work

  

To complete this assignment, you will need to access to the following databases: CINAHL, MEDLINE, Cochrane Library, and the Joanna Briggs Institute. I

know you can do this work, so don’t go short cut and mess it up. Research each heading and complete.

See the article I attached. Find more articles to complete to complete this work.

As a writer, you should first write a good introduction for each topic briefly say the story you about to tell, the subjects you going to talk about. 

You then tall this story by each subject.

You summarize all the story for conclusion

Don’t do lazy work no beginning , no end. Don’t be repetitive to fill the page 

Don’t copy old work

Don’t give me somebody’s work. I will know.

Grammer has got to improve. I end up deleting all work in the process of editing. Most time work below college level. I mean it. And sometimes it can be accepted at masters level.

1: Distinguish selected factors affecting U.S. healthcare delivery systems and organizations 

Introduction: Find good article

 1.

2.

3.

2: Examine factors affecting healthcare finance and payment systems 

Introduction

 1.

2.

3.

 3: Evaluate selected healthcare policy models and frameworks 

Intrduction: Find good article

Suptopics

 1.

2.

3.

4

5

6

7

4: Formulate strategies for coalition building and health advocacy 

Intrduction: Find good article

 1.

2.

3.

5: Synthesize selected policy analyses affecting advanced practice nursing

Intrduction: Find good article

 1.

2.

3.

Inclusion of all story work

Examples

Increased health insurance coverage

Payer pressures to reduce costs

• Medicare physician services payments are based on fee schedule (Resource Based Relative Value Scale, or RBRVS).

Change from “reasonable cost” to prospective payment system based on diagnosis related groups for hospital inpatient services begins under Medicare

Interview conducted and issues highlighted. Find issues in the policy or issues you can associate to the yellow highlighted in box

  

High staffing turnover

Diabetics patients are noncompliant   with medication is more predominant

The   facility denies any safety concerns

There is high staff turnover

No diabetics education protocol or   policy in 

place for the old and newly diagnosed   diabetics 

Facility   denies and sentinel event

Yes

The   relationship is good. Staff are not expected to take short cuts

Management   is open for suggestions or improvements

Examples:

Staff   members are not mistreated

Electronic health Record is not in   use, No plans for one. Still using   paper medical records

No   further issues

Diabetic education for noncompliant   diabetics patients

 

Very good role model

The nurse leader will be good preceptor

Transformational leadership

yes

  

Category

Points

%

Description

 

Introduction

Introduces the   interview, purpose of the interview, and provides rationale for engaged   interview process.

To determine existing   practice problem within the organization

 

Description   of Policy Issue

Please discuss the organizational assessment and how   you decided upon this particular policy. Also include any subtopics regarding   selected healthcare policy issue. Use examples from the interview that   support your assertions and relevant examples from your practice situation.

 

Presentation of Policy Analysis

Include eight subtopics regarding selected   healthcare policy analysis pathway. Summarize your subtopics using examples   from the interview that support your assertions as well as relevant examples   from your practice situation.

 

Conclusion

An effective conclusion identifies the main ideas   and major conclusions from the body of your report. Minor details are left   out. Summarize the benefits of the selected policy analysis to nursing   practice.

 

Clarity of writing

Use of standard English grammar and sentence   structure. No spelling errors or typographical errors. Organized around the   required components using appropriate headers.

 

APA   format

All information taken from another source,   even if summarized, must be appropriately cited in the report (including   citation of interview) and listed in the references using APA (6th   ed.) format:

1. Document setup

2. Title and reference pages

3. Citations in the text and references.

 

Total:

250

100%

A quality report will   meet or exceed all of the above requirements.

There are more than 9000 billing codes for individual procedures and units of care. But there is not a single billing code for patient adherence or improvement, or for helping patients stay well.”

Clayton M. Christensen

Health care financing in the United States is fragmented, complex, and the most costly in the world. The Affordable Care Act (ACA) of 2010 takes some steps to reshape how health care is paid for, but its primary purpose is to extend insurance coverage to approximately 30 million uninsured Americans through private insurance regulation, expansion of pubic insurance programs, and creation of health insurance marketplaces to foster competition in the private health insurance market. As the ACA is implemented, making health insurance more affordable and containing the rise in health care costs are significant ongoing policy challenges in system transformation. This chapter will provide an overview of the current system of health care financing in the United States, including the impact of the ACA.

Historical Perspectives on Health Care Financing

Understanding today’s complex and often confusing approaches to financing health care requires an examination of the nation’s values and historical context. Some dominant values underpin the U.S. political and economic systems. The United States has a long history of individualism, an emphasis on freedom to choose alternatives and an aversion to large-scale government intervention into the private realm. Compared with other developed nations with capitalist economies, social programs have been the exception rather than the rule and have been adopted primarily during times of great need or social and political upheaval. Examples of these exceptions include the passage of the Social Security Act of 1935 and the passage of Medicare and Medicaid in 1965.

Because health care in the United States had its origins in the private sector market, not government, and because of the growing political power of physicians, hospitals, and insurance companies, the degree to which government should be involved in health care remains controversial. Other developed capitalist countries, such as Canada, the United Kingdom, France, Germany, and Switzerland, view health care as a social good that should be available to all. In contrast, the United States has viewed health care as a market-based commodity, readily available to those who can pay for it but not available universally to all people. With its capitalist orientation and politically powerful financial stakeholders, the United States has been resistant to significant health care reform, especially as it relates to expanding access to affordable health insurance.

The debate over the role of government in social programs intensified in the decades after the Great Depression. Although the Social Security Act of 1935 brought sweeping social welfare legislation, providing for Social Security payments, workman’s compensation, welfare assistance for the poor, and certain public health, maternal, and child health services, it did not provide for health care insurance coverage for all Americans. Also, during the decade following the Great Depression, nonprofit Blue Cross and Blue Shield (BC/BS) emerged as a private 173insurance plan to cover hospital and physician care. The idea that people should pay for their medical care before they actually got sick, through insurance, ensured some level of security for both providers and consumers of medical services. The creation of insurance plans effectively defused a strong political movement toward legislating a broader, compulsory government-run health insurance plan at the time (Starr, 1982). After a failed attempt by President Truman in the late 1940s to provide Americans with a national health plan, no progress occurred on this issue until the 1960s, when Medicare and Medicaid were enacted.

BC/BS dominated the health insurance industry until the 1950s, when for-profit commercial insurance companies entered the market and were able to compete with BC/BS by holding down costs through their practice of excluding sick (with preexisting conditions) people from insurance coverage. Over time, the distinction between BC/BS and commercial insurance companies became increasingly blurred as BC/BS began to offer competitive for-profit plans (Kovner, Knickman, & Weisfeld, 2011. In the 1960s, the United States enjoyed relative prosperity, along with a burgeoning social conscience, and an appetite for change that led to a heightened concern for the poor and older adults and the impact of catastrophic illness. In response, Medicaid and Medicare, two separate but related programs, were created in 1965 by amendments to the Social Security Act. Medicare is a federal government-administered health insurance pro­gram for the disabled and those over 65 years (Kaiser Family Foundation [KFF], 2014c), and Medicaid, until recently, has been a state and federal government-administered health insurance pro­gram for low-income people, who are in certain categories, such as pregnant women with children.

Government Programs

Current Public/Federal Funding for Health Care in the United States

In the United States, no single public entity oversees or controls the entire health care system, making the payment for and delivery of health care complex, inefficient, and expensive. Instead, the system is composed of many public and private programs that form interrelated parts at the federal, state, and local levels. The public funding systems, which include Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), the U.S. Department of Veterans Affairs (VA), and the Defense Health Program (TRICARE) for military personnel, their families, military retirees, and some others, continue to represent a larger and larger proportion of health care spending. Other examples of federal programs are the Indian Health Service, which covers American Indians and Alaskan Natives, and the Federal Employees Health Benefits (FEHB) Program, which covers all federal employees unless excluded by law or regulation.

Federal health expenditures for these programs totaled $731.6 billion or 26% of all health care expenditures in 2012 (Martin et al., 2014). Medicare outlays were $572.5 billion in 2012 and accounted for 20% of all national health care expenditures with Medicare Advantage (a Medicare-managed care program provided by insurance plans that can be chosen by beneficiaries instead of the traditional Medicare program) growing most rapidly (Martin et al., 2014). Medicaid outlays in 2012 were $412.2 billion and accounted for 15% of total national health care expenditures, and its spending growth also decelerated that year (Martin et al., 2014).

Medicare

Before the enactment of Medicare in 1965, older adults were more likely to be uninsured and more likely to be impoverished by excessive health care costs. Half of older Americans had no health insurance; but by 2000, 96% of seniors had health care coverage through Medicare (Federal Interagency Forum on Age-Related Statistics, 2000).

Medicare had a beneficial effect on the health of older adults by facilitating access to care and medical technology, and, in 2006, prescription drug coverage helped improve the economic status of older adults. The percentage of persons over age 65 years living below the poverty line decreased from 35% in 1959 (when older adults had the highest poverty rate of the population) to 9% in 2012 (U.S. Census Bureau, 2014).

174

Americans are eligible for Medicare Part A at age 65 years, the age for Social Security eligibility, or sooner, if they are determined to be disabled. Medicare Part A accounted for 31% of benefit spending in 2012 and covers 52 million Americans. Medicare Part A covers hospital and related costs and is financed through payroll deduction to the Hospital Insurance Trust Fund at the payroll tax rate of 2.9% of earnings paid by employers and employees (1.45% each) (KFF, 2014a). Medicare Part B, which accounted for approximately one third of benefit spending in 2012, covers 80% of the fees for phy­sician services, outpatient medical services and supplies, home care, durable medical equipment, laboratory services, physical and occupational therapy, and outpatient mental health services. Part B is financed through subscriber premiums and general revenue funding as well as cost-sharing with beneficiaries.

Medicare Part C, or the Medicare Advantage Program, through which beneficiaries can enroll in a private health plan and also receive some extra services such as vision or hearing services, accounted for 23% of benefit spending in 2012 and had more than 14.1 million enrollees, or 28% of all Medicare beneficiaries in 2013 (Medpac, 2013). Medicare Advantage enrollment has been increasing and is up 30% since 2010 (KFF, 2014a). Extra payments that the federal government has made to private Medicare Advantage Plans are due to be phased out by the ACA, raising concerns that insurers will drop their Medicare Advantage Plans as a result.

Medicare Part D is a voluntary, subsidized outpatient prescription drug plan with additional subsidies for low- and modest-income individuals. It accounted for 10% of benefit spending in 2012 and enrolled 39 million beneficiaries in 2013 (KFF, 2014a, 2014b). Figure 18-1 presents Medicare benefit payments by type of service in 2012 (KFF, 2014a). Medicare Part D is financed through general revenues and beneficiary premiums as well as state payments for recipients who get both Medicare and Medicaid, also known as “dual eligibles” (KFF, 2014b). The ACA phases out the Medicare Part D “donut hole,” a period of noncoverage for prescription drugs that left many seniors unable to pay out-of-pocket for their medications.

FIGURE 18-1 Medicare benefit payments by type of service, 2012. (From Kaiser Family Foundation. [2014]. Retrieved from kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/.)

The ACA authorized that certified nurse midwives (CNMs) be reimbursed at 100% of the physician payment rate. Other advanced practice registered nurses (APRNs), including nurse practitioners (NPs), are paid 85% of the physician rate 175for the same services. In addition, Medicare will not pay for home care or hospice services unless they are ordered by a physician. And, unfortunately, the ACA required physician orders for durable medical equipment for Medicare beneficiaries.

Medicaid

Medicaid is the public insurance program jointly funded by state and federal governments but administered by individual states under guidelines of the federal government. Medicaid is a means-tested program because eligibility is determined by financial status. Before changes by the ACA, only low-income people within certain categories, such as recipients of Supplemental Social Security Income (SSI), families receiving Temporary Assistance to Needy Families (TANF), and children and pregnant women whose family income is at or below 133% of the poverty level were eligible. To qualify for federal Medicaid matching grants, a state must provide a minimum set of benefits, including hospitalization, physician care, laboratory services, radiology studies, prenatal care, and preventive services; nursing home and home health care; and medically necessary transportation. Medicaid programs are also required to pay the Medicare pre­miums, deductibles, and copayments for certain low-income persons who are eligible for both programs. Medicaid is increasingly becoming a long-term care financing program of last resort for older adults in nursing homes. Many older adults have to spend down their life savings to become low income and be eligible for Medicaid. Family and pediatric NPs and CNMs are also required to be reimbursed under federal Medicaid rules if, in accordance with state regulations, they are legally authorized to provide Medicaid-covered services.

In keeping with its goal to expand health insurance coverage to more Americans, the ACA expands eligibility for the Medicaid program to any legal resident under the age of 65 years with an income up to 138% of the federal poverty level. The intent of the health reform law was to have one eligibility standard across all states and eliminate eligibility by specific categories (Commonwealth Fund, 2011; Rosenbaum, 2011). The federal government has agreed to pay for nearly all the expansion costs to insure more low-income people. The U.S. Supreme Court, however, struck down the mandate to expand Medicaid and ruled that states could decide whether or not to expand the program. Figure 18-2 indicates that as of April 2014, 27 states had decided to expand Medicaid, 5 are still debating this, and 19 are not moving forward (KFF, 2014d). States that decide to opt out of the expansion can follow old federal guidelines for eligibility, leaving wide disparities in health insurance coverage between states and leaving uninsured large proportions of the population below 138% of the poverty level. Of the states that have opted out of expansion, all have Republican political leaders explicit in their opposition to the ACA, although Republican Governor Jan Brewer of Arizona pushed her state to expand Medicaid in 2013 so that 300,000 more poor and disabled residents of the state would have coverage (Schwartz, 2013). In many of the nonparticipating states, physicians, nurses, hospitals, and other health care organizations and stakeholders are pressuring their state governments to expand Medicaid as a way to improve access to health care for more low-income people.

FIGURE 18-2 State Medicaid expansion, November 2014. (From FamiliesUSA. [2014]. Retrieved fromfamiliesusa.org/product/50-state-look-medicaid-expansion; and Kaiser Family Foundation. [2014]. Retrieved fromkff.org/medicaid/fact-sheet/a-closer-look-at-the-impact-of-state-decisions-not-to-expand-medicaid-on-coverage-for-uninsured-adults/.)

CHIP was created in 1997 to help cover uninsured children whose families were not eligible for Medicaid. It has been funded through state and federal funds, but states set their own eligibility standards. The ACA commits the federal government to paying most of its costs, beginning in 2015, up to 100%. It also requires states to maintain their eligibility standards for CHIP (Emanuel, 2014). CHIP will be reauthorized in 2015, and, because it is expected that many more children will have gained coverage through family health insurance plans, debate is expected over the role of the program. CHIP is enrolling a record number of children now estimated to be one third of all children in the United States. Advocates want to maintain these high child health insurance rates until the ACA is fully implemented and full coverage for children under the provisions of the ACA is assured.

State Health Care Financing

State governments not only administer and partially fund some public insurance programs such as Medicaid and CHIP but they are also responsible for individual state public health programs. 176The definition of public health as compared with other types of health programs is not always well understood. The mission of public health as defined by the Institute of Medicine (IOM) is to ensure conditions in which people can be healthy (IOM, 1988). Whereas medicine focuses on the individual patient, public health focuses on whole populations. Medical care for the individual patient is associated with payment by health insurance, but population-based public health programs are funded by local, county, state revenues, often combined with grants from the federal government in areas such as maternal and child health, obesity prevention, HIV/AIDS, substance abuse, and environmental health. Even with a greater federal role in health care through the ACA, states will continue to have a major responsibility for the regulation of health insurance, health care providers and professionals, and public health activities.

Reduction of budgets for public health programs during times of fiscal constraint has resulted in the resurgence of infectious diseases such as tuberculosis and sexually transmitted diseases in some communities. A series of natural disasters such as tornados also brought to light gaps in the public health system, especially the ability to respond, for example, to mass casualty events. Although the ACA authorized $15 billion for the creation of a Prevention and Public Health Fund to invest in public health and disease prevention, Congress reduced by one third the amount of funding mandated by the law in 2012 and President Obama signed the legislation to pay for other initiatives (Health Policy Brief, 2012).

177

Local/County Level

Similar to state governments, local and county governments in many states also have the responsibility of protecting public health. Some provide indigent care by funding and running public hospitals and clinics, such as New York City’s Health and Hospitals Corporation and Chicago’s Cook County Hospital. Although receiving a subsidy from their local government, these hospitals, which have served primarily poor patients and those without health insurance, have gotten significant special payments, especially from Medicare to serve these populations. These disproportionate share hospital (DSH) payments are being gradually reduced under the ACA because it is presumed that eventually, under the ACA, many more people will gain health insurance coverage. Because public hospitals and clinics are so dependent on public funds, their budgets are historically squeezed during times of fiscal restraint by local, state, and federal governments, making them vulnerable to long-term sustainability. In fact, many public health hospitals have closed, and in many parts of the country, the populations they have served have been absorbed by other types of hospital providers (KFF, 2013).

The Private Health Insurance and Delivery Systems

The U.S. health care system has been predominantly a private one that operates more like a business and, more or less, according to free market principles. Private health insurance has been the dominant payer and, for most Americans, it is obtained as a benefit of employment in the form of group health insurance. However, until the passage of the ACA employers have had no obligation to provide employee health insurance, leaving many Americans uninsured or underinsured, especially those working in lower-wage jobs. As private health insurance premiums have risen, employers asked employees to pay for a greater percentage of their insurance premium, and to enroll in plans that required more cost-sharing in the form of copayment, deductibles, and coinsurance. Approximately 15% of insured Americans have purchased their health insurance from the nongroup individual insurance market. Typically, these plans were more expensive and insurers in all but a few states had been able to deny insurance to applicants with preexisting medical conditions, until the practice of discrimination based on medical history was outlawed by the ACA in 2010. Because private insurers are regulated by individual states, there are wide disparities in coverage from state to state, as private insurers are powerful political stakeholders who resist attempts at state or federal regulations to make insurance more accessible and affordable. Whereas private health insurance will continue to be a cornerstone of the U.S. health care financing system, public insurers such as Medicare and Medicaid are paying for an increasing percentage of health care costs.

It should be noted that health insurance is regulated by the states. Some states now mandate that NPs be considered primary care providers and eligible for credentialing and payment by private insurers. But there is wide variation in the extent to which APRNs are included in insurers’ provider panels. This variation can be seen among states, among insurers within a given state, and among the plans offered by an insurer (Brassard, 2014).

Most care in the United States is provided by nonprofit or for-profit hospitals and health care systems and private insurance plans (Truffer et al., 2010). Pharmaceutical companies, suppliers of health care technology, and the various service industries that support the health care system in the United States are part of what has been called the medical industrial complex (Meyers, 1970), and there is little government regulation of these industries. Although the private delivery system is dependent on payment from private insurers as well as government insurers, it has usually been resistant to government-directed efforts to expand access to care or cost-containment measures. Well-financed special interest groups representing industry stakeholders have had a great deal of influence over the political process at both the state and federal levels. For example, the medical device industry is lobbying Congress hard to repeal or reduce the medical device tax that the ACA levied to help pay 178for the expansion of insurance coverage under the health care law and has gained significant support in Congress (Kramer & Kasselheim, 2013).

The Problem of Continually Rising Health Care Costs

From the 1970s to the present, continually rising insurance premiums and health care delivery costs have strained government budgets, become a costly expense to businesses that offer health insurance to their employees, and put health care increasingly out of reach for individuals and families. Figure 18-3 depicts the annual percentage change in national health expenditures by selected sources of funds, 1960 to 2012 (KFF, 2014e).

FIGURE 18-3 Annual percentage change in national health expenditures, by selected sources of funds, 1960 to 2012. (From Kaiser Family Foundation. [2014]. Retrieved fromkaiserfamilyfoundation.files.wordpress.com/2014/02/annual-percent-change-in-national-health-expenditures-by-selected-sources-of-funds-1960-2012-healthcosts.png.)

Stakeholders in small and large businesses, government, organized labor, health care providers, and consumer groups have convened over the years to tackle the problem of rising health care costs, with little lasting success. Although a range of strategies was employed to curb rising health care costs over those 40 years, health care expenditures as a percentage of the gross domestic product (GDP) increased steadily over that time. Although multiple factors are responsible for rising health care costs as a percentage of GDP, the key one is that, unlike other capitalist democracies, the federal and state governments have little, if any, role in regulating what can be charged for health care services and supplies. Prices are largely negotiated between health insurances and providers, resulting in wide variances in prices for similar or exact services, largely based on the market clout of providers to negotiate higher prices. Other contributing factors to high health care costs include the complex administrative systems of insurers and providers, the use of expensive medical technology and medical specialists, and 179the incentive in fee-for-service reimbursement for providers to increase their volume of services and provide unnecessary health care. Consumers have also lacked knowledge of the actual cost of their care, leading to an inability of the market to accurately respond to cost and differential health care prices by region, type of hospital, or health care facility.

Future costs will also be impacted by the aging of the population and increasing number of people with complex chronic illness who use a disproportionately high percentage of the health care dollars. For example, from 1977 to 2007, a very stable 5% of the population who had complex chronic illness accounted for nearly 50% of the health care expenditures (KFF, 2010; Stanton, 2006), despite efforts to control costs among this population. In 2009, the costliest 5% of beneficiaries accounted for 39% of all Medicare fee-for-service spending. The least costly 50% of beneficiaries accounted for 5% of all spending (Medpac, 2013). The majority of those in the high-expenditure group are not older adults but rather those with complex chronic illnesses (Stanton, 2006).

All other industrialized countries spend significantly less on health care but have better health outcomes and a longer life expectancy. For example, the United States ranks among the worst of industrialized nations on important health indicators such as infant mortality, maternal mortality, and life expectancy at birth (Squires, 2014). Yet, in 2012, it ranked first in health care costs per capita at approximately $8915 per person (Organization for Economic Co-operation and Development [OECD], 2013b). This amounted to close to 18% of its GDP, compared with The Netherlands, which ranked second at 12% of its GDP (OECD, 2013a).

Cost-Containment Efforts

Over time, several approaches have been used to contain costs, including the following.

Regulation Versus Competition.

During the 1970s, modest government regulation attempted to contain health care costs through state rate-setting agencies and health planning mechanisms, such as Certificate of Need (CON) programs and regional Health Systems Agencies (HSAs), which evaluated and approved applications for the construction of new facilities, beds, and new technology. During the 1980s and early 1990s, when proponents of competition and free market health care became politically more influential, rate setting and CON programs were weakened and HSAs were eliminated. While free-market principles, as they apply to health care, have few similarities to a fully competitive market in economic terms, the rise of managed care programs and competition among health insurance plans in the 1980s may have temporarily slowed the growth of health costs before they began to rise again. As health insurers expanded the use of copayments, deductibles, and coinsurance as economic incentives to discourage care, the onus of cost-containment fell more heavily on the consumer/patient. However, ample research shows that low-income people may avoid necessary care because of copayments and deductibles. Chapter 17 more fully describes the mechanisms underlying the market system in health care.

Managed Care.

The origins of today’s managed care plans were in early prepaid health plans of the 1920s, which evolved into Health Maintenance Organizations (HMOs) in the 1970s, and into a variety of models in the subsequent 30 years, including Preferred Provider Organizations (PPOs). A managed care system shifts health care delivery and payment from open-ended access to providers, paid for through fee-for-service reimbursement, toward one in which the provider is a gatekeeper or manager of the patient’s health care and assumes some degree of financial responsibility for the care that is given through a capitated budget in which to pay for the patient’s care. Managed care implies not only that spending will be controlled but also that other aspects of care will be managed, such as quality and accessibility. In managed care, the primary care provider has traditionally been the gatekeeper, deciding what specialty services are appropriate and where these services can be obtained at the lowest cost. In the 1990s, negative media attention concerning the incentives to restrict care in the managed care model fueled a political backlash. Consumer and provider demands for 180greater choice for services and access to providers caused managed care plans to loosen gatekeeper requirements and provide more direct access to specialists. As a result, managed care became less effective in holding down expenditures and fueled a rise in health insurance premiums.

In addition, concerns of consumers and providers cha

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 Theoretical Psychology

What Is It and Who Needs It? Daniel N. Robinson

O XFORD U NIVERSITY

A BSTRACT . It remains unclear as to just what a ‘theoretical psychology’ might be or might claim as a mission. This is distinct from various and ad hoc psychological theories (e.g. Hullian learning theory, the opponent- process theory of color vision) which admit at least in principle of empiri- cal tests of adequacy. The example of theoretical physics is offered heuristically to test the different senses of ‘theoretical psychology’.

K EY W ORDS : central theories, civic development, culture of grant-getting, mainstream, metaphysics, morality, theoretical psychology

Psychological Theories and Theoretical Psychology

The history of psychology, contemporary and remote, includes any number of theories subject to tests of adequacy and coherence. Hullian learning theory, Freudian psychoanalytical theory and Ewald Hering’s opponent-process the- ory of color vision are illustrative. They are also indicative of the diversity of models and formulations plausibly subsumed under ‘psychological theo- ries’. Note that the three I’ve cited differ considerably in their generality. Psychoanalytic theory would seek to reach nothing less than culture itself, whereas the opponent-process theory is designed to account for such restricted phenomena as complementary after-images, small-field dichroma- tism and the dichromat’s ability to see yellow. What all three have in common is the articulation of a model of presumed processes or mechanisms on which observed outcomes are assumed to depend. Clearly, there are theories of many other and various psychological findings. If all that is meant by ‘theo- retical psychology’ are accounts of the factors reliably associated with the

T HEORY & P SYCHOLOGY Copyright © 2007 Sage Publications. V OL . 17(2): 187–198 DOI: 10.1177/0959354307075042 www.sagepublications.com

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188 THEORY & PSYCHOLOGY 17(2) observed main effects, then the specialty is exhausted by such models and by standards of coherence and adequacy now more or less conventional in sci- ence. Note that one might acknowledge the (alleged) under-determination of theory by data but still accept that, for example, normal ‘yellow’ perception by deuteranopes is a challenge to Helmholtz’s trichromatic theory of color vision, whereas it can be accommodated by versions of Hering’s opponent- process theory (Hurvich & Jameson, 1957).

Again, if all that is meant by ‘theoretical psychology’ is of this nature, then there is no need for theoretical psychologists to ‘engage’ the mainstream, for the theoretical psychologists (Hull, Freud, Hurvich and Jameson, et al.) sim- ply are mainstream. On this understanding, there is no distinct specialty of theoretical psychology, for the theories emanating from research are no more than reasonable implications that investigators draw from their findings. It would be doubtful in the extreme that some body of specialists in ‘theory’ would have done more with the available data than did Newton, Galileo, Darwin, Freud and Breuer, Hull. It is certainly arguable, then, whether there is or ought to be a ‘theoretical psychology’ (or, at any rate, theoretical psy- chologists) distinct from the mainstream.

Less debatable, I should think, is the need for some sort of meta-psychol- ogy devoted to conceptual examinations of the logical or psychological char- acter of research and of the theories putatively warranted by the findings. Illustrative of the better work in this area is Bennett and Hacker (2003) in their examination of the explanatory misfeasance so common in ‘cognitive neuroscience’. They are entirely successful in exposing the mereological (part-whole) fallacies at the bottom of reductionistic modes of explanation, as well as the reification of biological events into the very psychological reali- ties for which explanations are sought. It is doubtful that Bennett and Hacker would describe themselves as ‘theoretical psychologists’ or would even regard their significant contribution as a contribution to ‘theory’. It is, rather, a contribution to clear thinking, which, one would presume, is as available to the researcher as to the theorist in any field of inquiry.

A meta-psychology is, itself, beholden to conceptual and linguistic rigor, for its mission is nothing less than identifying the proper subject-matter of the discipline and the constraints and potentialities of various candidate methods. Consider the alleged tension between ‘idiographic’ and ‘nomo- thetic’ approaches to the study of personality (Allport, 1937). As Allport understood it, there is a conflict between accounts of the unique life lived by the actual person and the search for laws sufficiently general to encompass whole aggregates. Granting that in one sense every life is ‘unique’—which is the basis on which it can be identified as a given life—one might nonethe- less ask whether this requires abandoning the search for general laws through the study of collectives.

Much confusion surrounds this very issue. The problem is not that N = 1 must be an unreliable guide to the general state of things. The history of

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ROBINSON : THEORETICAL PSYCHOLOGY 189 medicine is replete with general laws unearthed through the exhaustive study of individual cases. All one needs to know about the Krebs Cycle in relation to carbohydrate metabolism can be gleaned from the examination of one healthy digestive system. In this case, the ‘idiographic’ approach serves the ‘nomothetic’ end. The sense in which each person is numerically unique may or may not bear upon the extent to which one person may be taken as a model of the collective.

I should expand this point. Suppose one had a hundred thermometers placed on buildings in 100 chosen towns and cities of the US for the purpose of discovering the ‘average temperature’ in the US. It is true but trivial that the average temperature does not help one determine the temperature in, say, Arizona or Alaska. The statistical average is misleading if used to describe or characterize the particular city. If one wishes to know how hot it is in Scottsdale, one must take readings in Scottsdale. What is important to keep clear on here is the difference between the failure of averages to describe indi- vidual cases, and the adequacy of thermometers in the task of assessing tem- peratures. One might say that the same modes of inquiry and measurements are validly applied both to the individual case and to collectives, but the aver- aging of results may be useless for the individual case. It is neither the meas- uring instrument nor the data that can settle questions regarding the aptness of a description or an explanation. It would be a mark of innocent incompre- hension if, after being told that the average temperature for the nation did not describe Scottsdale, the meteorologist were to conclude that something was wrong with the thermometers.

Perhaps in some sense what I’ve sketched above exemplifies ‘theoretical psychology’, though the more traditional subject of ‘philosophy of science’ seems to cover just this very terrain. Accordingly, if the aim of this volume is to host engagement with the mainstream by scholars in philosophy of psy- chology, one must applaud the mission, hope for its success and—with hope tamed by reality—expect little. There is scant evidence that the discipline has been especially attentive to important developments within philosophy of sci- ence. That more attention might be reserved just in case other psychologists are the bearers of the message seems implausible. In the following sections, I shall lightly work the grounds of my pessimism.

Metaphysical Considerations

According to the somewhat old-fashioned taxonomy, metaphysics has two interrelated sets of issues: issues regarding what there is and issues regarding how we know . Thus does textbook metaphysics arise from the twin-subjects of ontology and epistemology. I begin this brief section with a reflection on the most developed of all scientific thought, that which is subsumed under the heading physics.

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190 THEORY & PSYCHOLOGY 17(2) Consider the quite remarkable field of theoretical physics. It exists owing to the fact that there actually are physical entities and also theories about them and their interactions. It is possible to have theories about such entities and interactions because they are either subject to direct or aided observation or because an as-of-now successful theory requires them. What makes theoreti- cal physics so respectable—as in worthy of the respect of all who take physics itself seriously —is that it has generated a set of ultimately confirmed predic- tions and a set of relevantly related explanations that account for success at the level of prediction. It is in these respects that astrology is, alas, not respectable. So, the answer to the question ‘What is theoretical physics?’ would thus be something along these lines: theoretical physics is that domain of scientific inquiry in which models of what we take to be physical reality are constructed, and are framed in such a way as to allow (at least in princi- ple) specific experiments or observations sufficient to reveal the defects of these very models.

There are apparent similarities between the theoretical psychologists cited at the beginning of this essay and theoretical physicists. Note, however, that the latter frame theory to account for physical phenomena that are widely accepted as such. This is assuredly not the case with, for example, Freud, Hull and (even) specialists in color vision. For even in the last of these, there is such a dearth of realistic context that the theoretical disputes are less about color vision (as in seeing colors) than about the visual process. Freud and Hull, of course, were both guilty of importing theory terms directly into observation statements. The congruence between their efforts and those expended in the productive world of the theoretical is more at the level of appearance than substance.

The answer to the second question raised in connection with theoretical physics, ‘Who needs it?’, is simply: ‘Anyone seeking to avoid false or mis- leading or incoherent accounts of this very physical reality.’ If more is needed here, there may also be tacked on one or another version of the ‘inference to the best explanation’ qualifier. Thus, the best explanation we have for our send- ing persons to the moon and back is that the scientific laws and theories on which the project was based are sound. The best explanation for Raymond’s infection clearing up is that antibiotics function in the manner studied and asserted within the relevant fields of science. For theoretical psychology to avail itself of this sort of support, there would have to be clear evidence of successful predictions and modes of control that would be entirely unexpected in the absence of the theories that explain them.

It is useful to stay with theoretical physics a moment longer. Within its pro- ductive domain three different categories of theory are found. There are, first, what are referred to as central theories , such as classical mechanics, field the- ory and general relativity. It is here that one finds the most rigorously tested models, constructed in ways compatible with prevailing standards of scien- tific explanation, prediction and methodology. However, physics does not

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ROBINSON : THEORETICAL PSYCHOLOGY 191 wear this as a strait-jacket, for there is also ample space given to what are called proposed theories , which have not been subjected to observational modes of confirmation and, at a given time, might be beyond the possible. Here one finds M-theory, loop theory and, yes, the theory of everything. Finally—and most speculative of all—there are those fringe theories which occupy a limbo between the decisive dead end and the ultimately credible productive theory. Luminiferous aether theory is illustrative. Before Einstein, it seemed essential that light have some sort of aether-like medium for its propagation, a theory made otiose by relativity physics.

Against this background, we now might ask: What is theoretical psychol- ogy ? Following the model of theoretical physics, we would be inclined to say that it is the domain of inquiry in which models are constructed of what we take to be (some sort of) ‘psychological reality’. Further, we might say that the models are framed in such a way as to generate experiments and observa- tions of the sort that would reveal the defects of the models themselves. We might go on to liberate the theoretical enterprise by admitting not only cen- tral theories but also proposed and fringe theories not yet amenable to empir- ical and quantitative tests if only provisionally passed by the central theories. This much stated, we would then conclude that this aspect of inquiry is of fundamental importance to anyone hoping to avoid false, misleading or inco- herent accounts of psychological reality. And, by way of parity, we might then add the ‘inference to the best explanation’, noting that the best explanation of our success in predicting the color-naming behavior of dichromats is that our theories and laws of color vision are adequate.

It should be obvious by now, however, that the broader translation of the theoretical physics model into psychological terms does not work. First, color vision aside, there is no settled position regarding the contents and boundaries of ‘psychological reality’. As there is no settled ontology, there is no settled position on the nature of the interactions that might obtain between and among whatever ‘entities’ there may be. There is much talk of ‘processes’, but very little clarity as to just what renders events a ‘process’. Typically, the word merely reifies some data-set. Persons failing to recall briefly presented stimuli when stripped of possibilities for rehearsal may be said to have lim- ited ‘short-term memory’, but this, after all, merely summarizes the finding itself. To say that what is operating here is a short-term memory process adds nothing, explains nothing and predicts nothing.

It might be asserted in defense of process notions that they are the important ingredients of analogical models (a species of proposed theory) that might well rise to the level of central theory. The temporal range over which an observer retains briefly presented stimuli, considered now as a form of ‘buffer storage’, might be incorporated into a more general model of information- processing analogous to physical information-processing systems. This line of reasoning was advanced by George Sperling in his pioneering studies of visual short-term memory and proved to be productive (Sperling, 1960). Nonetheless,

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192 THEORY & PSYCHOLOGY 17(2) such carefully conducted research and credible explanation did not give rise to or prove to be grounded in a more general theory of psychological reality itself . It is important to be clear on this point. There is no area of psychological research and theory as developed as that of visual perception. Such journals as Vision Research and the Journal of the Optical Society of America rou- tinely include basic research and contributions to central theories by experi- mental psychologists at the leading edge of empirical and conceptual work. How revealing, then, that neither the specific studies nor any compilation of them as yet yields a coherent and general ontology of what is really seen . I refer here not to an account of, for example, alterations in the brightness of colored flowers as seen in sunlight and moonlight, or the waterfall illusion, or even why the sky is blue. I refer instead to the fundamental difference between (a) electromagnetic radiation falling in the range of wavelengths

from 360 to 760 millimicrons and (b) the psychological reality of the seen . Readers will be reminded here of Goethe’s famous Farbenlehre of 1810, which chided the Newtonians for thinking that the physics of light had much to say about the perception of color (Goethe, 1840). Although wrong in his appraisal of Newton’s physics, Goethe was sound in his distinction between the passive reality of light striking physical bodies and the active reality of percipients who introduce every variety of complexity into the equation. This fact raises but does not at all settle the fundamental ontological question. The robust development of vision science, to which psychologists have made core contributions, offers support for the claim that psychology’s central theories should be at the level of basic processes. The enduring near-independence of perceived reality in relation to these very processes offers support for the claim that psychology’s central theories should be at the level of global and richly contextualized experience and activity. It will not be the data and meth- ods of the vision sciences that resolve the conflict here, for the conflict is

conceptual—I dare say ‘philosophical’.
In the spirit of a pax philosophica it might be argued that the two

approaches are both valid, that different investigators have different interests, that studies of basic processes have always been the launching pad for more general theories, and so on. It might even be contended that physics itself is plagued by the inability to frame a totally unified theory incorporating both microcosm and macrocosm. One might applaud so liberal an outlook but one might also note the danger of enhancing a field of view by wearing blinders. Consider illustratively the jolt delivered to the well-developed and seemingly settled field of psychophysics with the advent of signal detection theory. Once the latter’s paradigm became more widely known, along with the empirical results of its application, it was obvious that any number of core assumptions in psychophysics had to be reconsidered, beginning with the very notion of a ‘threshold’ (Swets, 1964). It is simply (or not so simply) in the very nature of a creature with various and shifting interests and values, various and interacting motives and sentiments, and various and ontogenetically

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ROBINSON : THEORETICAL PSYCHOLOGY 193 dynamic psychological resources that any process-based strategy will explain all but the lived life itself. In a word, just in case there were to be a fuller appre- ciation of this, it would be necessary to invent a psychology adequate unto the task. The striking inadequacies of the current version are recorded monthly in the major journals.

It is in the nature of the interplay between ontology and epistemology that, lacking a settled a defensible ontology, there is no rational basis on which to choose a mode of inquiry. In order to establish what there is it is necessary to have the right sort of method, but then the right sort of method already pre- supposes at least a provisional answer to the question of what there is . Psychophysical research is predicated on a physicalistic ontology such that all the relevant participating entities are physical: quanta collide with molecules of photopigment at the receptor level, and so on. The psychophysical observer in this arrangement is something of a meter or measuring rod whose verbal or behavioral reports signal the presence or absence of a physical event or change in a physical event. Once the inquiry must take into account the over- all context, the payoff matrix, the subjective criteria of certainty, ands so on— once the rationale of signal detection theory is added—the previously settled ontology is transformed. No longer is the ontological domain of psychophysics limited to quanta and photopigments. Now included are entities with inter- ests, values and aims. This does not militate against orderly data and system- atic inquiry, but it does require us to incorporate into the narrow realm of inquiry more and more of the realm of reality.

This all confers on psychophysical investigation an enlarged ontology, a metaphysical foundation different from the purely physicalistic. As a result, there are fundamental epistemological consequences. Among these is the recog- nition that the ‘reality’ surrounding even the most basic perceptual events is not readily reducible to the physics of electromagnetic radiation. This is less an invitation to have the ghost enter the machine than a willingness to accept that the ghost is less mechanical than once thought.

To mention to psychologists the interplay of different factors in shaping a given outcome is to excite within most of them the nearly sacred image of the analysis of variance design. To go on to note that this sort of statistical manip- ulation is quite uncommon in science at large—used mostly by those working with, for example, X-ray scatter—is to find them undaunted. I recall a graduate student some years ago, liberated enough to accept that what he was interested in studying was likely to depend on just what persons are actually dealing with in life outside the laboratory, devising this strategy: the subjects would be instrumented in such a way as to hear an alarm, stop whatever they were doing, and then answer a set of questions. At no point did the student or his mentor understand the cause of the laughter confined to one or two witnesses to this proposed strategy. There seemed to be no thought about how such an arrange- ment would relegate ways in which research participants conducted themselves, given that their conduct would likely be distracted and shaped by the mode of

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194 THEORY & PSYCHOLOGY 17(2) inquiry itself. Bad science is such serious business as to leave its practitioners woefully deficient in witty but incisive self-criticism.

It will take a generation or longer for psychology-at-large to come to grips with the difference between statistics and measurement; between knowing the incidence of ‘ X ’ and the nature of ‘ X ’. Something is learned, of course, when we know the frequency with which events occur or the degree of coincidence between and among them. Insurance companies traffic in this sort of informa- tion all the time. But to assess how often something happens is not to know its magnitude, its place within the larger ontological framework of what there is, the ‘whatness’ of an event. When the psychophysicist constructs a frequency- of-seeing curve, the ordinate is indeed rendered as ‘percent seen’. But this is related to the physical magnitude of the stimulus. Moreover, ‘percent seen’ is, at least in principle, a figure that can be translated into, for example, ‘percent photopigment bleached’, itself subject to translation into, for example, ‘optic nerve discharge rate’, and so on. The measures are not ‘statistical’ as such, and the paradigm is assuredly not that of ANOVA.

Merely to invoke such a point of comparison is to stand too close to the threshold of foolishness. Multivariate statistical designs are mechanical approaches to problems already stripped of their realistic features. They offer the fool’s gold of confidence levels which pertain not to the confidence we might have that we’re on to something real, but only to the confidence we might have that, if we keep doing things this way, we’ll keep getting this as a reward for our efforts. That ‘everybody’s doing it’ should, of course, be alarming. It is sufficient to note that, before it died, the field of phrenology could boast more than a score of journals, most of them ‘peer review’.

In cynical and patronizing moments—lengthy or transient, depending on one’s choice of colleagues—the right answer to the question of what one might contribute to ‘the mainstream’ is: drain it . Then, with its minions finally having their feet on terra firma , lead an orderly march toward libraries and life. The libraries are the repository of failed attempts to settle once and for all the abiding questions; the repository of utterly successful attempts to trivilialize reality to such an extent as to make it seem simple; the repository of those few successful attempts to render the affair clearer and approachable.

If the diagnosis thus far is at all on target, something should be said of the aetiology which, in this case, is the very schooling of psychologists. What psychology’s mainstream provides by way of training is ultimately at the for- feiture of educating . Much of ‘higher education’ today would have been regarded as trite by junior high school students a half-century ago, and the discipline of psychology surely offers no counter to this. At the doctoral level in psychology, the already poorly instructed are now paced through ‘fields’ so intellectually barren as to render the product of it all ill-suited to an academic life. I have more to say on related matters in the following section.

On the verge of a rant, I had best return to the core ontological question: for there to be a discipline or field replete with theory and research and

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ROBINSON : THEORETICAL PSYCHOLOGY 195 denominated ‘psychology’, we should be clear as to what entities or events comprise it. To put it another way, is there any natural kind of entity properly conveyed to psychology for study? It is profitable for psychologists to ask with persistence just what sort of being or creature is the object of their inter- est, and whether such a creature might have a nature that may flourish or become degraded under broad and definable cultural and political conditions. As regards this question, cultural relativists need not apply, for if all things ‘psychological’ vary with local norms and long tradition, we’re back to the fads and fashions of history and surely not a systematic and scientific inquiry into psychological reality. The weather, too, is fickle, but meteorology is nonetheless a scientific undertaking, in possession of predictive and explica- tive laws. Psychology stands as a discipline only to the extent that it is pre- pared to accept something foundational and then to examine the conditions that find it flourishing or failing. If there is a visible obstacle to the attainment of this perspective and this degree of maturity, it is the traditional departmen- tal organization of thought to which I now turn, again all too briefly.

Institutional Considerations

On the whole, departments were among the damaging bequests of the 19th- century German model. The departmentalization of thought, including its narrowing by doctoral programs of research, would come to yield scholarship and scientific discovery of a very high order. Much of Newton’s best thinking was done on granny’s farm and in the solitude of his rooms at Cambridge. But the world of science and scholarship as we know it is not the product of the occasional and eccentric genius. It arises from the very institutionalization of research, the creation of scientific guilds, the designated roles of apprentices and masters, and the ever-growing number and variety of individual, corpo- rate and national patrons.

On the whole and at the practical level, the effects here have been dramatic and positive. At the cultural level, the story is more subtle and the progression of outcomes rather more worrisome. Science and technology yield tools. Their use falls into many hands, some horrifically skillful in their destructive agility. The limitations of space are especially frustrating here, and brevity will certainly convey what is not intended. I wish to say that, for all its faults and its false starts, a higher level of civilization includes and seeks to install a higher level of moral sensibility, a heightened respect for the other, aware- ness that powers entail duties, and that vulnerabilities create protective rights. Chivalry, recall, gave Europe a gentility, an etiquette, a gracefulness that did not eliminate evil but surely tamed its vulgarity.

Civilization is the product of forces that are civilizing , which means forces rendering one ever more fit for a life that is civic . When the ancient Greeks declared, Polis andra didaske —that we are taught and shaped by the city—they

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196 THEORY & PSYCHOLOGY 17(2) were recording their awareness of the extent to which the psychological depends on the civic. Of all disciplines, therefore, it is psychology that pays the heaviest price for abandoning that reality in which the psychological dimensions of life are most fully expressed and most fully shaped. This is not an invitation to expand course offerings in ‘cultural psychology’ (typically a buffet of fashion and fable). It is instead a warning about ‘course offerings’ per se and the culturally and intellectually narrowing effects of departmental modes of teaching and study.

Consider today’s psychology departments and their curricular offerings. Pick any college or university; they’re all pretty much the same. Examine what is now on offer and then try to get hold of the programs that were dom- inant, say, thirty years ago. Where Freud and Skinner once dominated, we now find ‘cognitive neuroscience’, which, oddly, makes even less contact with lived life than did Freud and Skinner. Say what you will about Walden Two , there’s more to it than functional neuroanatomy. Granted that the over- all level of civilization sustained by Skinnerian ‘token economies’ would soon bore even the lower primates, there is still an element of shared life, social interaction, and at least the possibility of a breakout.

To this must be added a word about money, for this is, alas, what preserves the institutionalization of thought. But aren’t grants wonderful? Do they not liberate serious scientists from the burdens of teaching? Doesn’t that gener- ous ‘indirect cost’ category allow academic institutions to enhance the facili- ties for study and research? It was Henry Louis Mencken who defined Puritanism as ‘the haunting feeling that someone, somewhere, may be happy’. I do not wish to rob today’s psychologists of the comforts created by grants, or the happiness and exhilaration they seem to experience when learn- ing that their grant applications have been approved. Nor would I strip doc- toral students of the subsidies made possible by these grants. I would, however, offer these observations which may apply to a greater number of instances than we would wish to believe:

1. The ‘culture’of grant-getting and grant awards tends to reward the pre- dictable, the safe, the mundane and the trite. In order to win grants and then renewals, investigators must be ‘productive’, meaning they must publish reg- ularly in peer-review journals. The expected rate of publication guarantees that the publications themselves will seldom rise higher than the predictable and will seldom add much to what was published earlier.

2. The collegial bonds forged by the culture of grant-getting is such that research specialists are more closely associated with those working in the same ‘field’ than those in their own departments, let alone those in their own colleges and universities. There is little by way of shared allegiances, common cause, mutual intellectual influence. Thus is today’s academic an essentially entrepreneurial type, able to pay for his/her own upkeep and ready to move the operation to a more congenial (‘supportive’) venue. Undergraduates? Oh, they’re everywhere; not to worry.

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ROBINSON : THEORETICAL PSYCHOLOGY 197 3. Persons eager to be liberated from the burdens of teaching should really be liberated from academic life. Those needing additional space, staff, facili- ties and subventions should understand that their needs and demands may be serving nothing grander than their own ambitions.

4. To institutionalize a practice is inescapably to bureaucratize it. Where large sums of mo

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MAJOR PAPER-FINAL

  

Major Paper – FINAL

DUE: May 19, 2019 11:55 PM

Grade Details

  

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N/A                      

 

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Assignment Details

  

Open Date

Apr   1, 2019 12:05 AM

 

Graded?

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Points Possible

150.0

 

Resubmissions Allowed?

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Top of Form

Assignment Instructions

Major Paper Assignment Instructions and Grading Rubric

This assignment meets the following Course Learning Objectives:

– Articulate basic drug terminology and drug taking behavior
– Identify the various addictive substances – legal and illegal – and their classifications
– Analyze the reasons people commonly abuse substances
– Analyze how substances affect the mind and body and society

In 2010, The American Academy of Pediatrics (AAP) released a policy statement addressing the complex relationships among children, adolescents, substance abuse, and the media. This assignment requires a critical examination of the AAP publication and a critique of a media portrayal of substance use, with links made to the AAP statement and course material. Conclusions about the implications of the media portrayals and the policies recommended by the AAP also should be made. Successful completion of this paper will require work over multiple weeks.  A two paragraph summary of the proposed example of substance use portrayal in the media was due by the end of Week 3. The full paper is due at the end of Week 7.

 

This is part one of the assignment that you did

 

This assignment proceeds in four steps: 

 Preparation

 Step One: Read the AAP Policy Statement located below. Make some notes for yourself about points of agreement or disagreement you have with the statement and specific findings regarding media depictions of substance use that you want to assess when you write the paper. 

 

 Step Two: Find a current example of substance use portrayal seen in the media; for example, scenes from a movie, a television show, or a commercial; print ads; or portrayals found in “new media” as discussed in the AAP article. The Internet is a good tool for finding film or television portrayals of substance use as well as examples of print ads if ready access to first-hand media is not available. A two paragraph summary of the proposed example of substance use portrayal in the media that will be used for the paper is due by the end of Week 3. This proposal is a separate assignment and is worth 10 points.

 Construction

 Step Three: Write the paper. Begin the paper with an introduction that summarizes the main findings of the AAP article and previews what will be covered in the coming pages. Next, compare and contrast the portrayal of substance use found in the media with the information learned about that substance in the class and course readings. What messages about the substance are being portrayed? How accurate are those messages relative to the actual data on substance use? Be sure to cite the course readings as needed.

 Continue by comparing and contrasting the portrayal of substance use found in the media with the criticism of media portrayals found in the AAP paper. Does the media example match their arguments or contradict them? What links and connections can be made? Be sure to cite the article as needed. 

 Next, draw some conclusions about the portrayal of substance use found in the media, addressing the following: What are the implications of this type of portrayal? What messages are being sent and to whom? Are those messages an accurate representation of the use of this substance? Should media portrayals be required to be accurate in their depictions of use, showing both positive and negative consequences? 

 Finally, review the guidelines suggested by the AAP at the end of their policy statement and address the following: Although directed specifically at pediatricians, which of those recommendations is most important? Why? Are these recommendations necessary? If followed, will they be effective in addressing the concerns raised earlier in the article? Be sure to cite sources as needed.

 Step Four: 

The required length of this paper is 11 pages, plus a required a cover page and a reference list. Papers must comply with APA formatting rules, including font size and margins, and must have a scholarly focus and tone.  Quoting of published material and use of the first-person “I” are not permitted and will result in point loss. All source material must be paraphrased into your own words and cited appropriately. 

 On submission your work will auto-run through Turnitin.com’s plagiarism checker software.    

 The grading rubric below details specific grading criteria.

The Final Major Paper document should be attached in the appropriate Assignment tab and will be evaluated using the rubric below: 

  

Component

Excellent

Satisfactory 

Needs Improvement 

Unsatisfactory 

Points Earned

 

Introduction

15 Points Possible

Student provides a clear   introduction which summarizes the AAP article and previews the major points   to be covered in the paper.   

Student provides a mostly accurate   introduction which summarizes the AAP article and previews the major points   to be covered in the paper. At times description lacks coherence. 

Student provides a marginal   introduction which summarizes the AAP article and previews the major points   to be covered in the paper. Sufficient details and supporting evidence are   lacking.

Student does not provide an   introduction which summarizes the AAP article or preview the major points to   be covered in the paper.

 

Choice of Media Example

15 Points Possible

Discussion of chosen media   portrayal is clear, accurate, and related to the assignment. Sources are   credited and cited appropriately.   

Discussion of chosen media   portrayal is mostly accurate, and related to the assignment. Sources are   credited and cited. At times description lacks coherence. 

Discussion of chosen media   portrayal is marginally accurate, and related to the assignment. Sources   are credited and cited but not using appropriate formatting. Sufficient   details and supporting evidence are lacking.

Student does not chose a media   portrayal that is accurate and/or related to the assignment. Sources not   credited and cited.

 

Comparison of Media Example to   Class Material

25 Points Possible

Student provides a comparison of   media with information from class material that is clear and   thoughtful. Questions outlined in the assignment are   answered. Sources are credited and cited appropriately.   

Student provides a mostly accurate   comparison of media with information from class material that is largely   clear and thoughtful. Questions outlined in the assignment are mostly   answered. Sources are credited and cited appropriately. At times   description lacks coherence. 

Student provides a marginal   comparison of media with information from class material that is partial   clear and thoughtful. Questions outlined in the assignment are   marginally answered. Sources are credited and cited appropriately.   Sufficient details and supporting evidence are lacking.

Student does not provide a   comparison of media with information from class material. Questions   outlined in the assignment were not answered.

 

Comparison of Media Example to AAP   article

25 Points Possible

Comparison of media presented by   the student with information from the AAP article is clear and   thoughtful. Questions outlined in the assignment are   answered. Sources are credited and cited   appropriately.   

Comparison of media mostly presented   by the student with information from the AAP article is mostly clear and   thoughtful. Questions outlined in the assignment are mostly   answered. Sources are credited and cited appropriately. At times   description lacks coherence. 

Comparison of media marginally   presented by the student with information from the AAP article is mostly   clear and thoughtful. Questions outlined in the assignment are   marginally answered. Sources are credited and cited   appropriately. Sufficient details and supporting evidence are lacking.

Student did not compare media   presented with information from the AAP article. Questions outlined in   the assignment were not answered.  

 

Strength of Conclusion

40 Points Possible

Student provides an insightful and   creative conclusion, logically summarizing the main elements of the case   and the scholarly literature findings, articulating a personal reflection on   the case study analysis process

Student provides a mostly   cogent conclusion, logically summarizing the main elements of the case   and the scholarly literature findings, articulating a personal reflection on   the case study analysis process

At times description lacks   coherence. 

Student provides a   marginal conclusion, loosely summarizing the main elements of the case   and the scholarly literature findings, articulating a personal reflection on   the case study analysis process

Sufficient details and supporting   evidence are lacking.

Student does not provide a   clear conclusion or logically summarizing the main elements of the case   or reference scholarly literature findings; lacks a personal reflection on   the case study analysis process

 

Paper Format and Mechanics;   Spelling, Grammar and Punctuation

30 Points Possible

Work is presented in a logical and   coherent way. Writing is clear, articulate, and error free. Citations are   composed in proper format with few or no errors. Paper is the required   length, is double-spaced with 1-inch top, bottom, left and right margins, and   in Calibri or Times New Roman styles, size 12 font. Cover   page, paper body, citations and References are in the correct APA   format. There are few to no spelling, grammar, or punctuation   errors.

Work is grammatically sound with a   few minor errors. Citations are composed in the proper format with some   errors. 

Work contains frequent grammatical   errors. Citations are inaccurate or improperly formatted. 

Work does not demonstrate   appropriate graduate level writing. 

 

Summary Comments: 

Total Points:   (150   points total)

Supporting Materials

Submission

   

READING

Alcohol

One of the most problematic, licit drugs in our society is alcohol. The simple process of fermenting sugar from a variety of naturally occurring fruits and grains has been ubiquitous across cultures and societies since the beginning of civilization. It is so pervasive within our society as to also seem to be a seamless part of it. One cannot easily characterize a particular type of person or group that is likely to be alcohol dependent; the affliction cuts across all imaginable demographics of society. Some people are able to drink on occasion for pleasure, whether alone or with friends. Others drink on a daily basis; others periodically binge. 

Here’s a quick, 9-minute history of the science, creation and use of alcohol across cultures, courtesy of SciShow.com:

At present, it has been estimated that approximately 18 million Americans have a serious problem related to the use of alcohol. These 30% of all consumers of alcohol account for about 80% of all alcohol consumed. Men outnumber women in heavy alcohol use by a ratio of around three to one.

The heaviest users of alcohol, in turn, directly or indirectly impact an even larger percentage of the population with their subsequent behaviors while intoxicated. The costs of alcohol abuse and dependence are significant: this drug is the third leading cause of death and is implicated in over half of all deaths and injuries in car accidents and half of all physical assaults and homicides. Further, it has been estimated that at least four family members are directly affected from the maladaptive behaviors that follow from the alcohol-abusing individual; you can quickly begin to see extensive the social, familial, occupational, and emotional impact of this disorder. 

What’s the difference between alcohol abuse and alcohol dependence?

The initial psychiatric diagnosis that could be made for an individual that habitually uses alcohol to excess would be alcohol abuse. This diagnosis is characterized by the continued use of alcohol for at least a period of one month, despite having a recurrent physical problem or some serious personal problem in one’s social or occupational functioning because of the excessive drinking or the repeated use of alcohol in situations (e.g., driving) when consumption is physically hazardous.

The diagnosis of alcohol dependence reflects an even greater degree of impairment in individuals compared to alcohol abuse. Alcohol dependence typically involves at least three of the following serious circumstances: (1) drinking alcohol in greater amounts and over a longer period of time than intended by the individual; (2) a strong desire by the individual to reduce consumption and several unsuccessful attempts to do so; (3) spending a great deal of time drinking or recovering from the negative effects of excessive drinking; (4) continued drinking even though physical and/or psychological problems are apparent and problematic in the individual’s life; (5) social, work, or recreational activities have been significantly reduced or abandoned because of excessive drinking; (6) the development of marked tolerance for alcohol; and (7) consumption of alcohol specifically to avoid the symptoms of withdrawal. About 15 percent of men and 10 percent of women in the United States have met the diagnostic criteria for alcohol dependence during their lifetime.

How does alcohol affect the brain?

Alcohol, as a drug, acts as a depressant on the individual’s central nervous system. It is a small molecule and is quickly absorbed in the bloodstream. Alcohol is linked to inhibiting receptors for the neurotransmitter GABA. In low doses, alcohol depresses the inhibitory functions of the brain, including those areas of the brain that typically adhere to the social controls and inhibitory rules that people typically follow in society. As the alcohol concentration increases in the bloodstream, the depressive function of alcohol extends from the cerebral cortex to areas of functioning that are further (and deeper) into the brain’s primitive and reflexive areas of functioning. In extreme dosing, inhibition of respiratory and motor centers can occur with other symptoms that include stupor or unconsciousness, cool or damp skin, a weak rapid pulse, and shallow breathing. It should be noted that alcohol can only be metabolized and leave the body at a specific rate, regardless of how quickly (or how much) alcohol has been taken in by the individual, so attempts to quickly “sober up” an individual will be unsuccessful.

For more illustration of the science and physical problems associated with habitual alcohol consumption, check out this 4-minute SciShow.com video:

What are the behavioral effects of using alcohol?

Individuals experiencing alcohol intoxication will exhibit a variety of maladaptive changes in their behavior and psychological functioning. Examples include inappropriate sexual or aggressive behaviors, impaired judgment, quickly changing moods, incoordination, impaired gait, slurred speech, impaired attention and memory (sometimes to the point of blackout), stupor, and unconsciousness. The degree of symptoms is dose dependent with more pronounced symptoms occurring as the alcohol blood-level increases.

Withdrawing from alcohol intoxication (i.e., a hangover) is also dependent on recent dosing, history of chronic abuse, and involves a variety of symptoms which can include autonomic hyperactivity in the form of profuse sweating and rapid heartbeat, hand tremors, nausea or vomiting, fleeting illusions or hallucinations, psychomotor agitation, anxiety. At worst, grand mal seizures can occur following periods of prolonged and heavy use. Another significant withdrawal phenomenon that chronic, prolonged abusers of alcohol can experience is delirium tremens that is characterized by disturbances in cognitive functions (especially consciousness), autonomic hyperactivity, vivid hallucinations, delusions, and agitation.

Chronic alcohol dependence can lead to a medical condition known as Alcohol-Induced Persisting Amnestic Disorder (also known as Wernicke-Korsakoff’s Syndrome). This disorder is believed to be caused by deficiencies in thiamine and Vitamin B because their absorption in blocked with habitual alcohol consumption. Individuals afflicted with this disorders experience retrograde (the past) and anterograde (new knowledge) amnesia as well as confabulation, which is the tendency to attempt to compensate for memory loss by fabricating memories.

What are some of the life problems associated with heavy alcohol use?

The pervasive impact of chronic alcohol abuse can be seen across several important areas of in life that generally impair one’s ability to function adaptively (i.e., take care of oneself in a manner appropriate for one’s age) and experience a good quality of life. It is a complex problem in living with psychological, physical, and behavioral components. These include (1) demonstrating a preoccupation with alcohol and drinking; (2) demonstrating emotional problems (e.g., depression); (3) having overt problems at work, within one’s family, and other important social relationships because of alcoholism; and (4) associated physical problems that result from habitual alcohol consumption.

Given that alcohol is a central nervous system depressant, it shouldn’t be a surprise that depression can become a comorbid (or co-occurring) condition for some individuals. In general, the incidence of depression in substance abusers is quite high. People who drink alcohol heavily to the point of intoxication can experience very strong emotions and are frequently disinhibited (i.e., impulsive). Feelings of hopelessness, helplessness, and suicidal thoughts often accompany bouts of heavy drinking.

To review the relationship among amount (dosing) of alcohol consumed, blood alcohol levels, and effects on the central nervous system and behavioral performance, check out this five-minute Healthy McGill video here:

Who is at greatest risk for abuse or dependence?

Research has demonstrated that two risk factors can contribute significantly to the manifestation of alcohol abuse and dependence in the individual. The first risk factor is a family history of chronic alcohol abuse. Children of alcoholic parents have a higher statistical risk of becoming alcoholics themselves when compared to children of nonalcoholic parents. Whether this represents an increase genetic or environmental risk, however, is difficult to determine since both are intertwined in such instances. A second and independent risk factor that has been identified is those cases where an individual has a genetic predisposition to have low response to the psychoactive effects of alcohol (and, as a result, requires higher amounts of alcohol to become intoxicated). Individuals with this lower response to alcohol are more likely to abuse alcohol, as they require considerably more drinking to obtain the level of intoxication experienced by others who drink less to get the same effect.

When taken together, an adult child of an alcoholic who also possesses a low response to the effects of alcohol has an even higher statistical chance of developing a pattern of alcoholism. Keep in mind that all of these examples are just risk factors and statistically probabilities – none of these outcomes are written in stone. Further, research demonstrates that there are also protective factors (variables) in the environment that can also help promote resiliency in some individuals and lead them not to drink alcohol in an excessive or maladaptive fashion when they are present. Clearly, again, the path to alcoholism (and responsible drinking and abstinence) is multi-factorial.

What are some of the treatment options for Alcohol Dependence?

        Unfortunately, flaws in methodology jeopardize much of the research on the effectiveness of alcohol treatment programs. That is, the studies aren’t well controlled in terms of error variance and it cannot be clearly determined whether the observed changes in the studies are due to the employed treatment or other, uncontrolled, factors during the study. For example, many studies do not use untreated comparison groups. One generalization that can be made from the available research is that formal treatments are not always adequate or even necessary. A positive outcome to treatment appears to be related more to the presence of certain psychosocial factors like specific threats to one’s physical or social well-being (i.e., hitting “rock bottom”) than any particular intervention. 

        There are, however, some treatments that have had some success. These treatments have several components in common, including covert sensitization and other forms of aversive counterconditioning. Antabuse, for example, is a medication that, when taken, will result in an individual becoming violently ill should they consume alcohol. Other treatments that put together broad-spectrum interventions such as social skills training, learning to drink in moderation, stress management techniques, and teaching coping skills and other self-control techniques help to teach the individual better, healthier alternatives methods when faced with environmental triggers to consuming alcohol.

        Many modern programs incorporate aspects of Alcoholics Anonymous and/or the drug Antabuse. However, the effectiveness of these treatments has not been empirically demonstrated. One criticism that has been levied on these treatments is that they do not take into account individual differences and the wide variety of psychosocial problems and/or lack of resources that can make successfully managing alcohol consumption. In general, individuals with severe problems with alcohol require more intensive treatments (e.g., inpatient hospitalization), while those who experience less pathological problems require more periodic, milder interventions.

        Another criticism that has been raised about some current treatment programs for alcohol abuse and dependence is that they tend to be based on the belief that failures in treatment are largely due to the individual’s denial of having a problem or otherwise not having an adequate level of motivation. Many therapists have not supported this line of thinking, however. Research on treatment outcome, alternatively, points to the importance of therapist factors such as their level of empathy toward clients and their attitudes about what constitutes healthy recovery as being more related to positive outcomes than client’s own motivation or personality characteristics. 

        Some experts in the field of alcohol research have emphasized the importance of the clients’ reaction to instances of relapse, especially from a cognitive (how they think) and emotional (how they feel) perspectives.  Researchers stress the need to get away from the idea that a relapse represents a “violation of abstinence” which can lead to anxiety, depression, self-blame and an increased likelihood of further alcohol consumption. Alternatively, relapses should be characterized as a mistake that came about from external, controllable factors and not the result of internal factors (e.g., personality characteristics) that are essentially thought to be out of one’s control.

Dually diagnosed individuals (those with a mental illness or personality disorder in addition to a substance abuse disorder) usually have a hard time finding treatment in one place. In many jurisdictions, they have to see a therapist at a mental health center and a separate therapist at a substance abuse center, or they are forced to make a choice of one over the other. You will find that there is often a lack of cross-training between mental health and substance abuse professionals, and that makes it harder for clients to get the treatment they need. Furthermore, in some places, you may find that the treatment support groups for substance abuse have an interpretation of sobriety that prohibits the use of psychotropic medication.

Legal Drugs in Our Society – Part II

        Hopefully, you have found the historical account to date of which drugs have largely been considered illicit, those that have typically been licit and readily available, and those that have switched from one designation to the other, to be an interesting review. Such distinctions among different groups of people and across different periods of time often speak to the changing cultural, social, religious, and scientific beliefs and morays of the time. This week, you will be studying two very popular and legally sanctioned drugs, tobacco and caffeine, that have been readily consumed by people since the beginnings of structured societies. 

Tobacco

From its use in religious ceremonies and purported medicinal herb thousands of years ago to the image of sophistication and modernism it has held in industrialized societies over the last few hundred years, tobacco has occupied a role of prominence among individuals and groups alike.  Think about it: what other drug has been so popularized in society as to be physically accommodated with lighters and ashtrays in automobiles and airplanes? What about spittoons in the restaurants and bars of the late 1800s and early 1900s? How about the smoking cars in trains and smoking sections at airports and restaurants? All these examples serve to demonstrate just how indoctrinated tobacco use has been in modern culture. 

How did tobacco, the plant, get to be such a big deal? Check out this 8-minute history and science video from DNews Plus:

How have patterns of tobacco use changed over the decades in the United States and the world? What are some of the reasons for these changes?

Tobacco is interesting and noteworthy in that it is one of the only drugs that has been commercially available, openly accessible, and integrated within the culture of many societies for hundreds and hundreds of years. Further, it has been monetized as a commodity with economic value for the purposes of trade and payment of debts. In some circles, over time and across cultures, tobacco was even used as its own form of currency. In fact, one could certainly argue that the colonization, formation, and military defense of the United States of America occurred largely in part through the economic power generated through tobacco cultivation, sale, and distribution to other European countries.

It is interesting to note the relationship between the amount of government regulation that exists with the tobacco industry and the resultant use by population. There is a clear relationship between the growing regulation in the United States that began in the early 1970s and the eventual decline of tobacco use among large segments of the U.S. population. This can be especially seen in new generational cohorts; that is, the adoption of chronic smoking habits by younger people. Many other European and South American countries do not employ such heavy restrictions on the advertisement, marketing, and accessibility of cigarettes and other tobacco products upon their population. As a result, the decreases in use and dependence that have been realized in the United States have not been generalized to other countries across the world. The zenith of tobacco use in the United States has come and gone. The preponderance of research has clearly demonstrated its pathological effect on the body and that information, plus rigorous regulation, has helped contribute to the decline in its use.

There are a variety of ways to consume tobacco products as a vehicle by which to introduce the drug nicotine into the bloodstream and the brain. Smoking (via cigars, pipes, and cigarettes), chewing, and snuffing are all legitimized drug-using behaviors whose differing favorability has waxed and waned over the years. Over the years, most individuals were shaped into eventually preferring the use of tobacco cigarettes, which could be mass-produced in very high volumes inexpensively.

The intense and intentional role of marketing has been very significant in shaping the appeal to certain demographic groups of the population. The aggressiveness of early mass marketing campaigns also extended themselves, ultimately, to the denial and cover up by corporate America with regards to the deleterious effects of tobacco use. It wasn’t until 1964 that the federal government began to formally investigate the health effects and cost of tobacco use and to institute policies that would eventually lead to the restriction of marketing and sales in the United States. 

What are some of the adverse consequences of smoking?

The deleterious effects, both physically and psychologically, that result from chronic tobacco use have been well documented. The three-fold combination of carbon monoxide, tar, and nicotine can produce a wide variety of lifelong physical ailments, including a higher risk for cardiovascular disease, respiratory disease, and lung cancer than for nonsmokers. As is widely popularized, there are literally thousands of chemical found in cigarette smoke, including ones commonly used in pesticides. Additionally, other forms of cancer have also been implicated with chronic tobacco use. In fact, the vast majority of deaths each year that can be attributed to drug use and dependence are the result of tobacco use and nicotine dependence.

The primary psychoactive drug in tobacco, nicotine, has been determined by research trials to be a dependence-producing substance. As you recall from previous lectures, drug dependence is defined by continued use of a drug even in the face of obvious occupational, physical, familial, and social problems that one experiences in direct relation to its use. This also includes the psychological experience of craving and high drug-seeking behaviors. The rate at which nicotine is absorbed into the blood stream and penetrates the blood-brain barrier certainly speaks to its strong psychoactive properties. Withdrawal symptoms begin as early as six hours after the last dose. Within 24 hours, common complaints can include headache, irritability, problems concentrating, and sleep disturbance. Finally, in the late 1990s, the tobacco industry finally conceded publically that the products they were producing were not only physically harmful to individuals but also that the nicotine contained within then was a dependence-inducing substance.

What are some of the best strategies to employ when attempting to stop using tobacco products?

    You know just how difficult it is to treat nicotine addiction in terms of a smoking cessation program. The research has demonstrated, much like successful treatment programs for other types of drugs, that have a high degree of dependence, that a multimo

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work

  

To complete this assignment, you will need to access to the following databases: CINAHL, MEDLINE, Cochrane Library, and the Joanna Briggs Institute. I

know you can do this work, so don’t go short cut and mess it up. Research each heading and complete.

See the article I attached. Find more articles to complete to complete this work.

As a writer, you should first write a good introduction for each topic briefly say the story you about to tell, the subjects you going to talk about. 

You then tall this story by each subject.

You summarize all the story for conclusion

Don’t do lazy work no beginning , no end. Don’t be repetitive to fill the page 

Don’t copy old work

Don’t give me somebody’s work. I will know.

Grammer has got to improve. I end up deleting all work in the process of editing. Most time work below college level. I mean it. And sometimes it can be accepted at masters level.

1: Distinguish selected factors affecting U.S. healthcare delivery systems and organizations 

Introduction: Find good article

 1.

2.

3.

2: Examine factors affecting healthcare finance and payment systems 

Introduction

 1.

2.

3.

 3: Evaluate selected healthcare policy models and frameworks 

Intrduction: Find good article

Suptopics

 1.

2.

3.

4

5

6

7

4: Formulate strategies for coalition building and health advocacy 

Intrduction: Find good article

 1.

2.

3.

5: Synthesize selected policy analyses affecting advanced practice nursing

Intrduction: Find good article

 1.

2.

3.

Inclusion of all story work

Examples

Increased health insurance coverage

Payer pressures to reduce costs

• Medicare physician services payments are based on fee schedule (Resource Based Relative Value Scale, or RBRVS).

Change from “reasonable cost” to prospective payment system based on diagnosis related groups for hospital inpatient services begins under Medicare

Interview conducted and issues highlighted. Find issues in the policy or issues you can associate to the yellow highlighted in box

  

High staffing turnover

Diabetics patients are noncompliant   with medication is more predominant

The   facility denies any safety concerns

There is high staff turnover

No diabetics education protocol or   policy in 

place for the old and newly diagnosed   diabetics 

Facility   denies and sentinel event

Yes

The   relationship is good. Staff are not expected to take short cuts

Management   is open for suggestions or improvements

Examples:

Staff   members are not mistreated

Electronic health Record is not in   use, No plans for one. Still using   paper medical records

No   further issues

Diabetic education for noncompliant   diabetics patients

 

Very good role model

The nurse leader will be good preceptor

Transformational leadership

yes

  

Category

Points

%

Description

 

Introduction

Introduces the   interview, purpose of the interview, and provides rationale for engaged   interview process.

To determine existing   practice problem within the organization

 

Description   of Policy Issue

Please discuss the organizational assessment and how   you decided upon this particular policy. Also include any subtopics regarding   selected healthcare policy issue. Use examples from the interview that   support your assertions and relevant examples from your practice situation.

 

Presentation of Policy Analysis

Include eight subtopics regarding selected   healthcare policy analysis pathway. Summarize your subtopics using examples   from the interview that support your assertions as well as relevant examples   from your practice situation.

 

Conclusion

An effective conclusion identifies the main ideas   and major conclusions from the body of your report. Minor details are left   out. Summarize the benefits of the selected policy analysis to nursing   practice.

 

Clarity of writing

Use of standard English grammar and sentence   structure. No spelling errors or typographical errors. Organized around the   required components using appropriate headers.

 

APA   format

All information taken from another source,   even if summarized, must be appropriately cited in the report (including   citation of interview) and listed in the references using APA (6th   ed.) format:

1. Document setup

2. Title and reference pages

3. Citations in the text and references.

 

Total:

250

100%

A quality report will   meet or exceed all of the above requirements.

There are more than 9000 billing codes for individual procedures and units of care. But there is not a single billing code for patient adherence or improvement, or for helping patients stay well.”

Clayton M. Christensen

Health care financing in the United States is fragmented, complex, and the most costly in the world. The Affordable Care Act (ACA) of 2010 takes some steps to reshape how health care is paid for, but its primary purpose is to extend insurance coverage to approximately 30 million uninsured Americans through private insurance regulation, expansion of pubic insurance programs, and creation of health insurance marketplaces to foster competition in the private health insurance market. As the ACA is implemented, making health insurance more affordable and containing the rise in health care costs are significant ongoing policy challenges in system transformation. This chapter will provide an overview of the current system of health care financing in the United States, including the impact of the ACA.

Historical Perspectives on Health Care Financing

Understanding today’s complex and often confusing approaches to financing health care requires an examination of the nation’s values and historical context. Some dominant values underpin the U.S. political and economic systems. The United States has a long history of individualism, an emphasis on freedom to choose alternatives and an aversion to large-scale government intervention into the private realm. Compared with other developed nations with capitalist economies, social programs have been the exception rather than the rule and have been adopted primarily during times of great need or social and political upheaval. Examples of these exceptions include the passage of the Social Security Act of 1935 and the passage of Medicare and Medicaid in 1965.

Because health care in the United States had its origins in the private sector market, not government, and because of the growing political power of physicians, hospitals, and insurance companies, the degree to which government should be involved in health care remains controversial. Other developed capitalist countries, such as Canada, the United Kingdom, France, Germany, and Switzerland, view health care as a social good that should be available to all. In contrast, the United States has viewed health care as a market-based commodity, readily available to those who can pay for it but not available universally to all people. With its capitalist orientation and politically powerful financial stakeholders, the United States has been resistant to significant health care reform, especially as it relates to expanding access to affordable health insurance.

The debate over the role of government in social programs intensified in the decades after the Great Depression. Although the Social Security Act of 1935 brought sweeping social welfare legislation, providing for Social Security payments, workman’s compensation, welfare assistance for the poor, and certain public health, maternal, and child health services, it did not provide for health care insurance coverage for all Americans. Also, during the decade following the Great Depression, nonprofit Blue Cross and Blue Shield (BC/BS) emerged as a private 173insurance plan to cover hospital and physician care. The idea that people should pay for their medical care before they actually got sick, through insurance, ensured some level of security for both providers and consumers of medical services. The creation of insurance plans effectively defused a strong political movement toward legislating a broader, compulsory government-run health insurance plan at the time (Starr, 1982). After a failed attempt by President Truman in the late 1940s to provide Americans with a national health plan, no progress occurred on this issue until the 1960s, when Medicare and Medicaid were enacted.

BC/BS dominated the health insurance industry until the 1950s, when for-profit commercial insurance companies entered the market and were able to compete with BC/BS by holding down costs through their practice of excluding sick (with preexisting conditions) people from insurance coverage. Over time, the distinction between BC/BS and commercial insurance companies became increasingly blurred as BC/BS began to offer competitive for-profit plans (Kovner, Knickman, & Weisfeld, 2011. In the 1960s, the United States enjoyed relative prosperity, along with a burgeoning social conscience, and an appetite for change that led to a heightened concern for the poor and older adults and the impact of catastrophic illness. In response, Medicaid and Medicare, two separate but related programs, were created in 1965 by amendments to the Social Security Act. Medicare is a federal government-administered health insurance pro­gram for the disabled and those over 65 years (Kaiser Family Foundation [KFF], 2014c), and Medicaid, until recently, has been a state and federal government-administered health insurance pro­gram for low-income people, who are in certain categories, such as pregnant women with children.

Government Programs

Current Public/Federal Funding for Health Care in the United States

In the United States, no single public entity oversees or controls the entire health care system, making the payment for and delivery of health care complex, inefficient, and expensive. Instead, the system is composed of many public and private programs that form interrelated parts at the federal, state, and local levels. The public funding systems, which include Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), the U.S. Department of Veterans Affairs (VA), and the Defense Health Program (TRICARE) for military personnel, their families, military retirees, and some others, continue to represent a larger and larger proportion of health care spending. Other examples of federal programs are the Indian Health Service, which covers American Indians and Alaskan Natives, and the Federal Employees Health Benefits (FEHB) Program, which covers all federal employees unless excluded by law or regulation.

Federal health expenditures for these programs totaled $731.6 billion or 26% of all health care expenditures in 2012 (Martin et al., 2014). Medicare outlays were $572.5 billion in 2012 and accounted for 20% of all national health care expenditures with Medicare Advantage (a Medicare-managed care program provided by insurance plans that can be chosen by beneficiaries instead of the traditional Medicare program) growing most rapidly (Martin et al., 2014). Medicaid outlays in 2012 were $412.2 billion and accounted for 15% of total national health care expenditures, and its spending growth also decelerated that year (Martin et al., 2014).

Medicare

Before the enactment of Medicare in 1965, older adults were more likely to be uninsured and more likely to be impoverished by excessive health care costs. Half of older Americans had no health insurance; but by 2000, 96% of seniors had health care coverage through Medicare (Federal Interagency Forum on Age-Related Statistics, 2000).

Medicare had a beneficial effect on the health of older adults by facilitating access to care and medical technology, and, in 2006, prescription drug coverage helped improve the economic status of older adults. The percentage of persons over age 65 years living below the poverty line decreased from 35% in 1959 (when older adults had the highest poverty rate of the population) to 9% in 2012 (U.S. Census Bureau, 2014).

174

Americans are eligible for Medicare Part A at age 65 years, the age for Social Security eligibility, or sooner, if they are determined to be disabled. Medicare Part A accounted for 31% of benefit spending in 2012 and covers 52 million Americans. Medicare Part A covers hospital and related costs and is financed through payroll deduction to the Hospital Insurance Trust Fund at the payroll tax rate of 2.9% of earnings paid by employers and employees (1.45% each) (KFF, 2014a). Medicare Part B, which accounted for approximately one third of benefit spending in 2012, covers 80% of the fees for phy­sician services, outpatient medical services and supplies, home care, durable medical equipment, laboratory services, physical and occupational therapy, and outpatient mental health services. Part B is financed through subscriber premiums and general revenue funding as well as cost-sharing with beneficiaries.

Medicare Part C, or the Medicare Advantage Program, through which beneficiaries can enroll in a private health plan and also receive some extra services such as vision or hearing services, accounted for 23% of benefit spending in 2012 and had more than 14.1 million enrollees, or 28% of all Medicare beneficiaries in 2013 (Medpac, 2013). Medicare Advantage enrollment has been increasing and is up 30% since 2010 (KFF, 2014a). Extra payments that the federal government has made to private Medicare Advantage Plans are due to be phased out by the ACA, raising concerns that insurers will drop their Medicare Advantage Plans as a result.

Medicare Part D is a voluntary, subsidized outpatient prescription drug plan with additional subsidies for low- and modest-income individuals. It accounted for 10% of benefit spending in 2012 and enrolled 39 million beneficiaries in 2013 (KFF, 2014a, 2014b). Figure 18-1 presents Medicare benefit payments by type of service in 2012 (KFF, 2014a). Medicare Part D is financed through general revenues and beneficiary premiums as well as state payments for recipients who get both Medicare and Medicaid, also known as “dual eligibles” (KFF, 2014b). The ACA phases out the Medicare Part D “donut hole,” a period of noncoverage for prescription drugs that left many seniors unable to pay out-of-pocket for their medications.

FIGURE 18-1 Medicare benefit payments by type of service, 2012. (From Kaiser Family Foundation. [2014]. Retrieved from kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/.)

The ACA authorized that certified nurse midwives (CNMs) be reimbursed at 100% of the physician payment rate. Other advanced practice registered nurses (APRNs), including nurse practitioners (NPs), are paid 85% of the physician rate 175for the same services. In addition, Medicare will not pay for home care or hospice services unless they are ordered by a physician. And, unfortunately, the ACA required physician orders for durable medical equipment for Medicare beneficiaries.

Medicaid

Medicaid is the public insurance program jointly funded by state and federal governments but administered by individual states under guidelines of the federal government. Medicaid is a means-tested program because eligibility is determined by financial status. Before changes by the ACA, only low-income people within certain categories, such as recipients of Supplemental Social Security Income (SSI), families receiving Temporary Assistance to Needy Families (TANF), and children and pregnant women whose family income is at or below 133% of the poverty level were eligible. To qualify for federal Medicaid matching grants, a state must provide a minimum set of benefits, including hospitalization, physician care, laboratory services, radiology studies, prenatal care, and preventive services; nursing home and home health care; and medically necessary transportation. Medicaid programs are also required to pay the Medicare pre­miums, deductibles, and copayments for certain low-income persons who are eligible for both programs. Medicaid is increasingly becoming a long-term care financing program of last resort for older adults in nursing homes. Many older adults have to spend down their life savings to become low income and be eligible for Medicaid. Family and pediatric NPs and CNMs are also required to be reimbursed under federal Medicaid rules if, in accordance with state regulations, they are legally authorized to provide Medicaid-covered services.

In keeping with its goal to expand health insurance coverage to more Americans, the ACA expands eligibility for the Medicaid program to any legal resident under the age of 65 years with an income up to 138% of the federal poverty level. The intent of the health reform law was to have one eligibility standard across all states and eliminate eligibility by specific categories (Commonwealth Fund, 2011; Rosenbaum, 2011). The federal government has agreed to pay for nearly all the expansion costs to insure more low-income people. The U.S. Supreme Court, however, struck down the mandate to expand Medicaid and ruled that states could decide whether or not to expand the program. Figure 18-2 indicates that as of April 2014, 27 states had decided to expand Medicaid, 5 are still debating this, and 19 are not moving forward (KFF, 2014d). States that decide to opt out of the expansion can follow old federal guidelines for eligibility, leaving wide disparities in health insurance coverage between states and leaving uninsured large proportions of the population below 138% of the poverty level. Of the states that have opted out of expansion, all have Republican political leaders explicit in their opposition to the ACA, although Republican Governor Jan Brewer of Arizona pushed her state to expand Medicaid in 2013 so that 300,000 more poor and disabled residents of the state would have coverage (Schwartz, 2013). In many of the nonparticipating states, physicians, nurses, hospitals, and other health care organizations and stakeholders are pressuring their state governments to expand Medicaid as a way to improve access to health care for more low-income people.

FIGURE 18-2 State Medicaid expansion, November 2014. (From FamiliesUSA. [2014]. Retrieved fromfamiliesusa.org/product/50-state-look-medicaid-expansion; and Kaiser Family Foundation. [2014]. Retrieved fromkff.org/medicaid/fact-sheet/a-closer-look-at-the-impact-of-state-decisions-not-to-expand-medicaid-on-coverage-for-uninsured-adults/.)

CHIP was created in 1997 to help cover uninsured children whose families were not eligible for Medicaid. It has been funded through state and federal funds, but states set their own eligibility standards. The ACA commits the federal government to paying most of its costs, beginning in 2015, up to 100%. It also requires states to maintain their eligibility standards for CHIP (Emanuel, 2014). CHIP will be reauthorized in 2015, and, because it is expected that many more children will have gained coverage through family health insurance plans, debate is expected over the role of the program. CHIP is enrolling a record number of children now estimated to be one third of all children in the United States. Advocates want to maintain these high child health insurance rates until the ACA is fully implemented and full coverage for children under the provisions of the ACA is assured.

State Health Care Financing

State governments not only administer and partially fund some public insurance programs such as Medicaid and CHIP but they are also responsible for individual state public health programs. 176The definition of public health as compared with other types of health programs is not always well understood. The mission of public health as defined by the Institute of Medicine (IOM) is to ensure conditions in which people can be healthy (IOM, 1988). Whereas medicine focuses on the individual patient, public health focuses on whole populations. Medical care for the individual patient is associated with payment by health insurance, but population-based public health programs are funded by local, county, state revenues, often combined with grants from the federal government in areas such as maternal and child health, obesity prevention, HIV/AIDS, substance abuse, and environmental health. Even with a greater federal role in health care through the ACA, states will continue to have a major responsibility for the regulation of health insurance, health care providers and professionals, and public health activities.

Reduction of budgets for public health programs during times of fiscal constraint has resulted in the resurgence of infectious diseases such as tuberculosis and sexually transmitted diseases in some communities. A series of natural disasters such as tornados also brought to light gaps in the public health system, especially the ability to respond, for example, to mass casualty events. Although the ACA authorized $15 billion for the creation of a Prevention and Public Health Fund to invest in public health and disease prevention, Congress reduced by one third the amount of funding mandated by the law in 2012 and President Obama signed the legislation to pay for other initiatives (Health Policy Brief, 2012).

177

Local/County Level

Similar to state governments, local and county governments in many states also have the responsibility of protecting public health. Some provide indigent care by funding and running public hospitals and clinics, such as New York City’s Health and Hospitals Corporation and Chicago’s Cook County Hospital. Although receiving a subsidy from their local government, these hospitals, which have served primarily poor patients and those without health insurance, have gotten significant special payments, especially from Medicare to serve these populations. These disproportionate share hospital (DSH) payments are being gradually reduced under the ACA because it is presumed that eventually, under the ACA, many more people will gain health insurance coverage. Because public hospitals and clinics are so dependent on public funds, their budgets are historically squeezed during times of fiscal restraint by local, state, and federal governments, making them vulnerable to long-term sustainability. In fact, many public health hospitals have closed, and in many parts of the country, the populations they have served have been absorbed by other types of hospital providers (KFF, 2013).

The Private Health Insurance and Delivery Systems

The U.S. health care system has been predominantly a private one that operates more like a business and, more or less, according to free market principles. Private health insurance has been the dominant payer and, for most Americans, it is obtained as a benefit of employment in the form of group health insurance. However, until the passage of the ACA employers have had no obligation to provide employee health insurance, leaving many Americans uninsured or underinsured, especially those working in lower-wage jobs. As private health insurance premiums have risen, employers asked employees to pay for a greater percentage of their insurance premium, and to enroll in plans that required more cost-sharing in the form of copayment, deductibles, and coinsurance. Approximately 15% of insured Americans have purchased their health insurance from the nongroup individual insurance market. Typically, these plans were more expensive and insurers in all but a few states had been able to deny insurance to applicants with preexisting medical conditions, until the practice of discrimination based on medical history was outlawed by the ACA in 2010. Because private insurers are regulated by individual states, there are wide disparities in coverage from state to state, as private insurers are powerful political stakeholders who resist attempts at state or federal regulations to make insurance more accessible and affordable. Whereas private health insurance will continue to be a cornerstone of the U.S. health care financing system, public insurers such as Medicare and Medicaid are paying for an increasing percentage of health care costs.

It should be noted that health insurance is regulated by the states. Some states now mandate that NPs be considered primary care providers and eligible for credentialing and payment by private insurers. But there is wide variation in the extent to which APRNs are included in insurers’ provider panels. This variation can be seen among states, among insurers within a given state, and among the plans offered by an insurer (Brassard, 2014).

Most care in the United States is provided by nonprofit or for-profit hospitals and health care systems and private insurance plans (Truffer et al., 2010). Pharmaceutical companies, suppliers of health care technology, and the various service industries that support the health care system in the United States are part of what has been called the medical industrial complex (Meyers, 1970), and there is little government regulation of these industries. Although the private delivery system is dependent on payment from private insurers as well as government insurers, it has usually been resistant to government-directed efforts to expand access to care or cost-containment measures. Well-financed special interest groups representing industry stakeholders have had a great deal of influence over the political process at both the state and federal levels. For example, the medical device industry is lobbying Congress hard to repeal or reduce the medical device tax that the ACA levied to help pay 178for the expansion of insurance coverage under the health care law and has gained significant support in Congress (Kramer & Kasselheim, 2013).

The Problem of Continually Rising Health Care Costs

From the 1970s to the present, continually rising insurance premiums and health care delivery costs have strained government budgets, become a costly expense to businesses that offer health insurance to their employees, and put health care increasingly out of reach for individuals and families. Figure 18-3 depicts the annual percentage change in national health expenditures by selected sources of funds, 1960 to 2012 (KFF, 2014e).

FIGURE 18-3 Annual percentage change in national health expenditures, by selected sources of funds, 1960 to 2012. (From Kaiser Family Foundation. [2014]. Retrieved fromkaiserfamilyfoundation.files.wordpress.com/2014/02/annual-percent-change-in-national-health-expenditures-by-selected-sources-of-funds-1960-2012-healthcosts.png.)

Stakeholders in small and large businesses, government, organized labor, health care providers, and consumer groups have convened over the years to tackle the problem of rising health care costs, with little lasting success. Although a range of strategies was employed to curb rising health care costs over those 40 years, health care expenditures as a percentage of the gross domestic product (GDP) increased steadily over that time. Although multiple factors are responsible for rising health care costs as a percentage of GDP, the key one is that, unlike other capitalist democracies, the federal and state governments have little, if any, role in regulating what can be charged for health care services and supplies. Prices are largely negotiated between health insurances and providers, resulting in wide variances in prices for similar or exact services, largely based on the market clout of providers to negotiate higher prices. Other contributing factors to high health care costs include the complex administrative systems of insurers and providers, the use of expensive medical technology and medical specialists, and 179the incentive in fee-for-service reimbursement for providers to increase their volume of services and provide unnecessary health care. Consumers have also lacked knowledge of the actual cost of their care, leading to an inability of the market to accurately respond to cost and differential health care prices by region, type of hospital, or health care facility.

Future costs will also be impacted by the aging of the population and increasing number of people with complex chronic illness who use a disproportionately high percentage of the health care dollars. For example, from 1977 to 2007, a very stable 5% of the population who had complex chronic illness accounted for nearly 50% of the health care expenditures (KFF, 2010; Stanton, 2006), despite efforts to control costs among this population. In 2009, the costliest 5% of beneficiaries accounted for 39% of all Medicare fee-for-service spending. The least costly 50% of beneficiaries accounted for 5% of all spending (Medpac, 2013). The majority of those in the high-expenditure group are not older adults but rather those with complex chronic illnesses (Stanton, 2006).

All other industrialized countries spend significantly less on health care but have better health outcomes and a longer life expectancy. For example, the United States ranks among the worst of industrialized nations on important health indicators such as infant mortality, maternal mortality, and life expectancy at birth (Squires, 2014). Yet, in 2012, it ranked first in health care costs per capita at approximately $8915 per person (Organization for Economic Co-operation and Development [OECD], 2013b). This amounted to close to 18% of its GDP, compared with The Netherlands, which ranked second at 12% of its GDP (OECD, 2013a).

Cost-Containment Efforts

Over time, several approaches have been used to contain costs, including the following.

Regulation Versus Competition.

During the 1970s, modest government regulation attempted to contain health care costs through state rate-setting agencies and health planning mechanisms, such as Certificate of Need (CON) programs and regional Health Systems Agencies (HSAs), which evaluated and approved applications for the construction of new facilities, beds, and new technology. During the 1980s and early 1990s, when proponents of competition and free market health care became politically more influential, rate setting and CON programs were weakened and HSAs were eliminated. While free-market principles, as they apply to health care, have few similarities to a fully competitive market in economic terms, the rise of managed care programs and competition among health insurance plans in the 1980s may have temporarily slowed the growth of health costs before they began to rise again. As health insurers expanded the use of copayments, deductibles, and coinsurance as economic incentives to discourage care, the onus of cost-containment fell more heavily on the consumer/patient. However, ample research shows that low-income people may avoid necessary care because of copayments and deductibles. Chapter 17 more fully describes the mechanisms underlying the market system in health care.

Managed Care.

The origins of today’s managed care plans were in early prepaid health plans of the 1920s, which evolved into Health Maintenance Organizations (HMOs) in the 1970s, and into a variety of models in the subsequent 30 years, including Preferred Provider Organizations (PPOs). A managed care system shifts health care delivery and payment from open-ended access to providers, paid for through fee-for-service reimbursement, toward one in which the provider is a gatekeeper or manager of the patient’s health care and assumes some degree of financial responsibility for the care that is given through a capitated budget in which to pay for the patient’s care. Managed care implies not only that spending will be controlled but also that other aspects of care will be managed, such as quality and accessibility. In managed care, the primary care provider has traditionally been the gatekeeper, deciding what specialty services are appropriate and where these services can be obtained at the lowest cost. In the 1990s, negative media attention concerning the incentives to restrict care in the managed care model fueled a political backlash. Consumer and provider demands for 180greater choice for services and access to providers caused managed care plans to loosen gatekeeper requirements and provide more direct access to specialists. As a result, managed care became less effective in holding down expenditures and fueled a rise in health insurance premiums.

In addition, concerns of consumers and providers cha

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Week 7

Part1- Due Thursday 

Respond to the following in a minimum of 175 words:

Read the following scenario and explain what power issues may arise. What factors influence statistical power?

A researcher is exploring differences between men and women on ‘number of different recreational drugs used.’ The researcher collects data on a sample of 50 men and 50 women between the ages of 18-25. Each participant is asked ‘how many different recreational drugs have you tried in your life?’ The IV is gender (male/female) and the DV is ‘number of reported drugs.’

Part2-PLEASE SEE ATTACHMENT

PART3-PLEASE SEE ATTACHMENT…THIS IS A GROUP ASSIGNMENT I ONLY HAVE TO COMPLETE A PART OF THE TABLE. I WILL POST MY PART ON TUESDAY

REFERENCE CHAPTER 13

LEARNING OBJECTIVES Explain how researchers use inferential statistics to evaluate sample data. Distinguish between the null hypothesis and the research hypothesis. Discuss probability in statistical inference, including the meaning of statistical significance. Describe the t test and explain the difference between one-tailed and two-tailed tests. Describe the F test, including systematic variance and error variance. Describe what a confidence interval tells you about your data. Distinguish between Type I and Type II errors. Discuss the factors that influence the probability of a Type II error. Discuss the reasons a researcher may obtain nonsignificant results. Define power of a statistical test. Describe the criteria for selecting an appropriate statistical test.

Page 267IN THE PREVIOUS CHAPTER, WE EXAMINED WAYS OF DESCRIBING THE RESULTS OF A STUDY USING DESCRIPTIVE STATISTICS AND A VARIETY OF GRAPHING TECHNIQUES. In addition to descriptive statistics, researchers use inferential statistics to draw more general conclusions about their data. In short, inferential statistics allow researchers to (a) assess just how confident they are that their results reflect what is true in the larger population and (b) assess the likelihood that their findings would still occur if their study was repeated over and over. In this chapter, we examine methods for doing so. SAMPLES AND POPULATIONS

Inferential statistics are necessary because the results of a given study are based only on data obtained from a single sample of research participants. Researchers rarely, if ever, study entire populations; their findings are based on sample data. In addition to describing the sample data, we want to make statements about populations. Would the results hold up if the experiment were conducted repeatedly, each time with a new sample?

In the hypothetical experiment described in Chapter 12 (see Table 12.1), mean aggression scores were obtained in model and no-model conditions. These means are different: Children who observe an aggressive model subsequently behave more aggressively than children who do not see the model. Inferential statistics are used to determine whether the results match what would happen if we were to conduct the experiment again and again with multiple samples. In essence, we are asking whether we can infer that the difference in the sample means shown in Table 12.1 reflects a true difference in the population means.

Recall our discussion of this issue in Chapter 7 on the topic of survey data. A sample of people in your state might tell you that 57% prefer the Democratic candidate for an office and that 43% favor the Republican candidate. The report then says that these results are accurate to within 3 percentage points, with a 95% confidence level. This means that the researchers are very (95%) confident that, if they were able to study the entire population rather than a sample, the actual percentage who preferred the Democratic candidate would be between 60% and 54% and the percentage preferring the Republican would be between 46% and 40%. In this case, the researcher could predict with a great deal of certainty that the Democratic candidate will win because there is no overlap in the projected population values. Note, however, that even when we are very (in this case, 95%) sure, we still have a 5% chance of being wrong.

Inferential statistics allow us to arrive at such conclusions on the basis of sample data. In our study with the model and no-model conditions, are we confident that the means are sufficiently different to infer that the difference would be obtained in an entire population?

Page 268 INFERENTIAL STATISTICS

Much of the previous discussion of experimental design centered on the importance of ensuring that the groups are equivalent in every way except the independent variable manipulation. Equivalence of groups is achieved by experimentally controlling all other variables or by randomization. The assumption is that if the groups are equivalent, any differences in the dependent variable must be due to the effect of the independent variable.

This assumption is usually valid. However, it is also true that the difference between any two groups will almost never be zero. In other words, there will be some difference in the sample means, even when all of the principles of experimental design are rigorously followed. This happens because we are dealing with samples, rather than populations. Random or chance error will be responsible for some difference in the means, even if the independent variable had no effect on the dependent variable.

Therefore, the difference in the sample means does show any true difference in the population means (i.e., the effect of the independent variable) plus any random error. Inferential statistics allow researchers to make inferences about the true difference in the population on the basis of the sample data. Specifically, inferential statistics give the probability that the difference between means reflects random error rather than a real difference. NULL AND RESEARCH HYPOTHESES

Statistical inference begins with a statement of the null hypothesis and a research (or alternative) hypothesis. The null hypothesis is simply that the population means are equal—the observed difference is due to random error. The research hypothesis is that the population means are, in fact, not equal. The null hypothesis states that the independent variable had no effect; the research hypothesis states that the independent variable did have an effect. In the aggression modeling experiment, the null and research hypotheses are:

H0 (null hypothesis): The population mean of the no-model group is equal to the population mean of the model group.

H1 (research hypothesis): The population mean of the no-model group is not equal to the population mean of the model group.

The logic of the null hypothesis is this: If we can determine that the null hypothesis is incorrect, then we accept the research hypothesis as correct. Acceptance of the research hypothesis means that the independent variable had an effect on the dependent variable.

The null hypothesis is used because it is a very precise statement—the population means are exactly equal. This permits us to know precisely the Page 269probability of obtaining our results if the null hypothesis is correct. Such precision is not possible with the research hypothesis, so we infer that the research hypothesis is correct only by rejecting the null hypothesis. We reject the null hypothesis when we find a very low probability that the obtained results could be due to random error. This is what is meant by statistical significance: A significant result is one that has a very low probability of occurring if the population means are equal. More simply, significance indicates that there is a low probability that the difference between the obtained sample means was due to random error. Significance, then, is a matter of probability. PROBABILITY AND SAMPLING DISTRIBUTIONS

Probability is the likelihood of the occurrence of some event or outcome. We all use probabilities frequently in everyday life. For example, if you say that there is a high probability that you will get an A in this course, you mean that this outcome is likely to occur. Your probability statement is based on specific information, such as your grades on examinations. The weather forecaster says there is a 10% chance of rain today; this means that the likelihood of rain is very low. A gambler gauges the probability that a particular horse will win a race on the basis of the past records of that horse.

Probability in statistical inference is used in much the same way. We want to specify the probability that an event (in this case, a difference between means in the sample) will occur if there is no difference in the population. The question is: What is the probability of obtaining this result if only random error is operating? If this probability is very low, we reject the possibility that only random or chance error is responsible for the obtained difference in means. Probability: The Case of ESP

The use of probability in statistical inference can be understood intuitively from a simple example. Suppose that a friend claims to have ESP (extrasensory perception) ability. You decide to test your friend with a set of five cards commonly used in ESP research; a different symbol is presented on each card. In the ESP test, you look at each card and think about the symbol, and your friend tells you which symbol you are thinking about. In your actual experiment, you have 10 trials; each of the five cards is presented two times in a random order. Your task is to know whether your friend’s answers reflect random error (guessing) or whether they indicate that something more than random error is occurring. The null hypothesis in your study is that only random error is operating. In this case, the research hypothesis is that the number of correct answers shows more than random or chance guessing. (Note, however, that accepting the research hypothesis could mean that your friend has ESP ability, but it could also mean that the cards were marked, that you had somehow cued your friend when thinking about the symbols, and so on.)

Page 270You can easily determine the number of correct answers to expect if the null hypothesis is correct. Just by guessing, 1 out of 5 answers (20%) should be correct. On 10 trials, 2 correct answers are expected under the null hypothesis. If, in the actual experiment, more (or less) than 2 correct answers are obtained, would you conclude that the obtained data reflect random error or something more than merely random guessing?

Suppose that your friend gets 3 correct. Then you would probably conclude that only guessing is involved, because you would recognize that there is a high probability that there would be 3 correct answers even though only 2 correct are expected under the null hypothesis. You expect that exactly 2 answers in 10 trials would be correct in the long run, if you conducted this experiment with this subject over and over again. However, small deviations away from the expected 2 are highly likely in a sample of 10 trials.

Suppose, though, that your friend gets 7 correct. You might conclude that the results indicate more than random error in this one sample of 10 observations. This conclusion would be based on your intuitive judgment that an outcome of 70% correct when only 20% is expected is very unlikely. At this point, you would decide to reject the null hypothesis and state that the result is significant. A significant result is one that is very unlikely if the null hypothesis is correct.

A key question then becomes: How unlikely does a result have to be before we decide it is significant? A decision rule is determined prior to collecting the data. The probability required for significance is called the alpha level. The most common alpha level probability used is .05. The outcome of the study is considered significant when there is a .05 or less probability of obtaining the results; that is, there are only 5 chances out of 100 that the results were due to random error in one sample from the population. If it is very unlikely that random error is responsible for the obtained results, the null hypothesis is rejected. Sampling Distributions

You may have been able to judge intuitively that obtaining 7 correct on the 10 trials is very unlikely. Fortunately, we do not have to rely on intuition to determine the probabilities of different outcomes. Table 13.1 shows the probability of actually obtaining each of the possible outcomes in the ESP experiment with 10 trials and a null hypothesis expectation of 20% correct. An outcome of 2 correct answers has the highest probability of occurrence. Also, as intuition would suggest, an outcome of 3 correct is highly probable, but an outcome of 7 correct is highly unlikely.

The probabilities shown in Table 13.1 were derived from a probability distribution called the binomial distribution; all statistical significance decisions are based on probability distributions such as this one. Such distributions are called sampling distributions. The sampling distribution is based on the assumption that the null hypothesis is true; in the ESP example, the null hypothesis is that the person is only guessing and should therefore get 20% correct. Such a distribution assumes that if you were to conduct the study with the same number of observations over and over again, the most frequent finding would be 20%. However, because of the random error possible in each sample, there is a certain probability associated with other outcomes. Outcomes that are close to the expected null hypothesis value of 20% are very likely. However, outcomes farther from the expected result are less and less likely if the null hypothesis is correct. When your obtained results are highly unlikely if you are, in fact, sampling from the distribution specified by the null hypothesis, you conclude that the null hypothesis is incorrect. Instead of concluding that your sample results reflect a random deviation from the long-run expectation of 20%, you decide that the null hypothesis is incorrect. That is, you conclude that you have not sampled from the sampling distribution specified by the null hypothesis. Instead, in the case of the ESP example, you decide that your data are from a different sampling distribution in which, if you were to test the person repeatedly, most of the outcomes would be near your obtained result of 7 correct answers.

Page 271

TABLE 13.1 Exact probability of each possible outcome of the ESP experiment with 10 trials

All statistical tests rely on sampling distributions to determine the probability that the results are consistent with the null hypothesis. When the obtained data are very unlikely according to null hypothesis expectations (usually a .05 probability or less), the researcher decides to reject the null hypothesis and therefore to accept the research hypothesis. Sample Size

The ESP example also illustrates the impact of sample size—the total number of observations—on determinations of statistical significance. Suppose you had tested your friend on 100 trials instead of 10 and had observed 30 correct answers. Just as you had expected 2 correct answers in 10 trials, you would now expect 20 of 100 answers to be correct. However, 30 out of 100 has a much Page 272lower likelihood of occurrence than 3 out of 10. This is because, with more observations sampled, you are more likely to obtain an accurate estimate of the true population value. Thus, as the size of your sample increases, you are more confident that your outcome is actually different from the null hypothesis expectation. EXAMPLE: THE t AND F TESTS

Different statistical tests allow us to use probability to decide whether to reject the null hypothesis. In this section, we will examine the t test and the F test. The t test is commonly used to examine whether two groups are significantly different from each other. In the hypothetical experiment on the effect of a model on aggression, a t test is appropriate because we are asking whether the mean of the no-model group differs from the mean of the model group. The F test is a more general statistical test that can be used to ask whether there is a difference among three or more groups or to evaluate the results of factorial designs (discussed in Chapter 10).

To use a statistical test, you must first specify the null hypothesis and the research hypothesis that you are evaluating. The null and research hypotheses for the modeling experiment were described previously. You must also specify the significance level that you will use to decide whether to reject the null hypothesis; this is the alpha level. As noted, researchers generally use a significance level of .05. t Test

The sampling distribution of all possible values of t is shown in Figure 13.1. (This particular distribution is for the sample size we used in the hypothetical experiment on modeling and aggression; the sample size was 20 with 10 participants in each group.) This sampling distribution has a mean of 0 and a standard deviation of 1. It reflects all the possible outcomes we could expect if we compare the means of two groups and the null hypothesis is correct.

To use this distribution to evaluate our data, we need to calculate a value of t from the obtained data and evaluate the obtained t in terms of the sampling distribution of t that is based on the null hypothesis. If the obtained t has a low probability of occurrence (.05 or less), then the null hypothesis is rejected.

The t value is a ratio of two aspects of the data, the difference between the group means and the variability within groups. The ratio may be described as follows:

The group difference is simply the difference between your obtained means; under the null hypothesis, you expect this difference to be zero. The value of t increases as the difference between your obtained sample means increases. Note that the sampling distribution of t assumes that there is no difference in the population means; thus, the expected value of t under the null hypothesis is zero. The within-group variability is the amount of variability of scores about the mean. The denominator of the t formula is essentially an indicator of the amount of random error in your sample. Recall from Chapter 12 that s, the standard deviation, and s2, the variance, are indicators of how much scores deviate from the group mean.

Page 273

FIGURE 13.1

Sampling distributions of t values with 18 degrees of freedom

A concrete example of a calculation of a t test should help clarify these concepts. The formula for the t test for two groups with equal numbers of participants in each group is:

Page 274The numerator of the formula is simply the difference between the means of the two groups. In the denominator, we first divide the variance ( and ) of each group by the number of subjects in that group (n1 and n2) and add these together. We then find the square root of the result; this converts the number from a squared score (the variance) to a standard deviation. Finally, we calculate our obtained t value by dividing the mean difference by this standard deviation. When the formula is applied to the data in Table 12.1, we find:

Thus, the t value calculated from the data is 4.02. Is this a significant result? A computer program analyzing the results would immediately tell you the probability of obtaining a t value of this size with a total sample size of 20. Without such a program, there are Internet resources to find a table of “critical values” of t (http://www.statisticsmentor.com/category/statstables/) or to calculate the probability for you (http://vassarstats.net/tabs.html). Before going any farther, you should know that the obtained result is significant. Using a significance level of .05, the critical value from the sampling distribution of t is 2.101. Any t value greater than or equal to 2.101 has a .05 or less probability of occurring under the assumptions of the null hypothesis. Because our obtained value is larger than the critical value, we can reject the null hypothesis and conclude that the difference in means obtained in the sample reflects a true difference in the population. Degrees of Freedom

You are probably wondering how the critical value was selected from the table. To use the table, you must first determine the degrees of freedom for the test (the term degrees of freedom is abbreviated as df). When comparing two means, you assume that the degrees of freedom are equal to n1 + n2 − 2, or the total number of participants in the groups minus the number of groups. In our experiment, the degrees of freedom would be 10 + 10 − 2 = 18. The degrees of freedom are the number of scores free to vary once the means are known. For example, if the mean of a group is 6.0 and there are five scores in the group, there are 4 degrees of freedom; once you have any four scores, the fifth score is known because the mean must remain 6.0. One-Tailed Versus Two-Tailed Tests

In the table, you must choose a critical t for the situation in which your research hypothesis either (1) specified a direction of difference between the Page 275groups (e.g., group 1 will be greater than group 2) or (2) did not specify a predicted direction of difference (e.g., group 1 will differ from group 2). Somewhat different critical values of t are used in the two situations: The first situation is called a one-tailed test, and the second situation is called a two-tailed test.

The issue can be visualized by looking at the sampling distribution of t values for 18 degrees of freedom, as shown in Figure 13.1. As you can see, a value of 0.00 is expected most frequently. Values greater than or less than zero are less likely to occur. The first distribution shows the logic of a two-tailed test. We used the value of 2.101 for the critical value of t with a .05 significance level because a direction of difference was not predicted. This critical value is the point beyond which 2.5% of the positive values and 2.5% of the negative values of t lie (hence, a total probability of .05 combined from the two “tails” of the sampling distribution). The second distribution illustrates a one-tailed test. If a directional difference had been predicted, the critical value would have been 1.734. This is the value beyond which 5% of the values lie in only one “tail” of the distribution. Whether to specify a one-tailed or two-tailed test will depend on whether you originally designed your study to test a directional hypothesis. F Test

The analysis of variance, or F test, is an extension of the t test. The analysis of variance is a more general statistical procedure than the t test. When a study has only one independent variable with two groups, F and t are virtually identical—the value of F equals t2 in this situation. However, analysis of variance is also used when there are more than two levels of an independent variable and when a factorial design with two or more independent variables has been used. Thus, the F test is appropriate for the simplest experimental design, as well as for the more complex designs discussed in Chapter 10. The t test was presented first because the formula allows us to demonstrate easily the relationship of the group difference and the within-group variability to the outcome of the statistical test. However, in practice, analysis of variance is the more common procedure. The calculations necessary to conduct an F test are provided in Appendix C.

The F statistic is a ratio of two types of variance: systematic variance and error variance (hence the term analysis of variance). Systematic variance is the deviation of the group means from the grand mean, or the mean score of all individuals in all groups. Systematic variance is small when the difference between group means is small and increases as the group mean differences increase. Error variance is the deviation of the individual scores in each group from their respective group means. Terms that you may see in research instead of systematic and error variance are between-group variance and within-group variance. Systematic variance is the variability of scores between groups, and error variance is the variability of scores within groups. The larger the F ratio is, the more likely it is that the results are significant.

Page 276 Calculating Effect Size

The concept of effect size was discussed in Chapter 12. After determining that there was a statistically significant effect of the independent variable, researchers will want to know the magnitude of the effect. Therefore, we want to calculate an estimate of effect size. For a t test, the calculation is

where df is the degrees of freedom. Thus, using the obtained value of t, 4.02, and 18 degrees of freedom, we find:

This value is a type of correlation coefficient that can range from 0.00 to 1.00; as mentioned in Chapter 12, .69 is considered a large effect size. For additional information on effect size calculation, see Rosenthal (1991). The same distinction between r and r2 that was made in Chapter 12 applies here as well.

Another effect size estimate used when comparing two means is called Cohen’s d. Cohen’s d expresses effect size in terms of standard deviation units. A d value of 1.0 tells you that the means are 1 standard deviation apart; a d of .2 indicates that the means are separated by .2 standard deviation.

You can calculate the value of Cohen’s d using the means (M) and standard deviations (SD) of the two groups:

Note that the formula uses M and SD instead of and s. These abbreviations are used in APA style (see Appendix A).

The value of d is larger than the corresponding value of r, but it is easy to convert d to a value of r. Both statistics provide information on the size of the relationship between the variables studied. You might note that both effect size estimates have a value of 0.00 when there is no relationship. The value of r has a maximum value of 1.00, but d has no maximum value. Confidence Intervals and Statistical Significance

Confidence intervals were described in Chapter 7. After obtaining a sample value, we can calculate a confidence interval. An interval of values defines the most likely range of actual population values. The interval has an associated confidence interval: A 95% confidence interval indicates that we are 95% sure that the population value lies within the range; a 99% interval would provide greater certainty but the range of values would be larger.

Page 277A confidence interval can be obtained for each of the means in the aggression experiment. The 95% confidence intervals for the two conditions are:

A bar graph that includes a visual depiction of the confidence interval can be very useful. The means from the aggression experiment are shown in Figure 13.2. The shaded bars represent the mean aggression scores in the two conditions. The confidence interval for each group is shown with a vertical I-shaped line that is bounded by the upper and lower limits of the 95% confidence interval. It is important to examine confidence intervals to obtain a greater understanding of the meaning of your obtained data. Although the obtained sample means provide the best estimate of the population values, you are able to see the likely range of possible values. The size of the interval is related to both the size of the sample and the confidence level. As the sample size increases, the confidence interval narrows. This is because sample means obtained with larger sample sizes are more likely to reflect the population mean. Second, higher confidence is associated with a larger interval. If you want to be almost certain that the interval contains the true population mean (e.g., a 99% confidence interval), you will need to include more possibilities. Note that the 95% confidence intervals for the two means do not overlap. This should be a clue to you that the difference is statistically significant. Indeed, examining confidence intervals is an alternative way of thinking about statistical significance. The null hypothesis is that the difference in population means is 0.00. However, if you were to subtract all the means in the 95% confidence interval for the no-model condition from all the means in the model condition, none of these differences would include the value of 0.00. We can be very confident that the null hypothesis should be rejected.

FIGURE 13.2

Mean aggression scores from the hypothetical modeling experiment including the 95% confidence intervals

Page 278 Statistical Significance: An Overview

The logic underlying the use of statistical tests rests on statistical theory. There are some general concepts, however, that should help you understand what you are doing when you conduct a statistical test. First, the goal of the test is to allow you to make a decision about whether your obtained results are reliable; you want to be confident that you would obtain similar results if you conducted the study over and over again. Second, the significance level (alpha level) you choose indicates how confident you wish to be when making the decision. A .05 significance level says that you are 95% sure of the reliability of your findings; however, there is a 5% chance that you could be wrong. There are few certainties in life! Third, you are most likely to obtain significant results when you have a large sample size because larger sample sizes provide better estimates of true population values. Finally, you are most likely to obtain significant results when the effect size is large, i.e., when differences between groups are large and variability of scores within groups is small.

In the remainder of the chapter, we will expand on these issues. We will examine the implications of making a decision about whether results are significant, the way to determine a significance level, and the way to interpret nonsignificant results. We will then provide some guidelines for selecting the appropriate statistical test in various research designs. TYPE I AND TYPE II ERRORS

The decision to reject the null hypothesis is based on probabilities rather than on certainties. That is, the decision is made without direct knowledge of the true state of affairs in the population. Thus, the decision might not be correct; errors may result from the use of inferential statistics.

A decision matrix is shown in Figure 13.3. Notice that there are two possible decisions: (1) Reject the null hypothesis or (2) accept the null hypothesis. There are also two possible truths about the population: (1) The null hypothesis is true or (2) the null hypothesis is false. In sum, as the decision matrix shows, there are two kinds of correct decisions and two kinds of errors. Correct Decisions

One correct decision occurs when we reject the null hypothesis and the research hypothesis is true in the population. Here, our decision is that the population means are not equal, and in fact, this is true in the population. This is the decision you hope to make when you begin your study.

Page 279

FIGURE 13.3

Decision matrix for Type I and Type II errors

The other correct decision is to accept the null hypothesis, and the null hypothesis is true in the population: The population means are in fact equal. Type I Errors

A Type I error is made when we reject the null hypothesis but the null hypothesis is actually true. Our decision is that the population means are not equal when they actually are equal. Type I errors occur when, simply by chance, we obtain a large value of t or F. For example, even though a t value of 4.025 is highly improbable if the population means are indeed equal (less than 5 chances out of 100), this can happen. When we do obtain such a large t value by chance, we incorrectly decide that the independent variable had an effect.

The probability of making a Type I error is determined by the choice of significance or alpha level (alpha may be shown as the Greek letter alpha—α). When the significance level for deciding whether to reject the null hypothesis is .05, the probability of a Type I error (alpha) is .05. If the null hypothesis is rejected, there are 5 chances out of 100 that the decision is wrong. The probability of making a Type I error can be changed by either decreasing or increasing the significance level. If we use a lower alpha level of .01, for example, there is less chance of making a Type I error. With a .01 significance level, the null hypothesis is rejected only when the probability of obtaining the results is .01 or less if the null hypothesis is correct. Type II Errors

A Type II error occurs when the null hypothesis is accepted although in the population the research hypothesis is true. The population means are

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MAJOR PAPER-FINAL

  

Major Paper – FINAL

DUE: May 19, 2019 11:55 PM

Grade Details

  

Grade

N/A                      

 

Gradebook Comments

None

Assignment Details

  

Open Date

Apr   1, 2019 12:05 AM

 

Graded?

Yes

 

Points Possible

150.0

 

Resubmissions Allowed?

No

 

Attachments checked for originality?

Yes

Top of Form

Assignment Instructions

Major Paper Assignment Instructions and Grading Rubric

This assignment meets the following Course Learning Objectives:

– Articulate basic drug terminology and drug taking behavior
– Identify the various addictive substances – legal and illegal – and their classifications
– Analyze the reasons people commonly abuse substances
– Analyze how substances affect the mind and body and society

In 2010, The American Academy of Pediatrics (AAP) released a policy statement addressing the complex relationships among children, adolescents, substance abuse, and the media. This assignment requires a critical examination of the AAP publication and a critique of a media portrayal of substance use, with links made to the AAP statement and course material. Conclusions about the implications of the media portrayals and the policies recommended by the AAP also should be made. Successful completion of this paper will require work over multiple weeks.  A two paragraph summary of the proposed example of substance use portrayal in the media was due by the end of Week 3. The full paper is due at the end of Week 7.

 

This is part one of the assignment that you did

 

This assignment proceeds in four steps: 

 Preparation

 Step One: Read the AAP Policy Statement located below. Make some notes for yourself about points of agreement or disagreement you have with the statement and specific findings regarding media depictions of substance use that you want to assess when you write the paper. 

 

 Step Two: Find a current example of substance use portrayal seen in the media; for example, scenes from a movie, a television show, or a commercial; print ads; or portrayals found in “new media” as discussed in the AAP article. The Internet is a good tool for finding film or television portrayals of substance use as well as examples of print ads if ready access to first-hand media is not available. A two paragraph summary of the proposed example of substance use portrayal in the media that will be used for the paper is due by the end of Week 3. This proposal is a separate assignment and is worth 10 points.

 Construction

 Step Three: Write the paper. Begin the paper with an introduction that summarizes the main findings of the AAP article and previews what will be covered in the coming pages. Next, compare and contrast the portrayal of substance use found in the media with the information learned about that substance in the class and course readings. What messages about the substance are being portrayed? How accurate are those messages relative to the actual data on substance use? Be sure to cite the course readings as needed.

 Continue by comparing and contrasting the portrayal of substance use found in the media with the criticism of media portrayals found in the AAP paper. Does the media example match their arguments or contradict them? What links and connections can be made? Be sure to cite the article as needed. 

 Next, draw some conclusions about the portrayal of substance use found in the media, addressing the following: What are the implications of this type of portrayal? What messages are being sent and to whom? Are those messages an accurate representation of the use of this substance? Should media portrayals be required to be accurate in their depictions of use, showing both positive and negative consequences? 

 Finally, review the guidelines suggested by the AAP at the end of their policy statement and address the following: Although directed specifically at pediatricians, which of those recommendations is most important? Why? Are these recommendations necessary? If followed, will they be effective in addressing the concerns raised earlier in the article? Be sure to cite sources as needed.

 Step Four: 

The required length of this paper is 11 pages, plus a required a cover page and a reference list. Papers must comply with APA formatting rules, including font size and margins, and must have a scholarly focus and tone.  Quoting of published material and use of the first-person “I” are not permitted and will result in point loss. All source material must be paraphrased into your own words and cited appropriately. 

 On submission your work will auto-run through Turnitin.com’s plagiarism checker software.    

 The grading rubric below details specific grading criteria.

The Final Major Paper document should be attached in the appropriate Assignment tab and will be evaluated using the rubric below: 

  

Component

Excellent

Satisfactory 

Needs Improvement 

Unsatisfactory 

Points Earned

 

Introduction

15 Points Possible

Student provides a clear   introduction which summarizes the AAP article and previews the major points   to be covered in the paper.   

Student provides a mostly accurate   introduction which summarizes the AAP article and previews the major points   to be covered in the paper. At times description lacks coherence. 

Student provides a marginal   introduction which summarizes the AAP article and previews the major points   to be covered in the paper. Sufficient details and supporting evidence are   lacking.

Student does not provide an   introduction which summarizes the AAP article or preview the major points to   be covered in the paper.

 

Choice of Media Example

15 Points Possible

Discussion of chosen media   portrayal is clear, accurate, and related to the assignment. Sources are   credited and cited appropriately.   

Discussion of chosen media   portrayal is mostly accurate, and related to the assignment. Sources are   credited and cited. At times description lacks coherence. 

Discussion of chosen media   portrayal is marginally accurate, and related to the assignment. Sources   are credited and cited but not using appropriate formatting. Sufficient   details and supporting evidence are lacking.

Student does not chose a media   portrayal that is accurate and/or related to the assignment. Sources not   credited and cited.

 

Comparison of Media Example to   Class Material

25 Points Possible

Student provides a comparison of   media with information from class material that is clear and   thoughtful. Questions outlined in the assignment are   answered. Sources are credited and cited appropriately.   

Student provides a mostly accurate   comparison of media with information from class material that is largely   clear and thoughtful. Questions outlined in the assignment are mostly   answered. Sources are credited and cited appropriately. At times   description lacks coherence. 

Student provides a marginal   comparison of media with information from class material that is partial   clear and thoughtful. Questions outlined in the assignment are   marginally answered. Sources are credited and cited appropriately.   Sufficient details and supporting evidence are lacking.

Student does not provide a   comparison of media with information from class material. Questions   outlined in the assignment were not answered.

 

Comparison of Media Example to AAP   article

25 Points Possible

Comparison of media presented by   the student with information from the AAP article is clear and   thoughtful. Questions outlined in the assignment are   answered. Sources are credited and cited   appropriately.   

Comparison of media mostly presented   by the student with information from the AAP article is mostly clear and   thoughtful. Questions outlined in the assignment are mostly   answered. Sources are credited and cited appropriately. At times   description lacks coherence. 

Comparison of media marginally   presented by the student with information from the AAP article is mostly   clear and thoughtful. Questions outlined in the assignment are   marginally answered. Sources are credited and cited   appropriately. Sufficient details and supporting evidence are lacking.

Student did not compare media   presented with information from the AAP article. Questions outlined in   the assignment were not answered.  

 

Strength of Conclusion

40 Points Possible

Student provides an insightful and   creative conclusion, logically summarizing the main elements of the case   and the scholarly literature findings, articulating a personal reflection on   the case study analysis process

Student provides a mostly   cogent conclusion, logically summarizing the main elements of the case   and the scholarly literature findings, articulating a personal reflection on   the case study analysis process

At times description lacks   coherence. 

Student provides a   marginal conclusion, loosely summarizing the main elements of the case   and the scholarly literature findings, articulating a personal reflection on   the case study analysis process

Sufficient details and supporting   evidence are lacking.

Student does not provide a   clear conclusion or logically summarizing the main elements of the case   or reference scholarly literature findings; lacks a personal reflection on   the case study analysis process

 

Paper Format and Mechanics;   Spelling, Grammar and Punctuation

30 Points Possible

Work is presented in a logical and   coherent way. Writing is clear, articulate, and error free. Citations are   composed in proper format with few or no errors. Paper is the required   length, is double-spaced with 1-inch top, bottom, left and right margins, and   in Calibri or Times New Roman styles, size 12 font. Cover   page, paper body, citations and References are in the correct APA   format. There are few to no spelling, grammar, or punctuation   errors.

Work is grammatically sound with a   few minor errors. Citations are composed in the proper format with some   errors. 

Work contains frequent grammatical   errors. Citations are inaccurate or improperly formatted. 

Work does not demonstrate   appropriate graduate level writing. 

 

Summary Comments: 

Total Points:   (150   points total)

Supporting Materials

Submission

   

READING

Alcohol

One of the most problematic, licit drugs in our society is alcohol. The simple process of fermenting sugar from a variety of naturally occurring fruits and grains has been ubiquitous across cultures and societies since the beginning of civilization. It is so pervasive within our society as to also seem to be a seamless part of it. One cannot easily characterize a particular type of person or group that is likely to be alcohol dependent; the affliction cuts across all imaginable demographics of society. Some people are able to drink on occasion for pleasure, whether alone or with friends. Others drink on a daily basis; others periodically binge. 

Here’s a quick, 9-minute history of the science, creation and use of alcohol across cultures, courtesy of SciShow.com:

At present, it has been estimated that approximately 18 million Americans have a serious problem related to the use of alcohol. These 30% of all consumers of alcohol account for about 80% of all alcohol consumed. Men outnumber women in heavy alcohol use by a ratio of around three to one.

The heaviest users of alcohol, in turn, directly or indirectly impact an even larger percentage of the population with their subsequent behaviors while intoxicated. The costs of alcohol abuse and dependence are significant: this drug is the third leading cause of death and is implicated in over half of all deaths and injuries in car accidents and half of all physical assaults and homicides. Further, it has been estimated that at least four family members are directly affected from the maladaptive behaviors that follow from the alcohol-abusing individual; you can quickly begin to see extensive the social, familial, occupational, and emotional impact of this disorder. 

What’s the difference between alcohol abuse and alcohol dependence?

The initial psychiatric diagnosis that could be made for an individual that habitually uses alcohol to excess would be alcohol abuse. This diagnosis is characterized by the continued use of alcohol for at least a period of one month, despite having a recurrent physical problem or some serious personal problem in one’s social or occupational functioning because of the excessive drinking or the repeated use of alcohol in situations (e.g., driving) when consumption is physically hazardous.

The diagnosis of alcohol dependence reflects an even greater degree of impairment in individuals compared to alcohol abuse. Alcohol dependence typically involves at least three of the following serious circumstances: (1) drinking alcohol in greater amounts and over a longer period of time than intended by the individual; (2) a strong desire by the individual to reduce consumption and several unsuccessful attempts to do so; (3) spending a great deal of time drinking or recovering from the negative effects of excessive drinking; (4) continued drinking even though physical and/or psychological problems are apparent and problematic in the individual’s life; (5) social, work, or recreational activities have been significantly reduced or abandoned because of excessive drinking; (6) the development of marked tolerance for alcohol; and (7) consumption of alcohol specifically to avoid the symptoms of withdrawal. About 15 percent of men and 10 percent of women in the United States have met the diagnostic criteria for alcohol dependence during their lifetime.

How does alcohol affect the brain?

Alcohol, as a drug, acts as a depressant on the individual’s central nervous system. It is a small molecule and is quickly absorbed in the bloodstream. Alcohol is linked to inhibiting receptors for the neurotransmitter GABA. In low doses, alcohol depresses the inhibitory functions of the brain, including those areas of the brain that typically adhere to the social controls and inhibitory rules that people typically follow in society. As the alcohol concentration increases in the bloodstream, the depressive function of alcohol extends from the cerebral cortex to areas of functioning that are further (and deeper) into the brain’s primitive and reflexive areas of functioning. In extreme dosing, inhibition of respiratory and motor centers can occur with other symptoms that include stupor or unconsciousness, cool or damp skin, a weak rapid pulse, and shallow breathing. It should be noted that alcohol can only be metabolized and leave the body at a specific rate, regardless of how quickly (or how much) alcohol has been taken in by the individual, so attempts to quickly “sober up” an individual will be unsuccessful.

For more illustration of the science and physical problems associated with habitual alcohol consumption, check out this 4-minute SciShow.com video:

What are the behavioral effects of using alcohol?

Individuals experiencing alcohol intoxication will exhibit a variety of maladaptive changes in their behavior and psychological functioning. Examples include inappropriate sexual or aggressive behaviors, impaired judgment, quickly changing moods, incoordination, impaired gait, slurred speech, impaired attention and memory (sometimes to the point of blackout), stupor, and unconsciousness. The degree of symptoms is dose dependent with more pronounced symptoms occurring as the alcohol blood-level increases.

Withdrawing from alcohol intoxication (i.e., a hangover) is also dependent on recent dosing, history of chronic abuse, and involves a variety of symptoms which can include autonomic hyperactivity in the form of profuse sweating and rapid heartbeat, hand tremors, nausea or vomiting, fleeting illusions or hallucinations, psychomotor agitation, anxiety. At worst, grand mal seizures can occur following periods of prolonged and heavy use. Another significant withdrawal phenomenon that chronic, prolonged abusers of alcohol can experience is delirium tremens that is characterized by disturbances in cognitive functions (especially consciousness), autonomic hyperactivity, vivid hallucinations, delusions, and agitation.

Chronic alcohol dependence can lead to a medical condition known as Alcohol-Induced Persisting Amnestic Disorder (also known as Wernicke-Korsakoff’s Syndrome). This disorder is believed to be caused by deficiencies in thiamine and Vitamin B because their absorption in blocked with habitual alcohol consumption. Individuals afflicted with this disorders experience retrograde (the past) and anterograde (new knowledge) amnesia as well as confabulation, which is the tendency to attempt to compensate for memory loss by fabricating memories.

What are some of the life problems associated with heavy alcohol use?

The pervasive impact of chronic alcohol abuse can be seen across several important areas of in life that generally impair one’s ability to function adaptively (i.e., take care of oneself in a manner appropriate for one’s age) and experience a good quality of life. It is a complex problem in living with psychological, physical, and behavioral components. These include (1) demonstrating a preoccupation with alcohol and drinking; (2) demonstrating emotional problems (e.g., depression); (3) having overt problems at work, within one’s family, and other important social relationships because of alcoholism; and (4) associated physical problems that result from habitual alcohol consumption.

Given that alcohol is a central nervous system depressant, it shouldn’t be a surprise that depression can become a comorbid (or co-occurring) condition for some individuals. In general, the incidence of depression in substance abusers is quite high. People who drink alcohol heavily to the point of intoxication can experience very strong emotions and are frequently disinhibited (i.e., impulsive). Feelings of hopelessness, helplessness, and suicidal thoughts often accompany bouts of heavy drinking.

To review the relationship among amount (dosing) of alcohol consumed, blood alcohol levels, and effects on the central nervous system and behavioral performance, check out this five-minute Healthy McGill video here:

Who is at greatest risk for abuse or dependence?

Research has demonstrated that two risk factors can contribute significantly to the manifestation of alcohol abuse and dependence in the individual. The first risk factor is a family history of chronic alcohol abuse. Children of alcoholic parents have a higher statistical risk of becoming alcoholics themselves when compared to children of nonalcoholic parents. Whether this represents an increase genetic or environmental risk, however, is difficult to determine since both are intertwined in such instances. A second and independent risk factor that has been identified is those cases where an individual has a genetic predisposition to have low response to the psychoactive effects of alcohol (and, as a result, requires higher amounts of alcohol to become intoxicated). Individuals with this lower response to alcohol are more likely to abuse alcohol, as they require considerably more drinking to obtain the level of intoxication experienced by others who drink less to get the same effect.

When taken together, an adult child of an alcoholic who also possesses a low response to the effects of alcohol has an even higher statistical chance of developing a pattern of alcoholism. Keep in mind that all of these examples are just risk factors and statistically probabilities – none of these outcomes are written in stone. Further, research demonstrates that there are also protective factors (variables) in the environment that can also help promote resiliency in some individuals and lead them not to drink alcohol in an excessive or maladaptive fashion when they are present. Clearly, again, the path to alcoholism (and responsible drinking and abstinence) is multi-factorial.

What are some of the treatment options for Alcohol Dependence?

        Unfortunately, flaws in methodology jeopardize much of the research on the effectiveness of alcohol treatment programs. That is, the studies aren’t well controlled in terms of error variance and it cannot be clearly determined whether the observed changes in the studies are due to the employed treatment or other, uncontrolled, factors during the study. For example, many studies do not use untreated comparison groups. One generalization that can be made from the available research is that formal treatments are not always adequate or even necessary. A positive outcome to treatment appears to be related more to the presence of certain psychosocial factors like specific threats to one’s physical or social well-being (i.e., hitting “rock bottom”) than any particular intervention. 

        There are, however, some treatments that have had some success. These treatments have several components in common, including covert sensitization and other forms of aversive counterconditioning. Antabuse, for example, is a medication that, when taken, will result in an individual becoming violently ill should they consume alcohol. Other treatments that put together broad-spectrum interventions such as social skills training, learning to drink in moderation, stress management techniques, and teaching coping skills and other self-control techniques help to teach the individual better, healthier alternatives methods when faced with environmental triggers to consuming alcohol.

        Many modern programs incorporate aspects of Alcoholics Anonymous and/or the drug Antabuse. However, the effectiveness of these treatments has not been empirically demonstrated. One criticism that has been levied on these treatments is that they do not take into account individual differences and the wide variety of psychosocial problems and/or lack of resources that can make successfully managing alcohol consumption. In general, individuals with severe problems with alcohol require more intensive treatments (e.g., inpatient hospitalization), while those who experience less pathological problems require more periodic, milder interventions.

        Another criticism that has been raised about some current treatment programs for alcohol abuse and dependence is that they tend to be based on the belief that failures in treatment are largely due to the individual’s denial of having a problem or otherwise not having an adequate level of motivation. Many therapists have not supported this line of thinking, however. Research on treatment outcome, alternatively, points to the importance of therapist factors such as their level of empathy toward clients and their attitudes about what constitutes healthy recovery as being more related to positive outcomes than client’s own motivation or personality characteristics. 

        Some experts in the field of alcohol research have emphasized the importance of the clients’ reaction to instances of relapse, especially from a cognitive (how they think) and emotional (how they feel) perspectives.  Researchers stress the need to get away from the idea that a relapse represents a “violation of abstinence” which can lead to anxiety, depression, self-blame and an increased likelihood of further alcohol consumption. Alternatively, relapses should be characterized as a mistake that came about from external, controllable factors and not the result of internal factors (e.g., personality characteristics) that are essentially thought to be out of one’s control.

Dually diagnosed individuals (those with a mental illness or personality disorder in addition to a substance abuse disorder) usually have a hard time finding treatment in one place. In many jurisdictions, they have to see a therapist at a mental health center and a separate therapist at a substance abuse center, or they are forced to make a choice of one over the other. You will find that there is often a lack of cross-training between mental health and substance abuse professionals, and that makes it harder for clients to get the treatment they need. Furthermore, in some places, you may find that the treatment support groups for substance abuse have an interpretation of sobriety that prohibits the use of psychotropic medication.

Legal Drugs in Our Society – Part II

        Hopefully, you have found the historical account to date of which drugs have largely been considered illicit, those that have typically been licit and readily available, and those that have switched from one designation to the other, to be an interesting review. Such distinctions among different groups of people and across different periods of time often speak to the changing cultural, social, religious, and scientific beliefs and morays of the time. This week, you will be studying two very popular and legally sanctioned drugs, tobacco and caffeine, that have been readily consumed by people since the beginnings of structured societies. 

Tobacco

From its use in religious ceremonies and purported medicinal herb thousands of years ago to the image of sophistication and modernism it has held in industrialized societies over the last few hundred years, tobacco has occupied a role of prominence among individuals and groups alike.  Think about it: what other drug has been so popularized in society as to be physically accommodated with lighters and ashtrays in automobiles and airplanes? What about spittoons in the restaurants and bars of the late 1800s and early 1900s? How about the smoking cars in trains and smoking sections at airports and restaurants? All these examples serve to demonstrate just how indoctrinated tobacco use has been in modern culture. 

How did tobacco, the plant, get to be such a big deal? Check out this 8-minute history and science video from DNews Plus:

How have patterns of tobacco use changed over the decades in the United States and the world? What are some of the reasons for these changes?

Tobacco is interesting and noteworthy in that it is one of the only drugs that has been commercially available, openly accessible, and integrated within the culture of many societies for hundreds and hundreds of years. Further, it has been monetized as a commodity with economic value for the purposes of trade and payment of debts. In some circles, over time and across cultures, tobacco was even used as its own form of currency. In fact, one could certainly argue that the colonization, formation, and military defense of the United States of America occurred largely in part through the economic power generated through tobacco cultivation, sale, and distribution to other European countries.

It is interesting to note the relationship between the amount of government regulation that exists with the tobacco industry and the resultant use by population. There is a clear relationship between the growing regulation in the United States that began in the early 1970s and the eventual decline of tobacco use among large segments of the U.S. population. This can be especially seen in new generational cohorts; that is, the adoption of chronic smoking habits by younger people. Many other European and South American countries do not employ such heavy restrictions on the advertisement, marketing, and accessibility of cigarettes and other tobacco products upon their population. As a result, the decreases in use and dependence that have been realized in the United States have not been generalized to other countries across the world. The zenith of tobacco use in the United States has come and gone. The preponderance of research has clearly demonstrated its pathological effect on the body and that information, plus rigorous regulation, has helped contribute to the decline in its use.

There are a variety of ways to consume tobacco products as a vehicle by which to introduce the drug nicotine into the bloodstream and the brain. Smoking (via cigars, pipes, and cigarettes), chewing, and snuffing are all legitimized drug-using behaviors whose differing favorability has waxed and waned over the years. Over the years, most individuals were shaped into eventually preferring the use of tobacco cigarettes, which could be mass-produced in very high volumes inexpensively.

The intense and intentional role of marketing has been very significant in shaping the appeal to certain demographic groups of the population. The aggressiveness of early mass marketing campaigns also extended themselves, ultimately, to the denial and cover up by corporate America with regards to the deleterious effects of tobacco use. It wasn’t until 1964 that the federal government began to formally investigate the health effects and cost of tobacco use and to institute policies that would eventually lead to the restriction of marketing and sales in the United States. 

What are some of the adverse consequences of smoking?

The deleterious effects, both physically and psychologically, that result from chronic tobacco use have been well documented. The three-fold combination of carbon monoxide, tar, and nicotine can produce a wide variety of lifelong physical ailments, including a higher risk for cardiovascular disease, respiratory disease, and lung cancer than for nonsmokers. As is widely popularized, there are literally thousands of chemical found in cigarette smoke, including ones commonly used in pesticides. Additionally, other forms of cancer have also been implicated with chronic tobacco use. In fact, the vast majority of deaths each year that can be attributed to drug use and dependence are the result of tobacco use and nicotine dependence.

The primary psychoactive drug in tobacco, nicotine, has been determined by research trials to be a dependence-producing substance. As you recall from previous lectures, drug dependence is defined by continued use of a drug even in the face of obvious occupational, physical, familial, and social problems that one experiences in direct relation to its use. This also includes the psychological experience of craving and high drug-seeking behaviors. The rate at which nicotine is absorbed into the blood stream and penetrates the blood-brain barrier certainly speaks to its strong psychoactive properties. Withdrawal symptoms begin as early as six hours after the last dose. Within 24 hours, common complaints can include headache, irritability, problems concentrating, and sleep disturbance. Finally, in the late 1990s, the tobacco industry finally conceded publically that the products they were producing were not only physically harmful to individuals but also that the nicotine contained within then was a dependence-inducing substance.

What are some of the best strategies to employ when attempting to stop using tobacco products?

    You know just how difficult it is to treat nicotine addiction in terms of a smoking cessation program. The research has demonstrated, much like successful treatment programs for other types of drugs, that have a high degree of dependence, that a multimo

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Effective communication between professional health care staff, and cancer patients.

Hi,

I have attached the instructions to this email on a pdf file. I have started my research,I have decided on what I want to do my proposal on. My Teacher has commented on the paragraph I have already done so please take a look.

Thank you

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Culturally Inclusive Teaching and Empowerment

Teachers of ELLs must understand the role of language and culture in learning, as well as the unique political and psychological factors that affect language acquisition among long-term English learners (LTELs), recent arrivals (RAEL), and students with interrupted formal education (SIFEs). Beyond the classroom, teachers can ensure the success of their students by implementing culturally inclusive practices, and by engaging and empowering families of ELL.

For this assignment, create a 15-20 slide digital presentation in two parts to educate your colleagues about meeting the needs of specific ELLs and making connections between school and family.

Part 1

In the first part of your presentation, provide your colleagues with useful information about unique factors that affect language acquisition among LTELs, RAELs, and SIFEs.

This part of the presentation should include:

  • A description of the characteristics of LTELs, RAELs, and SIFEs
  • An explanation of the cultural, sociocultural, psychological, or political factors that affect the language acquisition of LTELs, RAELs, and SIFEs
  • A discussion of factors that affect the language acquisition of refugee, migrant, immigrant and Native American ELLs and how each of these ELLs may relate to LTELs, RAEL, or SIFEs
  • A discussion of additional factors that affect the language acquisition of grades K-12 LTELs, RAEL, and SIFEs

Part 2

In the second part of the presentation, recommend culturally inclusive practices within curriculum and instruction. Provide useful resources that would empower the family members of ELLs.

This part of the presentation should include:

  • Examples of curriculum and materials, including technology, that promote a culturally inclusive classroom environment.
  • Examples of strategies that support culturally inclusive practices.
  • A brief description of how home and school partnerships facilitate learning.
  • At least two resources for families of ELLs that would empower them to become partners in their child’s academic achievement.
  • Presenter’s notes, title, and reference slides that contain 3-5 scholarly resources.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using the documentation guidelines found in the APA Style Guide, located in the Student Success Center.

 

LINKS FOR HELP PROVIDED:

 

View the “ELL Parent Involvement” video.

URL:

https://youtu.be/3_-aLWOk9Og

View the “Immersion: A Short Fiction Film” video.

URL:

http://www.immersionfilm.com/

Review “A Closer Look at Culture,” located on The National Center for Cultural Competence website.

URL:

https://nccc.georgetown.edu/documents/pptculture.pdf

 

Read “How to Support ELL Students with Interrupted Formal Education (SIFEs),” by Robertson and Lafond, located on the Colorín Colorado website.

URL:

http://www.colorincolorado.org/article/how-support-ell-students-interrupted-formal-education-sifes

Read “Building Culturally Responsive Communities,” by Polleck and Shabdin, from Clearing House (2013).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=88089498&site=ehost-live&scope=site

 

Read “Building Culturally Responsive Communities,” by Polleck and Shabdin, from Clearing House (2013).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=88089498&site=ehost-live&scope=site

 

Read “Building Culturally Responsive Communities,” by Polleck and Shabdin, from Clearing House (2013).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=88089498&site=ehost-live&scope=site

 

Read “Border Kids in the Home of the Brave,” by Zimmerman-Orozco, from Educational Leadership (2015).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ1062901&site=eds-live&scope=site

 

Read “Are Schools Getting Tongue-Tied? ESL Programs Face New Challenges,” by Schachter, from District Administration (2013).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ1013941&site=eds-live&scope=site

 

Read “Improving Family-School Communication with Parents of Long-Term English Learners,” by Bermudez, Kanaya, and Santiago, from Communique(2017).

URL:

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=123022303&site=ehost-live&scope=site

 

Read Chapters 1, 8, and 10.

URL:

http://www.gcumedia.com/digital-resources/pearson/2017/crosscultural-language-and-academic-development-handbook_a-complete-k-12-reference-guide_6e.php

WE ALL KNOW CLASSWORK IS BORING. THUS, OUR ESSAY HELP SERVICE EXISTS TO HELP STUDENTS WHO ARE OVERWHELMED WITH STUDIES. ORDER YOUR CUSTOM PAPER FOR 20% DISCOUNT. USE CODE SAVE20

Culturally Inclusive Teaching and Empowerment

Teachers of ELLs must understand the role of language and culture in learning, as well as the unique political and psychological factors that affect language acquisition among long-term English learners (LTELs), recent arrivals (RAEL), and students with interrupted formal education (SIFEs). Beyond the classroom, teachers can ensure the success of their students by implementing culturally inclusive practices, and by engaging and empowering families of ELL.

For this assignment, create a 15-20 slide digital presentation in two parts to educate your colleagues about meeting the needs of specific ELLs and making connections between school and family.

Part 1

In the first part of your presentation, provide your colleagues with useful information about unique factors that affect language acquisition among LTELs, RAELs, and SIFEs.

This part of the presentation should include:

  • A description of the characteristics of LTELs, RAELs, and SIFEs
  • An explanation of the cultural, sociocultural, psychological, or political factors that affect the language acquisition of LTELs, RAELs, and SIFEs
  • A discussion of factors that affect the language acquisition of refugee, migrant, immigrant and Native American ELLs and how each of these ELLs may relate to LTELs, RAEL, or SIFEs
  • A discussion of additional factors that affect the language acquisition of grades K-12 LTELs, RAEL, and SIFEs

Part 2

In the second part of the presentation, recommend culturally inclusive practices within curriculum and instruction. Provide useful resources that would empower the family members of ELLs.

This part of the presentation should include:

  • Examples of curriculum and materials, including technology, that promote a culturally inclusive classroom environment.
  • Examples of strategies that support culturally inclusive practices.
  • A brief description of how home and school partnerships facilitate learning.
  • At least two resources for families of ELLs that would empower them to become partners in their child’s academic achievement.
  • Presenter’s notes, title, and reference slides that contain 3-5 scholarly resources.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using the documentation guidelines found in the APA Style Guide, located in the Student Success Center.

 

LINKS FOR HELP PROVIDED:

 

View the “ELL Parent Involvement” video.

URL:

https://youtu.be/3_-aLWOk9Og

View the “Immersion: A Short Fiction Film” video.

URL:

http://www.immersionfilm.com/

Review “A Closer Look at Culture,” located on The National Center for Cultural Competence website.

URL:

https://nccc.georgetown.edu/documents/pptculture.pdf

 

Read “How to Support ELL Students with Interrupted Formal Education (SIFEs),” by Robertson and Lafond, located on the Colorín Colorado website.

URL:

http://www.colorincolorado.org/article/how-support-ell-students-interrupted-formal-education-sifes

Read “Building Culturally Responsive Communities,” by Polleck and Shabdin, from Clearing House (2013).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=88089498&site=ehost-live&scope=site

 

Read “Building Culturally Responsive Communities,” by Polleck and Shabdin, from Clearing House (2013).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=88089498&site=ehost-live&scope=site

 

Read “Building Culturally Responsive Communities,” by Polleck and Shabdin, from Clearing House (2013).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=88089498&site=ehost-live&scope=site

 

Read “Border Kids in the Home of the Brave,” by Zimmerman-Orozco, from Educational Leadership (2015).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ1062901&site=eds-live&scope=site

 

Read “Are Schools Getting Tongue-Tied? ESL Programs Face New Challenges,” by Schachter, from District Administration (2013).

URL:

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ1013941&site=eds-live&scope=site

 

Read “Improving Family-School Communication with Parents of Long-Term English Learners,” by Bermudez, Kanaya, and Santiago, from Communique(2017).

URL:

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=123022303&site=ehost-live&scope=site

 

Read Chapters 1, 8, and 10.

URL:

http://www.gcumedia.com/digital-resources/pearson/2017/crosscultural-language-and-academic-development-handbook_a-complete-k-12-reference-guide_6e.php

WE ALL KNOW CLASSWORK IS BORING. THUS, OUR ESSAY HELP SERVICE EXISTS TO HELP STUDENTS WHO ARE OVERWHELMED WITH STUDIES. ORDER YOUR CUSTOM PAPER FOR 20% DISCOUNT. USE CODE SAVE20

Topic 2: Language Basics

QUESTION1:

Why is it important for ELL teachers to be thoughtful about the elements of language within ELL instruction?

 

QUESTION2:

What is the difference between language learning and language acquisition? Provide examples to support your explanation.

WE ALL KNOW CLASSWORK IS BORING. THUS, OUR ESSAY HELP SERVICE EXISTS TO HELP STUDENTS WHO ARE OVERWHELMED WITH STUDIES. ORDER YOUR CUSTOM PAPER FOR 20% DISCOUNT. USE CODE SAVE20