Marketing Strategy Essay

1. Social media advertisement such as Facebook and Twitter. Through this activity of creating advertisement, their business will be more visible to the public and will be known to the market. People would just hit share and likes, and a possibility to reach to the people who are in need of a dormitory. 2. Flyers and Print ads. Flyers will be given anywhere, like outside the school, crowded area, and offices, along the streets or in any event that the flyers could be distributed. Make sure that the flyers that will be distributed has the information that the consumer needs to know and noticeable to the market. They will post tarpaulins near schools, offices and on their designated target markets. So that people will notice and be aware of this area. 3. Commission based Referrals A form of payment to an agent for services rendered. 4. Word of Mouth Seeding a message or information to a lot of people. So that consumer has an idea were to go if they will find a Dormitory or they will refer it to someone. 5. Text Blast Forward text messages about the Dormitory of those in need and give information about the Dormitory. Action Plan 1. Product Improve services, like security guard. 2. Price Minimum of 2600, max 3500 (fixed price) Price must be affordable especially one of their target markets is students. 3. Place It has laundry area, cafeteria, rooms 4. Promotions Tarpaulin should be place near schools, terminals, along the streets. Flyers must have more specified information and must be given to students, offices, along the streets or crowded area.

Pastoral Care and Counseling

Introduction Pastoral care and Counseling is one of the important ministries in the Church at any place in the world. Our churches are filled with people who experience crisis, lost, loneliness, anxiety, depression, divorced, and family problems. Pastors have a huge opportunity to help people just by listening and encouraging those in household of faith. In some cases it is just enough to listen and teach biblical principles of living but in the other cases there is the need to be specifically train people for a specialized ministry of counseling with deeper problems.In the context of my Country, Russia, I choose three issues which mostly need response in the churches. These issues are Premarital Counseling, Marriage Counseling and Crisis care and Counseling. Most of the times we do not feel comfortable to talk about these issues on the church but it do not mean that the problems do not exist. To have a healthy church these issues need to be addressed and pastors need to learn how to approach people because the people are not going to approach pastors first and ask for help. Part I: Premarital CounselingPsychologist Carl Rogers once gave a sobering perspective on marriage. â€Å"If 50-75 percent of Ford or General Motors cars completely fell apart within the early part of their lifetimes as automobiles,† Rogers wrote, â€Å"the public outcry would be overwhelming and drastic steps would be taken to correct the situation. † But this happens to many marriages and hardly anyone rises any complain. Divorce is fre ¬quent, fewer than half of the marriages that persist could be considered successful, and often couples seem unable or unwilling to correct the situation.The same situation and attitude to marriage we have in Russian, people usually get marry in age of 20 and mostly marriages fail after first three years. When I was getting my bachelor degree, 90% of my classmates were getting married at ages of 20 – 21 but 95% of them got divorced i n the senior year of College. I am talking about secular world and we may have a different statistics among Christians but the fact is that young people have no clue what marriage is about.There are many reasons for the present instability of marriages, but one of the many causes of failure is built prima ¬rily on sexual attraction, the desire to escape from a difficult home situation, a vague feeling of love, or some equally fleeting motive. Many marriage relationships are too flimsy to survive the pressures, challenges, and storms of daily living. Unprepared for the stresses or for the effort and determination required making mar ¬riage work, many people prefer to give up and bail out. That which was meant to be meaningful and fulfilling thus becomes frustrating and personally devastating.I believe that if the society in Russian would pay more attention on premarital counseling in the church and outside then the family institution would have grow stronger and that would lead t he country to success because the foundation of any country is the family institution. Premarital counseling seeks to help individuals, couples, and groups of couples to prepare for and build happy, fulfilling, Christ-honoring, and successful marriages. There are many values in premarital counseling if it is done carefully and consistently by the pastor. One of these values is the satisfaction that it brings to him personally.One pastor cannot change this societal attitude by himself, but each one can experience the inner reward of knowing he has done his part to change this pre ¬vailing attitude. The values of premarital counseling are first of all to help the couple to approach marriage more realistically because they are aware of only two things that they are in love, and they want to spend their lives together. Another value of premarital counseling is that it affords each partner a better understanding of himself. A value of great importance is the knowledge that each partner gains of the other through the counseling process.The pastor must help the partners to gain a greater understanding of the thought patterns of each other. Another practical value of premarital counseling is that partners can see the value of, and gain experience in the skill of communication. Finally, a great value of premarital counseling is that it helps persons to realistically determine if they are making the right choice regarding marriage. Reasons for premarital guidance Gary Collins outlines seven basic principles of premarital counseling that I found helpful in my context. These are: 1.Unrealistic Expectations That Can Lead to Disillusionment. When they ap ¬proach marriage, perhaps most people assume that they have unique relationships. Perhaps these expectations are changing now that marriage failures are so much taken for granted. Often there is impatience, insensitivity, self-centered, attitudes, inadequate skill in relating, and great disappointment and disillusionmen t when one's expectations for marriage are not met quickly. Premarital counseling lets couples express, discuss, and realistically modify their expectations for marriage. 2.Personal Immaturity That Can Lead to Insensitivity. Most 92% marriages in Russian happened because of pregnancy and this is the normal thing nowadays. It is not surprising that one's attitudes and behavior within a marriage differ little from the characteristics that were brought to the relationship. If one or both of the participants are self-centered, hypercritical, impatient, competitive, or striving for status—that is, immature—before marriage, these traits will put a strain on marital stability later. People who are irresponsible before marriage tend to be irresponsible after the wedding.Premarital counseling should seek to uncover and discuss the self-centered tendencies that put strain on a marriage. The couple must be taught how to resolve differences, and they must develop both sensitivity and a willingness to accept and meet each other's needs. This involves giving freely to one's mate just as Christ gave to us. 3. Changing Roles That Can Lead to Confusion. Confusion and conflict may follow when a man and woman each come to marriage with unclear roles and vague expectations about their own and each other's responsibilities.Differing assumptions and views about who is supposed to do what can lead to tension unless the couple has learned to communicate honestly, not defensively, and in loving way. Premarital counseling provides an opportunity for a couple to begin this type of communication. Together they can learn to discuss their different expectations and decide on areas of responsibility. Such role clarification must not ignore biblical teachings. According to Scrip ¬ture, both the Christian husband and wife must be filled with the Spirit: daily confessing sin, giving thanks, and praying for the Holy Spirit to control each of their lives.There also must be an att itude of mutual submission to each other, but the more stringent requirements are laid on the husband. The husband and wife are equally valuable and equally important in the building of a good marriage, but they have different responsibilities. 5. Loosening Sexual Standards That Can Lead to Immorality. Sex before marriage is not new and neither is it rare, even among Christians. But as a result of these more liberal attitudes, dating for many has become a time for exploring each other's bodies and genitals instead of each other's mind, feelings, beliefs, values, and expectations.Sexual standards are loosening and premarital sex, even among Christians, appears to be more preva ¬lent. Nevertheless the Bible still calls this immorality a violation of God's best for our lives. Issues like this should be discussed honestly, faced compassionately, and examined biblically. 6. Previous Experiences That Can Lead to Overconfidence. Books on premarital counseling often assume that most coupl es are young, inexperienced, and entering their first marriage. This is not always true. Many prospective brides and grooms have been previously married.Some previously married people recognize the need for new adjustments and appreciate the help that can come from a sensitive counselor. More often, it seems, people approaching remarriage resist premarital counseling and assume that it is unnecessary and only for those who have had no prior marital experience. The counselor can challenge unrealistic attitudes, help the couple see potential problems that even previously married people might miss, and guide them to resolve issues that may have been unresolved following the previous marriage. 7. Circumstances That Can Lead to Later Misery.When they come to marriage, some people bring what one counselor calls red-flag situations that need special scrutiny and evaluation. Some of these circumstances were mentioned as pregnant bride, one or both participants on the rebound from a previous marriage or engagement, serious drug involvement, emotional problems or mental instability, serious mental or physical handicaps, no financial security, contrasting cultural backgrounds or religious beliefs, wide gaps in education or age differences, and knowing each other for a very short time. Many marriages do not survive.Premarital counseling should not be viewed as a painful procedure designed to snatch unsuspecting couples from the grips of marital misery. Most premarital counseling is done, not with pathological people, but with relatively healthy indi ¬viduals who can be helped to enhance and enrich a growing relationship. Format It should be obvious that a counselor cannot accomplish all of these purposes in one brief interview. Most writers recommend that there be at least five or six one-hour sessions prior to the wedding. This of course can be demanding.It is easy for time pressures and counselee busyness to combine in convincing the counselor that a briefer period of premarital counseling would suffice. Try to resist that temptation. There is much to be discussed if a marriage is to be built on a solid foundation. The general goals according to Hamilton, include the following: (1) an understand ¬ing of the meaning of marriage within the framework of biblical truth and Christian theology, (2) an understanding of the problems affecting marriage in contemporary culture, and (3) an understanding of the Christian concept of the value of human personality.As the pastor deals with these broad concepts he seeks to expand his counselees' awareness of the importance of marriage in the light of its biblical and historical roots, of the unique pressures being brought upon marriage in our times, and of Christianity's view of the worth of persons. All of these goals are of vital importance in building a sound philosophy of marriage.The specific goals, according to Hamilton, center in the following areas: (1) an understanding of each partner's role-percepti on in the forth ¬coming marriage, (2) an understanding of each partner's role-expectation of the other, (3) an understanding of how each partner evaluates the strengths and weaknesses of the other, (4) an understanding of the potential strengths and weaknesses of the proposed marriage, and (5) a careful examination of particular problems likely to arise.The underlying, practical goal of all premarital counsel ¬ing is twofold: (1) to enable the partners to pre-solve some potential marriage problems before they arise; and (2) to give the partners knowledge of, and experience in, the art of com ¬munication, which is so necessary in the building of a rich and rewarding relationship. The pastor who wishes to do a creditable job of premari ¬tal counseling should think in terms of at least three sessions: (1) one with the woman, (2) one with the man, and (3) one with both.In each of the individual sessions the pastor will be engaging in four main functions: (1) listening, (2) quest ion ¬ing, (3) analyzing, and (4) teaching. Listening As in other types of counseling, the pastor needs to hear what is, and is not, being said. Only by careful listening can the pastor come to valid insights regarding the counselee’s real feelings about his personal relationship with the proposed marriage partner. Questioning Skillful use of questions enables the pas ¬tor to gather the type of data he needs to help persons prepare for marriage.Questioning will center in the two broad areas of facts and feelings. The area of facts will have to do with such aspects as how they met, how long they have known each other, how long they have dated, and when they plan to marry. The questioning should then move to the deeper level of feelings. This area has to do with such matters as the counselee’s true feelings about the idea of marriage, the de ¬mands of marriage, his perception of his partner as a marriage mate, and his own feelings regarding his ability to be a suità ‚ ¬able marriage partner.The pastor should not hesitate to question his counselees regarding their feelings about every aspect of the marriage relationship including such matters as where they will live and in what kind of dwelling, how many children they want, where they will attend church, whether the wife will be em ¬ployed outside the home (along with how long, how much, and what kind of work), how they will use their leisure time, where they will find their friends and how they will develop social relationships, how each feels about the husband's job, and if either plans for further education.He should also ex ¬amine their attitudes toward in-laws, money, and sex. As the pastor probes the deeper levels of his parishioners' feelings he gains the type and amount of information he needs as he pro ¬ceeds to analysis. Analyzing After the data is sorted out and analyzed, the pastor is ready for a joint session (or sessions) with the partners. In most cases there will be some di fferences in how each partner perceives certain aspects of the future marriage. These are the areas that will need to be given special and care ¬ful attention during the joint session.It is at this time that the two partners will need to be shown the importance of com ¬munication. It will also provide a rich opportunity for them to begin to develop new and better ways of communicating their feelings to each other. Teaching Lastly, the pastor engages in the function of teaching. The amount and type of teaching that is to be done will be determined by what the pastor has discovered in the individual counseling sessions. The broad areas covered in his teaching will usually include the Christian view of mar ¬riage, the tatus of marriage in contemporary culture, the responsible use of sex, the basic differences in maleness and femaleness (most feel they understand the opposite sex but do not), and the art of communication. As a part of his teach ¬ing function the pastor should be prepared to recommend and loan helpful books and articles in areas where the partners lack understanding. It is also important for the pastor to point out the value of a medical examination for the prospective bride, if not for both partners. Thorough work in premarital counseling may involve more than three counseling sessions, but that is the minimum.While this is both time-consuming and exhausting, it is less so than marriage counseling. If a pastor does his premarital counseling work well he may be saving himself, or some other pastor or counselor, from involvement in more extensive mar ¬riage counseling later on. Of greater significance, of course, is that premarital counseling helps couples to build the kind of relationships that are both solid and satisfying We have high incidences of divorce in the church in Russia particularly among young people because they are often pushed into early marriage by teenage pregnancies.Such people do not have any opportunity for premarital counseling. The church often treat them with disdain and may not be readily open to give them some basic premarital counseling that would help sustain them when they get married. Part II: Marriage Counseling Marriage is not a very stable institution at least in the Western and Eastern worlds. In Russia the average duration of a marriage is only 5 years. More than a million couples are divorced every year. Many who stay together have marriages tolerable but not especially happy.Even though happy marriages like these do exist and are possible, we live in a time when marital unhappiness is more common and where many see divorce as a convenient and ever-present fire escape should marital conflicts get too hot to handle. Marriage, the permanent union created by God, is treated more and more as a temporary arrangement of convenience. Marriage is one of the first topics discussed in the Bible. But what does the Bible say about marital problems and ways to help troubled mar ¬riages? Almo st nothing!It should be remembered that marital conflict often is a symptom of something deeper, such as selfishness, lack of love, unwillingness to forgive, anger, bitterness, communication problems, anxiety, sexual abuse, drunkenness, feelings of inferior ¬ity, sin, and a deliberate rejection of God's will. Each of these can cause marital tension, each can be influenced by husband-wife conflict, and each is discussed in the Bible. The causes of marital problems Some common marital problems as found in Russian culture outline by Collins as follow: 1. Faulty Communication.In the professional literature, this probably is the most commonly mentioned cause of marital discord. Citing James 4:1-3, psychologist Lawrence Crabb notes that communication problems inevitably result when people pursue self-centered goals, but sometimes problems also come because individuals have not learned how to communicate clearly and efficiently. Most of us would agree that occasional miscommunication bet ween spouses is inevitable. When miscommunication is more common than clear communication, however, the marriage begins to have serious problems.Poor communication tends to breed more of the same. Try to remember that communication is a learned interaction. Even when it is not good, people can learn to make it better. 2. Underintegrated or Overintegrated Relationships, Getting close to another person is risky. We open ourselves to criticism and possible rejection when we let another person know us intimately, he become aware of our insecurities, or see our weaknesses. Since most of us have learned the value of fending for ourselves, it is not easy to trust another person—even when that other person is a marriage partner 3 Interpersonal Tension.When two people marry, each comes to the marriage with approximately two or more decades of past experiences and ways of looking at life. Each has perspectives that are not shared by the other and sometimes, even when there is a sincere desire for compromise or synthesis, couples still has diffi ¬culty resolving their differences. What happens if there is unwillingness to change, insensitivity to the other person's viewpoints, or a refusal to acknowledge the differences?Often there is tension that frequently centers on one of the following issues: Sex: At times most couples have sexual problems. These include lack of accu ¬rate knowledge, unrealistic expectations, fear of not being able to perform ade ¬quately, differences in sexual drive, inhibiting attitudes about sex, and insufficient opportunities for privacy. Roles: We live at a time when traditional male-female roles are being reeval ¬uated. This often leads to conflict over what it means to be a husband or wife. The society gives little guidance because opinions seem to be changing so rapidly.Inflexibility: When a man and woman marry, each brings a unique personality to the marriage. Sometimes these personality differences complement each other and blend into a mutually compatible relationship. Often marriages take on personalities of their own, each of which can have strengths and weak points. There can be difficulties, however, if one or both of the partners is rigid, unwilling to give, or strongly resistant to change. Religion: The Bible warns of problems when a believer and an unbeliever try to live together in marriage.Counselors have observed tensions when a husband and wife differ from each other in their denominational preferences, degree of com ¬mitment to spiritual things, interest in religion, or expectations about the religious education of children. Sometimes these differences create tension in other areas such as choice of friends, views of ethics, whether and to whom charitable donations will be given, or the use of time on Sundays. Religion can be a binding, strengthening force in a marriage, but when a husband and wife have different viewpoints, religion can also be a destructive focus for marital tension.Va lues: What is really important in life? How should we spend our time and money? What are our goals? These questions concern values. When a couple has similar values, the marriage is often healthy and growing. When values are in con ¬flict, however, the relationship may be one of tension, power struggles, and mutual criticism. Value conflicts are at the heart of many marital problems. Consider, for example, how some of the following value alternatives could create potential for conflict. Functions of the Marriage Counselor The functions of the Marriage Counselor are: To hear the hurts that the counselees are feeling. In many cases these hurts have been intense, of long duration, and unexpressed to a third party. The reason that the counselor needs to hear the hurts is because the counselee feels his or her partner has not truly heard him or her. Attempts to be heard by his mate have been aborted, and this adds to his anxiety and frustration. When he feels that his counselor is gett ing his message and is feeling with him, he experiences the catharsis he needs in order to approach his problem more realistically. 2. To clarify problems.Most persons who come for counsel are aware of symptoms but they do not understand what is producing those symptoms. Most people are so confused they do not know what their problem is until they visit a counselor. 3. To help in the understanding of roles. Most couples are confused of their roles. Be ¬cause it is difficult for one to see the gap between his per ¬ception of himself and his behavior, he feels that he is misunderstood if his mate points out this discrepancy to him. When both partners are thus criticizing each other, each feels mistreated and frustrated. . To fa ¬cilitate communication. A communication problem happens when partners have unresolved conflict between them. The counselor helps deal with the conflicts then now they have free flow of communication. 5. To encourage change in perception and behavior. It is not enough for the counselor to hear hurts, clarify problems, aid in the understanding of roles, and aid in facilitating communication. He must help motivate the partners both to think themselves into a new way of behaving and to behave themselves into a new way of thinking.Moti ¬vation is usually achieved, at least to a degree, when feelings have been ventilated, the problem is seen in clearer perspec ¬tive, and communication lines have been opened. Some marital problems in Russia are like an inflamed appendix, capable of killing but relatively simple to remove. Other problems will be of such depth and severity that the pastor will not be able to deal with them. This means that he will need to refer them to a professional counselor, a psychologist or a psychiatrist. The pastor need not feel defeated by his inability to help such persons.If it is any comfort to him, he should be aware that some marital problems lie beyond the skill of even the best of professionals. Therefore , while he may be truly sorry that he is not able to help in some cases, he should not be embarrassed by this inability. Such failures should, however, encourage him to continue his study of counseling so that his knowledge will expand and his skills will increase. Part III: Care and Counseling in Crises Situation A crisis happens all the time in all cultures nobody is exempted from crisis: big or small, reach or poor, educated or uneducated.A crisis is a part of our lives it is usually happen when person cannot solve the problems by himself. This is where pastoral service is required. A personal crisis develops in four stages: (1) the problem causes tension to the person. (2) Failure to respond to this need produce feelings of anxiety, confu ¬sion, and guilt. (3) When this continues unsolved it develops into a crisis situation that may require external help. (4) If the problem is not resolved, the inner stress of unmet needs mounts until it reaches another threshold—the br eaking point. This is full blown crisis.Caplan in his book Principle of Preventive Psychiatry distinguishes two categories of crises Developmental and Accidental: Developmental crises are normal in the sense that they happen as an integral part of all or many people's growth. Among these are birth, weaning, toilet training, the oedipal conflict, going to school, adolescence, leaving home, completing school, entering a vocation, engagement, marriage adjustment (or the adjustment of singlehood), pregnancy, parenthood, the middle-age crisis, loss of parents, menopause, retirement, death of spouse, death of friends, and eventually one's own dying.These stressful experiences are the occasions of crises for an individual to the extent that they pose problems for which her or his previous coping abilities are inadequate. Each developmental stage and crisis is the occasion for a variety of caring and counseling opportunities. Accidental crises can occur at any age, precipitated by unexpecte d losses of what one regards as essential sources of need satisfaction.Precipitating experiences include all the life events listed on the Holmes-Rahe scale below, loss of status and respect; an accident or surgical operation; mental illness or alcoholism; a physical handicap; an unwanted pregnancy; a natural disaster such as a flood or earthquake; or a massive social calamity such as a war or economic depression. Crises can be triggered by seemingly positive changes such as a job promotion or graduation from college. All these events produce emotionally hazardous situations. Crises happen in people rather than to them, but they tend to occur in high-stress, emotionally hazardous situations.A crisis is more than simply a time of danger, pain, and stress to be endured. It is important for the counselor to see that it is a turning point, a growth opportunity where persons move toward or away from greater personality strength and wholeness. This makes crisis counseling a strategic help ing opportunity. Informal Crisis Counseling Much of the counseling done by pastors takes place in informal settings without being called counseling. This is what happen most in my context. Pastors meet a need a attend to it immediately without insisting that the person concerned must book an appointment before seeing him to discuss the issue.Some occurs in the minister's office or home when people drop by for a chat, without an appointment. By allowing the sensitivities and skills of counseling to permeate their many informal and chance encounters, ministers can help many times the number of people they could reach through formal counseling alone. While it is important that pastors should have some private time for themselves and family, it also important to have parishioners know that their pastor ordinarily is available when severe crises strike unexpectedly.As ministers learn to recognize and utilize the pastoral care opportunities potentially present in many interpersonal contac ts, this becomes a natural pastoral reflex. They discover frequent opportunities to do informal one-session crisis counseling during the ordinary encounters of parish life. Occasionally these will become formal and multiple-session counseling relationships. Informal counseling is informal in one or more of these ways – the setting may be anywhere—a street corner, a grocery store, a hospital room, the church lounge, a parishioner's office or living room, in meeting, etc.The counseling happens in the context of a relationship not identified as counseling—a chance encounter or a pastoral call, perhaps following a meeting or Sunday service. The person's mind-set reflects this informal atmosphere. He/she probably thinks of what occurs as â€Å"talking over a problem with the pastor† rather than counseling. The structure and sequence of formal counseling interviews—appointments, stated time limits, and an agreed-upon series of sessions—are usually lacking. Such brief informal counseling can be very helpful to some people.Informal crisis counseling opportunities occur frequently during a pastor's home and hospital visits. Much of what is done during such calls is general pastoral care. It becomes a counseling issue when the counselee is aware of his /her problem and the pastor shows his willingness to help with the problem. The counselee is able to overcome his/her fear of disclosing the problem to another person with the hope that he/she is going to be helped in such action. Such confidence to disclose the problem does not normally come automatically. It comes with a lot of struggles.Such persons often are receptive to informal counseling long before they enter formal counseling. Some people have great difficulty making a formal appointment for counseling, even when wrestling with very painful problems. They feel that to do so would be to admit failure, which would increase their feelings of low self-esteem and powerlessness . This is why the ability of pastors to go to people, make themselves emotionally available, offer help, and establish informal counseling relationships is a priceless professional asset, which should be used to the full!How can ministers create opportunities, during their pastoral contacts, for care-giving conversations, informal and formal counseling? First, they know or suspect that such and such is in particular need of pastoral care—the bereaved, the sick, the unemployed, the depressed, the hospitalized, the disgruntled, those in psychotherapy, newlyweds, new parents, the recently retired, the handicapped, alcoholics and their families, the lonely, those with disturbed or handicapped children, and those who face painful crises and perplexing decisions.An alert pastor often senses intuitively that a certain family is under extreme pressure. Such â€Å"pastoral care suspects† should go on the Special Help List. By devoting extra pastoral visitation time to these per sons, ministers can build strong relationship bridges with them. Such relationship can bring pastoral care and informal counseling help to the troubled, and also make it easier for them to seek formal counseling. The building of relationship bridges with those who are likely to need help but are not yet motivated to seek it, are described by Seward Hiltner as precounseling.The many interpersonal contacts of pastors contribute to this objective if people feel they are warm, nonjudgmental, caring, competent, shockproof, not â€Å"too busy,† and human—aware of their own humanity . Clinebell believes that, a pastor's sensitivity to the subtle signs of distress is an asset in spotting potential counseling opportunities. Many ministers walk by on the other side of their parishioners' Jericho Roads simply because they lack awareness. The pastor's emotional radar antennas should be tuned to the wavelength of people in order to pick up subtle cries for help and coded â€Å"may day† signals.Clinebell highlights some basic typical distress signals that can help pastors understand people in need. These are: Embarrassment at the minister's call: A frantic attempt to keep the conversation on the surface, avoiding all depth encounters. Depression: including such symptoms as sleeplessness; loss of interest in one's usual pleasures; anxious agitation or heavy sluggishness; feelings of worthlessness, emptiness/meaninglessness or helplessness; a phony-fixed smile. Veiled antagonism between spouses: sometimes hidden behind saccharine-sweet surface behavior.Emotionally disturbed children: including those with behavior problems, (which often reflect hidden marital unhappiness). Frequent intoxication: particularly at inappropriate times. A radical change in usual behavior: including church attendance. Irrational or frantically compulsive behavior. Guilty avoidance of the pastor. Affiliating with extremist political or religious groups. When such distress signals are identified, pastors should make every effort to be emotionally accessible to the persons and to offer help in a way that respects their right to refuse it.A third way to open up informal and formal counseling opportunities is the judicious use of â€Å"openers†Ã¢â‚¬â€questions or statements designed to interrupt superficial conversation and provide an opening for people to discuss their real feelings and issues if they choose. Here are some samples: â€Å"How are things going for you in this difficult situation? † â€Å"What you're saying feels very heavy. † â€Å"How are things going with you really? † â€Å"You seem to be feeling very discouraged (upset, angry, remorseful). † â€Å"I get the feeling you have a burden on your mind. Although such openers may startle people initially, they express the pastor's concern and by implication, offer help. A well-chosen question, asked with warmth and empathy, can help free people to talk about their burdens. A question about one's spiritual health is as appropriate from a minister as is a question about one's physical health from a family doctor. Conclusion Pastoral Care and Counseling ministry is the most important ministry next to the ministry of preaching of the Gospel. People who are hurting they are not be able to listen the Gospel without a healing balm of their wounds.Only Pastors are caring such methods of healing. The Gospel itself addresses to totality of man: spiritual and body. When one part is addressed to the negligence to the other the total needs of man will not be made. Pastors who are sensitive to the hurts of members of their congregation and unable to address such hurts through the appropriate counseling technique are more likely to be successful in ministry then those who neglect these needs. The course Pastoral Care and Counseling has opened my understanding to these needs in our congregation. I got more focused in this area of ministry.And I wish to purs ue it in the future. Bibliography: Benner, David. Strategic Pastoral counseling. Michigan: Baker Book House,1998; Barister C. W . Pastoral care in the church. San Francisco: Harper San Francisco, 1992; Cavanagh, John. Fundamental Pastoral Counseling. Ireland: The mergier press, 1963; Cobb, John. Theology and Pastoral Care. Philadelphia: Fortress, 1979; Collins, Gary. Christian Counseling . Dallas: Word Publishing, 1988; Clinebell Haward. Basic Types of Pastoral care and Counseling. Nashville: Abingdon Press, 1992; Hamilton, James. The ministry of Pastoral Counseling. Michigan: Baker Book House 1975.

Research paper on the author Dylan Thomas Example | Topics and Well Written Essays - 1750 words

On the author Dylan Thomas - Research Paper Example J.M. Kertzer has already noted that Thomas’ critics have made two conflicting claims: â€Å"some insist that he is "the least intellectual poet of the century" because his poetry does not appeal to or depend on reason; others hold that his work displays "rigorous intellectual organization" which provokes a subtle play of thought† (295). While the first assertion implied that the wild poet has created his poems spontaneously without resorting to logic; the second claim employed that Thomas had a rigorous intellectual control over his creations, although he was inspired by â€Å"the cult of irrationality†. Dylan Thomas, paradoxically, acknowledged both views and tried to reconcile them. On the one he asserted that his poems’ â€Å"form was consistently emotional† and â€Å"illogical naturally† (cited by Kertzer 295). On the other hand, he defined himself as a "painstaking, conscientious, involved and devious craftsman in words† (295). He advocated â€Å"passionate ideas† in order to reconcile both views. For him those â€Å"‘passionate ideas’ come to life ‘out of the red heart through the brain’ (EPW, p. 165). Both thought and feeling must be engaged in ‘the antagonistic interplay of emotions and ideas ... brain chords and nerve chords’† (295). Thus, he focused on mind-body relationship while he tried to synthesize rational thoughts with emotions as they are engaged in a battle. Furthermore, for him, a poem must be both intellectual and emotional â€Å"adventure† for the reader. Dylan Thomas’ notion of â€Å"adventure† must be examined more closely in order to have a better understanding of his poetics. According to Thomas, adventure is movement and â€Å"all poetical impulses are towards the creation of adventure† (296). For him, a poem does not reflect life; but itself must be part of life, as he described a poem in terms of action, and

Greer's observation of masculinity run riot Essay

Greer's observation of masculinity run riot - Essay Example According to Greer (894), research conducted by Skuse found out that different treatment was subjected to the feeding infants was wired into the mothers’ routines such that boys got away with cries that appeared to be demanding for food. On the contrary, girls were allowed time to learn between cries and feeding which perhaps teaches them patience and less masculinity in their later life. â€Å"Mothers perceive boy babies as hungrier and as better feeders than girls; what this means is probably that they enjoy feeding their boy babies more than they enjoy feeding their girls, for whatever reason,† Greer (894). The toughening that the boy eventually gets from the traditional masculine myths of how tough men ought to be further propels the boy to very high heights of virtual gender status preached by masculinity. It is clearly illustrated in Greer’s essay that boys learn the virtue of courage from the manner in which the mothers breastfeed them and later pay attention to them better than what fathers offer to their daughters. The female strength in sociability and intuition enables boys to have a better learning experience regarding their environment than what girls make of their learning from their fathers. â€Å"Daughters will develop more self-confidence if their fathers are encouraging and appreciative of their efforts, but fathers seldom give such matters much attention and, if they do, usually demand objective verification of a daughters merit before giving encouragement. By â€Å"masculinity run riot,† Greer (898) implies that the male fraternity under the masculinity perception regime in the society attacks those they feel inadequate to propel the tough roles that males ought to play. It follows that a regrouping occurs where soft males are isolated and made fun of due to the fact that they fall short of the masculine cult expectations. It is possible therefore that the majority of males who feel superior to others due to

Supernormal Elements Essay Example | Topics and Well Written Essays - 250 words

Supernormal Elements - Essay Example The text describes event which was weird and out of ordinary. In order to analyze hidden meaning which are designed to attract readers’ fascination with ghosts and spirits, rhetorical argumentation becomes a major tool. It is an important literary means to explore the hidden information. The need for rhetorical criticism crops up because of the fact that the words and texts are cleverly used to put forward ideas that would influence the thoughts processes of the readers. It identifies traits and emotive responses of the target audience to enhance its impact on the readers. The writer uses techniques and instruments that are designed to persuade readers to his or her views in order to gain confidentiality and trust so as to earn credibility. My article had discussed the existence of supernormal elements in the form of ghosts or spirits as seen by my brother when he was young. The need to make it fascinating so that reader connects with the events was important factor in using words and expressions that deliberately evoked a sense of dà ©jà   vu and bizarre happening. Hence, rhetorical argumentation becomes critical to delve deeper into the meanings of words and phrases to demystify the element of surreal reality. The need to expose the real picture through rhetorical analysis would help to deconstruct the motive of the writer. In this case, the ethos and pathos as used by myself must be identified and revealed through rhetorical criticism in order to expose the real intent of the writer or article.

Rhetorical Analysis Essay Example | Topics and Well Written Essays - 750 words - 3

Rhetorical Analysis - Essay Example Firstly, the pathos of the video is clear and apparent from the very first frame of the video; as the viewer is greeted with an expansive cemetery perforated by concentric lines of seemingly endless white crosses. Further pathos is invoked due to the dramatic elements of the music that is represented to the listener. Hardship and drama with regards to the emotional connection that the viewer must have to the individuals on the screen is represented through a steady stream of images connecting homelessness, poverty, orphans, and a post-apocalyptic environment. Each of these emotionally charged images is capable of invoking a response upon the part of the viewer; a response that the director and producer of this brief advertisement were fully aware could be evoked. Similarly, the ethos of the particular advertisement in question is much less complex and much easier to define as compared to the pathos which is been discussed above. Due to the fact that UNICEF is a global outreach entity that is represented in nearly each and every nation throughout the globe, the degree and extent to which ethos is directly represented merely by mentioning the name UNICEF is innate. As such, even though this ethos is not directly linked to the advertisement until the credits screen flashes just prior to the advertisement concluding, it nonetheless is evident and cannot be ignored by an individual interviews the contents of such a message. It is further arguable that without the UNICEF emblem being represented at the end of this advertisement the overall believability and trust an individual might have with regards the contents therein could greatly be diminished. Finally, seeking to understand this advertisement from yet another perspective, the rhetorical approach of logos, demands that the individual focus upon the moment in time it just prior to the advertisement concluding and/or the moments prior to the UNICEF emblem being flashed upon the screen. Within this brief period of time all of the preceding information that has been driven by thoughts and a sense of emotional distress and need for action is juxtaposed with the logos of the statement: â€Å"What we see as fiction... Is real in Ethiopia† (Unicef 2007). Such a statement of fact links all of the seemingly disjointed emotionally charged imagery and tax that was presented previously and the advertisement to a definitive and logical conclusion. Whereas it may be hard for the individual to accept the images of orphans, innately poor, struggling to survive in burned out towns with no viable means of support or education as a fictitious rendering of a post-apocalyptic world, this is very much unfortunately the case within many parts of Ethiopia and Eastern Africa that are heavily impacted by the AIDS epidemic. By referencing all of this information and utilizing all three of the previously denoted rhetorical strategies, the director and producer, and indeed all of the people responsible for the p roduction of this ad, effectively integrated with as large a market audience as is possible. As has been denoted through previous levels of research, effectively representing pathos, logos, and the post in

Assignment Example | Topics and Well Written Essays - 250 words - 137

Assignment Example Thus, the equation is equal. Adding the exponents is just the shortcut in doing the multiplication of equation with different exponents. 2. The equation  is not equal to . As you can see, when you substitute the variable with the quantity 2, the first equation will yield 24,576 while the second will result to 2,304, which are not the same values. Thus, it is wrong to assume that in raising a power to another power you add their exponents. Instead, the exponents will have to be multiplied. Here is what will happen to the given equation: To test if the equation is correct, substituting the variable with any quantity will yield the same results. For example, substituting the variable with number 2 will result to 24,576 to both sides. As you can see, the only way to raise the power with another power is to multiply the exponents. 3. We can simplify the equation  + 3  because they have the same base raised to the exponent 4. As a general rule with addition, you can only add like terms. In simplifying the equation using reverse distribution method, here is what will happen: The common term common to both the sides taken as general factor is . Thus, the equation is simplified. On the other hand,  + 4  can not be simplified further because the base p is not raised to the same power. You can not add unlike terms. Thus, the equation can not be simplified

Long Term Decisions Research Paper Example | Topics and Well Written Essays - 1000 words

Long Term Decisions - Research Paper Example This infrastructure is what fast tracts quick growth of business developments in the country and creates a workable business environment. This makes the country a good investment hub as it has the appropriate infrastructure for business development. The government’s involvement also leads to improvement in the infrastructure institutionally. This is where the government regulates performance of business to curb transaction vices such as corruption and fraud. Consumers would have to bear a heavy burden of high prices facilitated by calculated behind the scene moves by some unscrupulous traders who want fleece consumers of their hard-earned coin if price setting is left to the forces of demand and supply. The government comes in to set price controls in order to make the goods affordable to low income earners enable the manufacturers get the right return on their investment. The government’s main role is to control and maintain this balance. Other cases of government†™s involvement in the market system are the high investment projects. These are investment projects that need huge capital for them to pick up and that the country must have. The government has to take up the task since to private investors lack the financial muscle to undertake it. Such projects include electricity generation and distribution for the entire country, harbors and airports of international stature e.t.c On the other hand, government’s involvement in business is discouraged considering its drawbacks such as the cumbersome procedures encountered due to the bureaucracy in formation of the business. This leads to market inefficiencies due to the time and money wasted in boardroom meetings to come up with the right policies and structures to legitimize every business transaction such as licensing, leasing, taxation, e.t.c leading to delay in decision making thus the industry is unable to take advantage of emerging opportunities due to its rigidity. The civil serva nts who lack incentives from the government such as good salaries and allowances also lead to inefficiency in the market system. This is because they are not well motivated. Due to their low salaries, they, together with board members who are regulators of the system, engage in corruption and fraud to make an extra coin. This is common in tax officials who will opt to take huge tax bribes to wipe off a tax offender’s record instead of enforcing the set laws. Too much involvement of the government in the market system may lead to miscommunication in the industry. These is because the participants feel the government is too strict or firm thus fear to pass across information that may be vital for the smooth running and operations of businesses in the market process. This eventually leads to turbulent effects in the market such as deflation, inflation, and economic depressions. Such tides are usually very unconducive for business performance as it wrecks its environment. The USA is the leading world economy. As such, the government intervenes in the market process to ensure that this remains so and that the USA citizens enjoy the best there is to offer. The government intervenes to regulate FDI investments. This is because it wants to ensure that the country owns a major stake or controllable share in the establishment. The USA has the largest market in the world and many businesses seek to share part of it. The country has a mixed economy.

Evaluate the Range of Alternative International Assignment Forms Essay Example for Free

Evaluate the Range of Alternative International Assignment Forms Essay An international assignment of 3-5 years is usually considered as Long Term Assignment. One of the reasons that it is becoming extremely more expensive for MNE’s is due to the nature of the job scope and the International Assignee’s (IA) personal considerations. Interestingly, according to the 2009 Global Relocation Trends Survey [ (Brookfield Global Relocation Services, 2009) ] report, when multinational companies are relocating their employees for assignments overseas these days regardless of short or long term, they tend to dispatch older and more experienced employees due to the low risk of assignment failure. This is one of the reasons why it has become increasingly and extremely more expensive for MNE’s [ (Harzing, 1995) ]. Following the expatriate demographic provided by the survey, family concerns sit on top of the chart which remain the most overwhelming reason of 92% for assignment refusal and also the top reason for early returns from assignments which recorded at high of 27%. Historically, the top five challenges over the years of the survey have been family adjustment, partner resistance, difficult location, children’s education, and partner’s career [ (Borstorff, 1997) ]; [ (Brett, 1995) ]. These are also the reasons why it is difficult to find the right candidates with the right experience to fill the vacancy for long term assignment [ (Shaffer, 2001) ]. Antidotes for the Poisons Exploiting Other Alternatives Due to the above dilemma faced by most of the MNE’s, they are now looking at other alternatives which can provide them with the best ‘antidotes’ to the ‘poisons’ that are stinging them. The ranges of alternatives of international assignments that the multinational companies can consider apart from the long term assignment include short term, self-initiated, commuter, and virtual assignments. Short term assignments This type of assignments can last from a few weeks to months. According to the PricewaterhouseCooper’s survey 2001, there is a sharp increase of almost 60% in the popularity of companies implementing this approach in their respective organizations. This is due to the nature of these assignments which give the companies an ‘instant’ solution in resolving skills shortages and are in general easier to manage [ (Solomon, 1999) ]. Apart from that, in comparison with the long term assignments, short term assignments imposed lower cost to the companies due to the assignment length and duration. In addition, companies do not need to spend on relocation on their entire employees’ family and it is also a good means to circumvent family-related problems which can be seen in most of the traditional assignments such as family upheavel. Self-initiated assignments Over the years, there is this trend that is growing in numbers where the assignees make their arrangements to find work abroad and are employed on local work contracts. According to [ (Suutari, 2000) ], they have identified a series of distinct characteristics of the self-initiated assignees as compared to traditional expatriation. These characteristics, which may not be that ‘bull’s eye’ accurate, however does speaks most common assignees may have and practice. These include young and single, be more motivated in moving abroad due to interest in internationalism and poor employment situations at home, working for companies at lower hierarchical levels, and receive no repatriation promises and view their relocation as a more permanent move. The benefit of recruiting the self-initiated assignees is that it can offer companies the potential of not having to undertake preparation. In fact, the assignees recruited could have been resident in a particular location for years where they are well blend with the socio-cultural of the place. One of the drawbacks is that the assignees are not familiar with the organizational culture which until a certain extent where such familiarity is important will be driven by the nature of the assignment. Commuter assignments This type of assignment involves employees commuting from their home to an office in another country by means of travelling by land, sea or air. One of the examples would be employees travelling by airplane on a weekly or bi-weekly basis [ (Assignment types explained, 2012) ]. In contrast with short term assignments, the commuter assignments allow company to fill in the skills shortage without disrupting the employee’s spouse’s career or the children’s education or family affair. This gives the assignees the opportunity to work abroad without leaving their home when carrying out their assignments. However, the drawbacks of the assignment are the quality life of the assignees may be affected. This is due to the likelihood of the assignees returning late from work due to the unspeakable distance of commuting and not to mention the fatigue due to the travelling journey. This affects the communication and the quality time between the assignees and their family which further prolong may affect their emotional and indirectly affects their productivity in the company. Virtual assignments The assignees manage the variety of international activities across several countries which do not require the assignees to be physically relocated to a foreign organizational unit. Although relocation is not necessary but extensive travel is inevitable. The advantages of a virtual assignment seem to be overwhelming over the traditional expatriate assignment. Firstly, the assignees are less expensive due to their wages are paid on local basis (without expatriate allowance) but perhaps with travel expenses. With the increasing use of video conferencing and other communication development, it has narrow down the possibility of this approach and making it less necessary in the future. Secondly, there is no need for any special scheme for the assignees such as insurance, foreign social security, and pensions as they can stick back to only local scheme. This gives the company another cost saving solution and as well as cutting on the unnecessary procedure in establishing a new scheme for the assignees. Lastly and most importantly, the assignees work-life balance is not tremendously affected. The assignees do not need to move their family abroad and their children’s education are not affected. The current trend of expatriation 2011 As the global economy continues to improve, more and more companies are increasing their presence in the emerging market where international assignments have become key aspect in the global economic recovery. Following the reliable source from the 2011 Global Relocation Trends Survey published by Brookfield Global Relocation Services [ (Brookfield GRS 2011 Global Relocation Trends Survey Report, 2011) ], China is where they are heading. According to the survey, China ranked the most common new destination followed by Brazil, India and Singapore. In terms of difficulties, China still sits on top of the list followed by India, Russia and Brazil. This gives a good reflection of the assignee volume going into these locations and the competition for housing and schooling will create delays and difficulties to the relocation and at the same time giving negative impact on the relocation experience. Conclusion In order to draw a bottom line on the above discussion, I personally view that self-initiated assignment would be the acceptable form of assignment from my generation. The current trend is leaning more towards modern thinking and not being hold back by the conventional belief and thinking. Take for example, the young adult nowadays do not rush through their marriage at early age and the average marriage age have increased to over 30 years old in contradictory with 18-22 years old during the olden days. This has indirectly give an impact to the working trend where employees remain single till the age of over 30 years old and they tend to be mobile and not restricted to family pressure or spouse’s career. Coming to this modern generation, we are starting to adapt to a very competitive environment where the local market is getting more and more saturated. In order to overcome this matter, we have to go out from our home country to get a well-paid jobs rather than saturating further in the local market. Therefore, this type of assignment is some kind of ‘killing two birds with one stone’ where companies can expect to save cost by hiring these assignees on contract basis and the assignees can expect to earn higher foreign exchange rate wages overseas compared to working in their home country. Considering the mutual benefits from this type of assignments, in the coming future we can expect to see the self-initiated assignment to gain popularity among the companies and also the prospective employees.

The Story of an Hour Essay Example for Free

The Story of an Hour Essay The Story of an Hour† by Kate Chopin is about a woman named Mrs. Mallard, who learns that her just died in an accident. As I continued to read the story I learned that Mrs. Mallard, was not your ordinary grieving widow, she is actually somewhat happy of the news of her husband’s death. Chopin uses symbolism and irony to show readers the world through Mrs. Mallard’s eyes. Symbolism was a strong term in the story, mainly because Chopin uses symbols in many of her paragraphs. Also the author uses irony to get readers to understand why she is so happy that she is free of her husband. The two literary elements that are prevalent in the story is symbolism and irony because Chopin uses them the most to create different feelings in the readers’ minds. In the â€Å" Story of an Hour† Chopin uses symbolism as much as she can throughout the story. The symbolism begins when Chopin says â€Å" the delicious breath of rain was in the air† (23). I believe this means she is about to start a new life, and that she can finally start living for herself. Another example, is â€Å" there stood facing the open window, a comfortable, roomy armchair† (23). The open window symbolizes being open to change; the adjectives roomy and comfortable symbolizes a feeling of being embraced, a feeling of love and security. While looking through the window Chopin describes other symbols such as: The warm weather which suggest life rather then the cold of winter that symbolizes death. I believe the quote â€Å" were all quiver with the new spring life† (23), symbolizes a new life to come, or maybe something new and exciting was about to happen in her life. The setting of a â€Å" delicious breath of rain† in the air refers to the calmness and quietness after the storm (23). I believe Chopin uses that to refer to Mr. Mallard’s death and the new life she will have now that she is free of him. Another thing outside the window are the â€Å" singing of birds† and â€Å" the distant song of someone who was singing (23). This symbolizes a feeling of relief that she is finally free of her husband, almost as if a burden has been lifted from her shoulders. In the story, Mrs. Mallard is described as being â€Å" a fair, calm face† (23), symbolizing beauty and innocence. I believe Chopin used the symbols in an underlying way to give the readers a feeling empathy for Mrs. Mallard. In â€Å"The Story of an Hour† this is much irony used throughout the story. Irony is first detected in the way Mrs. Mallard reacts to the death of her husband. Instead of reacting like a typical grieving widow, she accepts it and wants to be alone in her room, where she visualizes her life being better off without him rather than missing him. Another example, of irony is when Mrs. Mallard whispers, â€Å" free, free, free† (23). But as the story continues, we learn that ironically she really isn’t free because Mr. Mallard didn’t die after all. Another thing that is ironic is when the doctors say she died of the â€Å"joy that kills† (24). In reality the doctors are correct, but they don’t understand what joy actually killed her, it wasn’t the joy of her husband being alive, but rather that she was finally able to live her life without him. The recognized irony in the story was the fact that Mrs. Mallard was excited about her new life, but ironically she only gets to enjoy her new life for an hour before she dies. In closing, Chopin uses symbolism and irony to get the readers to understand the underlying message that she was trying to get across. Symbolism and irony are two very important literary elements because they provide the story with incite and heighten the readers expectations and interest throughout the story. I feel that Chopin did a very good job in implementing irony and symbolism into the story especially when trying to get the readers to view the world through Mrs. Mallard’s eyes and to describe her state of being regarding her husband’s death.

Nursing Care for Acute Exacerbation of COPD

Nursing Care for Acute Exacerbation of COPD Introduction This essay is focused on the signification of health assessment throughout the nursing process of a scenario of patient (Mr Lee) who diagnosed with acute exacerbation of COPD and express how health assessment and emergency assessment help to plan a suitable nursing care for Mr Lee. Background Firstly, let’s describe of Mr. Lee’s health status. Mr. Lee, aged 70, graduated from high school, retired. He have a son and living with wife and son. He had smoking habit (2 packs / day), but had been quit recently. He also has drinking habit (2 beers per week). He has allergic history of drug – Sulfonamides. For the past history, Mr. Lee had myocardial, hypertension, left-sided heart failure and fractured ankle. He also previously diagnosed with emphysema. Mr. Lee admitted hospital with wheelchair at 23:30 hour on 23 Jan 2014 by complaint of increased cough and laboured breathing at home for past 24 hours. Pain rated 4/10 (10 is being the worst) with cough and mucus sputum. Dyspnoeic breathing, breath sounds heard on the bilateral lung field. Vital signs checked: temperature 37.3 à ¢Ã¢â‚¬Å¾Ã†â€™, pulse 90/ min, respiration 22 /min, blood pressure 130/84 mmHg, SpO2: 95% on room air. Urine test results normal. General condition fair and conscious, emotion stable but showed anxious and claim had insomnia. Mr. Lee is obese: BW 84kg, Height 1.6m (BMI 32.8), he also has oedematous on both ankles (size ++). His vision and hearing are normal. Mr. Lee speaks Cantonese with clear communication. Appetite normal with denture which kept by patient, special diet: low sodium 4g should be given to patient. Elimination is normal, bowel pattern usual habit once per day. For the mobility part, Mr. Lee ambulates independently with fairly steady gait. He did not have disability but need to assist the self-care ability. Medical orders At 01:30 of 24 Jan 2014 MO (Dr Chow) went to see Mr. Lee and prescribed some medical orders as below: Prednisolone (steroid, 80mg po daily) improve respiratory function and oxygenation by reduce inflammation. However sever adverse effect may occur by taking oral steroids, such as hypertension, fluid retention, GI upset, anxious etc. Nurse need to assess and close monitor BP, in/out put, emotion and give low sodium diet for patient. Due to Mr. Lee have MI history, Aspirin (Salicylate, 80mg po daily) prescribe for inhibit platelet aggregation avoid MI relapse. Nurse need to assess coagulation function and liver function. Prescription of two bronchodilators: Atrovent (2 puffs t.i.d.) and Ventolin (2 puffs q6hr prn) are for COPD treatment by make bronchial smooth muscle relaxation. Nurse need to assess the technique of inhalation and difficulty breathing. Furosemide (diuretic, 40mg po daily) prescribe for removes the stimulus of sodium, chloride absorption because of Mr. Lee has oedematous on both ankles. This drug causing a profound increase in urine output, Nurse need to assess the in/output balance and electrolyte level. Metoprolol (Beta-blocker, 50mg po daily) causing vasodilation to treat hypertension and prevent heart attack. Nurse need to assess the BP and heart rate before given. Mr. Lee has left-sided heart failure history, MO prescribes Digoxin (cardiac glycoside, 0.125mg po daily) which help maintain normal heart rhythm and improve blood circulation. Nurse need to assess the apical rate make sure >60/min before given. To make sure the above drugs are safety administer to Me. Lee, not only notice the special precautions of each drug state as above and apply three check five right in giving medication, nurse also should give assessment for patients’ health history especially allergy history; general survey such as vital signs q4hr and p.r.n., I/O chart; physical assessment e.g. breathing pattern and follow laboratory results (CXR, CBP, R/LFT, ABG, Urinalysis), assess and detect any abnormal finding before drug given, assess the drug efficacy and side effect after receive drugs. Oxygen therapy Except oral drug, Dr Chow also prescribes oxygen to Mr. Lee with maximum 4L/min to keep pulse oximetryà ¢Ã¢â‚¬ °Ã‚ §90%. During administering oxygen, hanging notice near Mr. Lee, let everyone know he is on oxygen therapy and the flow rate. Nurse should be awareness that COPD patients can cause respiratory depression or acidosis (pH Nurse should ensure the setting of oxygen delivery is smooth, on the right type i.e. low-flow devices; and method i.e. nasal cannula or simple mask. Assess and monitor pulse oximetry level and respiratory rate closely. Keep vision observation of presentation of Mr. Lee such as SOB. Follow the medical review and the ABG result which may affect the need and level adjustment of oxygen. Assessment of SOB Base on the chief complain of laboured breathing for Mr. Lee, nurse need to pay more attention on his clinical presentation. If patient suffering short of breath (lack of oxygen and/or excess carbon dioxide in the blood) symptoms include: breathing rate become faster and shallow, tachycardia, unable to speak long sentences, cyanosis, use accessory muscles of respiration. Patient also may have chest pain or getting confused. Besides, nurse can apply assessment tool ‘COLDSPA’ asking the symptoms of SOB as below: Character: Ask Mr. Lee to describe the difficulty breathing. Onset: Ask whether the onset of difficulty breathing is sudden or gradual. Location: Ask have chest pain or not and the manifestation and stationary or moves. Duration: Ask how long the SOB lasts, does it appear when walk or doing activities. Severity: Ask how much it bothers Mr. Lee. Pattern: Ask what cause SOB being better or worse. Associated factors: Ask is there any symptoms occur with it and does it affect patient. Physical assessment also can use to assess SOB includes four parts: Inspection to give observation of skin (shin skin, cyanosis), body weight (fat, oedema), breathing pattern (faster respiratory rate, using accessory muscles), chest wall (barrel chest). Palpation mainly focus on the degree of expansion of chest, COPD patient may symmetrically reduced lung expansion. Percussion which to tap the lung and produced sounds. Different types of sound mean the chest filled with air, fluid or solid. Mr. Lee with SOB may have full of air in the lung, the tapping sound will be hyper resonant. Auscultation is use stethoscope to listen the sound of breathing. Mr. Lee with SOB, the breath sound would be wheeze and crackles. Nursing action on N shift Base on the assessment, the nurse should keep close observation of Mr. Lee clinical presentation, pulse Oximetry and vital sign monitoring. Give Ventolin puff if patient SOB. Set NS block for used. Chart I/O for the fluid balance. Pend investigations such as CXR and blood taking as quick as possible. Important information hand over to A shift nurse The information of Mr. Lees’ health history, general survey and physical assessment and the nurse action done at night shift should be hand over to A shift nurse. Also told the nurse that Mr. Lee dyspnea at night, advise chasing lab results, suggest doctor order sputum test and Peak flow rate checking. Important health problem identification To identify the main problem of Mr. Lee, nurse need to compare the objective and subjective data of the below groups. Oxygen: (subjective data) Mr. Lee complaint dyspnoeic gradually, increase cough with mucus sputum, labored breathing at home 24hours. History of smoking 2 packs/day, quite recently. (Objective data) Mr. Lee diagnosed acute exacerbation of COPD, GC fair, dyspnea at night shift, pulse Oximetry from 95% reduce to 88%, Heart Rate from90/min increase to 110/min and Respirations are difficulty at 30/min with right lower lobe crackles and wheezing bilaterally. Fluid (subjective data) Mr. Lee have denture kept by himself, drink 2beers/week. No complaint of eating and drinking, (Objective data) He is obesity with BMI 32.8 abnormal level , there also oedematous on both ankles. At night Mo prescribe Furosemide (40mg Po QD) and offer special diet (low sodium 4g). His I/O is positive balance, NS block setup and voiding per urinal. Safety of physical and psychological (subjective data) Mr. Lees’ vision and hearing are normal, non disability but pain rated 4/10 (10 is being the worst) with cough. He also claims insomnia. (Objective data) Mr. Lee doesn’t tolerate get up to restroom need to use voiding per urinal. For mobility, he ambulates independently with fairly steady gait but self-care ability need assisted. He has hypertension history BP 130/84, Metoprolol (50mg po daily) prescribed for him. His mental stable but emotion shows anxious. He suffers dyspnea at night with Pulse Oximetry 88%, Fast Heart Rate 110/min and RR 30/min. Comparison with three groups’ data, the most important health problem for Mr. Lee is Gas Exchange, Impaired related to altered oxygen supply and the evidence already showed above. Although Mr. Lee also has excess body fluid and risk of safety problems, but the problem priority should be meet the physical needs of the patient, and then consider other levels of need. Problem of oxygen supply is immediate threat to life may cause dysnea or brain hypoxia etc, and need to take immediate action to solve it. Besides fluid retention is a symptom of acute exacerbations of COPD and anxious is related to the dyspnoeic, so if the Gas Exchange, Impaired solve, the other problems may improve. To improve Mr. Lee’s condition, A shift nurse need to have some essential assessment and measures perform for him. Give general assessment including: monitor vital sign and notice any abnormal reading which directly reflect metabolism, oxygenation and circulatory functions; Monitor O2 saturation where Mr. Lee at risk for desaturation; Assess skin colour and perfusion for development of cyanosis; Communication such as any changes in orientation and behavior. Use IPPA to check lung condition i.e. use accessory muscles, lung sound, expansion of chest, noting any signs and symptoms of SOB or airway resistance, also pay attention to breathing pattern, respiration rhythm and dept can reflex lung function such as decrease lung volume and ventilation. Nurse also can use peak expiratory flow rate to measure airflow obstruction, Follow the lab report of CXR, ABGs etc and note changes. Assess the positioning of Mr. Lee to notice any physical effort on oxygenation. Also assess patients ability to cough effectively to clear airway secretions. Note the quantity, color, and consistency of sputum. After assessments, nurse need to compare with the normal standards, noted any abnormal finding which help to give suitable measures. The measures includes keep continues assessment and monitor which state on above. Positioning of patient, eating and drinking assist avoid dehydration. Medication should be given as prescription and assess any side effect appear. Also use anxiety scale to check the emotion then give psychological care to reduce the anxiety level. The expected outcome in the A shift for Mr. Lee is free of difficulty breathing by showed as maintains pulse oximetryà ¢Ã¢â‚¬ °Ã‚ §90%, normal ABGs result and alert responsive, reduce anxious level. However there may occur undesirable situation such as patients condition remain unchanged even become worse. In that way, nurse need to refresh the data and reassessment patient’s health condition to modify the aim and intervention to meet the need of patient. Important information hand over to B shift nurse A shift nurse should hand over the information of Mr. Lees’ health history, general survey and physical assessment, Mr. Lees’ condition in A shift and the nurse action done at A shift. In conclude nursing assessment is a process with planning, purposeful and systematic and run through hold nursing process of Mr. Lee. It helps nurses collect information to master health condition of patient. The assessment provides evidences to nurse analysis, judgment and give proper nursing care, which increase the accuracy of nursing diagnosis and the management, fit the health needs of the patient more specifically.

Madness and Insanity in Shakespeares Hamlet Essay example -- GCSE Eng

Hamlet and Insanity      Ã‚  Ã‚   William Shakespeare’s creation of the character of Hamlet within the tragedy of that name left open the question of whether the madness of the protagonist is entirely feigned or not. This essay will treat this aspect of the drama.    George Lyman Kittredge in the Introduction to The Tragedy of Hamlet, Prince of Denmark, explains the lack of success with Hamlet’s pretended insanity, and in so doing he implies that the madness is entirely feigned and not real:    The necessity for some device like the play within the play is due to the failure of Hamlet’s assumed madness to achieve its purpose. [. . .] In Shakespeare’s drama, however, Hamlet’s motive for acting the madman is obvious. We speak unguardedly in the presence of children and madmen, for we take it for granted that they will not listen or will not understand; and so the King or the Queen (for Hamlet does not know that his mother is ignorant of her husband’s crime) may say something that will afford the evidence needed to confirm the testimony of the Ghost. The device is adopted on the spur of the moment (i.5, 169ff.), and, once adopted, it must be maintained. But it is unsuccessful. The King is always on his guard, and the Queen is not an accomplice. (xii)    The question arises: Is it truly possible to have a noble tragic hero who is indeed bereft of the proper use of his mental faculties? Doesn’t this â€Å"lack† compromise the very essence of a â€Å"noble† protagonist who is worthy of the tragic ending? A.C. Bradley in Shakespearean Tragedy staunchly adheres to the belief that Hamlet would cease to be a tragic character if he were really mad at any time in the play (30). On the other hand, W. Thomas MacCary in Hamlet: A Guide ... ....: Cambridge Univ. P., 1956.    Kittredge, George Lyman. Introduction. The Tragedy of Hamlet, Prince of Denmark. In Five Plays of Shakespeare. Ed. George Lyman Kittredge. New York: Ginn and Company, 1941.    MacCary, W. Thomas. Hamlet: A Guide to the Play. Westport, CN: Greenwood Press, 1998.    Mack, Maynard. â€Å"The World of Hamlet.† Twentieth Century Interpretations of Hamlet. Ed. David Bevington. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1968.    Rosenberg, Marvin. â€Å"Laertes: An Impulsive but Earnest Young Aristocrat.† Readings on Hamlet. Ed. Don Nardo. San Diego: Greenhaven Press, 1999. Rpt. from The Masks of Hamlet. Newark, NJ: Univ. of Delaware P., 1992.    Shakespeare, William. The Tragedy of Hamlet, Prince of Denmark. Massachusetts Institute of Technology. 1995. http://www.chemicool.com/Shakespeare/hamlet/full.html No line nos.

Loss and Healing in The River Warren :: River

Loss and Healing in The River Warren   Ã‚  Ã‚  Ã‚   Each of us, in time, will experience a heart-stopping reality - the death or loss of someone or something we love. Maybe it will be of a family member or just a pet we dearly cherished, but the feelings we have are all too real and all too painful. This loss is probably by far the greatest and most severe emotional trauma we can encounter, and the sense of loss and grief that follows is a healthy, natural, and important part of healing ("Death"). In The River Warren by Kent Meyers Jeff Gruber learns to deal with the grief associated with the loss of his younger brother, Chris. This grief is perhaps the strongest of all emotions that bind families together, but it can also be the hardest to overcome. We never really get over these feelings; we just absorb them into our lives and move on. According to Dr. Elizabeth Kubler-Ross, there are five basic stages of grief. They are denial and isolation, anger, bargaining, depression, and finally acceptance. It is n ot unusual for people to be lost in one of the first four stages, and until they move on to acceptance    their lives may be difficult and even painful ("Stages"). In The River Warren Jeff Gruber deals with these five stages of grief and finds peace in his life and with his father. The first stage of grief is denial and isolation. After Chris's death, life went on, but it went on in silence when it came to picking up rocks. Chris had loved to hear about the glacier that brought the rocks up, and it was difficult for Jeff and Leo to speak of it. Despite wanting to scream at Leo for working and pretending Chris was dead, Jeff could not. Instead he confides in his wife saying, "He never really stopped working, Becca. Just kept on working. Things kept on growing, and he kept on working." When Becca asked him, "What should he have done, though? The world didn't end." his reply was, "Didn't it?" (Meyers 76)    His father's capacity for work bothered Jeff. To him it seemed as though nothing had

Curriculum Access for Students with Low-Incidence Disabilities

NCAC Curriculum Access for Students with Low-Incidence Disabilities: The Promise of Universal Design for Learning This report was written with support from the National Center on Accessing the General Curriculum (NCAC), a cooperative agreement between CAST and the U. S. Department of Education, Office of Special Education Programs (OSEP), Cooperative Agreement No. H324H990004. The opinions expressed herein do not necessarily reflect the policy or position of the U. S. Department of Education, Office of Special Education Programs, and no official endorsement by the Department should be inferred. ———————————————— Curriculum Access for Students with Low-Incidence Disabilities: The Promise of Universal Design for Learning Written by Richard M. Jackson, Director of Practice and CAST’s Liaison to Boston College for the National Center on Accessing the General Curriculum â €”———————————————- Edited by Valerie Hendricks ————————————————- This report addresses the following questions: * What is Universal Design for Learning (UDL)? * What are low-incidence disabilities? Why are schools and communities particularly challenged in serving students with low-incidence disabilities? * What are the needs of students with low-incidence disabilities? * What curricula and instructional practices are currently used with students with low-incidence disabilities? * What planning models are in use for students with low-incidence disabilities? * How can IEPs ensure greater access to the general curriculum for students with low-incidence disabilities? * What approaches exist for enabling students with low-incidence disabilities to participate in state- and district-level assessment systems? How can the UDL framework increase access to the general curriculum for students with low-incidence disabilities? Acknowledgements When one completes a writing project of this size and effort, there are many to recognize and thank. Foremost is CAST’s Valerie Hendricks, whose editing skills remain unparalleled. Valerie’s critical review, suggested reorganizations, and detailed edits in the final stages of the writing proved enormously helpful, contributing greatly to the overall quality of the work.I am also indebted to Kelly Harper and Lisa White, OSEP-supported research assistants based at Boston College, for their careful and extensive library research and literature summaries. Additionally, I want to recognize and thank other Boston College research assistants who helped with earlier editing and reference checking. They include Xiaoxia Chen, Jennifer Hawthorne and Randall Lahann. Finally, I want to express my gratitude to Chuck Hitchcock, NCAC’s project director at CAST, and David Rose, NCAC’s principal investigator at CAST, for their patience, encouragement, and commitment in seeing this project through to completion.Table of Contents Introductionvi Overviewviii I. What is Universal Design for Learning (UDL)? 1 Origins of Universal Design1 Universal Design in Architecture2 Universal Design in Education4 Universal Design for Learning (UDL)5 II. What are low-incidence disabilities? 9 Alternative Systems for Classification9 A Focus on Incidence9 III. Why are schools and communities particularly challenged in serving students with low-incidence disabilities?†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 12Insufficient Numbers12 Finding the Le ast Restrictive Environment13 IV. What are the needs of students with low-incidence disabilities? 15 Special Education is Not a Place15 Categories and Characteristics15 Addressing Intense and Complex Needs16 Clusters of Low-Incidence Disabilities17 Blind/Low Vision18 Deaf/Hard-of-Hearing19 Deaf-Blind22 Significant Developmental Delay23 Significant Physical and Multiple Disabilities25 Autistic Spectrum28 Considering Generic Needs29 V. What curricula and instructional practices are currently use with students with low- incidence disabilities?†¦Ã¢â‚¬ ¦. 1 Curriculum and Instructional Practices31 Toward a Definition of Curriculum33 Facing the Challenge of Curriculum Access35 Blending General and Specialized Curriculum37 Blind/Low Vision38 Deaf/Hard-of-Hearing42 Teaching Approaches43 Inclusion of Deaf and Hard-of-Hearing Students45 Deaf-Blind49 Communication50 Orientation and Mobility50 Individualized Education51 Transition51 Inclusion in Family51 Teaching Strategies and Content Mod ifications51 Significant Developmental Delay52 Curriculum54 Instructional Adaptations56 Significant Physical and Multiple Disabilities60Autistic Spectrum61 Sensory-Motor Therapy63 Communication Therapy64 Social Skills Training64 Applied Behavior Analysis65 Multi-Treatment Programs65 VI. What planning models are in use for students with low-incidence disabilities? 67 The Evolution of the Individualized Education Plan (IEP)67 Person-Centered Planning69 Group Action Planning (GAP)69 Making Action Plans (MAPs)70 Planning Alternative Tomorrows with Hope (PATH)71 Circle of Friends73 Collaborative Planning and the General Curriculum74 Planning in the Context of the General Curriculum76 VII.How can IEPs ensure greater access to the general curriculum for students with low-incidence disabilities?†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 78 Expanding Roles and Functions of IEP Team Members78 Origins of the IEP79 Purpose of the IEP80 Limitations of the IEP82 IDEA ’97 Challenges for the IEP82 Addre ssing the General Curriculum with the IEP85 VIII. What approaches exist for enabling students with low-incidence disabilities to participate state- and district-level assessment systems? 91 The Role of Assessment in Standards-Based Reform91 Broad-Scale Assessment Systems92Standards-Based Assessment and Students with Disabilities93 Participation of Students with Disabilities in Assessment and Accountability Systems94 Changes in Assessment Systems for Students with Disabilities96 Accommodations98 Modifications99 Alternate Assessment Systems99 Massachusetts Alternate Assessment102 Issues Remaining with Alternate Assessment108 IX. How can the UDL framework increase access to the general curriculum for students with low-incidence disabilities†¦Ã¢â‚¬ ¦. 113 Universal Design Revisited114 UDL and the Curriculum116 UDL Components117 Goals119 Methods120 Materials121The National Instructional Materials Accessibility Standard (NIMAS)123 Assessment124 Curriculum Flexibility for Students wit h Low-Incidence Disabilities125 References129 Appendices145 Appendix A: Tips for Universally Designed Teaching145 Appendix B: Principles of Universal Design for Instruction (UDI)147 Appendix C: Design Principles for Lesson Adaptations148 Appendix D: Expanded Core Curriculum for Blind/Low Vision Students149 Appendix E: Six Core Principles153 Appendix F: Alaska’s State Recommendations154 Appendix G: Six Guidelines for Inclusive Programs155 Appendix H: Alternate Assessment Approaches157Appendix I: Five Best-Practice Steps for States158 Introduction Twenty years ago, the publication of A Nation At Risk instigated two decades of educational reform in the United States. Yet improving our educational system remains a national priority. Today, various school reform efforts brought about by enabling legislation and funding streams are converging on the goal of providing a single high-quality education for all of America’s students. Expectations of excellence and equal access, a s well as a focus on outcomes, are driving the effort to â€Å"leave no child behind. The goal of much of this reform work is to ensure that children of color, children living in poverty, children learning English as a second language, and children with disabilities encounter no barriers as they receive the best education possible in order to become independent, productive, and participating members of the communities in which they will live as adults. Once, the â€Å"factory† model of schooling in America viewed all children as mere â€Å"raw material† to be measured and then either mainstreamed or side-tracked, with children disadvantaged by color, poverty, language, or disability automatically winding up outside the mainstream.This system of sorting and then tracking children institutionalized inequality and denial of opportunity. Reform efforts of today are directed toward eliminating this ad hoc marginalization of groups of children, such as those listed above, w ho are viewed as â€Å"at risk† in America’s schools. Reforming education, improving schools, and raising student achievement are noble and socially just pursuits, but by what means are these lofty goals to be accomplished?Many of the diagnostic and prescriptive approaches of the past have resulted in practices where presumably the least capable receive significantly less curricula. An alternative approach to understanding student learning difficulties becomes available when assessments are applied to a school itself, or, more particularly, to a school’s curriculum, instead of to students. Measurement can then proceed with the following questions: How accessible and user-friendly is the curriculum? To what extent does the curriculum permit multiple entry and exit points?To what degree does the curriculum allow for wide participation? How accurately and fairly does the curriculum assess student progress? In order to make a single high-quality public school educat ion available to all, the curriculum itself must be examined. The typical lecture-and-textbook curriculum, made accessible only to those who could demonstrably benefit from it, implies that any failure to grasp the material calls for the student him- or herself to be examined for flaws, as has traditionally been the case.Failure to examine the curriculum and to consider modifications to it presents a crucial question: are the problems confronting public schools today rooted in the students or in the curriculum? In the following pages, we take the position that the challenge of educating students with disabilities or students who are not achieving rests with the curriculum, not with the student. In particular, we posit that the problem resides within the static presentation of typical curriculum, which is unresponsive to the many and varied ways in which individual learners differ.In order to begin addressing not the deficits of students but rather the barriers erected for them by tr aditional curriculum, a framework is required for examining the curriculum as it is and for suggesting ways in which it may be made most accessible to all students. One such framework is Universal Design for Learning (UDL) (Rose & Meyer, 2002). UDL takes a trifold approach to assessing curriculum as it examines, first, the ways in which content can be represented; second, the means by which students can respond; and third, the conditions under which students can engage in the learning process.UDL anticipates an increasingly digitized information source for curriculum, which allows a UDL framework to guide the development of future digital media, delivery mechanisms, and technology tools for use in education. Today, an object as static as a textbook can be transformed in seemingly limitless ways when presented digitally (such as audio, CD-ROM, HTML). As schools become more inclusive and democratic institutions, and as technology develops exponentially, unprecedented opportunities lie ahead for all students to reach high standards in their learning and to experience a high quality of life in adulthood.In the discussion that follows, we present practices that hold promise for increasing access to the general education curriculum for our nation’s most vulnerable populations of students with disabilities. It is the general curriculum that prepares children to take on independent, responsible, and productive roles as adults. The general curriculum—delivered through publicly-funded schools (and therefore by or through democratic institutions)—affords a central opportunity for all to pursue the American dream.For students who are blind, deaf, multiply disabled, or significantly developmentally delayed, equal opportunity to pursue that dream is out of reach without advances in how we prepare and employ our teaching force, how we set policy that raises standards and expectations without discrimination, and, above all, how we deliver a curriculum tha t is flexible and widely accessible for all learners. Equal access to the general curriculum implies that all students have the right to strive for the same educational goals.Equal opportunity implies that accommodations are in place to remove or minimize the impact of disability on authentic performance, thus leveling the playing field. Equal opportunity also implies that modifications to entry points to and benchmarks of the curriculum can be made so that students with disabilities are enabled to make progress to the maximum possible extent. The central question at hand is how communities and state and local education authorities organize to provide the best education possible for students with low-incidence disabilities.One answer is that public education, equally afforded to all, can be accomplished through collaboration among stakeholders, including families, educators (both special and general), administrators, and policy-makers. We will demonstrate how adherence to a UDL fram ework for curriculum reform can yield a flexible and accessible curriculum for all students, including those with disabilities. Overview When Congress reauthorized the Individuals with Disabilities Education Act in 1997 (IDEA ’97), conditions were set for profound change in the ways disability is viewed in the broader context of schools and society.Originally, in the mid-1970s, Congress acted to ensure that no child, regardless of extent of disability, could be denied a free, appropriate, and public education (FAPE) in the least restrictive environment. At that time, an â€Å"appropriate† education meant a special education—one that would be individually designed to address the needs that result from disability. Now, more than thirty years later, the law states that no child may be denied access to the general education curriculum—specifically, that curriculum which schools and school districts make available to all non-disabled students (IDEA ’04) .Currently, the general curriculum consists of core subject areas plus varying elective subject options. Broad frameworks for core content areas are more or less determined by individual states, which also set requisite standards for grade advancement and graduation. In the larger, national effort to reform education in general, students with disabilities are not to be denied access to the same opportunities afforded their non-disabled schoolmates.In this way, Congress seeks to align opportunities for students with disabilities with those available to the non-disabled student population. Using broad-scale assessment systems, states now measure the extent to which all students, and the schools they attend, achieve intended outcomes. There is less emphasis on analyzing the discrepancy between what schools actually provide and what they intend to provide (inputs) in favor of greater focus on results as measured by standards attainment (outputs). Better results for schools presumably le ad to better adult outcomes for students.Just as schools are held accountable for student learning through standards testing, so too will schools be held accountable for supports and services they provide for students with disabilities in order to allow them to access the general curriculum. Accordingly, students with disabilities are now compelled by IDEA ‘97 and subsequent amendments to participate in all state- and district-level assessment systems. Today, the touchstone of special education law remains the Individualized Educational Plan (IEP), which is a document detailing the range and intensity of services and supports intended for each eligible student with a disability.Unlike in the past, however, the IEP now formalizes the collaborative relationship between general and special education and also aligns the general curriculum with specially-designed instruction and other support structures necessary for enabling access to the curriculum. Some support structures relate to how instruction accommodates a student’s disability without altering standards (e. g. , extra time allotted for task completion, Braille in place of print).Other supports may involve curriculum modifications that adjust performance levels or entry points but continue to address standards’ content domain or framework. Accommodations or modifications stipulated in an IEP to adjust instruction or adapt curriculum for a student also apply to the administration of state- and district-level assessments. For students with significant developmental delays, accommodations alone may be neither sufficient nor appropriate. Alternatively, states and districts may employ alternate assessments to ascertain the extent to which students meet goals delineated on their IEPs.Alternate assessments in these cases are modifications of state standards, but they nonetheless follow the broad frameworks identified for each state’s core knowledge areas. Alternate assessment procedures can be authentic and performance-based. In frequent use are portfolios, evaluated according to rubrics that reveal the depth to which students meet standards. Alternate assessment procedures are labor intensive both to design and to carry out. Scoring by state authorities is also laborious and time-consuming.Presumably, however, the use of alternate assessments is limited to 1–3% of school-aged children, thus minimizing the extent of onerous time and effort. Moreover, time spent by teachers in initially documenting alternate assessments is well invested, as procedures become more routine over time with an IEP’s implementation. To many, this adherence to states’ curriculum standards for students with significant developmental delays appears unrealistic, but, clearly, Congress’ intent in IDEA ’97 and IDEA ’04 is to remove barriers that historically limit access to the same curriculum taught to non-disabled students.This amounts to a zero-rejec t from the general curriculum so that all students must participate in and make progress within the general curriculum to the maximum extent feasible. If one conceives of the general curriculum as the vehicle through which all students can achieve adult outcomes—outcomes understood in a broad sense as independence, participation, and productivity—then, in a just and democratic society, opportunity cannot be denied for students with disabilities.In the discussion that follows, we examine practices intended to improve access to the general curriculum for students with low-incidence disabilities. For many reasons, this population presents unique and daunting challenges for all committed to meeting IDEA ’97’s mandates. We follow a question-and-answer format in order to address key issues and to arrive at basic understandings concerning students with low-incidence disabilities. Since much of this report refers to a UDL framework, UDL will be defined.Low-incide nce disabilities are then contrasted with high-incidence disabilities to uncover some distinguishing characteristics of this population. Next, particular challenges confronting schools and communities that endeavor to serve these students and their families are examined. We then concentrate on identifying the needs of students with low-incidence disabilities. We also present disability-related needs that are unique to a particular category of specific disability and other, more generic needs that cut across categories.The reason for this is the fact that IDEA retains the use of specific disability categories for eligibility determination and classification. Over the past few decades, however, both professional literature and actual practice have supported alternative approaches for defining and classifying students with low-incidence disabilities. Thus, in order to provide students with low-incidence disabilities with appropriate and effective services, supports, and ancillary aids, it is necessary to examine alternative frameworks, differing from those traditionally in place, for understanding needs.Specialized curricula and instructional practices that hold particular promise for students with low-incidence disabilities are presented. Just as it is important to understand need from multiple perspectives, so too must curriculum and instructional practices be understood as meeting both unique as well as shared needs among students with low-incidence disabilities. We focus on curricula and practices that are highly specialized as well as those that address more typically shared needs.Because IDEA requires access to the general education curriculum for all students, it is necessary to examine ways in which specialized curricula and instructional practices can support or otherwise connect with broader approaches for improved access, participation, and progress for students with disabilities. Curriculum is highly complex. Historically, it has been examined through many different lenses. The complicated nature of curriculum theory and practice makes it difficult to envision innovative ways of making it accessible for students with disabilities.Thus, we will also examine and attempt to demystify some of that complexity. Instructional practices presented in the context of our discussion are intended to bring an effective focus to eliminating or reducing curriculum needs associated with low-incidence disabilities. As with the consideration of need, curricular options and instructional practices can also be both highly specialized to a specific disability and highly generic across disabilities. For example, approaches for engaging students who are blind or deaf can be quite unique to those disabilities, given the varieties of existing communication modes.Other approaches can be quite generic, involving, for example, applied behavior analysis or systematic instruction. After grounding in student need, curriculum, and instructional techniques, we e xamine models for collaborative planning. Students with low-incidence disabilities require services and supports beyond the classroom. These may intensify at various transition points throughout a life span and broaden out to include an array of community agencies. We examine the IEP in turn as a tool for pulling services together in support of access to the general curriculum.We then focus on approaches for enabling students with low-incidence disabilities to participate in state- and district-level assessment systems. Finally, we conclude with a consideration of how access to the general curriculum can be improved for students with low-incidence disabilities through the application of principles of universal design. I. What is Universal Design for Learning (UDL)? A major premise of this report is that access to the curriculum for students with low-incidence disabilities is greatly enhanced by universal design.Universal Design for Learning (UDL) is a particular framework that appli es to education. More specifically, UDL is an approach that can guide curriculum reform. A universally-designed curriculum includes multiple means of representation (to allow various ways of acquiring information and knowledge), multiple means of expression (to allow alternatives for demonstrating knowledge), and multiple means of engagement (to challenge appropriately, to motivate, and to allow learners to express and participate in their interests). A number of current contrasting approaches to universal design will be described.We conclude with an explanation of UDL. This will allow the reader to keep UDL in mind while progressing through subsequent sections until UDL solutions for curriculum access are more closely examined in our conclusion. Origins of Universal Design Architecture reveals the extent to which humankind can establish dominion over the natural environment by harnessing resources that it has to offer. Architectural design can be subjected to all manner of criteria , including beauty, convenience, utility, durability, safety, and even exclusivity.Only in recent times has the criterion of exclusivity been successfully challenged. As populations grew, built environments afforded travel and facilitated commerce. The need for standards in architectural design became apparent as built environments became interconnected. Architects needed to consider the preferences and capabilities of those who would access built environments. In more recent times, users of built environments were living longer and, therefore, functioning with less mobility and stamina. Notions of democracy and community were transforming views of belonging and participation.During the 1960s, social movements that began in Europe around such concepts as normalization, deinstitutionalization, and communitization were beginning to have a profound impact upon those who would advocate for the disabled in the United States. Thus, the needs of people who would potentially access the buil t environment were beginning to be understood as complex and diverse. Universal Design in Architecture The passage of the Vocational Rehabilitation Act of 1973 essentially outlawed discrimination on the basis of disability.So far-reaching was this piece of federal legislation that it took nearly three years for a beleaguered Congress to write the regulations that would ostensibly remove architectural barriers from all publicly supported buildings and properties. During this era, universal design in architecture was born. Like the dream of building inclusive communities for all to enjoy equally, universal design is an ideal with a process to ensure maximum participation for all. The challenge of removing physical barriers and retrofitting solutions to barriers proved to be a costly and cumbersome process, often yielding unsatisfactory results.Universal design sought to embed solutions into features at the design level—features that would benefit all, not merely accommodate the few. Curb cuts intended for wheelchair users, for example, were also found to be helpful for users of baby strollers, shopping carts, skateboardes, among others. In 1990, the Americans with Disabilities Act (ADA) extended the prohibition against discrimination on the basis of disability to the private sector, requiring all entities doing business with the public to make every reasonable accommodation in providing access.Accessibility standards, while necessary for guidance and compliance monitoring, can appear onerous or threatening in light of the fact that they are government regulations, particularly when coupled with the public’s misperceptions regarding disability. Universal design, as envisioned by Ron Mace and his colleagues at North Carolina State University’s Center for Universal Design, was intended to promote the design of products and environments that would appeal to all. North Carolina State’s Principles of Universal Design are listed below in bri ef form (without associated guidelines). PRINCIPLE ONE: Equitable Use The design is useful and marketable to people with diverse abilities. PRINCIPLE TWO: Flexibility in Use The design accommodates a wide range of individual preferences and abilities. PRINCIPLE THREE: Simple and Intuitive Use Use of the design is easy to understand, regardless of the user’s experience, knowledge, language skills, or current concentration level. PRINCIPLE FOUR: Perceptible Information The design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities.PRINCIPLE FIVE: Tolerance for Error The design minimizes hazards and the adverse consequences of accidental or unintended actions. PRINCIPLE SIX: Low Physical Effort The design can be used efficiently and comfortably and with a minimum of fatigue. PRINCIPLE SEVEN: Size and Space for Approach and Use Appropriate size and space is provided for approach, reach, manipulation, and use, regardless of user’s body size, posture, or mobility. † Principles of Universal Design, version 2. 0 (Center for Universal Design, North Carolina, 1997).Application of these principles has established a framework for developing design standards in architecture, as well as for creating consumer products, that permit the greatest degree of access and usability for the widest possible range of individuals. Today, millions of Americans with disabilities enjoy access to buildings, restaurants, movie theatres, sporting events, transit properties, walkways, commercial vehicles, and bank teller machines—to name only a few venues that were once inaccessible to them.Wheelchair users, once limited to home instruction or restricted to special school buildings, now attend their neighborhood schools alongside their non-disabled agemates. However, although physical access to classrooms and other education facilities is an important first step toward educational equity for the disabled, it is not sufficient to ensure that all students with disabilities have equal access to the general curriculum or enjoy comparable opportunity to derive benefit from what school curriculum has to offer.Additional changes in the classroom environment and in the curriculum itself are also required in order for full equity to be achieved. Universal Design in Education Universal design in architecture recognized the importance of building environments that were more in line with the needs of an aging population and the requirements of those persons with disabilities who were being welcomed into the general community during the 1970s.In the 1980s, attention was brought to bear on the rapidly increasing diversity of America’s students through the publication of A Nation At Risk, a report presented to the U. S. Department of Education by the National Commission on Excellence in Education. According to this report, our nation’s schools—particularly in urban centers—appeared ill-equipped to prepare a diverse population to compete successfully in an increasingly global economy. The findings of the Commission spurred a wave of reform initiatives ith enabling legislation aimed at raising standards and outcomes for our nation’s most under-served students. More recent federal legislation, such as No Child Left Behind (NCLB, 2001) and the Individuals with Disabilities Education Act (IDEA, 1997; 2004), seeks to build one education for all students, improve teacher quality, align curriculum with standards, measure outcomes at multiple points, and hold schools accountable for student performance.For no child to be excluded from—or left behind by—the general curriculum, the curriculum itself must be examined and re-designed from a fresh perspective, much in the same way that buildings, environments, and products were critically examined by the original advocates of universal design in architecture resulting in im portant and lasting changes in building standards. Colleagues at the University of Connecticut’s National Center on Postsecondary Education and Disabilities have developed a set of principles building upon and extending the principles originated at North Carolina State’s Center for Universal Design.Note that their educational design principles are essentially the same as those outlined by North Carolina State for architectural and product design (with the addition of principles 8 and 9—community of learners; instructional climate). Their new principles address more educational constructivist perspectives regarding communities of learners and a climate of high expectations and social interaction. Together, these principles set a framework for what Scott, McGuire, and Shaw (2001) call Universal Design for Instruction (UDI).Application of these principles allows postsecondary institutions in particular to dramatically widen the accessibility of course offerings by designing accommodations into course structures rather than retrofitting a series of educational work-arounds to try and meet the specialized needs of individual students after course materials have been prepared. UDI principles are listed and defined in Appendix B. Universal Design for Learning (UDL) Calls for critically examining curriculum from a universal design perspective have come from many quarters (King-Sears, 2001; Hitchcock, 2001;Nolet & McLaughlin, 2000; Pugach & Warger, 2001; Rose & Meyer, 2002; Turnbull, et al. , 2002; Wehmeyer, et al. , 2002). The principles of Universal Design for Learning (UDL) as put forth by the Center for Applied Special Technology (CAST, Inc. ) were first presented in an Office of Special Education Programs (OSEP) Topical Brief (Orkwis & McLane, 1998). Currently, typically taught curriculum in schools is a â€Å"one-size-fits-all† curriculum, best exemplified by the ubiquitous textbook.It generally lacks flexibility in how it presents inf ormation to students, how it permits students to respond, and how it engages students in the learning process. In order for typical textbooks and other curriculum materials to become accessible to many disabled students, they must undergo numerous time-consuming transformations and interpretations, to the extent that the student’s participation in classroom activities is often fragmented or delayed.Several projects supporting universal design and access approaches to the general curriculum were reviewed in Research Connections (Danielson, 1999), a bi-annual review of OSEP-sponsored research on topics in special education. Prominently featured were projects underway at CAST to create a universally designed early literacy curriculum (Scholastic’s WiggleWorks) and a universally designed document processor (CAST’s eReader).Also featured in the review was a framework advanced by the University of Oregon’s National Center for Improving the Tools of Education (N CITE) for designing the ‘architecture’ of effective instructional practices (Kameenui & Simmons, 1999). (Their design principles for lesson adaptations are available as Appendix C. ) CAST’s work is important because it demonstrates how flexible and malleable curriculum can be with the use of digital media and digital technology tools following a UDL framework.The NCITE’s work on the architecture of instruction is important because it draws upon the current knowledge base regarding effective instructional practices and illustrates how instruction can be tailored to learners depending on the degree of explicitness required. Over the years, many proposals have emerged to counter the old factory model approach to mass education begun in the 19th century with graded education.Approaches to individualized, personalized, or otherwise differentiated instruction have made enormous contributions to thinking about teaching and learning processes. What might distingui sh UDL from other efforts to improve instruction in general—or other perspectives on universal design in particular—is that UDL establishes a framework for curricular reform in education (Rose & Meyer, 2002) yet also recognizes the need to maintain a balance between curriculum and instructional practice (Hitchcock, 2001).Moreover, a UDL framework provides a perspective for collaborative teams of special and general education personnel to provide access to the general curriculum while addressing disability-specific needs in multi-level or inclusive classroom situations (Jackson & Harper, 2002). While UDL anticipates the coming digital curriculum with its inherent potential for flexibility and built-in options, it is not wholly reliant upon technology. UDL can ensure accessibility with new media and technology tools, but it depends upon the application of evidenced-based teaching practices to yield desired results (Hitchcock, 2002).To achieve these results, a UDL framewo rk relies upon three guiding principles—multiple means of representation, multiple means of expression, and multiple means of engagement—for the development of flexible teaching approaches and curriculum resources. These principles emanate from analyzation of available research on the brain and new conceptualizations of how neuroscience informs our appreciation of learning and knowing (Rose & Meyer, 2000).Areas in the brain that contribute to learning can be grouped roughly into three interconnected networks, each with a fundamental role in learning: (a) â€Å"recognition† networks, specialized to receive and analyze information (the â€Å"what† of learning); (b) â€Å"strategic† networks, specialized to plan and execute actions (the â€Å"how† of learning); and (c) â€Å"affective† networks, specialized to evaluate and set priorities (the â€Å"why† of learning) (Rose & Meyer, 2002).New insights into neurological systems worki ng within these three regions of the brain connected with learning has led to the formulation of the three guiding principles of UDL: 1. To support diverse recognition networks, provide multiple, flexible methods of presentation. For example, when introducing students to a new concept or unit, a teacher may provide multiple structures to present that information, such as a lecture, a digitized text, an activity-based exploration, a demonstration. 2. To support diverse strategic networks, provide multiple, flexible methods of expression and apprenticeship.For example, when a teacher requests student responses to demonstrate understanding and knowledge, he or she could provide a range of tools that allow students to respond in various formats, such as in writing, orally, with a slide show, with a video, with a drawing. 3. To support diverse affective networks, provide multiple, flexible options for engagement. Allow students to select an area of interest within a topic or concept to r esearch or study. For example, allow students to select one of the natural resources in a geographic area under study to research rather than assigning resources (Rose & Meyer, 2002).UDL also establishes a framework for providing access to, participation in, and progress within the general curriculum as first mandated by IDEA ’97. Hitchcock, Meyer, Rose, and Jackson (2002) have defined four main components of the general curriculum: 1. goals and milestones for instruction (often in the form of a scope and sequence), 2. media and materials to be used by students, 3. specific instructional methods (often described in a teacher’s edition), and means of assessment to measure student progress.Each component can be transformed for accessibility and participation by all students by adherence to the principles of UDL. UDL offers new ways to think about teaching and learning. Students with sensory challenges, for example, require curriculum that contains alternative approaches for presenting information. Students with motor challenges, on the other hand, may require curriculum that provides alternative ways of expressing what they know and can do, while students along the autism spectrum may require curriculum that contains alternative ways to become engaged in or connected with the learning process.Broadly stated learning goals may allow students who are cognitively challenged to enter the curriculum at points where appropriate levels of challenge and support can yield both tangible and measurable results. Methods and materials with designed-in supports may permit wider access and greater participation in the general curriculum by all students, including those with disabilities. Instructionally embedded assessments may provide more immediate feedback and more frequent data points for progress monitoring and instructional decision-making.These are some of the promises of UDL. II. What are low-incidence disabilities? Alternative Systems for Classification Students with disabilities can be classified in many ways. IDEA ’97 continues to recognize disabilities in the form of more or less discrete diagnostic categories, such as mental retardation, specific learning disabilities, or emotional disturbance. Other approaches to classification include categorizing disabled individuals by degree of severity of their needs, or by how atypical an individual may be when compared to a norm.Still other approaches may emphasize the level of intensity of supports necessary for an individual to function optimally in home, school, community, and work settings. Each of these approaches has advantages and disadvantages. The categorical approach taken by IDEA may emphasize learner characteristics for each disability, but, in so doing, it could also foster a self-fulfilling prophecy in which all members of a group sharing a categorical label, in a sense, become that label.A severity approach may emphasize developmental milestones at the expense of i gnoring strengths in functional skills. An intensity approach may meaningfully focus on levels of needed support, but, at the same time, limit opportunities for an individual to move to a less restrictive setting. None of these systems of classifying individuals with disabilities are either entirely satisfactory or entirely lacking in merit.For educators, it is important to be aware that several systems of categorizing students with disabilities exist simultaneously, because eligibility criteria, placement alternatives, intervention strategies, and teaching credentials may all vary substantially from school to school, depending on which system of classification is currently being employed. A Focus on Incidence When the issue at hand for students with disabilities centers on the provision of services in local schools, the availability of qualified personnel and the technical sophistication of necessary resources must be carefully considered.In order to provide students with disabilit ies with a free and appropriate public education, it is useful to classify learners in terms of incidence, or how many students with any particular disability or combination of disabilities reside in a community. Under such a system, students with the most commonly-seen disabilities may be more appropriately served by local public schools while students with relatively rare disabilities may not find adequate resources or highly qualified personnel.High-incidence disabilities include— * communication disorders (speech and language impairments) * specific learning disabilities (including attention deficit hyperactivity disorder [ADHD]) * mild/moderate mental retardation * emotional or behavioral disorders Low-incidence disabilities include— * blindness * low vision * deafness * hard-of-hearing * deaf-blindness * significant developmental delay * complex health issues * serious physical impairment * multiple disability * autismNone of the disabilities listed under low-inc idence disabilities generally exceed 1% of the school-aged population at any given time. The relative rarity of students with these disabilities in public schools often poses significant challenges for local schools struggling to meet their needs. Since they encounter these students so infrequently, most local schools have little if any knowledge of how to best educate these students, of what technologies are available to assist them, and of how to obtain needed and appropriate support services from outside agencies.All students with low-incidence disabilities thus experience a commonality: they are difficult to serve in current local public school programs. III. Why are schools and communities particularly challenged in serving students with low-incidence disabilities? Insufficient Numbers Students with low-incidence disabilities are difficult to serve in today’s public schools because none of the low-incidence categories alone can form a group large enough to warrant the pr esence of full-time, school-based, and highly specialized personnel, except in the largest of big-city school districts.Therefore, students with low-incidence disabilities are more likely to be served in less inclusive settings (such as in special classes, separate schools, and residential facilities) than are students with high-incidence disabilities. Local schools that do attempt to provide maximum inclusion most often support these efforts through the use of itinerant personnel, usually teachers/consultants who travel from school to school as needed, often crossing district lines to serve the needs of their students.Each variety of low-incidence disability brings its own unique challenges to a local school system. When intensive, specialized instruction is required, such as the learning of Braille for blind students or American Sign Language (ASL) for the deaf, teacher consultation models of intervention can prove woefully inadequate for the delivery of specially-designed and car efully-targeted intensive instruction.Similarly, when faced with students who present with complex healthcare needs, local schools frequently lack the capacity to respond appropriately to medical emergencies or to provide required routine intensive care. Each group of students with a low-incidence disability has its own set of specialized needs, requiring specialized supports and specially-trained personnel to maximize their educational opportunities. While some generic support services are of use to nearly all students, most are specialized to one group.For example, a deaf or autistic child is unlikely to need to learn Braille, while a blind student will not need the level of constant medical support that a quadriplegic child or one under medical treatment for leukemia is likely to require. The low-incidence nature of these disabilities also makes it extremely challenging to maintain an adequate supply of qualified professionals to serve them. The skills and knowledge sets of these professionals are highly technical, requiring a significant commitment of time and effort to acquire through professional preparation, typically at university centers.Yet the caseloads of these professionals are small and likely to change in composition from year to year. Further added to this supply challenge is the paucity of university-based, professional preparation programs to prepare sufficient numbers of practitioners to adequately serve these students. Moreover, administrative supervision and mentoring of new inductees to the field are frequently inadequate. These professionals are mostly isolated from colleagues, limiting their opportunity for collaboration and shared growth.Opportunities for targeted professional development may be extremely limited. In sum, it is difficult to attract qualified individuals into these fields to begin with and perhaps even more difficult to nurture, support, and retain them once employed. Finding the Least Restrictive Environment Often, the least restrictive environment for students with low-incidence-disabilities cannot be found in their local public school.While IEP teams must presume that a student is to be placed in the public school closest to her or his home, a team may be compelled by assessment findings to urge placement in a specialized setting where highly-trained personnel and appropriate technologies can be concentrated and unique needs can be appropriately targeted for intensive instruction. Although students with low-incidence disabilities are required to have access to the general education curriculum, that requirement does not state that the only way in which such a condition may be met is in a full-inclusion setting in a general education classroom.An IEP team may determine that an alternative and highly specialized setting is the most appropriate, and therefore least restrictive, placement available for meeting the specific needs resulting from a student’s disability(ies), particularly if thei r local public school is not sufficiently equipped to provide a safe and successful educational experience for that student. Thus, in many cases of students with low-incidence disabilities, the true path toward greatest access to the general education curriculum may be pursued more appropriately in a separate setting (for example, in a school for the deaf or a residential school for the blind).However, in some cases, appropriate program planning for students with low-incidence disabilities in local public schools is possible and may be the preferred placement according to the IEP team, which includes the student and the student’s family. Adequate provision for these students in inclusive settings requires broad community engagement and significant systems change. Collaboration and commitment among stakeholders at the local, state, and federal levels are necessary to effect such change.With thoughtful and appropriate approaches to planning, such as those to be described, willi ng communities can amass the supports necessary to ensure high-quality educational services for even those students with the most significant cognitive disabilities or complex healthcare needs. IV. What are the needs of students with low-incidence disabilities? Special Education is Not a Place With the enactment of IDEA ’97, special education is no longer considered a place but rather a network of services and supports designed to enable students to derive full benefit from a public school education (Heumann & Hehir, 1997).As stated earlier, this does not mean that students with disabilities cannot be appropriately served in specialized settings. Rather, the intent of the law is to emphasize that â€Å"placement† or location of services is the last decision an IEP team makes during a team assessment and planning process. In earlier times, a disability-specific label itself would dictate placement, and that placement would define the treatment or nature of interventions for students. Today’s approaches use comprehensive and holistic assessments to reveal the extent of need in suspected areas of risk associated with a student’s disability.Their team then determines the setting in which needed services can best be provided, selecting from a continuum or array of placement options ranging from full inclusion in a general education classroom to residency in a hospital setting (Drasgow, Yell, & Robinson, 2001). An IEP team always starts with the presumption that a student will be placed in the same setting in which he or she would be educated if disability were not an issue, namely, a regular public school classroom (Turnbull & Turnbull, 1998).Thus, in order to place a student in a less inclusive setting, this starting presumption must be rebutted by assessment data before such a placement outside a general education setting can be made. Categories and Characteristics IDEA designates categories of disability with which specific learner ch aracteristics have been associated in the special education knowledge base (Hallihan & Kaufman, 2002; Hardman, et al. , 2002; Heward, 2003; Turnbull, et al. , 2002).These characteristics are correlates of particular disabilities and not necessarily connected with a particular disability—that is to say, they are characteristics that are commonly found in students with these particular disabilities, but for which there are often exceptions, such as cases where a student has a particular disability but not one or more of its expected associated characteristics or behaviors. â€Å"Learned helplessness,† for example, is associated with specific learning disabilities, but not all students with learning disabilities have acquired this psychological adaptation.Rather, they are at risk for acquiring learned helplessness. While there are often litanies of learner characteristics described as unique or disability-specific, the extent to which these areas of risk are observed in a n individual student can vary widely. Careful assessment and observation of an individual student and his or her needs must be undertaken to document actual need for initial intervention and not merely expected need. Such an assessment establishes a baseline of educational need(s) against which progress can be measured.Students with disabilities often become â€Å"handicapped†Ã¢â‚¬â€unnecessarily or unfairly restricted—not by their disabilities in and of themselves, but by the environment in which they live, learn, and relate. Consequently, extent of need cannot adequately be assessed without consideration of broader contexts in which an individual lives. This context includes family, community, and the local public school which would be a student’s default placement location.Thus, a team’s determination of the least restrictive and most appropriate environment for a student must take all these factors into consideration when judging the capacity or prep aredness of home, community, and local school to support and nurture a student in areas of assessed need and in assuring a student access to the general curriculum. It is imperative that any set of disability-specific needs not serve to stereotype a student, to lower expectations for a student, or to contribute to negative self-fulfilling prophecies for a student.So-called unique or disability-specific needs should be taken only as possible areas of risk for IEP teams to investigate, not inevitable features automatically conjoined to a specific disability in question. Addressing Intense and Complex Needs Identified needs of students with low-incidence disabilities are frequently complex and multiple (Browder, 2001). Addressing severe and complex needs of students is challenging for family, school, and broader community.Since the ultimate goal of education is community inclusion and high quality of life, an appropriate education must contain opportunities for each individual to achie ve independence, enjoy community participation, and increase productive and rewarding work to the maximum extent possible. Most children identified by IDEA categories as having low-incidence disabilities possess sensory, motor, or neurological deficits, and, consequently, they are typically identified and managed early in their lives through a medical model.Families of infants and toddlers with established risks receive early intervention services, most generally under the auspices of state departments of public health. Such services prepare a family and their local community to understand and cope with the impact of a child’s disability on their lives. Such services also prepare a family to actively participate in the planning and decision-making processes that accompany transitional events throughout the child’s life. Thus, early intervention and early childhood education can be effective in preventing or minimizing many long-term and predictable consequences of disa bility.Because of the possibility of mitigating many of the consequences of disability early on in a child’s life, possibly to the point where a disability essentially vanishes, IDEA encourages states to withhold disability categorization until age nine. The more generic term developmental delay is used instead, to avoid the stereotyping and lowered expectations that follow disability-specific labeling. However, states still have the option of using, for example, the terms â€Å"blind† or â€Å"deaf† if preferred.According to IDEA ’97),decisions made about a child with a disability must be informed by â€Å"persons knowledgeable about the disability† or by â€Å"qualified professionals. † States must â€Å"qualify† professionals through certification or licensure. Thus, for blind students to receive specially-designed instruction in Braille literacy, deaf students in ASL, and motor-impaired students in augmentative communication, stat es must ensure that an adequate supply of appropriately prepared professionals is available to support such students in educational programs.The need for the specialized knowledge and skills possessed by these professionals is often cited as a basis for retaining IDEA’s system of categorical labeling, as well as states’ systems for categorical teacher certification (Hallihan & Kaufman, 2002). Clusters of Low-Incidence Disabilities Hereafter, low-incidence disabilities are defined and described under the following headings: * Blind/Low Vision * Deaf/Hard-of-Hearing * Deaf-Blind * Significant Developmental Delay * Significant Physical and Multiple Disability * Autistic SpectrumNote that some of these headings do not match with IDEA’s current categories, being more general. Where appropriate, legal categorical definitions are quoted from IDEA ’97 in the text so that readers will note congruence with federal law. Blind/Low Vision According to IDEA ’97, Visual impairment including blindness means an impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness. Authority: 20 U. S. C. 1401(3)(A) and (B); 1401(26)Historically, students with visual impairment have been referred to as blind, visually handicapped, visually disabled, visually impaired, partially sighted, partially blind, visually limited, or sight impaired. To understand the needs of students with visual impairments, the following factors must be taken into account: age at onset of visual impairment, degree of impairment, site of impairment, prognosis for improvement or degeneration in condition, day-to-day stability of condition, individual tolerance for visual fatigue, nd the extent and complexity of any co-existing additional impairments. Blind children are particularly challenged in understanding and moving about in physical space (Blasch, Wiener, & Welch, 1997). Withou t opportunity to directly observe space during locomotion, blind children have difficulty mentally representing and manipulating spatial concepts. They are also challenged in obtaining, manipulating, and producing many types of information, such as text, graphics, facial expressions, and gestural cues (Swensen, 1999).Achieving self-esteem is also difficult for blind children since self-awareness in the social context of school is often affected by such factors as social isolation, low expectations, and over-protection (Tuttle & Tuttle, 1996). Classroom instruction typically exploits the visual/motor channel of communication and relies upon social mediation for student achievement. Because blind students cannot partake of the visual channel of communication and are often socially isolated, they generally have limited opportunities for incidental learning.This places them at a disadvantage when attempting to participate in classroom activities. Often gaps exist in concept development, making it difficult for classroom teachers to activate prior knowledge, or leading them to make false assumptions in regard to the fundamental understanding these students have of the world around them. Moreover, the need for Braille as a necessary alternative to print creates a challenge for general education classroom teachers to provide invaluable corrective feedback, as very few general education classroom teachers can read and write Braille.Lack of eye contact and the impossibility of visually-based social recognition can have a profound impact on a blind student’s opportunity to form meaningful and cooperative relationships with peers. Such barriers must be carefully examined and skillfully addressed by practitioners in order to provide genuine and valid access to the general curriculum for blind students. Deaf/Hard-of-Hearing According to IDEA ’97, Deafness means a hearing impairment that is so severe that [a] child is impaired in processing linguistic informat ion through hearing, with or without amplification, that adversely affects a child’s educational performance.Hearing impairment means an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance but that is not included under the definition of deafness in this section. Authority: 20 U. S. C. 1401(3)(A) and (B); 1401(26) Needs of children who are hearing impaired must take into account factors such as age at onset of disability (in particular, pre-lingual vs. post-lingual deafness), audiometric hearing status (particularly in speech range with amplification), type of hearing loss (conductive, sensorineural, mixed, central) and possible presence of concomitant disabilities.The needs of children who are deaf and children who are hard-of-hearing must be understood as quite distinct when considering communication use. The native language of deaf children is American Sign Language (ASL), but children who are hard-of-hea ring may understand speech with amplification and may not identify with members of Deaf culture. Severity of hearing loss is measured by decibels (dB) or units of loudness. A hearing loss between 15 and 20 dB is considered slight. A person with a hearing loss of 60 dB has difficulty hearing conversational speech without amplification.An individual with a hearing loss of 100 dB is not able to hear a power lawnmower without amplification (Kirk, Gallagher, & Anastasiow, 2000). Children and adults with hearing disabilities characteristically confront significant issues with regard to social and intellectual development, speech and language development, and edu