Sunday, March 15, 2020
Interventions For Substance Abuse Amongst Young People INTRODUCTION Interventions For Substance Abuse Amongst Young People , 20,688 young people accessed substance misuse services, with the majority of this number accessing services for abuse of cannabis (64%) or alcohol (29%) (National Drug Treatment Monitoring System, 2012). Over half of the users were aged 16 to 18 (53%), whilst the rest were aged under 16 (National Drug Treatment Monitoring System, 2012). About two thirds (64%) of the young people who accessed specialist substance misuse services in 2010-11 were male.Ã Overall, females accessing substance misuse services for young people are younger with 19% of males aged under 15 years compared to 27% of females. AlmostÃ halfÃ ofÃ theÃ youngÃ peopleÃ enteringÃ specialistÃ substanceÃ misuseÃ servicesÃ areÃ recordedÃ asÃ beingÃ in mainstreamÃ education, suchÃ asÃ schoolsÃ andÃ furtherÃ educationÃ colleges,Ã followedÃ byÃ aÃ furtherÃ 19%Ã in alternativeÃ education, suchÃ asÃ schoolingÃ deliveredÃ inÃ aÃ pupilÃ referralÃ unitÃ orÃ homeÃ setting.Ã A further 19% are recorded as not in education or employment.Ã However, it should be noted that educationÃ andÃ employmentÃ statusÃ wasÃ reported for only newÃ youngÃ peopleÃ enteringÃ specialistÃ servicesÃ during the year. Therefore, the total will be lower than that of all young people (National Drug Treatment Monitoring System, 2012). Referrals to drug and alcohol treatment services commonly come from youth offending teams, although around 14% of referrals come from mainstream education institutions and 7% are made up of self-referrals. Perhaps surprisingly referrals from the Child and Adolescent Mental Health service (CAHMS) make up only 3% of referrals (National Drug Treatment Monitoring System, 2012). These figures paint a perhaps surprising picture. For example, more young people are referred to specialist drug and alcohol services from mainstream education than specialist educational centres, suggesting that substance abuse could be far rifer amongst young people as might be expected. It could be argued that failure of school authorities to take a more effective preventative approach to drug and alcohol abuse may be contributing to the overall problem. These figures also suggest that immediate attention and intervention must be offered to young people to reduce negative outcomes associated with such high drug use. The statistics reveal that there is a high rate of drug and substance abuse among young people in the UK. The high of level concern about the use of illicit drugs and substances has an effect on health, educational and political discussions in the UK. The governmentÃ¢â¬â¢s national strategy for ten years on drug misuse views young people as a critical priority group in need of quick prevention and treatment intervention (Keegan and Moss, 2008) and recognises the need to improve our understanding of the role played by illicit drugs and substances in the lives of such young people. Educators, health practitioners and policy makers should have comprehensive understanding when it comes to discussions involving the abuse of illicit drugs. For example, the Government must take into account factors such as a lack of understanding amongst young people as to the laws that govern different classes of illegal drugs. Abuse of alcohol and other drugs leads to the destruction of cognitive and emotional development in young people and exposes them to an increased possibility of accidental injury or even death. Finally, there is also a risk of users becoming drug dependent. Abuse of drugs and alcohol by young people can also lead to such negative consequences as coronary heart diseases, lung cancer, AIDS, violent crime, child abuse and unemployment (Gurnack, Atkinson Osgood, 2002). As a result, individuals indulging in the use of alcohol and other drugs incur tremendous costs in their individual lives, their family lives and even their future careers. Society is also not exempt as it pays a price in different ways. For instance, society incurs extra costs in health care, drug and alcohol treatment, law enforcement and supporting the seriously affected families who have been rendered helpless by the situation. There are many reasons why young people become involved in substance abuse. From a sociology perspective it has been argued that the recreational abuse of drugs has become Ã¢â¬ËnormalisedÃ¢â¬â¢ (Parker, Measham and Aldridge, 1995) among certain groups of young people. However, Shiner and Newburn (1997) have argued that this theory is reductionist and simplifies the reasons behind a young personÃ¢â¬â¢s choice to abuse drugs. In reality, the reasons as to why a young person may begin to abuse drugs can range from having poor adult role models who may also use drugs and alcohol as a way of coping or even a genetic predisposition toward poor self-regulatory behaviours (Spooner and Hall, 2002). Evidence shows that adolescent alcohol and drug abuse is not influenced by a single factor but a large number of factors which are not necessarily confined to any single part of the an adolescentÃ¢â¬â¢s world (Connors, Donovan DiClemente, 2001). Environment The environment in which a person lives is very instrumental when it comes to the kind of life that people lead, especially young people. If the environment is for example characterized by pronounced unemployment then young people in such an environment will indulge in activities that make them forget even for a moment the realities of the unemployment situation. If, for example, in their immediate environment young people face the situation of a large supply of drugs and everyone around them is abusing drugs or alcohol, then it is easy for such young people to adopt this kind of lifestyle and become drink or drug abusers. The above explanation shows that the kind of environment a young person stays in has a very direct influence on the habits that are finally adopted by this group of young people. Curiosity Young people naturally have the tendency to try new things and to find out how it feels doing something new.Ã Young people in the United Kingdom are not an exception and most of them usually try drinking and drugs just to explore and find out what the experience is like. This however results in the young people becoming victims of the consequences that follow (Woo and Keatinge, 2008). The Defence Mechanism A good number of young people use drugs specifically to assist them in easing trauma that may result from unsatisfactory relationships and also physical or emotional abuse that may arise from families or homes that lack happiness. Promotion and Availability There is always a great amount of pressure from advertisement of alcohol over the media. The colourful nature of these promotions is often very enticing and mostly misleading. In the promotions or commercials, alcohol is glamorised hence the young people are influenced to indulge and as a result end up facing the dire consequences. This review will analyse the different interventions utilised when working with young people who abuse drugs and alcohol. These include those carried out by mental health workers, religion-orientated interventions, community based interventions and more psychiatric, medication based interventions. Motivational based interventions are also discussed. Aims and Objectives The aim of this project will be to review and critically evaluate the literature regarding different interventions for young people who abuse drugs and alcohol in the UK. To achieve this aim the project has set the following objectives: To critically examine the interventions for young people (aged 16 to 21) who use drugs and alcohol in UK, with the aim of providing recommendations to improve the care given to the youths who are addicted or at risk of substance abuse. To use secondary data to identify the importance of different interventions in dealing with young people (age 16 to 21) who use drugs and alcohol in the UK. Rationale Interventions for young people aged 16 to 21 who use drugs and alcohol has elicited varied opinions from professionals involved in their care. This has been a result of the often complex and varied needs of young people with substance abuse issues, such as mental health issues (Weaver et al., 2003), social exclusion (Fakhoury and Priebe, 2006) and involvement with the criminal justice system (Hamdi and Knight, 2012; Lundholm et al., 2013). Therefore, there is often disagreement on where the intervention should focus primarily. Various strategies have been advanced to address the involvement of young adults in drugs and substance abuse. For example, medication by mental health nurses in cases of addiction (Bennett and Holloway, 2005). However, due to the variety of interventions available for treating young people with substance abuse disorder, it is important to continuously review the literature in this area and pin point the most effective interventions for treating this group of individuals. [Client must write some words here on why they have chosen this topic (this is essential according to the assignment brief).] SEARCH STRATEGY In preparation for this critical literature review, a number of sources including journals, articles and health text books were used. The search was conducted using computerised databases which enabled access to literature on interventions for young people who abuse drugs and alcohol. Examples of such databases are given below: The Department of Health NHS Evidence (National Institute for Health and Clinical Excellence, 2012). PsycINFO (American Psychological Association, 2013). PubMed (National Center for Biotechnology Information, 2013). Google Scholar (Google, 2013). net (EMAP Publishing, 2013). Nursing and Midwifery Council publications (Nursing and Midwifery Council, 2010). Royal College of Psychiatrists useful resources (Royal College of Psychiatrists, 2013). Royal College of Nursing library services (Royal College of Nursing, 2013). These databases contained numerous useful sources such as journal articles, recommendations, guidelines and reviews that were used to gather evidence relevant to interventions for young people who abuse drugs and alcohol. Search terms used included; Ã¢â¬Ëdrugs and substance abuseÃ¢â¬â¢, Ã¢â¬Ëalcohol abuseÃ¢â¬â¢, Ã¢â¬Ëeffects of alcohol abuseÃ¢â¬â¢, and Ã¢â¬Ëintervention measures for drugs and substance abuseÃ¢â¬â¢. It was not uncommon for a search to produce many results. Therefore, for any search that produced more than 50 results, the first 50 results were observed to pick out the most relevant and interesting studies. The remaining results were not looked at because of time constraints. In addition to searching for relevant sources through online databases, reference lists within articles were also utilised to search for other relevant sources. Inclusion Criteria For an effective review of the subject area, there was a need to select relevant articles to achieve the set objectives. Therefore, only sources relevant to intervention for young people who abuse drugs and alcohol, papers published in the English language and papers published after the year 1999 were selected. Although sources pertaining to studies carried out in the USA were still considered relevant, a priority was given to sources from the UK. If a source had used an adult sample but was still considered relevant and useful then it was considered for inclusion. Exclusion Criteria General papers on drugs and substance abuse not specific to youths, papers published in languages other than English and published before the year 1999 were not included. An example search strategy when using one of these sources, the British Nursing Index, is given below. Search Strategy Example: British Nursing Index (BNI). Through citing the term Ã¢â¬Ëintervention for young people who abuse drugs and alcoholÃ¢â¬â¢, 5,000 articles were gathered without limiters. Limiters such as Ã¢â¬Ërole of mental health nursesÃ¢â¬â¢ and Ã¢â¬Ëonly book and journals concerned with drugs and substance abuseÃ¢â¬â¢ were applied to the second search, which reduced the output to 2,034 books and journals. In the third search, additional limiters such as year of publication (2000-2012) were applied, which then reduced the number of books and journals to 734. After all further limiters were applied, such as articles that only used an age group of 16 to 21 years as participants, 70 journals and books were chosen for further analysis. Only 23 articles were considered relevant for this review and analysis due to their in depth exploration of the subject and their meeting of inclusion and exclusion criteria. LITERATURE REVIEW Interventions for substance abuse serve a number of purposes including reducing use of illicit or non-prescribed drugs and curbing problems related to drug misuse, including health, social, psychological and legal problems and last but not least tackling the dangers associated with drug misuse, including the risks of HIV, hepatitis B and C and other blood-borne infections and the risks of drug-related death. Prevention and intervention are usually categorised into primary (direct prevention), secondary (early identification of the problem and subsequent treatment) and tertiary levels (late identification and treatment). Furthermore, interventions are now often categorised into population wide interventions, selective interventions aimed at only high risk groups and early interventions for at-risk groups (Cuijpers, 2003). The nature of interventions has also evolved over the years. Twenty to thirty years ago the emphasis was on providing young people with information and buffering moral values whereas in the more modern era, a social dimension has been added and young people are taught resistance skills to avoid peer pressure (Gilvarry, 2000). Alcohol related deaths are rife in the UK, with 8,748 alcohol related deaths in the UK in 2011 (Office for National Statistics, 2013). However, there were 1,883 noted drug related deaths in 2010, a decrease of 299 from 2009 (Ghodse et al. 2012). These statistics reflect the importance of interventions for drug abusers, which could be protecting some individuals from the most extreme consequence of substance abuse. Mental Health Interventions Research has evidenced that Major Depressive Disorder (American Psychiatric Association, 1994) is often co-morbid in young people who abuse drugs and alcohol (Sutcliffe et al., 2009; Marshall and Werb, 2010; Marmorstein, Iacono and Malone, 2010). Due to the potentially devastating effects of depression at both the individual (Galaif et al., 2011; Petrie and Brook, 2011) and societal level (Sobocki et al., 2006), substance abuse is viewed as something that must be dealt with swiftly and effectively. This co-morbidity of mental illness and substance abuse means that mental health nurses are often involved in interventions with young people. Mental illness is a psychological anomaly that is generally associated with distress or disability that is usually not considered to be a component of an individualÃ¢â¬â¢s normal development (Nursing and Midwifery Council, 2008). Despite the fact that standard guideline criteria are used all over the world to define mental illness, diagnosis and i ntervention is often incredibly complex, especially when substance abuse is also a factor. Community services are offered to people with such problems through assessment by different psychiatrists and clinical psychologists, or sometimes social workers. All these professionals use methods of observation and inquiries through asking questions to help establish any given patientÃ¢â¬â¢s condition. Mental health nurses are often at the front line in providing care and support in both hospitals and the community. In the United Kingdom, mental health nurses play a great role in taking care of young people with mental disorders and mental illnesses that may have developed as a result of substance abuse (Department of Health, 2012). They offer counselling services in order to help people focus on their goals or outcomes; help people develop strategies that support self-care and enable individuals and their families to take responsibility for and participate in decisions about their health. They provide a range of services including education, research and knowledge sharing and e vidence informed practices. They also perform the role of addiction counsellors in order to provide intake co-ordination, assessment, treatment and follow-up care for youths with addictions, mental illness and mental health problems using common assessment tools. They can provide health promotion, prevention and early detection of problematic substance use; use core competencies and knowledge in addictions and a full range of withdrawal management services including detoxification services using best practice treatment protocols, outreach, prescribing, counselling, and harm reduction However, mental health nurses are often faced with challenges that hinder them from successfully achieving their goals. Challenges include non co-operation of the patientsÃ¢â¬â¢ families and also the complex nature of patient problems (Nursing and Midwifery Council, 2008). In a comprehensive review, RachBeisel, Scott and Dixon (1999) found that there was a much higher prevalence of substance abuse amongst individuals with mental illness and that the course of mental illness was significantly negatively influenced by the abuse of illegal substances. These findings highlight a key issue in mental health interventions for young people who abuse substances, namely that it is important to determine the relationship between the substance abuse and mental illness before allocating a suitable intervention. For example, if a young person has developed a mental illness as a result of abusing substances, a mental health focused intervention may not be appropriate as it would not be treating the root of the problem or the reason why the young person started to use illegal substances in the first place. Psychiatric and Medical Interventions Psychiatric and medical based interventions refer to the treatment of substance abuse in a young person by a psychiatrist who is medically trained and able to provide an additional dimension of treatment than a psychologist or mental health worker is able to. An example of this is the prescription of methadone, a synthetic opiate that is used to help young people withdraw safely from heroin use. The National Institute for Health and Clinical Excellence (2007) recommend a psycho-social approach when treating individuals with substance abuse disorder and advocate the use of medication. However, use of medication with young people who are suffering from substance abuse disorders should be used with care due to the risk of dangerous side effects (Webster, 2005). Motivational Interventions Motivational interventions are brief interventions used by professionals to enhance a young personÃ¢â¬â¢s motivation to change and stop abusing substances (Tevyaw and Monti, 2004). In a review of the effectiveness of motivational interviewing (Smedslund et al., 2011) it was found that although motivational interviewing techniques were more effective at reducing the extent of future substance abuse when compared to no intervention, the technique was no more effective when compared to other types of intervention. For example, motivational interviewing was no better at reducing extent of substance abuse that simply assessing a patient and providing feedback. The authors reviewed 59 studies that had been accessed from a range of online databases. This is a reasonable number of studies as the body of literature on motivational interviewing as an intervention for substance abuse is quite limited. However, the authors failed to collect evidence on other measures of efficacy such as a redu ction in future criminal prosecution for drug offences or improvement in overall quality of life. The efficacy of motivational interviewing has been studied in young people in particular by McCambridge and Strang (2003). 200 young people from inner city London were randomly allocated to either a motivational interviewing condition or a non-intervention education control condition. All participants were aged between 16 and 20 and were using illegal drugs at the time of the study. The motivational interviewing intervention consisted of a brief, one hour face-to-face interview and self-reported changes in the use of cigarettes, cannabis, alcohol and other drugs was used as the outcome measure both immediately after the interview and at a three month follow up point. It was found that in comparison to the control group, young people who received motivational interviewing as a brief intervention reduced their use of cigarettes, alcohol and cannabis. Although these results initially seem in favour of motivational interviewing as an intervention for young people who have substance abuse issues, it should be noted that self-report measures are very open to bias and it is possible that the reported reduced use of drugs and alcohol was much higher than the actual reduction in use. This was reflected in a follow up study by the same authors 12 months later (McCambridge and Strang, 2005) where it was found that the difference in reduction in substance use between the experimental and control groups found after three months had completely disappeared. This result suggests that although motivational interviewing may be an effective short term intervention for treating young people with substance abuse issues, it has no enduring effectiveness over a long period of time. This may be due to a lack of follow-up support for young people and the brief nature of the intervention. Community-Based Interventions Community drug and alcohol services offer interventions such as comprehensive assessment and recovery care planning, support and care co-ordination,Ã advice and information, stabilisation, counselling and relapse prevention and motivational interviewing (Nursing and Midwifery Council, 2008). Hepatitis B vaccinations, Hepatitis C testing and referral to treatment for these diseases, are also essential due to the risk of infections through needle sharing. Like most interventions, these community services are aimed at promoting recovery from addiction and enabling the achievement of individual goals, helping individuals to remain healthy, until, with appropriate support, they can achieve a drug-free life. This may involve stabilising service users on prescribed substitute medication to improve withdrawal symptoms and to reduce cravings. In their review of community-based interventions, Jones et al. (2006) found a limit on the effectiveness of such interventions, especially when it ca me to long term and enduring effect for reducing substance abuse. The results suggested that a change in community-based interventions was needed. Morgenstern et al. (2001) found a very high level of satisfaction among community based substance abuse counsellors who had received training in delivering cognitive behavioural therapy (CBT) to clients. This suggests that perhaps one way of increasing the effectiveness of community-based interventions would be to equip community-based workers with a wider range of skills with which they can help young people suffering from substance abuse. Supporting this recommendation was a study by Waldron and Kaminer (2004) who found that use of CBT was associated with clinically significant reductions in substance abuse amongst adolescents. Religious Interventions Some interventions are religious in nature. For instance, the United Methodist Church follows a holistic approach which stresses prevention, involvement, treatment, community organization, and advocacy of abstinence. The church could be argued to have a progressive role by offering a spiritual perception on the issue of substance abuse. Another popular religious based approach to tacking alcohol abuse in particular is the 12-step program offered by Alcoholics Anonymous. Individuals are commonly encouraged or possibly even required cut any acquaintances with friends who still use alcohol.Ã The 12-step programme motivates addicts to stop consuming alcohol or other drugs and also it helps to scrutinize and modify the habits related to theirÃ cause of addiction. Numerous programs accentuate that recovery is a long-lasting process with no culmination. For drugs which are legal such as alcohol, complete abstinence is recommended rather than attempts atÃ moderation which may cause rel apses. Fiorentine and Hillhouse (2000) found that participants in a 12-step program stayed in future treatment for a much longer period of time and were much more likely to be able to complete a 24-week intervention programme. It was also found that a combination of a 12-step program and an alternative substance abuse intervention was more effective than either treatment alone. This suggests that providing young people with interventions in isolation may not be the most effective way of helping them overcome their substance abuse. However, literature on religious based interventions tends to focus on adults and although still applicable to the treatment of young people in many ways, young people may be put off by the religious nature of these 12-step programmes and may be intimidated by the group nature of the treatment. In support of this criticism, Engle and MacGowan (2009) found that only two out of 13 adolescent group treatments of substance abuse could be categorised as showing potential efficacy in treating young people with these problems. Family-Oriented Interventions It has been argued that the family has a central role in both increasing and reducing the risk of problem behaviours in young people such as substance abuse (Vimpani and Spooner, 2003). A review by Velleman, Templeton and Copello (2005) echoed this view that the family can have both a positive or negative impact on a young personÃ¢â¬â¢s risk of substance abuse. Kumpfer, Alvarado and Whiteside (2003) have identified that support for families based within the home, family education and skills training, improving parental behaviour and time-limited family therapy are all highly effective forms of family-based interventions for young people with substance abuse issues. However, as research has shown that the family can also play a role in increasing risk of substance abuse, professionals must be confident that family therapy is suitable and not run the risk of worsening a young personÃ¢â¬â¢s relationship with their family and in turn worsening their substance abuse. School-Based Interventions Education about the use of drugs and alcohol within schools has been advocated as a preventative intervention for young people at risk of substance abuse disorder. Fletcher, Bonell and Hargreaves (2008) found that interventions focused around encouraging a positive school environment and improving young peoplesÃ¢â¬â¢ relationships was associated with a reduction in risky substance abuse. However, part of this conclusion was based on the review of observational studies, which are open to bias and subjectivity. CONCLUSIONS AND FUTURE RECOMMENDATIONS This essay has reviewed a number of sources regarding the efficacy and suitability of certain interventions for young people with substance abuse issues. A key limitation of much of the literature is the tendency to put emphasis on drugs as a generic material with very little distinction is made between different types of illicit substances. With the very varied effects of different drugs on the user, it could be argued that the specific reasons for a young personÃ¢â¬â¢s drug usage will have an impact on the effects that a drug has. For example, stimulant drugs will most likely be used for nervous system arousal, while other drugs such as alcohol and cannabis are sedatives and cause nervous system depression. These kinds of drugs can be termed as instrumental drugs since the reasons behind their usage correspond to the effect of the different kind of drug that is used (Brick, 2008). Therefore, it might be useful for professionals to base their interventions on the types of substanc e abused. From the above literature review it is evident that there is need for mental healthcare especially to help young people who are adversely affected by the use of drugs and other substance abuse. Some youths suffer from psychiatric disorders as a result of indulgence in drugs and substance abuse. Others experience mental problems that need serious rehabilitation measures taken in order to counter such problems hence emphasis should be laid on the care that is to be given to the young people affected by any of the above problems caused by the abuse of drugs and other substances. Therefore, mental health interventions remain an important intervention for young people. A number of recommended adjustments in healthcare to cater for young people struggling with abuse have been identified. For example, there should be an increased application of various musical strategies in helping patients suffering from various mental health conditions as a result of substance abuse (Connors, Donovan DiClemente, 2001), as this kind of intervention appears to be lacking in use with young people. Another main limitation in research that aims to measure the effectiveness of intervention measures is the lack of control that researchers have. It would be considered unethical if young people with drug abuse problems were randomly allocated to intervention procedures, especially if one was chosen as a control condition and was not believed to be effective in treating substance abuse issues. This means that it can be difficult to compare intervention methods. Another limitation lies in the types of measure researchersÃ¢â¬â¢ use to measure effectiveness of intervention methods. For example, a self-report measure may be used to assess whether young people have either stopped or at least reduced their intake of illicit substances. This type of questionnaire may also be used to see if the young people are seeing a positive result from receiving an intervention. However, self-report measures are open to social desirability bias meaning that many young people may fabricate their answer s in order to either please the professionals who are involved with helping them or to conceal ongoing substance abuse. The review has also emphasized the causes or triggers of alcohol and drug abuse among young people in the United Kingdom showing that the environment a young person stays in is one of the greatest factors that lead to indulgence in alcohol, drug and substance abuse. Other factors like enjoyment, peer pressure, promotions in the media and rebellion are also causes of alcohol, drug and substance abuse among the youth in the United Kingdom (Gurnack, Atkinson and Osgood, 2002). More focus on these root causes could help improve prevention and reduce the need for later intervention, which has a poor track record of success. Finally, there is need according to the literature review to improve media perception of mental health patients in order to help alleviate the conditions of psychiatric disorders that are caused by the indulgence of young people in alcohol, drug and substance abuse (Berglund and Thelander, 2003). This doesnÃ¢â¬â¢t indicate failure in the mental nursing services but it just implies that mental health workers and psychiatrists need reinforcement in order to positively contribute to successful intervention (Califano, 2007).Ã This suggestion is based on the need for a more holistic approach when it comes to treating young people with substance abuse issues, where the effect on all areas of their life including their mental health must be taken into account during intervention. Strengths of this Critical Literature Review Secondary data was reviewed in this project, which provided larger scope on choices of information for the project. In addition this review was able to identify key areas for improvement of health condition interventions for youths affected by substance abuse. Limitations of this Critical Literature Review This literature review was small in scale, since word and time limits were set. 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(1997) Definitely, maybe not? The normalisation of recreational drug use amongst young people. Sociology, 31(3), pp. 511-529. Smedslund, G., Berg, R.C., Hammerstrom, K.T., Steiro, A., Leiknes, K.A., Dahl, H.M. and Karlsen, K. (2011) Motivational interviewing for substance abuse. Cochrane Database for Systematic Reviews, Issue 5. Sobocki, P., Jonsson, B., Angst, J. and Rehnberg, C. (2006) Cost of depression in Europe. The Journal of Mental Health Policy and Economics, 9(2), pp. 87. Spooner, C. and Hall, W. (2002) Preventing drug misuse by young people: we need to do more than Ã¢â¬Ëjust say no.Ã¢â¬â¢ Addiction, 97(5), 478-481. Sutcliffe, C.G., German, D., Sirirojn, B., Latkin, C., Aramrattana, A., Sherman, S.G. and Celentano, D. (2009) Patterns of methamphetamine use and symptoms of depression among young adults in Northern Thailand. Drug and Alcohol Dependence, 101(3), pp. 146-151. Tevyaw, T.O. and Monti, P.M. 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APPENDICES Appendix A Search Term: Ã¢â¬Å"Drugs and substance abuse.Ã¢â¬ Ã Source Number of Relevant Hits Department of Health 0 NHS Evidence 5597 PsychINFO 22 PubMed 2337 Google Scholar 1,070,000 Nursing.net 4435 Nursing and Midwifery Council 59 Royal College of Psychiatrists 477 Royal College of Nursing library services 1,753 Ã Search Term: Ã¢â¬Å"Alcohol Abuse.Ã¢â¬ Ã Source Number of Relevant Hits Department of Health 0 NHS Evidence 6893 PsychINFO 92 PubMed 87,995 Google Scholar 1,480,000 Nursing.net 1760 Nursing and Midwifery Council 138 Royal College of Psychiatrists 629 Royal College of Nursing library services 1,654 Search Term: Ã¢â¬Å"Effects of alcohol abuse.Ã¢â¬ Ã Source Number of Relevant Hits Department of Health 0 NHS Evidence 5476 PsychINFO 31 PubMed 21,363 Google Scholar 1,430,000 Nursing.net 8502 Nursing and Midwifery Council 40 Royal College of Psychiatrists 531 Royal College of Nursing library services 2,590 Ã Search term: Ã¢â¬Å"Intervention measures for drugs and substance abuse.Ã¢â¬ Ã Source Number of Relevant Hits Department of Health 0 NHS Evidence 3169 PsychINFO 3 PubMed 215 Google Scholar 174,000 Nursing.net 7672 Nursing and Midwifery Council 23 Royal College of Psychiatrists 302 Royal College of Nursing library services 3,250 Ã Ã Appendix B Ã Title First Author Publication Year 1 Drug treatment and twelve-step program participation: the additive effects of integrated recovery activities. Fiorentine 2000 2 A critical review of adolescent substance abuse group treatments. Engle 2009 3 Co-occuring severe mental illness and substance use disorders: A review of recent research. RachBeisel 1999 4 Statistics for young people in specialist drug and alcohol services in England 2011-12 National Drug Treatment Monitoring System 2012 5 Substance abuse in young people. Gilvarry 2000 6 The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomised trial. McCambridge 2004 7 The role of the family in preventing and interviewing with substance use and misuse: a comprehensive review of family intervention, with a focus on young people. Velleman 2005 8 School effects on young peopleÃ¢â¬â¢s drug use: a systematic review of intervention and observational studies. Fletcher 2008 9 A review of community-based interventions to reduce substance misuse among vulnerable and disadvantaged young people. Jones 2006 10 Motivational enhancement and other brief interventions for adolescent substance abuse: foundations, applications and evaluations. Tevyaw 2004 11 Motivational interviewing for substance abuse. Smedslund 2011 12 On the learning curve: the emerging evidence supporting cognitive-behavioural therapies for adolescent substance abuse. Waldron 2004 13 Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: within treatment and posttreatment findings. Morgenstern 2001 14 Family-based interventions for substance use and misuse prevention. Kumpfer 2003 15 Deterioration over time in effect of Motivational Interviewing in reducing drug consumption and related risk among young people. McCambridge 2005 16 Drug misuse: psychosocial interventions: full guideline. National Institute for Health and Clinical Excellence 2007 17 Substance abuse treatment and the stages of change: Selecting and planning interventions. Connors 2001
Thursday, February 27, 2020
Response to "Is the American Dream Over" - Essay Example The primary question is Ã¢â¬Å"is the American Dream Over?Ã¢â¬ Whereas this question has been asked over and over by different scholars, there seems to lack a definite answer to this question. This is because different authors and scholars seem to have a different definition of the topic Ã¢â¬Å"The American Dream.Ã¢â¬ However, Cal goes on to explain define what American Dream is. He argues that American Dream simply means fulfilling oneÃ¢â¬â¢s life objectives. However, he goes on to claim that the institutional frameworks of the American government have been so corrupted that it is impossible for the common American person to achieve the American Dream. The question Ã¢â¬Å"Is American Dream OverÃ¢â¬ is arguably a debatable question at issue. This is because the question brings about the room for debate on both sides of the issue. For example, in his work Cal actually points to the possibility of old and new definitions of American dream and then takes on the modern definition. He however goes on to explain why he believes that the American dream died long time ago because of the challenges facing the modern American citizen. This opens up room for debate because, a significant number of Americans are actually living a life of their dreams. Indeed, it can be debated that American dream has been achieved to some extent. However, the question at issue also overlaps as a controversial issue because it opens wide the room for criticizing the government for the failure of Americans to achieve the American dream The issue of American dream is a question at issue because it provides a good and fair basis in which both proponents and opponents can exchange intellectual fists. Indeed, the question of whether American dream is alive or dead has received equal measure of debate from both sides. In his side, Cal gives reason such as lack of Ã¢â¬Å"employment, overspending, overtaxing, and overregulating governmentÃ¢â¬ as some of the reasons why American
Tuesday, February 11, 2020
American Lives as they were before, during, and after The Civil War - Essay Example ix). Of course this was in reference to slavery and ensuring that there would one day be the possibility to eliminate slavery from the face of the United States altogether. From a historical perspective it can be assumed that this was one of the main forces that led up to the beginnings of the Civil War. Southerners were against freeing slaves and when the two sides clashed it promoted a split of ideas across the borders and states of the country. All of this took a great deal of time before War seemed to be the only way to change the future outcome of the people in America. Many states in the Deep South had their own particular way of life before the civil war. Many of the upper class southerners had huge slave plantations that were ran by enslaved African Americans. Some of the slave masters were decent individuals who treated their workers fairly and without prejudice yet they kept them as slaves which went against many beliefs of those in the Northern states of the country. ... one well known area that utilized slave workers quite abundantly and as has been stated there were differing degrees to how this was carried out and how it was perceived. The frontier of plantations in Florida was abundant in the era before the civil war, with these lands accruing miles upon miles of land. Many of them had cotton and sugar, of which slave women would work in, picking the cotton and processing the sugar, then the plantation owners selling it for sustenance to live on. Of course there was great wealth to be made for those who owned slave plantations in the time period under discussion (Baptist 2002, p.1).Furthermore, history shows that there were many reasons why there was such a high migration to the Deep South by white citizens, especially to the region of Florida and the outlying states surrounding it. The soil was good for planting in the state as well as growing orchards for spring harvests, of which many southerners were very found of. Before the civil war, white upper class southern families had their fortunes laid out for them. They had opportunities that were vast and land that was open for claiming, however their abuse of African Americans and using them as slave workers the way the did was one of the very reasons that destroyed the southern way of life (Baptist 2002, pg.1). Though times were extremely good for the white settlers, they were extremely poor for the black people of the south. The reason for this was there was no equality, no chance for African Americans to break free from the chains of slavery, no opportunities to become separate individuals from their slave masters. For African Americans, many times their lives seemed hopeless to them as they were sold in and out of slavery, never being able to hold on to any form of
Friday, January 31, 2020
Internet Marketing Ã¢â¬â Acquisition and Retention Essay The methods of conducting business have really changed as the impact of globalization has causes several flexibilities and easiness in our lifestyles and daily life. Many businesses find it costly to open it in a physical location and expanding through outlets, which often does not target large audience. Therefore, many businesses are starting through internet where they can target customers from all over the world, market their products or services easily and economically, and get payments right away. Not only this, those businesses that do not operate virtually and have physical locations are finding it more effective and financially beneficial to market their products through internet, and that what is called Internet Marketing. Internet marketing also contains the elements of Direct Marketing, where the promotion of products is done online such as, websites (ResearchStarters, 2008). It does not mean that when businesses are started online they would always save costs and be successful; in fact, many businesses fail due to several factors and one significant of them is poor marketing strategies. Of course, the consumers would not have any idea that a new business has started that for instance, sells soccer jerseys, through its website. The target market should have to be made aware of that business, the products, new offers/deals, customer value, feedback, etc. Therefore, all this requires the business to use effective marketing tools and strategies where it can convey the message to the audience, impress them, convince them to purchase, and provide feedback. Businesses can use online marketing strategies such as, designing websites that grab the attention of the customers at first sight, force them to explore, make them realize that they are everything for the company, provide them with ease in shopping online, and let them give a chance to give a feedback. Moreover, businesses can also use the strategy of mass-emailing to the customers or potential customers whether they are individuals or other entities. Placing ads on popular and most-visited websites is another strategy but is quite expensive. And finally, the use of social networking websites such as, Facebook, Twitter, and MySpace, is lucrative since it is inexpensive and targets wide range of audience. Customer Acquisition and Retention There is absolutely no doubt about the fact that it takes a business much more to spend in acquiring new customers than to retain the old or present customers. The reason being that the acquisition of new customers require the business to conduct market research, target them in a new way, shape the products or services according to their needs, reposition the brand that might damage it, and shape the marketing strategies accordingly. These all result in occurring more and more costs for the company; whereas, retaining old or present customers is quite prolific since they have already tried the products, have an image for it, know the company and its reputation, and most importantly can result in promoting them through word-of-mouth. Other marketing strategies for retaining such customers include offering them membership programs, building good relationships with them, increasing the contact with them, asking them for feedback about whether they are satisfied or not, enhancing support for them, and making them realize that they are part of the database and are given importance (Hughes, 2010). Moreover, retention of customers require the company to reshape and bring innovative features and qualities in their products to make those dormant customers restart buying the products if they have stopped to. There is a rule called 80/20 rule, which means that 80% of the revenue comes from 20% of the loyal customers. Therefore, businesses should not feel bothered if they have to invest more on those customers because they are providing them with more sales. So, companies can conduct sales promotion activities or other marketing campaigns for rejuvenating them and milking them. Also, when businesses get to know that their certain customers have stopped buying the products, they should conduct surveys where they should ask the customers what were the reason due to which they stopped buying, what flaw they saw in it, what improvements they want, etc (Businessfast4ward, 2010).
Thursday, January 23, 2020
Econ 157 Health Economics Aram Cherkezyan Analytical Policy Write-Up Assignment 1 Affordable Health Care (ACA) In last few decades Health care sector many times helped to drag the economy from recession. However in last two years health care spending grew more slowly than the economy, and most probably it will repeat this year. Ongoing debates during last week continued about the pros and cons of Affordable Care Act and whether it will help the economy or not. Affordable Health Care plays a huge and a very important role in current US economy and particularly on employment, that is why I decided to focus my writing on Affected Health care and its consequences on US labor economy. The opponents of Affordable Care Act (ACA) claim that the Act will significantly worsen an economic condition in the country. However, in this write-up IÃ¢â¬â¢m going to focus on the advantages of Affordable Health Care and write only positive aspects of it. Congressional Budget Office (CBO) presents six ways that the ACA is helping the labor market, laying the foundation for future economic growth, and improving familiesÃ¢â¬â¢ financial security and well-being. I am going to provide an explanation for the most important points. First of all, preventing the growth of health care costs will decrease unemployment in near future. Currently United States has an unprecedented slowdown in the growth of healthcare (the lowest growth in the history during last three years), thus it will reduce the insurance premium costs for employers. Furthermore, employers will be able to hire more workers as soon as health care premium costs going to be smaller. Slower growth in health care costs reduces the growth of the health insurance premiums paid by employers, which has i... ...ty. Fifth and last point is the reduction in the long-term deficit and the foundation for future growth. ACA will reduce the deficit by about $10o billion and the ACAÃ¢â¬â¢s deficit-reducing effects will increase over time. CBO guesses that over the next two decades, the ACA will reduce the deficit by an average of 0.5 percent of GDP each year, thus reducing approximately $1.6 between 2022 and 2032. The decrease in long-term deficit will increase national savings, reducing foreign borrowing thus increasing national income. These factors will improve standards of living in the future. Relaying on these five major points I believe that Affordable Healthcare Act may shave a positive effect on US economy, improve health condition of low-income families, increase demand for goods and services, reduce foreign borrowing and decrease an unemployment rate in the United States. Essay -- Econ 157 Health Economics Aram Cherkezyan Analytical Policy Write-Up Assignment 1 Affordable Health Care (ACA) In last few decades Health care sector many times helped to drag the economy from recession. However in last two years health care spending grew more slowly than the economy, and most probably it will repeat this year. Ongoing debates during last week continued about the pros and cons of Affordable Care Act and whether it will help the economy or not. Affordable Health Care plays a huge and a very important role in current US economy and particularly on employment, that is why I decided to focus my writing on Affected Health care and its consequences on US labor economy. The opponents of Affordable Care Act (ACA) claim that the Act will significantly worsen an economic condition in the country. However, in this write-up IÃ¢â¬â¢m going to focus on the advantages of Affordable Health Care and write only positive aspects of it. Congressional Budget Office (CBO) presents six ways that the ACA is helping the labor market, laying the foundation for future economic growth, and improving familiesÃ¢â¬â¢ financial security and well-being. I am going to provide an explanation for the most important points. First of all, preventing the growth of health care costs will decrease unemployment in near future. Currently United States has an unprecedented slowdown in the growth of healthcare (the lowest growth in the history during last three years), thus it will reduce the insurance premium costs for employers. Furthermore, employers will be able to hire more workers as soon as health care premium costs going to be smaller. Slower growth in health care costs reduces the growth of the health insurance premiums paid by employers, which has i... ...ty. Fifth and last point is the reduction in the long-term deficit and the foundation for future growth. ACA will reduce the deficit by about $10o billion and the ACAÃ¢â¬â¢s deficit-reducing effects will increase over time. CBO guesses that over the next two decades, the ACA will reduce the deficit by an average of 0.5 percent of GDP each year, thus reducing approximately $1.6 between 2022 and 2032. The decrease in long-term deficit will increase national savings, reducing foreign borrowing thus increasing national income. These factors will improve standards of living in the future. Relaying on these five major points I believe that Affordable Healthcare Act may shave a positive effect on US economy, improve health condition of low-income families, increase demand for goods and services, reduce foreign borrowing and decrease an unemployment rate in the United States.
Wednesday, January 15, 2020
BAE Business Case Study Submitted by: Susan Pacheco April 17, 2013 Table of Contents Part 1: Executive Summary3 Part 2: Main Issue4 Part 3: Systemic Issues4 Leadership & Project Management issues4 Political Pressure to Fast-Track Project5 Design Issues5 Communication Breakdowns6 City Involvement (Delays)6 BAE Conditions on Contract Signing (April 1992)6 Part 4: Environmental & Root cause Analysis7 Qualitative Analysis:7 Project Management7 People (Unqualified):8 Build-Design8 Economic & Political Considerations8 Success with United Airlines9 Part 5: Alternatives and/or Options:9 Alternative A9Alternative B11 Part 6: Recommendations and Implementation11 Recommendation:11 Recommendations Implementation Plan:12 Part 7: Monitor and Control:13 Part 8: Conclusion:13 Part 9: References, Exhibits and Appendixes13 Part 1: Executive Summary In order to address the immediate issue of the letter received by the City Mayor holding us responsible for the delay of the new baggage system by charging BAE a penalty of $12k/day backdated to October 29, 1993 and also requesting a charge back for the $50M tug-and-cart baggage backup system, immediate action and priority needs to be given to address this accusation.A prompt analysis of our project plan and missed milestones with reasons and factual data is critical in defending our position. We need to prove where certain milestones outside our control were missed and the domino effect it created and where dependencies to our commitments were broken and by whom. There were many points at which we voiced our concerns on the project delays and access issues that further hindered our ability to perform but no one took responsibility or acknowledged the delay.In addition, the Build-Design approach has in itself created many hurdles and time delays outside our control as well as created unfavourable working conditions that were unsustainable for our teams. Our current situation is a mere symptom of a lack of a proper project management s tructure and qualified personnel at DIA. Also lack of sponsorship by the city Mayor has created silos and a negative effect on the project flow. The build-design approach is one of the biggest issues but with proper management it can be overcome.Based on BAEÃ¢â¬â¢s experience and successful past projects, we can confidently recommend a new structure that has worked in past projects. Given that history I feel we need to propose a drastic change to DIAÃ¢â¬â¢s Project Management team and propose a new structure which includes a new Project Manager to oversee the entire project team, appointment of additional team members (see Appendix 1) and new hires with the right skill sets. See Appendix 2 to see RACI Matrix proposal.The proposal is to continue with the new airport wide baggage system implementation only under the condition that DIA restructure their project management team and obtains sponsorship from the City Mayor and Aviation Director. A team approach must be understood by a ll parties involved as there are too many moving parts and it is impossible to expect BAE to independently manage all moving parts for what is out of our control especially with a Build-Design plan.This new platform will allow BAE and DIAÃ¢â¬â¢s members to educate, make timely critical decisions, identify risks and critical milestones and hold members accountable for their respective roles. Assuming our proposal is accepted, the overall expected timing from initial contact to identifying risks under the new team structure is 9 weeks. With this plan, a backup system would not be required, thereby avoiding this $50M additional cost. The seriousness of this accusation would put BAE at permanent financial risk if not bankruptcy.Promptness and priority in handling this situation is critical. Beyond the financial impact, there is also the reputation BAE has always enjoyed as being a leader in the marketplace worldwide can also have a negative effect on current and future projects with o ther institutions. Part 2: Main Issue City of Denver issued a penalty request of $12k/day backdated to original start-up completion date of October 29, 1993 including a $50 M charge back for a tug-and-cart baggage backup system. This main issue is a result of the systemic issues which are listed below. Part 3: Systemic IssuesLeadership & Project Management issues Shared leadership between city of Denver & Consultant team created many inefficiencies, duplicate work and lack of real ownership. Additionally no organizational structure change at DIA was ever made to accommodate this new baggage system project. Further complicating the matter was the communication channels and roles between city, PMT and consultants were not defined or controlled. All were working in silos. Engineers are inefficiently creating piles of change documentation that are not really managed or communicated.Waste of time just to cover their tracks. There is NO real qualified Project Manager to oversee the entire project and bridge the gap between DIA and their top Carriers United & Continental, City Council and BAE. We have been expected to manage the project with everyone working in their silos with no real support or team goal or management as a whole. In order to keep things moving along, we need a DIA counterpart to produce engineering alternatives and make quick decisions on cost, alternatives, scheduling etc.Currently there are too many chefs in the kitchen with no real one person in charge. They had to balance project administration political and social responsibilities. The Working Area 4 Managers that was assigned to us have no experience in airport construction, baggage system technologies or new technologies, their main experience is in construction project control management. As such they donÃ¢â¬â¢t know how to properly support our requests and needs to keep the project going forward.In addition to this since there is no project manager in charge and lack of proper structure we have to liaise with and to obtain feedback from each Concourse Senior manager and Main terminal manager. It is apparent that they each operate independently making any agreement difficult as we need to transcend the decisions and get agreement across all four managers. It is apparent that they each are making independant decisions and trying to tie them all together is very difficult. This creates further bottlenecks for us.Lack of a designated project manager to oversee and manage inputs/outputs from the City, DIA and BAE created a painful process, hurt relationships and lack of accountability and control. Head of DIA project resigned and death of Chief Airport Engineer Walter Slinger (Oct. 1992), a strong proponent of the baggage system and closely involved in negotiations with us had a significant impact on the project. He was a decisive, empowered decision maker who knew how to address problems and get them resolved promptly. His successor Gail Edmond was not successful in ca rrying ut the same duties as she was much less experienced and lacked the autonomy, experience and guts to make much needed quick decisions. Her hands were tied with red tape and took much longer to make any decisions. Overall we had a poor relationship with the management team who had no prior baggage handling competence or experience. The project was mainly treated as a major public works project resulting in a lack of support when we needed it for any of our complaints on timing, access etcÃ¢â¬ ¦ Political Pressure to Fast-Track ProjectThere were many factors that influenced and pressured this project to a fast-track pace which had some resulting serious consequences both in delays and cost. This pushed the project into a Build-Design project which had created some major delays and cost increases. Some of the other influencing factors are as follows: * DBO Date of Beneficial Occupancy payback date of January 1, 1994 * Project Management Team pressured to push project ahead at al l cost due to long periods of assessment, negotiation and final approvals. Political pressure from Mayor to force project through a fast-track for their own political stature gain and public optics Design Issues The decision to install a new large scale airport-wide baggage system came after the building design was already determined and we were faced with fully defined project specs which underplayed the importance and significance of some important requirements of a baggage system (space, electrical power needs, building structure requirements, ventilation and air conditioning to dissipate) These issues created further bottlenecks and delays in our implementation.Further delays and changes resulted from DIAÃ¢â¬â¢s lack of consulting with and conducting a needs assessment with their two top carriers United & Continental which accounted for more than 70% of passenger traffic prior to project start. Their needs were never incorporated into the initial design and program, as a resul t further changes were requested to design and software just 6 months prior to the needed opening date. We had to deal with this even though the mechanical and software designs were supposed to be frozen. Communication BreakdownsWe communicated to United we would need 1 more year to get system up and running but no one listened nor was the message passed along to DIA or the City. We also at many points tried to engage DIA about the delays, access issues and construction bottlenecks that was causing direct delays in our work and we were not given precedent or access when needed. Infact the attitude was that these construction workers were not reporting to BAE to have to listen. City Involvement (Delays) Law restrictions forcing 30% of minority-owned firms and 6% women.This law forced us to forgo our original proposal of using our own qualified employees in lieu of external outside contractors which estimated an increased cost of approximately 60%. Some of our expertise was lost due t o this fact in addition to causing further delays to our project. In Sept. 1993 we went into maintenance negotiations which lead to a 2 day strike of 300 millwrights that was joined by 200 electricians over a $8/hr delta pay dispute. We lost the maintenance contract as well as a 2 day delay. BAE Conditions on Contract Signing (April 1992)The conditions and milestones we placed upon accepting the job was not respected by the city or adhered to, nor was there any provisions made to address issues along the way. ( i. e. freeze dates for mechanical design, software design, power requirements and the like, all around access, timely completion of certain areas, provision of permanent power, computer roomsÃ¢â¬ ¦ these were all set as milestones in our project plan. The city had agreed to these conditions with unrestricted access with priority for BAE equipment yet we didnÃ¢â¬â¢t even have reasonable access.For example: * Electricians had to leave work where concrete grinders were creati ng clouds of dust, * Fumes from chemical sealants forced others to flea * Trucks blocking and restricting * Design Freeze dates not adhered to: Airlines requested changes to system designing even though mechanical/software designs were frozen. (6 months prior to opening airport, still moving equipment around, changing controls and software design! * Energy issues Ã¢â¬â City unable to supply Ã¢â¬Å"cleanÃ¢â¬ electricity to the baggage system. Motors and circuitry used in system extremely sensitive to power surges and fluctuations.Filters were purchased to correct the problem and a City Worker cancelled a contract without realising that the filters were part of it. Filters arrived several months later in March 1994. 1. Construction already begun on terminal and concourses with substantial changes needed on construction to accommodate expanded system. We wrote a letter to city (Jan, 29, 1995) to request prompt action advising of inability to complete project under these condition s with no response or support. Part 4: Environmental & Root cause Analysis Qualitative Analysis:BAE is a highly qualified with a revered reputation, experienced in projects across the US, Europe and Australia in the development, design, manufacture and install and support of every project it undertook from start to finish. We established a strong position in the US accounting for about 90% of U. S. baggage sorting equipment sales. Since 1972 Ã¢â¬â 1994 we had successfully designed, manufactured and installed nearly 70 automated baggage handling systems worth almost $50M at major airports in the US, New York, Dallas-Fort Worth, Chicago, San Francisco, Miami, Newark and Pittsburgh.We also consulted in the installation of a $550M terminal for the New Seoul Metropolitan Airport in South Korea. Given our successful history and past accomplishments, it is without a doubt that our management capabilities and expertise in handling various types of projects, with various types of people a nd countries, proves our commitment, capabilities and expertise in handling complex variables and situations for every project we undertake. Knowing the strategic importance and complexity of this particular project, we had agreed to take on the project only upon acceptance of certain conditions which was accepted by the City.Many of these conditions were not honored throughout the process causing unnecessary delays, additional costs, strained relationships both with the City and DIA management and hurt our reputation Project Management Lack of communication, ownership and project management both at DIA & the City of Denver was the source of this pivotal problem. Since the contract was awarded by the City, they were responsible to enforce the compliance of the agreed upon conditions and communicate and enforce these conditions to DIA and their employees.In turn DIA did not have a specific Project manager to oversee the entire project as a whole and to act as a liaison between us, th e City and their Carriers. Instead we were forced to deal with their respective Ã¢â¬Å"AreaÃ¢â¬ managers one on one which was counterproductive, time consuming and ineffective. We also had to deal with direct changes from the Carriers themselves which further haulted our project. We were setup for failure given the lack of direction and control at DIAÃ¢â¬â¢s side and the CityÃ¢â¬â¢s dogmatic approach to making decisions.For a project of this magnitude, there was no consideration made to employ either Key Managers or Project Manager to oversee, manage and liaise between the three concourse areas. This created some major gaps and no one was there to keep the pulse on the project itself. This was not implemented thus creating a gap in communication, a silo-type attitude amongst decision makers creating no support-system for the major role we played in this implementation. It was apparent that roles between the City, PMT at DIA and Consultants were not defined or controlled.Every one was working in silos. People (Unqualified): In addition to the management issues, our Assigned Area 4 Managers, lacked the experience in airport construction and baggage system technologies, therefore could not understand the importance and properly support our needs nonetheless handle our requests in a prompt manor. In order to keep things moving along, we needed a DIA counterpart who would be able to produce engineering alternatives and have the autonomy to make decisions. The death of DIAÃ¢â¬â¢s Chief Airport Engineer, Walter Slinger created significant impact to our operations as he was decisive and addressed problems promptly. This was an important critical role required for the success of this project. His successor, Gail Edmond lacked the experience, know-how, decision making capabilities and autonomy that further haulted the process. Build-Design The Political pressure to fast-track this project lead to a Build-Design approach to this airport construction which caused many unknown risks and design issues that we had to deal with upon commencement.We were unaware of the construction scope and details to be able to fully understand the scope of the project before undertaking. This also lead to a reactive vs. proactive planning. This posed many unknown risks, changes and modifications to our plans along the way. The instability of this process created many points of change, delays and cost additions and we did our best to manage what was in our control. The point is that many of these delays were NOT within our control, nor did we have any support from the city to enforce DIAÃ¢â¬â¢s construction project to meet our agreed upon milestones to meet our own obligations.Economic & Political Considerations The economy in mid 1980Ã¢â¬â¢s was plummeting with a 37% job loss average across Stapeltons Employment Industries. The Pena administration aggressively promoted the airport relocation, marketing the new airport as a technologically advanced, state-o f-the Ã¢â¬â art structure to draw businesses, import federal capital and fund the creation of new jobs with bonded debts to overcome the short-term decline in the economy. It was to become a grand project that would be the main showcase for the Public Works Department.The relationship between BAE and the City was strained primarily because their focus was on airport project speed and bond re-payment and not on the project itself. They were motivated by their own public perception in the political realm. Their Ã¢â¬Å"hands-offÃ¢â¬ approach was detrimental in the success of this project and served more as a crutch and hinderance. When it came to asking for support it felt like they were working against us and not with us. Their strength was not in project management but they had the power to make key decisions which influenced and affected our overall success.The added pressure of paying the DBO by Jan 1, 1994 forced quick management decisions, early construction without a full scope analysis and risk mitigation not just with BAE but also with DIA. Forced the Build-Design approach which inherently greatly affected our ability to succeed given the lack of adherence to the agreed conditions. Success with United Airlines Once the contract was signed with United exclusively things went smoothly. The successful implementation of the baggage system with United highlighted what was lacking in dealing with DIA and City directly.The success highlighted and confirmed our ability to manage the project with a partner who understood the technical and project management needs. Part 5: Alternatives and/or Options: Alternative A Continue with the contract for installing the baggage handling system conditional upon the following restructuring & requirements: Hiring of new qualified members at DIA. 1. DIA to hire a dedicated qualified Project Manager for the baggage handling system overall project with prior project management experience.One whom understands the key tasks, key players has a strong construction and technological background with project management skills to document, track, address and facilitate the communications between all DIA parties and that of BAE and City Administration. A clear definition of this personÃ¢â¬â¢s role, decision-making authority and sponsorship by Senior Management is critical. 2. DIA to hire a new Chief Airport Engineer with strong decision making and leadership skills with the autonomy to make decisions and propose Gail Edmond work under him/her as Chief Associate Engineer. . The new Project ManagerÃ¢â¬â¢s goal is to gather all appropriate key stakeholders as proposed in Appendix 1 to conduct 3 main initial sessions with all key stakeholders (*see Appendix 1) to: I. Conduct a full risk assessment whereby identifying all risks, prioritise them, have an action plan to mitigate some of them, formulate contingency plans and assign responsible persons to manage the risks. II. Establish a Project Objective Statemen t, and Create a new project master plan, III.Team member establishment: Establish who key players are, their strengths, weaknesses, outlining roles and create a RACI matrix *See Appendix 2 for DIA, BAE, and City for roles and responsibilities for all planning and execution tasks of the project 4. City to hire or appoint a qualified Liaison with construction, engineering and or technical background experience who is solely assigned to this project with no other conflicting priorities with the autonomy to make decisions.This personÃ¢â¬â¢s role is to ensure that legislation doesnÃ¢â¬â¢t interfere or adversely cause timing risks to the project plan and expedite issues/roadblocks when they arise between DIA, BAE and the city. This proposal is supported by the fact that our design has proven it will work given the proper management setup framework as demonstrated by our successful implemention of the new baggage handling system with United Airlines. The current lack of the Ã¢â¬Å"righ tÃ¢â¬ project team members will be addressed by this new proposed structure. With the right sponsorship and roject management setup, this will encourage all to be on the same page and working towards the same goal. The added benefit of this is that timelines will be clear and visible and will hold those truly responsible for delays in their respective areas and help them and all team members understand the domino affect and impact it can have on the entire project as a whole. This will discourage the current work Ã¢â¬Å"siloÃ¢â¬ mentality and will promote an integrated meeting of the minds where risks and opportunities for improvement can be quickly identified, communicated and cascaded to the right people.This will also ensure that the right decision makers are present to make judgement calls on plan changes as they come along and not further hold up the process. This should put the plan back on target and give us a working plan going forward where all key players are informe d, consulted and responsible for outcomes. The cost of setting up this new structure is by far a more economical way to get the task done without the added financial burden of creating a new Ã¢â¬Å"backupÃ¢â¬ system. Pros: * Renewed Focus on project with key roles and responsibilities outlined setÃ¢â¬â¢s clear goals, accountability and ownership. Address risks and enable the team to mitigate them * Clear direction and leadership by all stakeholders and their inputs * Expedite critical milestones and ensure we are on the path * Maintain reputation * No further $ investment for backup system Cons: * New hires required Alternative B Cancel the contract with Denver. Discontinue involvement in any further development unless directly contracted by Carriers. Pros: * Focus on core business Cons * Damaged reputation for BAE * Litigation costs * $12k / day penalty Law suit risk Ã¢â¬â Pay back of $50M Baggage system backup plan Part 6: Recommendations and Implementation Recommendation: Based on my analysis the strategic impact of cancelling the project at this point would further create a bad reputation for BAE, especially considering the current damage already made to BAE by the unsolicited test plan executed by the mayor and the bad press that has already caused. The decision to continue with the project conditional upon a new team structure is a reasonable request given our past successful history and project management expertise.I feel that we have a strong argument for our position backed up by facts that are undeniable and can thus prove our innocence and lack of responsibility for the delay. This will prove to be a sensitive topic as it appears that it is easier to blame us for the delays. With a mutual understanding about the current situation, I believe it will be easier to convince the Mayor and Aviation director the value the new structure would bring and that a new backup system is not the answer and would cause unnecessary further financial burden, h urt relationships and bad press which no one wants.The success of BAE in installing UnitedÃ¢â¬â¢s baggage system will be highlighted as an example of the right team structure and how we can achieve the same if we are united in the goal and agree to this plan. Recommendations Implementation Plan: Some of the short term elements of the recommendations are already completed or in progress such as building our case / position with regards to reasons for the delays. The following outlines the steps required to make this happen. Task| Responsible| Timing| Build case.Engage with Project Manager BAE to identify original plan & milestones and detailed reasons for incomplete tasks. Prepare PPT presentation with key dataWrite back to City Mayor, acknowledging letter and request for a formal meeting to present response with a set date. | BAE Project MgrBAE AdminGene DiFonso| 3 days2 days1 day| Invite to meet with DIA Director of Aviation to present challenges/issues faced throughout the proje ct and the delay outcome. Explain the current position we are in with regards to the cityÃ¢â¬â¢s demands with the objective to gain support for the new proposed structure. Gene DiFonso| 1 day fixed| Invite DIA Director of Aviation & City Mayor to formal meeting to present project delay reasons/issues & recommendation for continuation of project with recommended structure| Gene DiFonso| 1 day (fixed)| Prepare & Present the proposed structure and Project Team Method Matrix and explain itÃ¢â¬â¢s criticality and past effectiveness in other successful projects and why this is necessary even if a backup baggage system is implemented | Gene DiFonso| 3 days| Assume DIAÃ¢â¬â¢s buy Ã¢â¬â in and that it takes DIA 1 month to hire Project Manager and restructure the Project Management Team| Director of Aviation| 30 days| Work with new Project Management Team to identify construction risks that interfere with our design/implementation plans & come up with alternate solutions. | Gene DiFo nso & PMT| 1 week| Develop new Strategy with new key Milestones | Gene DiFonso, | 2 weeks| Obtain Buy-In & Committment from key stakeholders| City Mayor, Director of Aviation| 1 day (fixed| | Total| 9 weeks| 1st Meeting with new Project Team Members| | | | | | Any critical changes to the original plans will be reported promptly to DIA Project Manager and voiced in Team Meetings. Any critical plan changes will equire Sponsor sign offs (acknowledgment and approval of change to plan for reasons outside BAEÃ¢â¬â¢s control) before BAE continues with implementation. Part 7: Monitor and Control: * Weekly internal meetings with BAEÃ¢â¬â¢s project management team will be conducted to keep pulse on project timelines and areas of risk. * Attend weekly Project Meeting Team meetings to identify risks, action items, schedule changes and react to them. * Submit bi-weekly reports on status to key sponsors & stakeholders. * Hold monthly review meetings with Sponsors Part 8: Conclusion: In conclu sion, the current difficulties we are experiencing with DIA and City Administration has served as a costly example of lack of poor management structure for a project of this magnitude.Our past successes can speak for itself in approaching DIA and City Mayor for their support to the new proposal based on our experience. If this new approach is accepted, this will save BAE millions of dollars in lawsuits and cost of new baggage system as charged by the City Mayor. The optics of getting back on track, having a strong management team and continuing with the original plan will serve in favour of all, the Mayor, our shareholders, as well as redeem our own reputation as leaders in the market. We will then be positioned without a tarnished brand and enjoy further growth opportunities. Part 9: References, Exhibits and Appendixes Appendix 1 Ã¢â¬â New Project Management Team Structure Appendix 2 Ã¢â¬â RACI Matrix example (for initial phase) of new structure
Monday, January 6, 2020
A Chinese proverb accredited to Confucius says that to define the future, you need to study the past. Indeed, studying and understanding the past is paramount to understand the current situation of SVGB crimes in the CAR. Therefore, the following Chapter will focus on a brief analysis of the history of the CAR, highlighted its political instability. The CAR, located in central Africa, is currently the scene of some of the most atrocious human right violations. The landlocked country extending on 622,984 square kilometres neighbours countries such as Chad, Sudan, South Sudan, the Democratic Republic of the Congo (DRC), the Republic of Congo and Cameroon. Its diverse ethnic composition includes the two main ethnic groups, namely the Baya (33%) and the Banda (27%). Likewise, the religious composition is a diverse one with 25% of the population being Protestant, 25% Roman Catholics, 15% Muslims and 35% indigenous beliefs followers. 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