesco increase their profits. Link between organisational objectives and marketing objectives Marketing objectives shouldn’t be contradicting a business’s main objective, but should be contributing in achieving that. A business will not succeed if it’s been pulled apart in two different directions. An example of this is if Tesco want to increase their sales by a certain percentage then different functional areas have to contribute to achieve this such as advertising they may advertise products that are on offer or any seasonal products e.g. Christmas, new years or valentines. Tesco’s could also send out more offers with their Club Card meaning more customers may shop i n the business. By this way Tesco will be informing a lot more people that they have sales on which might bring more customers into the business. Market leadership This is where a business has the most market share in a given product or service, this could be measured by the amount of goods sold or the value of those goods. If a business wants to become a market leader they need to be 51% or more in sales for it to become a market leader. For example, Tesco is the leading supermarket in the supermarket market place as you can see in this screenshot (January 2012). Charity do no compete with market share as they all have similar aims and objectives but need maximum funds to stay in operation. Some charities will be more valuable then others depending on how much donations they receive. Oxfam is at the top along with cancer research UK, British Heart Foundation and many more. Brand awareness Brand awareness is making people aware of the business and what they do/ sell. Brand awareness is the NHS’s number one objective, they want all of Great Britain’s public to know what they do. Brand awareness may be an individual product or the whole business itself. Tesco may advertise their Tesco club card so people are more aware of the club card you can get when you sign up with them. Perceptions of customers A customer’s perception of a business or a brand often affects their purchasing decision. An example of this is a business might have a lot of brand awareness but their products might not be of the highest quality. This will make the customer not want to come back into the store as they are paying for a cheap quality product. Tesco has a reputation of selling goods a cheap price to everyone, if they start selling their products higher than their competitors then they are likely to lose out on customers and sales which are why they try keep their prices as low as possible. People may also decide to shop at Oxfam for clothes rather than buying clothes from the high street as they know their money goes to good use. Techniques: Growth strategies Businesses grow through their products/ services every time they put a product on the market more and more people will find out about the product. For example Tesco have been using growth strategies as they are expanding with their services, such as Tesco Money, you can now have a credit card with Tesco which people who may don’t normally do not shop at Tesco may have their Tesco credit card. Oxfam use growth strategies through advertising. Every time they advertise someone new will hear about Oxfam and how they are helping to take people out of poverty in third world countries. Survival strategies This is important for all business if they want to keep operating. The reason why Tesco are expanding into different markets is in case one market fails them they have other services which will help them keep out of making a loss for example if Tesco started making cars and sold a few thousand but then was not successful. They are likely to start making a loss but as they are successful in other markets they are unlikely that they would shut down. With Oxfam with all their stores open they can use them stores to survive. Branding Business need to have a strong brand image in order for them to survive. Providing high customer service will increase the brand image. Advertising is also a factor to increase the brand image. Tesco and Oxfam both have a very strong brand image as they are at the top of their tables Tesco is globally a very well known business and Oxfam is also globally well know as they operate in the UK and in third world countries. Relationship marketing Building a relationship with customers is very important for the business as they will think that the business cares about them. Tesco can build relationships with its customers at the tills, the cashier can communicate with the customer building a positive relationship. This is also the same with Oxfam when people buy products from the stores they are building a relationship with the business or if you support Oxfam through direct debit you will receive a welcome pack with updates every month about what the persons many is doing and how they are helping people in poverty.

Vaso-Occlusive Events In Sickle Cells Case Study - 746 Words

Vaso-occlusive events are moments of severe pain common in sickle cell patients; it is a result of the adhesion of cells to the endothelial lining. While leukocytes play a role in vaso-occlusive events, erythrocyte activity plays an even bigger role. It was discovered that the receptors on the erythrocytes and the endothelial cell were responsible for the mediation of the adhesion of erythrocytes to the endothelial lining (Stuart; Nagel, 2004). The adhesions of these cells to the cell wall is what leads to inflammatory disease, and certain types of acute chest syndrome. Vaso-occlusive events are common in sickle cell patients, but they are not the leading cause of death. Acute chest syndrome takes that spot. Acute chest syndrome is†¦show more content†¦Acute chest syndrome has been studied extensively in the past due to two reasons. First, it is the leading cause of death in patients with sickle cell disease. Secondly, there is not optimal treatment for acute chest syndrome. This is because there are so many factors that can cause it. Pulmonary fat embolism can cause acute chest syndrome, but so can viral infections, bacterial infections, and mixed infections (Vichinsky, 2000). While there are so many causes of acute chest syndrome, the most noticeable was pulmonary fat embolism, which account for 8.8% of all acute chest syndrome occurrences (Vichinsky, 2000). On table 4, you can see each disease that caused the onset of acute chest syndrome, and how many people it affected. To properly treat patients with sickle cell disease who are suffering from acute chest syndrome, multiple precautions must be taken into account. First, broad-spectrum antibiotics should be administered due to the high chance that it is caused by a bacterial infection. Secondly, airway hyperreactivity should be assumed and checked for even if wheezing or coughing is not present. Thirdly, if possible, patients who suffer from anemia should seek blood transfusions before the onset of respiratory distress. Lastly, if the patient sees no improvement, they may be treated with alternative drugs such as nitric oxide or hydroxyurea, but this is only in severe cases. As previously stated,Show MoreRelatedDo Teenagers With Sickle Cell Disease Experience True Pain? Essay2656 Words   |  11 PagesDO TEENAGERS WITH SICKLE CELL DISEASE EXPERIENCE TRUE PAIN OR ARE THEY SIMPLY DEPENDENT ON PAIN MEDICATIONS? Salve Aguilar West Coast University Pathophysiology Dr. Isabelle Tardif August 14, 2015 Do Teenagers with sickle cell disease experience true pain or are they simply dependent on pain medication? Situation: A case study about a 15 year old African male with sickle cell disease was rushed to emergency room by his mother due to complaint of unbearable pain all over his bodyRead MoreHesi Practice31088 Words   |  125 Pages(CNS) depressants. B. Avoid taking antianxiety agents at bedtime. C. Avoid taking antianxiety agents on an empty stomach. D. Avoid consuming aged cheese when taking antianxiety agents. 71. A preschool-age child with sickle cell anemia is admitted to the health care facility in vaso-occlusive crisis after developing a fever and joint pain. What is the nurse s highest priority when caring for this child? A. Providing fluids. B. Maintaining protective isolation. C. Applying cool compresses to affected

The View Of The East - 936 Words

Carl Ernst sheds light on a very key issue that Muslims have faced and still continue to face in stating, â€Å"It is safe to say that no religion has such a negative image in Western eyes as Islam† (Ernst, 11). The representations of Islam by Western societies have taught non-Muslims – even those outside of the West due to imperialism – what to think of Islam. The negative imagery surrounding Islam has then created a discourse which fuels fear, hostility, and a misunderstanding of the religion and its adherents and thus fosters violence and aggression towards Muslim communities both in and outside of the West. Such discourse reinforces the notion that ‘the West’ is essentially opposite of ‘the East,’ a concept rooted in colonialism and primarily cited as a justification for the oppression of what is now called the Middle East. â€Å"The extraordinary mismatch between Euro-American ideas of Islam and the realities lived by Muslims will form a recurring theme†¦ There is no one simply or easy explanation, though one must look both at history and at contemporary political interests to see the larger patterns† (Ernst, 4). The development of this West/East dichotomy reduces the complexities of the region and provides a very dangerous space for misunderstanding. The West/East dichotomy further suggests a Good/Bad dichotomy which paints the actions of the West as justified and the reactions of those in the East as backwards or barbaric. 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