Process Of Unstructured Clinical Judgement Health And Social Care Essay

Process Of Unstructured Clinical Judgement Health And Social Care Essay However, there continues to be an increasing  interest  and  expectation  on professionals from the public and the criminal justice system in regards to the potential  danger  posed by  serious  offenders  being released  back into the community and the need for the offenders to be better managed, in order  to adequately protect  the public from dangerous individuals (Doyle et el, 2002). As the assessment of risk  is made  at various stages in the management process of the violent offender, it is  extremely  crucial that mental health professionals have a structured and consistent approach to risk assessment and evaluation of violence. (Doyle et el, 2002). This paper will examine three models of risk assessment that  are used  to reduce potential danger to others, when integrating violent offenders back into the community. These three approaches are unstructured clinical judgement, structured clinical  judgement  and actuarial  assessment. It is not intended, in this paper, to explore the various instruments used in the assessment process for the  respective  actuarial and structured clinical approaches. Unstructured Clinical Judgement Unstructured clinical judgement is a process involving no specific guidelines, but relies on the individual clinicians  evaluation  having regard to the clinicians experience and qualifications (Douglas et al, 2002).  Doyle et el(2002, p650) refers to  clinical  judgement as first generation, and sees clinical judgement as allowing the clinician  complete  discretion in relation to what information the clinician will or will not take notice of in their final determination of risk level. The unstructured clinical  interview  has been widely criticised because it  is seen  as inconsistent and inherently lacks structure and a  uniform  approach  that does not allow for  test, retest reliability over time and between clinicians (Lamont et al, 2009). It  has been argued  that this inconsistency in  assessment  can lead to  incorrect  assessment of offenders, as either high or low risk due to the subjective opinion inherent in the unstructured clin ical assessment  approach  (Prentky et al, 2000). Even with these limitations discussed above the unstructured clinical  interview  is still likely to be the most widely used  approach  in relation to the offenders violence risk assessment (Kropp, 2008). Kropp (2008), postulates that the continued use of the unstructured clinical  interview  allows for idiographic analysis of the offenders  behaviour (Kropp, 2008, p205).  Doyle et al (2002) postulates, that clinical studies have shown, that clinicians using the risk analysis  method  of unstructured interview, is not as  inaccurate  as  generally  believed.  Perhaps this is due, largely to the level of experience and  clinical  qualifications of those conducting the assessment. The unstructured clinical  assessment  method  relies heavily on verbal and non verbal cues and this has the potential of influencing individual clinicians assessment of risk, and thus in turn has a high probability of over reliance in the assessment on the exhibited cues (Lamont et al, 2009).  A major flaw with the unstructured clinical interview, is the apparent lack of structured standardized methodology  being used  to  enable  a  test  retest reliability  me asure  previously mentioned.  However, the lack of consistency in the assessment approach is a  substantial  disadvantage in the use of the unstructured clinical interview.   The need for a more structured  process  allowing for  predictable  test retest reliability would  appear  to be a  necessary  component of any risk assessment in relation to violence. Actuarial Assessment Actuarial  assessment  was developed  to  assess  various risk factors that would improve on the probability of an offenders recidivism. However, Douglas et al (2002, p 625) cautions that the Actuarial  approach  is not conducive to violence prevention. The Actuarial approach relies heavily on standardized instruments to assist the clinician in predicting violence, and the majority of these instruments  has been developed  to predict future  probability  of violence amongst offenders who have a history of mental illness and or criminal offending behaviours. (Grant et al, 2004) The use of actuarial  assessment  has increased in recent years as more non clinicians  are tasked  with the responsibility of management of violent offenders such as community corrections, correctional officers and probation officers. Actuarial risk assessment methods enable staff that do not have the experience,  background  or necessary  clinical  qualifications to  conduct  a standardised clinical  assessment  of offender risk. This actuarial  assessment  method  has been found  to be extremely  helpful  when having risk assessing offenders with mental health, substance abuse and violent offenders. (Byrne et al, 2006). However, Actuarial assessments have limitations in the inability of the instruments to provide any information in relation to the management of the offender, and strategies to prevent violence (Lamont et al, 2009).  Whilst such instruments may provide transferable  test  retest reliability, there is a need for caution when the instruments  are used  within differing samples of the  test  population  used as the validation  sample  in developing the  test  (Lamont et al, 2009).  Inexperienced and  untrained  staff  may not be aware that tests  are limited  by a range of variables that may limit the reliability of the test in use. The majority of actuarial tools  were validated  in North America (Maden, 2003). This has  significant  implications when actuarial instruments  are used  in the Australian context, especially when indigenous cultural complexities are not taken into account. Doyle et al (2002) postulates that the actuarial  approach  are focused  on prediction and that risk assessment in mental health has a much broader  function  and has to be  link  closely with management and prevention (Doyle et al, 2002, p 652). Actuarial instruments rely on measures of static risk factors e.g. history of violence, gender, psychopathy and recorded so cial variables.  Therefore, static risk factors  are taken  as remaining constant.  Hanson et al (2000) argues that where the results of unstructured  clinical  opinion  are  open  to questions, the empirically based risk assessment  method  can significantly predict the risk of re offending. To rely  totally  on  static  factors that  are measured  in Actuarial instruments, and not incorporate dynamic risk factors has led to what Doyle et al (2002) has referred to as, Third Generation, or as more commonly acknowledged as structured professional judgement. Structured Professional Judgment Progression toward a structured professional  model, would  appear  to have followed a process of evolution since the 1990s.  This  progression  has developed through  acceptance  of the complexity of what risk assessment entails, and the pressures of the courts and  public  in developing an expectation of increased predictive accuracy (Borum, 1996).  Structured professional judgement brings together empirically validated risk factors, professional experience and contemporary knowledge of the patient (Lamont et al, 2009, p27).  Structured professional judgement approach requires a  broad  assessment  criteria covering both static and dynamic factors, and attempts to bridge the gap between the other approaches of unstructured clinical judgement, and actuarial  approach  (Kropp, 2008).  The incorporation of dynamic risk factors that are taking  account  of variable factors such as current emotional  level  (anger, depression, stress), social supports or lack of and willingness to participate in the treatment rehabilitation process.  The structured professional approach incorporates  dynamic  factors, which  have been found, to be also crucial in analysing  risk  of violence (Mandeville-Nordon, 2006).  Campbell et al (2009) postulates that instruments that  examine  dynamic risk factors are more  sensitive  to  recent  changes that may  influence  an increase or decrease in risk potential. Kropp (2008) reports that research has found that Structured Professional Judgement measures also  correlate  substantially  with actuarial measures. Conclusion Kroop, (2008) postulates that either a structured professional judgement approach, or an actuarial approach presents the most viable options for risk assessment of violence.  The unstructured  clinical  approach  has been widely criticised by researchers for lacking reliability, validity and accountability (Douglas et al, 2002). Kroop, (2008) also cautions that risk assessment requires the assessor to have an appropriate level of specialized knowledge and experience. This experience should be not only of offenders but also with victims.  There would  appear  to be a valid argument that unless there is consistency in  training  of those conducting risk assessments the validity and reliability of any measure, either actuarial or structured professional judgement, will fail to  give  the  level  of predictability of violence that  is sought.  Risk analysis of violence will always be burdened by the  limitation  which lies in the fact that  exact  an alyses are not  possible, and  risk  will never be totally eradicated (Lamont et al, 2009, p 31.). Doyle et al (2002) postulates that a combination of structured clinical and actuarial approaches  is warranted  to assist in risk assessment of violence. Further research appears to be warranted to improve the evaluation and  overall  effectiveness of risk management.

Heart of Darkness Critical Paper Essay

Joseph Conrad’s novel, Heart of Darkness, is a work of complexity. â€Å"His stories often represent and suggest more than they say† (Skinner). Conrad gives the novel a perplex side through his tactfully written words. This unique language that Conrad uses gives a sense of duality to many phrases in the novel. The double meanings of much of the language that Conrad uses contribute to a reoccurring aspect of the novel, which is that often times there is far more substance to something than appears on the surface. This theme is played out in the novel through the setting and through the two main characters, Marlow and Mr. Kurtz. The novel takes place right in the heart of Africa, down the long and windy Congo River. The river in the setting is a crucial component of the novel because it brings a sense of darkness. â€Å"Conrad manages to hint at the darkness beyond the senses and to represent the experience of struggling with the impossibility of existential revelation in various ways, in terms of both content and form,† because not only does he describe the river’s topography, but also describes the river as having a mind of its own (Skinner). When describing the river, Conrad writes, â€Å"the long stretches of the waterway ran on, deserted, into the gloom of overshadowed distances†(Conrad). This description of the river creates an image of a vast and gloomy river. However, Conrad’s use of personification gives the river a personality, as if it is vulnerable to the dark surroundings that it’s engorged within. In the novel, Marlow’s spoken words also possess a sense of duality. On the outside, Marlow seems like a composed gentleman, who takes little regard for emotions. He speaks in a matter of fact manner, describing everything that he sees in its purest form. When conveying his thoughts about Kurtz he says ,â€Å"He was just a word for me. I did not see the man in the name any more than you do†(Conrad). Marlow’s description of Kurtz at first seems merely a factual statement, but it means more than that because â€Å"there is what is not said because it is merely left unstated (Skinner). The understated nature of his words suggests that Marlow is struggling to compress everything that he feels about Kurtz into a sentence. Furthermore, when Marlow says, â€Å"I will be loyal to the nightmare of my choice†, the reader obtains two meanings from his words (Conrad). On the exterior, Marlow simply means that he will not betray Mr. Kurtz, but on the interior, he is trying to express that he will not let go of the desire that he had to meet Mr. Kurtz, even though the experience strayed far away from his original expectations. Conrad also uses Mr. Kurtz to showcase his way of writing phrases that contain different depths of meaning. Mr. Kurtz is an individual who unknowingly lost sight of his own self because of the heart of darkness in which he is enwrapped. He is unable to blatantly express how his greed and feelings of superiority over the natives have tarnished his character. Therefore, Conrad gives depth to the words that Kurtz speaks, to allow the reader a glimpse into Kurtz’s heart, without needing to have Kurtz deliver his personal sentiments. Towards the end of the novel when Kurtz cries, â€Å"save me!† he literally is pleading for the salvation of his ivory, but figuratively, it’s a plea for someone to save his soul. â€Å"The Horror! The Horror!† are Mr. Kurtz’s notorious last spoken words. On the surface, these words may appear to be describing the face of death, but it seems plausible that Kurtz’s is instead horrified with himself for the way he has so cruelly treated the natives, and that abominable images of the native’s oppression are flashing before his eyes. The duality in meaning of Conrad’s words not only contributes to the complexity of the novel, but also helps to develop the setting and the characters. Conrad’s â€Å"unsaid dialogue and narrative hint at layers of meaning beyond what is read, and Conrad’s explicit and implicit insistence on mysteries beyond words emphasize the unsayable†(Skinner). These techniques that Conrad uses allows the novel to transcend past a simple narrative.(Singer)

The Contingency Theory Of Management

Starbucks has evolved one of the fastest flourishing companies in the United States. Get downing from 1992, the company ‘s net gross improved at a compounded growing rate of 20 % , to $ 3.3 billion in financial 2002. Gross net incomes have grown at an one-year compounded growing rate of 30 % to $ 218 million in financial 2002, which is the highest figure in net earning of company ‘s history ( See Exhib it 1 ) . As Business Week tells it: On Wall Street, Starbucks comes last biggest growing narrative. Its stock, including four splits, has raised more than 2,200 % over the old decennary, exceling Wal-Mart, General Electric, PepsiCo, Coca-Cola, Microsoft, and IBM in aggregative return. Now at $ 21 [ September 2002 ] , it is vibrating near its all-time high of $ 23 in July [ 2002 ] , before the overall pronounced bead. 1 To go on this rapid gait of growing, the house ‘s senior executives are looking to spread out internationally. Specifically, they are interested in farther enlargement in Europe ( including the Middle East ) , Asia Pacific ( including Australia and New Zealand ) and Latin America. Expanding in these three continents represents both a challenge and an chance to Starbucks. While the chance of increased grosss from farther enlargement is readily evident to the company ‘s top direction, what is non clear is how to cover with turning â€Å" anti-globalization † sentiment around the universe. This instance looks at issues that are originating as Starbucks starts to rule java markets around the universe and explores the alterations which might be required in scheme. The 25-year end of the company is to be an enduring, and great company with the uttermost respected and recognized trade name in the universe, known for inspiring and fostering the human sprit. The mission statement of the company is to joint several steering rules to estimate the rightness of house ‘s determination. In depicting Starbucks ‘ echt attack towards competition, Fortune notes: The scheme is straightforward: Blanket an country wholly, even if the shops cannibalize each other ‘s concern. A new shop will frequently pull off to capture about 30 % of the gross revenues of a nearby Starbucks, but the company takes this as a good thing: The everywhere attack of the Starbucks cuts down the costs direction and bringing, it decreases the client lines at single shops, and increases pes traffic for all the shops in an country. Last hebdomad 20 million people purchased a cup of java at a Starbucks. No American retail merchant has a highest figure of client visit. A typical client Michigans by 18 times a month ; since the company went public, It has climbed an norm of 20 % a twelvemonth. Even in down economic system, Starbucks traffics have risen between 6 to 8 per centum a twelvemonth. Possibly even most noticeable fact that Starbucks has managed to bring forth those sorts of the Numberss with virtually no selling by giving merely one per centum of one-year income on advertisement. For several old ages, Perceivers have found that US coffee-bar market may be nearing towards impregnation. They point to tag consolidation, as bigger participants of java saloon snap up some of the smaller java saloon rivals. More, they take a note that Starbucks ‘ shop base is excessively maturing, and making to lag in the growing of unit volume and house net income. In the response of that, some point, Starbucks has changed its way towards foreign markets for the continued growing. For illustration Business Week notes: To counterbalance the hesitating returns of its first decennary, Starbucks has no pick but to export its construct smartly. Indeed some perceivers give Starbucks merely 2 old ages maximal before it saturates the U.S. market. The concatenation now [ in August 2002 ] operates 1200 international mercantile establishments, from Beijing to Bristol. This gives immense room for grow. Infact, about 400 or its planned 1200 new shops in this twelvemonth would be constructed overseas, which will stand for a 35 % rise in its foreign base. Starbucks hopes to duplicate the measure of its shops globally, to about 10,000 in 3 twelvemonth period. Our attitude towards international enlargement is to set focus foremost on the partnership, and state 2nd. We believe in local connexion to get everything up and working. Finding the right local spouses is the key to negociate local ordinances and others jobs. We search for spouses who are common in our values, civilization, and motivations about community development. We are fundamentally interested in spouses who could steer us in the procedure of induction in foreign location. We are seeking the houses with: ( 1 ) common doctrine to ours in footings of shared values, corporate citizenship, and committedness to be in the concern for long draw, ( 2 ) experience with multi-unit eating house, ( 3 ) For the bar of impersonators, holding resources to spread out the Starbucks construct rapidly. , ( 4 ) To pick premier existent estate locations, holding strong real-estate experience along with cognition, ( 5 ) Must be holding cognition of retail market, and ( 6 ) committedness of the peop le should be available to our undertaking. In an international joint venture, it is the spouse that chooses shop sites, does all the preparatory and choice work, which are so submitted for blessing to Starbucks. Cydnie Horwat, VP for International Assets Development Systems and Infrastructure, elaborates how a Starbucks market entry program initiates with trade name edifice, which afterwards facilitates further rapid enlargement in a state: When come ining a market foremost, we look for different things in the initial 1 to 3 old ages than subsequently on. During these early old ages we are developing our trade name. Our shops are the largest beginning of advertisement, as they do n't make a batch of separate advertisement. Therefore we possess higher investing in shops in the first 3 old ages. Approximately 60 to seventy per centum of shops which are opened in these initial 3 old ages are our biggest brand-builders. Before 10 old ages, we had 125 shops and 2000 employees. Today we have 62,000 employees working in 30 different states outside of North America, who are functioning about 22 million clients in a hebdomad. Our nucleus client comes about 18 times a month. With the bulk of grownups throughout ball imbibing 2 cups of java a twenty-four hours and with Starbucks holding less than seven percent portion of aggregative java ingestion in the U.S. and less than one per centum globally, these are the initial yearss for the growing and advancement of company. We have got a theoretical account that is rather good tested from market to market. Starbucks is good on its way to go a planetary trade name. Harmonizing to Business Week: [ T ] he Starbucks name and image is associated with 1000000s of people around the universe who consume its merchandises. In Business Week study of the top hindered international trade names published in August 5 [ 2002 ] It came one of the quickly turning trade names. At a clip when one corporate star after another has collapsed to earth, brought down by disclosures of net incomes misstatements, executive greed, or worse, Starbucks has non faultered. But being a international company is non risk free. As Business Week points out, Global enlargement carries a large hazard for Starbucks. For one thing, it makes decreased money one every overseas shop as most of them are operated with local spouses. While this makes easier to get down on foreign sod, it decreases company ‘s portion of the net incomes to merely 20 to 50 per centum.

The Existential Isolation And Biopsychological Change

An Analysis of the Existential Isolation and Biopsychological Change in The Metamorphosis and â€Å"Letter to my Father† by Franz Kafka and Unwelcome Visitors† by Tessa Farmer This literary and art analysis will define the correlation between the writings of Kafka and the installation art of Tessa Farmer’s in relation to the themes of existential isolation and biopsychological change. Gregor’s anxiety in The Metamorphosis is partially due to the alienation of society, which cases an existential period of isolation in which he transforms into a bug. In Kafka’s â€Å"Letter to my Father†, the abuses of his father cause Kafka to isolate in his bedroom as a coping mechanism against hostility. Kafka’s novel and personal experiences define the biopsychological effects of anxiety and isolation that cause him to change into the â€Å"other† or, in this case, a bug. In a similar manner, Tessa Farmer’s â€Å"Unwelcome Visitors† at the Holbourne Museum represent an installation of small-scale human skeletons (aka. faeries) that have real insect wings attached to the back, which represent a biopsychological chan ge in the human form to an insect form. Much like Gregor, the skeleton-bugs of Famer’s installation are seen as alien intruders in a traditional museum setting. In essence, define the correlation between the writings of Kafka and the installation art of Tessa Farmer’s in relation to the themes of existential isolation and biopsychological change. In The Metamorphosis by Franz Kafka, the main