Medical Home Practice-Based Care Coordination

Medical Home Practice-Based Care Coordination: A Workbook By: Jeanne W. McAllister Elizabeth Presler W. Carl Cooley Center for Medical Home Improvement (CMHI) Crotched Mountain Foundation & Rehabilitation Center; Greenfield, New Hampshire Beyond the Medical Home: Cultivating Communities of Support for Children/Youth with Special Health Care Needs Funded by: H02MC02613-01-00 United States Maternal and Child Health Bureau, Integrated Services for CSHCN, HRSA June 2007Workbook Contents This workbook includes the tools and supports needed for a primary care practice to develop their capacity to offer a pediatric care coordination service; particularly for children with special health care needs. The health care team, determined to develop such an explicit service, makes an assessment of current care coordination practice and frames their improvement efforts to achieve proactive comprehensive practice-based care coordination.Tools included in this resource are: a definition of care coordi nation in the medical home, a care coordination position description, a framework for care coordination services including structures and processes, strategies for the protection of devoted staff time, and a logical sequence of care coordination improvement ideas offered in the context of the Model for Improvement (Langley, 1996). Each tool can be used as is or it can be customized in a manner which best fits your practice environment and the strategic plans your organization holds for medical home improvement activities.Table of Contents Medical Home Practice Based Care Coordination Medical Home Care Coordination A Definition & A Vision Is It Medical Home Care Coordination? A Checklist Medical Home (Practice Based) Care Coordination – Position Description – A Worksheet A Medical Home (MH) Care Coordination Framework – Framework – Worksheet Time Protection Tips & Strategies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦5 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦7 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦9 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 10 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11Care Coordination Development: The Model for Improvement †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦12 Care Coordination Aim Statement †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦13 Care Coordination Outcomes †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦14 Plan Do Stud y Act (PDSA) Worksheet & Examples †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦15 1) Care Coordination Role/System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦16 2) Care Coordination – Needs Assessment †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18 3) Comprehensive Care Planning †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦20 Medical Summary, Action & Emergency Plans 4) Transition to Adult Care & Services †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦22 5) Community Outreach & Resources †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦24 Appendices A.Websites and References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦.. 26 2 Medical Home – Practice-Based Care Coordination This workbook is designed to suppor t practice-based quality improvement teams in their efforts to build comprehensive primary care â€Å"medical homes†. The focus is specifically upon the professional role development for the provision of practice-based care coordination. The ideal care scenario is one where the staff within the medical home is proactively prepared to support the central care giving role of families.The role of care coordination discussed within this workbook is one designed in the service of children/youth with special health care needs (CYSHCN). It is acknowledged that care coordinators in different environments will apply their skills and efforts toward the care of all children as well as adults with special needs or chronic health conditions; you should find the structures and processes offered within suitably applicable.Workbook Goals and Objectives: Goal: To put forth a practice-based medical home care coordination framework from which practices can select and suitably customize. Content s include a medical home care coordination checklist, definition, position description, model framework with structures and processes, and strategies for effective and successful care coordination development and implementation. Objectives: 1) Define practice-based care coordination for children with special health care needs in a medical home ) Select and appropriately modify a position description that fits each unique medical home improvement team environment 3) Use a care coordination model framework to fit the role well within each practice environment 4) Draw from a list of time protection and resource allocation strategies those with the best fit for the practice environment and related improvements 5) Develop tests of change (PDSA – plan, do, study, act) for the incremental development of a comprehensive care coordination service model to include: care services, assessment of needs, care planning, transition support, and community outreach with resource linkages.It is established in the literature that the medical home is meant to be a centralizing resource for children and families, particularly for CYSHCN (AAP Medical Home Advisory Committee, 2002) Evidence is building that care coordination is essential to a medical home (Antonelli, 2004). It has been suggested that you cannot be a strong medical home without the capacity to link families with a designated care coordinator; this is the ideal.The policy statement issued by the American Academy of Pediatrics on Care Coordination (CC) describes CC as complex, time consuming, even frustrating but as key to effective management of complex issues in a medical home; and states that a designated care coordinator is necessary to facilitate optimal outcomes and prevent confusion. Care coordination takes resources and time. Practices need to be reimbursed for this labor intensive role (AAP Committee on Children with Disabilities, 1999).Horst, Werner, and Werner (2000) state that in all types of systems, care coordination is an essential element to ensure quality and continuity of care for CSHCN and their families. In a 10 point strategy to 3 achieve transformational change within health care for all, issued by the Commonwealth Fund, care coordination is cited as one of ten key components to organize care and information around the patient (Davis, K. 2005). Ideal care coordination provides timely access to services, continuity of care, family support, strengths-based rather than deficit-based thinking and advocacy.This is very time consuming, whether accomplished by parents or by parent professional partnerships (Presler, 1998). At the front lines of care, in the medical home Antonelli (2004) states that without the ability to support care coordination at the level of the medical home, barriers to achieve the Healthy People 2010 objectives remain. In the Future of Children (2005) the author claims that care coordination requires (at the very least) adequate personnel and time and i s often limited in primary care by lack of the very time and resources necessary.This is substantiated by the AAP Periodic Survey of Fellows #44, (2000), by a national Family Voices Survey (2000) with parents reporting their physicians have the skill for coordination but are difficult to access and have minimal time available for care coordination activity/implementation. Similarly a survey of state Title V Directors and their perception of barriers to care coordination in the medical home includes: time, reimbursement, lack of physicians, lack of skill/training, and limited cultural effectiveness.Successful medical homes result when partnerships with families offer fully implemented practice-based care coordination. Proactive care coordination and care planning are fundamentally essential for improved care quality, access to services and resources, health and function of children and youth, and quality of life as well as improved systems of care. No medical home will achieve optima l comprehensive, coordinated and compassionate care without dedicated time and resources to develop, implement, and evaluate a complement of care coordination activities.Such an investment is favorable in terms of cost and benefit for children/youth and families, primary care practices and their broader health care systems. In summary, care coordination: Is accomplished everyday by families with and for their children and youth, but Support is desirable, feasible and beneficial coming from the medical home Requires critical funding and protected time Requires tested tools and strategies (some are included in this workbook, others have been developed and continue to evolve) Is a defining characteristic (element) of a fully implemented and comprehensive medical home Medical Home Care Coordination – A Definition The literature offers several definitions of care coordination but most have been written for application across varied health care environments such as hospitals, speci alty based centers, community & home health agencies. Few definitions focus exclusively on the distinctions found within the primary care medical home for the role of practice-based care coordinator.The focus of the Center for Medical Home Improvement is on the primary care practice with the provision of team-based care coordination, delivered from the centralizing resource of a primary care medical home with physician leadership and by experienced nurses, social workers, and/or comparable professionals. Care CoordinationPractice-based care coordination within the medical home is a direct, family/youth-centered, team oriented, outcomes focused process designed to: Facilitate the provision of comprehensive health promotion and chronic condition care; Ensure a locus of ongoing, proactive, planned care activities; Build and use effective communication strategies among family, the medical home, schools, specialists, and community professionals and community connections; and Help improve , measure, monitor and sustain quality outcomes (clinical, functional, satisfaction and cost (McAllister, et al, 2007)A Vision for Practice Based Care Coordination Children, youth, and families have seamless access to their team, enhanced by they availability of a designated care coordinator who facilitates a team approach to family-centered care coordination services. (McAllister, et al, 2007) 5 CC CHECKLIST Is It Medical Home Care Coordination? Checklist – how are you doing? What elements are in place, which require some additional attention? NO / PARTIALLY/ YES 1) Families know who their care coordinator is and how to access him or her (or their backup)? ) Values of family-centeredness are known to the medical home team and drive the development and provision of care coordination? 3) A medical home care coordination position description is established; roles/activities are clearly articulated and care coordination training and education is available? 4) Administrative lead ership helps to develop/support a care coordination service system; protected time allows for CC role development? 5) CYSHCN identification and assessment of child/family needs/unmet needs are completed; care planning is a core CC/medical home response? ) Education and counseling are offered as an essential part of medical home care coordination? 7) Care coordination includes comprehensive resource information, referrals, and cross agency/organization communication? 8) Child/family advocacy is a part of care coordination 9) Families are asked for feedback about their experiences with health services/care coordination? 10) Medical home system improvements are implemented simultaneously with the development of care coordination (care coordinator contributes to this quality improvement process)? 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 1 2 2 3 3 1 2 3 1 2 3 Total score: _________/ out of 30. Notes: 6 Medical Home (Practice Based) Care Coordination – Position Description The care coor dinator works within the context of a primary care medical home, from a team approach, and in continuous partnership with families and physicians to promote: timely access to needed care, comprehension and continuity of care, and the enhancement of child and family well being.Care Coordination Qualifications: The care coordinator shall have: Bachelor’s preparation as a nurse, social worker, or the equivalent with appropriate past experience in health care Three years relevant experience, or the equivalent, in community based pediatrics or primary care, particularly in the care and service of vulnerable populations such as children/youth with special health care needs (CYSHCN) Essential leadership, advocacy, communication, education and counseling, and resource research skills Core philosophy or values consistent with a family-centered approach to care Culturally effective capabilities demonstrating a sensitivity and responsiveness to varying cultural characteristics and belie fs Medical Home Care Coordination Responsibilities The care coordinator will: 1) Demonstrate and apply knowledge of the philosophy/ principles of comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services 2) Facilitate family access to medical home providers, staff and resources 3) Assist with or promote the identification of patients in the practice with special health care needs (such as CYSHCN); add to registry and use to plan and monitor care 4) Assess child/patient and family needs and unmet needs, strengths and assets 5) Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child/youth or family member at any given point in time 6) Build care relationships among family and team; support the primary care-giving role of the family 7) Develop care plan with family/youth/team (emergency plan, medical summary and action p lan as appropriate) 8) Carry out care plans, evaluate effectiveness, monitor in a timely way and effect changes as needed; use age appropriate transition timetables for interventions within care plans 9) Serve as the contact point, advocate and informational resource for family and community partners / payers 10) Research, find, and link resources, services and supports with/for the family 11) Educate, ounsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or facilitate referrals appropriately 12) Cultivate and support primary care & subspecialty co-management with timely communication, inquiry, follow up and integration of information into the care plan 13) Coordinate inter-organizationally among family, medical home, and involved agencies; facilitate â€Å"wrap around† meetings or team conferences and attend community/school meetings with family as needed and prudent; offer outreach to the community related to the population o f CYSHCN 14) Serve as a medical home quality improvement team member; help to measure quality and to identify, test, refine and implement practice improvements 15) Coordinate efforts to gain family/youth feedback regarding their experiences of health care (focus groups, surveys, other means); participate in interventions which address family/youth articulated needs 7 Position Description WorksheetMedical Home (Practice Based) Care Coordination Position Description Responsibilities Worksheet – Customize for Your Practice Care Coordination in a Medical Home – The Care Coordinator will: 1) Demonstrate and apply knowledge of the philosophy/ principles of 2) 3) comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services Facilitate family access to medical home providers, staff and resources Assist with or promote the identification of those with special health care needs (such as CYSHCN); add them to the regi stry and use it to plan and monitor care Assess child/patient and family needs/unmet needs, strengths and assets Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child, youth or family member at any given point in time Build care relationships among family and team; support the primary care giving role of the family Develop care plan with family/youth/team (emergency plan, medical summary and action plan as appropriate) Carry out care plans, evaluate effectiveness, monitor in a timely way and make changes as needed; use age appropriate transition imetables for interventions within care plans Serve as contact point, advocate and informational resource for family and community partners/payers Research find, and link resources, services and supports with/for the family Educate, counsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or fac ilitate referrals appropriately Cultivate and support primary care & subspecialty co-management with timely communication, inquiry, follow-up and integration of information into the care plan Coordinate interorganizationally among family, the medical home, and involved agencies; facilitate â€Å"wrap around† meetings or team conferences and attend community/school meetings with family as needed and prudent; offer outreach to the community related to the population of CYSHCN Serve as a medical home quality improvement team member; help to measure quality and to identify, test, refine and implement practice improvements Coordinate efforts to gain family feedback regarding their experience with health care(focus groups, surveys, other means); participate in interventions that address family/youth articulated needs Accept Reject 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) *** Add additional key responsibilities here (use additional paper): 8 A Medical Home (MH), Team Based, Care Co ordination (CC) Framework Fundamental Tools Structures Medical Home Interventions Access to Medical Home, Health Care and Other Resources Identify and register the CYSHCN opulation Establish with families effective means for medical home/office access Provide accessible office contract for family and community agencies Catalog resources to link families to appropriate educational, information and referral sources Promote and â€Å"market† practice-based care coordination to families and others (e. g. brochures, posters, outreach efforts) Establish alliances with community partners Facilitate practice & family linkages with agencies (e. g. family support, schools, early intervention, home care, day care &agencies offering respite, housing, & transportation) Align transition support activities with schools & other groups Collaborate to improve systems of care for CYSHCN (families, payers, provides, and agencies) Community Connections Fundamental Processes Proactive Care Plannin g Medical Home Interventions Help to maintain health and wellness & prevent secondary disease complications Maximize outcomes (e. g. lleviation of the burden of illness, effective communication across organizations, enrollment in needed services, and school attendance/success) Listen, counsel, educate, & foster family skill building Screen for unmet family needs Develop written care plans; implement, monitor and update regularly Plan for future transition needs; incorporate into plan of care Facilitate subspecialty referrals, communication & help family integrate recommendations of specialists Link family, staff to educational/financial resources †¢ †¢ †¢ †¢ Establish alliances with community partners Facilitate practice & family linkages with agencies (e. g. family support, schools, early intervention, home care, day care & agencies offering respite, housing, & transportation) Align transition support activities with schools & other groups Collaborate with famil ies, payers, providers and community agencies to improve systems of care for CYSHCN Improving and Sustaining Quality 9 Framework Worksheet A Medical Home (MH) Care Coordination Framework – WORKSHEET Fundamental Structures Access to Medical Home, Health Care and Other Resources Who? How? Medical Home InterventionsIdentify and register the CYSHCN population Establish with families effective means for medical home/office access Provide accessible office contract for family and community agencies Catalog resources to link families to appropriate educational, information and referral sources Promote and â€Å"market† practice-based care coordination to families and others (e. g. brochures, posters, outreach efforts) Establish alliances with community partners Facilitate practice & family linkages with agencies (e. g. family support, schools, early intervention, home care, day care &agencies offering respite, housing, & transportation) Align transition support activities wit h schools & other groups Collaborate to improve systems of care for CYSHCN (families, payers, provides, and agencies) Community Connections Fundamental Processes Proactive Care Planning Medical Home InterventionsHelp to maintain health and wellness & prevent secondary disease complications Maximize outcomes (e. g. alleviation of the burden of illness, effective communication across organizations, enrollment in needed services, and school attendance/success) Listen, counsel, educate, & foster family skill building Screen for unmet family needs Develop written care plans; implement, monitor and update regularly Plan for future transition needs; incorporate into plan of care Facilitate subspecialty referrals, communication & help family integrate recommendations of specialists Link family, staff to educational/financial resources †¢ †¢ †¢ †¢ Establish alliances with community partners Facilitate practice & family linkages with agencies (e. g. amily support, schools, early intervention, home care, day care & agencies offering respite, housing, & transportation) Align transition support activities with schools & other groups Collaborate with families, payers, providers and community agencies to improve systems of care for CYSHCN Who? How? Improving and Sustaining Quality 10 Time Protection Tips & Strategies The statement (on page 4) that no medical home will achieve optimal comprehensive, coordinated and compassionate care without dedicated time and resources to develop, implement, and evaluate a complement of care coordination activities warrants a few tips about how to achieve such dedicated time.Ideas for the successful implementation of practice based care coordination include administratively supported techniques and the resulting implemented care coordination (systematic) processes. Consider the following suggestions for time protection and use them to craft your own strategic approaches. Administrative Strategies for Achieving Some  "Think† and Implementation Time Personnel – proactively allocate a block of dedicated time. This includes the number of hours, days and time blocks or hours and how those hours will be prepared for, spent and accounted for. (This can be done as a trial or test of change) You may need a private place, an office, or even a â€Å"my care coordination development hat is on today† sign!Clear activities – Use the position description and the CC framework on page 9 to select the focus and logical progression of this role development and how time will be spent Determine how you will document and/or account for this time Team based care coordination – determine how you will allow for the development of care coordinator – family partnership. Could there be a designated clinic time for specific group of CYSHCN, or a special condition focused approach with a care coordination protocol? Some practices have held what is referred to as a DIGMA (drop in grou p medical appointments) for a group of families with children with similar conditions. A DIGMA can take on many forms such as family education, community resource connections, or even time for care coordination introduction and development with the opportunity to meet, greet and complete care plans.Approaches Helpful to Building Time into Your System Use your population identification system to determine who needs care coordination Use the development of your CC role to establish systematized screening assessments and resulting care planning and monitoring Hold medical home related staff meetings; offer education regarding CYSHCN and gain buy-in and staff understanding for the value of providing care coordination Engage families who can educate staff about the complexity of their child’s needs Create a reporting line to senior leaders from the Care Coordinator so that CC development is built into their role expectation Develop the capacity for care coordination â€Å"roundsà ¢â‚¬  by discussing direct CC efforts around individual children and youth with staff; gaining the input of colleagues will help you with staff education and their buy in to the medical home and practice-based care coordination approach; all will then learn about complex health and community based needs and resources Maximizing Reimbursement for Care Coordination: Ensuring affordability and sustainability by: Developing smart legitimate up-coding; Tracking CC data (service/outcome) to negotiate new payment opportunities Prepare for the use of new codes (care plan oversight) Become aware of and access Title V supports 11 Care Coordination Development: 1) The Model for Improvement 2) Care Coordination Aim Statement 3) Plan Do Study Act (PDSA) cycles or â€Å"tests of change†Model for Improvement Questions 1) What are we trying to accomplish? Medical Home Improvement Responses Medical Home – Care Coordination 2) How will we know that a change is an improvement? Measures – Medical Home Index, Medical Home Family Index & Survey, Other 3) What changes can we make that will result in an improvement? Good ideas – ready for use (e. g. CC definition, job description, framework & activities, PDSA examples 12 2) Care Coordination Aim Statement A good aim statement includes the following elements: Population – CYSHCN Timeframe – by when Intent – what/why Stretch goals – e. g. identify 100% CSHCN Example: Overarching Aim – Care CoordinationBetween Learning Session 2 and spring of 2006 we will customize and use a model of medical home care coordination for children/youth with special health care needs so that a position description and framework of activities are explicit, with time protected and accounted for and ~ 75% (goal) of children, youth and families report that they: Know who their care coordinator is Know they are receiving care coordination Participate in decisions about the level of care coordination needed Are satisfied with their access to care, care coordination, and resources (most of the time) For Veterans – Advanced Care Coordination Aim Goals Youth and families report that: A transition timetable is shared among family, practice and community professionals They have coordinated support getting their child’s needs met within the community and from sub-specialists 13 Thinking Through Some Measurement Ideas – For Practice-Based Care Coordination – PDSA Cycles Care Coordination Outcomes Family satisfaction decrease in worry and frustration (CMHI survey tools) increased sense of partnership with professionals (CMHI survey tools) improved satisfaction with team communication (CMHI survey tools)Staff satisfaction improved communication and coordination of care improved efficiency of care elevated challenge and professional role Improved child/youth outcomes Decrease in ER visits, hospitalizations, & school absences (family, plan report) Increase in a ccess to needed resources (CMHI survey tools) Enhanced self-management skills (CMHI survey tools) Improved systems outcomes decreased duplication decreased fragmentation improved communication and coordination (CMHI Medical Home Index) 14 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen?How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 15 CMHI Plan-Do-Study-Act (PDSA) Worksheet PDSA Example Team: #1 Care Coordination Role/System Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) We will develop and test a clearly defined system of care coordination (CC) services using strategies that fit our practice environment.This will include the use of a: 1) clear CC definition, 2) CC position description and 3) CC framework with an outline of activities. CC role, contact and access information will be explicit for families. {Our test of change will include dedicated time for the CC to share plans with staff and implement CC PDSA cycles (see examples in following pages). We will feed back lessons learned to our Medical Home Improvement team for guidance and direction. What additional information will you need to take action? Knowledge of and securing the availability of senior leader support with designation of one (or more) staff members to provide CC leadership What do you predict will happen?There will be false starts with â€Å"tyranny of the urgent† keeping us from our task; our will, ideas and execution will overcome this in the end. How will you know your ch ange is an improvement? Staff/families begin to ask for care coordination / CC activities (e. g. care plan); selected outcome measures improve (see page 14) DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 16 PDSA Worksheet PDSA Team: Aim:CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 17 CMHI Plan-Do-Study-Act Worksheet PDSA Example Team: #2 Care Coordination Needs Assessment Aim: Use from page 13 or create own PLAN:Objective: (Including details (who, what, where, when) With MH lead physician review pending CYSHCN visits; select 3 CYSHCN who will benefit from an assessment for care coordination. By â€Å"a week from next Tuesday† complete an assessment (e. g. parent/youth screening tool in appendices behind page 26) either before the office visit or by pre-visit phone call. Begin care planning process with child/youth and family What additional information will you need to take action? Listing of pending CYSHCN visits from the CYSHCN list or â€Å"registry† What do you predict will happen? Some false starts finding the right CYSHCN and with timing; we will succeed if persistent over slightly longer time span How will you know your change is an improvement?Follow up with 3 families in 2 weeks to determine if pre-visit assessm ent and follow-up planning are helpful and what needs to be added/improved; review value with lead physician as well. DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 18 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen?How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 19 CMHI Plan-D o-Study-Act Worksheet PDSA Example #3 Comprehensive Care Planning Team: Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) 1) Develop/choose care plan medical summary and use with 5 identified CYSHCN/week. 2) Add an emergency plan if warranted. ) Study provider and family feedback and integrate to improve the plan and the process for plan use. Create immediate action plan for how to meet resource, educational and other needs of CYSHCN/patient and family 4) Use lessons learned to share, engage, educate and spread medical home to staff. What additional information will you need to take action? Sample care plans to choose from using team priorities; identified CYSHCN with pending visit to initiate plan with. Also identify educational needs of staff /families. What do you predict will happen? Will start slow, 1-2 per week and pick up speed to reach 5. Value will result in better preservation of care coordinator time to complete plans, thus i ncreased use of CC and team process.Ultimately, we may schedule comprehensive care planning â€Å"rounds† with team/staff; review 3-5 CYSHCN/patients who are receiving this care coordination. Use rounds to review successes, challenges, needs of child/family with staff and address questions. How will you know your change is an improvement? Review with families for benefit, follow up in 4-6 weeks; review also with staff DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 20 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN:Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO : Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 21 CMHI Plan-Do-Study-Act Worksheet PDSA Example #4 Transition to Adult Care & Services; Up-coding to maximize reimbursement Team: Aim: Use from page 13 or create own PLAN:Objective: Have MD & Care Coordinator jointly see (2) YSHCN & family for transition visit; use a transition assessment (timetable) checklist to guide the visit and align activities with community partners. Bill for visit – document nature of complexity Details (who, what, where, when) CC Schedules 2 YSHCN for transition care plan visit next week, with family permission informs/communicates with key community partners about assets & needs. Codes for â€Å"99214† for 60 minute visit with established patient and document extent and complexity of the visit What additional information will we need to take action? – Extract from list of CYSHCN youth over 14 due for visit; communicate with family and learn community partners – Clarify with senior leaders ability to track reimbursement results for these visits What do we predict will happen? (E. g.May take time to match YSHCN with open slots; will need to follow up with payers for denials and use documentation to justify activities). How will you know your change is an improvement? Review with family staff; community partners. Select other ongoing measures (p14) DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 22 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Obj ective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen?How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 23 CMHI Plan-Do-Study-Act Worksheet PDSA Example #5 Community Outreach / Resources Team: Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) Plan for care continuity across the: medical home, school, and community agencies with 4 families and children/youth over the next four weeks.Use a selected communication strategy (fax back, email, NCR paper, electronic forum, other) to centralize key information with strengths, goals, care plans, access information, an d releases fostering cross organizational communication; the CC performs as a â€Å"hub of the wheel function† in these activities. What additional information will you need to take action? Identification of children/youth and families in need of transition and/or community-based coordination; identification of key community partners; consensus on communication strategy What do you predict will happen? Territorial barriers will crop up and family will need to be front and central to the process.How will you know your change is an improvement? Review with family and agencies whether there has been improved care communication, also consider other systematized outcome measures (see page 14). DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of c hange: 24 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action?What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 25 Appendices A. Key Websites for Care Coordination Tools 1) Center for Medical Home Improvement (CMHI): www. medicalhomeimprovement. org 2) National Center for Medical Home Initiatives (AAP) www. medicalhomeinfo. org 3) Utah Medical Home Portal www. medhomeportal. orgReferences 1) McAllister, J. W. , Cooley, W. C, Presler, E. Practice-Based Care Coordination: A Medical Home Essential. Pediatrics, Volume 120, Number 3, S eptember 2007, e1e11. 2) American Academy of Pediatrics, Medical Home Initiatives for Children with Special Health Care Needs Project Advisory Committee. The medical home. Pediatrics, 2002; 110:184-186. 3) American Academy of Pediatrics, Committee on Children with Disabilities. Care Coordination: Integrating Health and Related Systems of Care for Children with Special Health Care Needs, Pediatrics, 1999, Vol. 104:978-981. 4) American Academy of Pediatrics, Division of Health Policy Research.Periodic Survey of Fellows #44. Health Services for Children with and without Special Needs: The Medical Home Concept Executive Summary. Elk Grove Village, Illinois: American Academy of Pediatrics; 2000. Available at: www. aap. org/research/ps44aexs. htm. Accessed April, 2005. 5) Antonelli, R. , Antonelli, D. , Providing a Medical Home: The Cost of Care Coordination: Services in a Community-Based, General Pediatric Practice. Pediatrics (Supplement) 2004; Vol. 113: 1522-1528 6) Cooley, W. C. and M cAllister, J. W. Building Medical Homes: Improvement Strategies in Primary Care for Children with Special Health Care Needs. Pediatrics (Supplement) 2004; 113: 1499-1506. ) Davis, K. , Transformation Change: A Ten Point Strategy to Achieve Better Health Care for All. The Commonwealth Fund. Accessed at www. cmwf. org April 13, 2005. 8) Family Voices. What Do Families Say About Health Care for Children with Special Health Care Needs in California: Your Voice Counts. Boston, MA: Family Voices at the Federation for Children with Special Health Care Needs; 2000. 9) Future of Children, Health Insurance for Children; Care of children with Special Health Care Needs. Key Indicators of Program Quality. Available at www. futureofchildren. org/information2827/Accessed April 13, 2005. 10) Horst, , Werner, R. , & Werner, C. 2000) Case management for children and families Journal of Child and Family Nursing, 3, 5-14. 11) Langley, G. J. , et al. The Improvement Guide: A Practical Approach to Enhanc ing Organizational Performance. Jossey-Bass, San Francisco, 1996. 12) Lindeke, L. L. , Leonard, B. J. , Presler, B, Garwick, A, Family-centered Care Coordination for Children with Special Health Care Needs across Settings. Journal of Pediatric Health Care, Vol. 16, No. 6, November/December, 2002, 290-297 ** 13) Presler, B. (1998, March/April) Care Coordination for Children with Special Health Care Needs. Orthopedic Nursing, (Supplement), 45-51. 26 CMHI Center for Medical Home Improvement (CMHI) Crotched Mountain Foundation Greenfield, New Hampshire 2007 27

Psychosocial Stage Essay

Psychological development is generally accepted as product of the interaction among social and psychological forces which directly affect and shape the personality of every individual (Erikson, 2000). This may also encompass changes in self-control, and prosocial behavior. In relation to this, Erik Erikson established a unifying theory on the social and psychological aspects of human development throughout life span. In his eight developmental stages, each individual should, from infancy to senescence, accomplish psychological tasks in line with his or her social experiences. In addition, his theory, often called as â€Å"the stages of man,† is primarily grounded on the notion that every individual develops self-images through others’ perceptions and his or her own perceptions (Erikson, 2000). Erikson described the development of personality and the process by which an individual acquires societal role and shapes his or her identity. In contrary to Freud’s psychosexual emphasis, Erickson accentuated the development of one’s attitudes, skills, and the sense of responsibility. Further, Erikson argued that individuals undergo the different developmental stages, each with crisis or dilemma, and expected to resolve specific conflict in every stage. Unresolved conflicts in the previous stage will pass on the succeeding stages which impart negative traits in one’s personality (Erikson, 2000). On the other hand, as an individual successfully confronted every developmental crisis, he or she achieves positive traits or psychological attributes. Generativity versus Stagnation Erikson viewed â€Å"development† as a continuous process of facing the complexities of life (Santrock, 2002). A young professional, for example, to ensure success and intimate relations, he or she must perceive and accomplish the task of creating and caring his or her life role or style. Erickson’s 7th stage of psychosocial development, generativity versus stagnation, coincides with the middle adulthood period of humans. As defined by Erikson, generativity is the desire to take an active role in establishing the society and nurturing the youth to ensure the continuity of human generation (Lerner, 2002). In this stage, individuals should develop concern for the next generation in order to prevent personal stagnation (Santrock, 2002). While some individuals accomplish this through active community involvement and participation, some contribute for the welfare of the society through responsible parenthood. In any means, the dynamic that must be attained is the outward shifting from the well-being of one’s self to the consideration and care for the humanity. As such, the strength of care is achieved through creating, parenting, volunteering, and mentoring. For instance, by means of genuine care and concern, the generative religious teachers indoctrinate traditional religious view on development. Generative adults, on the other hand, may take responsibility on the cycle of life by leading and guiding their children in the first five stages of psychosocial development (Santrock, 2002). Meanwhile, a key element of â€Å"generativity versus stagnation† is the continuity of stages and cumulative implications of various experiences in life (Santrock, 2002). The adults’ sense of generativity is stimulated by encouraging and supporting the future of the next generation. However, individuals who fail to bestow the continuity to the next generation may possibly become engorge with his or her personal needs, disregard the needs of other individuals, and eventually become stagnated. Influences on my Personality The psychosocial development constructs of Erickson encompasses every experience of an individual that processes and shapes his or her personality, generativity, and perceptions. These processes are deemed universal; that is, although individuals experience family, social, and cultural life differently, the variations are minor. The minor variations account for other individual variables such as socioeconomic status, age, race, gender, ethnicity, religion, education, and culture (Lerner, 2002). Hence, the psychosocial processes in the middle adulthood show variations on themes but of similar dynamic of change. Erikson outlined these changes in every developmental stage through specific conflicts or tasks that one needs to attend to or resolve. As such in middle adulthood, generativity versus stagnation is the conflict that needs to be resolved. However, as the resolution of conflicts in the early adulthood influences this stage, the outcome in this stage will directly affect the late adulthood period (Lerner, 2002). As well, as individuals are expected to provide inspiration, care, and guidance for the youth, they are also challenged to acquire productive roles for the societal development and continuity. Generativity then should not only be confined in parenting but should stretch out to community involvements through projects, leadership, and commitment. It must be deemed with respect to the manner by which an individual handle his or her relations with his or her family, societal institutions, friends, relatives, and with other individuals. Whereas every social behavior is determined by myriad of factors, the commitment and concern for the welfare of the next generation must be the primary motivation in all those aforementioned social responsibilities and activities (Lerner, 2002). As I learned the middle adulthood psychosocial stage of Erikson, about 35-40 years of ages, I examined the present state of my personality in terms of generativity and stagnation. That is, I assessed my self if I am productive in my field of endeavor and geared towards inspiring and guiding my children and other youngsters and young adults. I became concern with the achievement of generativity for Erikson argued that it is crucial for a positive outlook during midlife. As such, I formulated my developmental goals of preparing my self for my senescence period and caring for and guiding the youngsters for adulthood. However, life experiences in this stage of life are not identical among individuals; some are still single adult while others are happily married or divorced during this period. Generally, the middle adulthood has developmental discontinuity and continuity. In particular, psychological attributes like cognitive functioning may rapidly change while the others such as intelligence and personality may attain stability during midlife (Lachman, 2001). I realized then that in defining life’s success, experiences in midlife have significant roles. During middle adulthood, every individual compensates for and copes with life’s losses which tend to be apparent as senescence life approaches. As revealed by psychological researches, life satisfaction is at its peak in midlife; this is the period of life where subjective happiness and well-being are rated best as compared to other stages of life (Lachman, 2001). Thus, midlife is known as the prime of one’s life, where most middle adults are at the summit of their family and professional careers, and income generation. In addition, middle adults experience a very satisfactory psychological well-being; they have positive outlook in life, autonomy, and aim for both personal and professional growth (Lachman, 2001). They perceived midlife as the period where one should function best. Thus, my consciousness on my work performance, multiple-role playing, and parenting styles were awakened. Nevertheless, at the other extreme of middle adulthood are the midlife crises. Based on psychological reports, middle adulthood is battered by worries in life such as the feelings of individuals of life losses and failures, non-achievement and underachievement, and trivial and non-essential goals (Lachman, 2001). Yet, amidst these crises and as compared to other stages of life, middle adulthood is the period of less depression and higher well-being. In this period, most individuals attained their professional and personal goals. Those who are susceptible to environmental factors, limited resources, and poverty, are at risk to psychological and physical distress (Lachman, 2001). It was then clarified in my mind that during midlife, individuals may either enjoy the fruition of their respective labors or suffer the cumulative deficits of their life due to unresolved conflicts in previous stages. Therefore, middle adulthood, as generativity versus stagnation implies, is not only a period of fulfillment and accomplishment but also a transition period for the past and present events of life basically influence the later life’s transition. Midlife is the stage of life when individuals, more frequently, have already decided for a lifestyle and other social context like vocation, routine, neighborhood, and support network. Thus, I postulated that personality molds the life of an individual, rather than life experiences shapes the personality of an individual. In particular, only specific aspect of personality is altered by dramatic life events during middle adulthood. For example, career or marriage failure, affliction due to mental or physical disorder, and death of a loved one may alter the behavioral trait of an individual which in turn only causes minor shifts in personality but do not reflect in the holistic personality structure. Moreover, the concept of midlife crisis, perceived as inevitable in middle adulthood, was found to be false (Lerner, 2002). Even though midlife is a stage of reflection, increased anxiety, midcourse correction, and unpredictable transformation, researches revealed that during middle adulthood, individuals still undertake the shifting of life perspective from birth until to their last years to live (Lerner, 2002). The nature of an individual’s response to midlife challenges is largely affected by personality attributes and less by the individual’s present developmental stage or chronological age. As proposed, the enduring nature of midlife crisis is possibly related to the capability of an individual to cope with the tragic life events and in the end still considers his or her self as fairly fortunate. In sum, Erikson suggested the importance of finding oneself in another during midlife developmental stage. By merely serving oneself or own family, an individual becomes engorge with his or her personal needs, disregard the needs of other individuals, and eventually ends as stagnated. Hence, I must not confine my self in looking at and working only for the welfare of my family. Bringing up my children into the best that they can be is inadequate contribution for the welfare of the society. I need to acquire the sense of altruism in order to contribute whatever resources I have, actively involve myself to community projects, and to extend whatever support I can give for the welfare of the next generation. In addition, since midlife crisis is inevitable in middle adulthood, I realized that in order to face every travail, empathy and support to others are crucial so as to establish a network support where I can lean on as I resolve any form of midlife crisis. References Erikson, E. H. (2000). The Erik Erikson Reader. Coles, R. Ed. New York: Norton. Santrock, J. W. (2002). Life-span development. New York: McGraw-Hill. Lachman, M. E. (2001). Handbook of Midlife Development. New York: John Wiley. Lerner, R. M. (2002). Concepts and Theories of Human Development, 3rd ed. Mahwah, NJ: Erlbaum.

Automated Daily Time Record

In compliance with the Civil Service Commission’s (CSC) rules on personnel management, each agency shall require a daily record of attendance of officers and employees including those serving in the field or on the water; to be kept on the proper form, and whenever possible, registered on the bundy clock (KMD,Solution Fit for e-DTR. 2008. Online November 24, 2013. http://ilocos. net. ph/DTRMANUAL/eDTR%20MANUAL%20basic. pdf). It is important to remember that the time record is a legal document that provides the basis for payment of salary and accrual of leave credits.The time record must contain a certification statement attesting to the accuracy of the record, which must be signed by the employee. The time record must also be certified by the supervisor. The record of attendance must show actual hours worked.This includes all hours worked beyond the basic workweek for both overtime eligible and overtime ineligible employees. Since supervisors are required to certify the actual hours worked by both overtime eligible and overtime ineligible employees, supervisors must monitor the actual hours worked by these employees.Supervisors should ensure that procedures and expectations with respect to additional hours of work have been clearly communicated to employees (John Currier. 2000. Online. 2013 from http://www. brockport. edu/~shra/pef_attend. htm. ).Automated Employee Attendance Daily time record system is a computerized medium of gathering data, this is the time taken to achieve a given daily objective or task. The time will vary with a given task and can range from house related tasks to work related task.It is the method of logging and organizing time information. (http://www. technologyevaluation. com/search/for/data-flow-diagram-of-daily-time-record-system. html). It can be used for work projects, bus schedules, and airplane schedules or at school schedules.Computerized Daily Time Record completely replaces manual time card machines or your hand writte n time and attendance records. It is a computer based time clock and time keeping solutions that record and monitor employees’ log-in/log-out times by means of computer system.According to www. system. webcrawler. com there are several positive factors that DTRS can give, it will give an accurate time control management to the employee, and it can give accurate time computation, decreases the paper works and other equipment expenses.AEADTR plays major rule in the payroll system, thus, it gives computerized and ready to use data instantly. DTRS can make payroll processing easy and it may lead to accurate recording of payroll information.This Automated Employee Attendance Daily Time Record focuses on the need to design a system that will automatically arrange the record and calculate the average attendance of each employee. A well-conceived and implemented automated employee record system can reduce the costs of handling the paperwork associated with record keeping.Manual atten dance record system is not efficient and requires time to arrange record and to calculate the average attendance of each individual employee. Automated employee Attendance Daily Time Record is intended to replace the manual model of attendance record keeping.Merry Child School is using ball pen or log book to record its attendance this system need a computer and the employee will record his/her attendance with a password and the system will arrange the record and calculate the average attendance of the employee.By the programmed database, it will provide job details to the human resources department as the salary period comes. With this programmed database, the accumulation of employee information will be possible and at the same time helps managers to employ simple approach to inspect the employee information for verification of truth.This programmed database will allow the supervisor to establish timetable for each employee including recess times, holidays and whether overtime is needed. Daily Time Software is used by many organizations to assist hold course of employee hours for payroll purposes.Daily Time Software tracks employee time information in a database that helps managers to have simple entry to employee data and to analyze the data for accuracy. The Daily Time Clock packages provide scheduled administration. Daily Time Software innovative structure features fundamental coverage and connections to payroll systems.At the conclusion of the salary time, each employee's hours are automatically reported to the human resources department, reducing paperwork and eliminating errors. Arrival and exit times using a computer time clock. To log in/log away, employees take unusual identifiers, such as cards with magnetic stripe or barcodes, biometric input devices that stop fingerprints or handprints, and iris scanners that are not widely distributed because of privacy concerns. Daily Time Software completely replaces manual time card machines or your hand writ ten time and attendance records.Daily Time Software eliminates the need for you to spend more hours each week compiling your manual Bundy systems into a report to supply to your payroll department. Daily Time Software saves hours of generating automated payroll reports for your employees by simply, printing out the reports and write the checks.Daily Time Software supports weekly. You can put together a real workforce solution through Daily Time Software ( beverly82, august 2011. Online. http://www. studymode. com/essays/Automated-Daily-Time-System-Literature-756653.html. ) It records and provides real time and updated Merry Child School employee time-ins and outs, pass slips (personal or official), leave credits, overtimes and even deviances. The office policies (internal and external) were used as the basis of the automated computations and as the guideline for the implementation of the system. This system attempts to lessen the time spent of the Personnel Unit in manually computin g the leave credits and overtimes; thus making the maintenance of the records of the staffs of MCS easier.It also records the number of hours spent by an employee whenever he/she gets out of the office by virtue of the pass slip or request for a vehicle. Employee’s violations such as tardiness and under-times are likewise recorded. With the automation of the processes, the Personnel Unit are has more time to work on their other deliverables, thus improve their productivity.The proposed system contains attendance record in electronic files containing details of absence or presence of a specific employee registration during a semester. Attendance records have been collected on paper forms and verified with hand written signatures.However, the increasing demand for automated employee attendance daily time record should be implemented as soon as possible in order to reduce the costs of handling the paper works with record keeping. (2013, 11. Daily Time Record. StudyMode. com. Ret rieved 11, 2013, from http://www. studymode. com/essays/Daily-Time-Record-1831449. html .This proposed system described in this document should be implemented also in different school and all automated systems must follow the standard procedures. This study will try to organize the current school attendance record system that will be much quicker and will save time.Statement of the ProblemThe proposed â€Å"Automated Employee Attendance daily time record† to the Merry Child School seeks to develop their current system and provides answers to the following problems specifically on payroll processing such as the security issues, inaccurate calculation of working time, total late, total absences, and under time.Manual process can lead to poor service and delayed payroll creation. Damage or loss of the manual process may lead to inaccurate file restoration and it’ll affect the momentum of payroll creation and both the employer and the employee will suffer.ObjectivesThe sol e purpose of this study is to provide quality and genuine service involving the employee’s personal information to create a system that is called the Automated Employee Attendance Daily Time record. It may solve related issues according to the data gathered from the school.This system is designed to create an automated DTR or so called the AEADTR system that will ensure the employee to receive a total security of its data, proper monitoring of reports in each employee, and for rating and prompting the employee for their overall remarks according to their record.It also provides a user friendly environment that would ensure both quality and easy manipulation. This system is developed to provide accurate and safe computation of data being gathered through each employee of Merry Child School, to provide proper time management to the administration, to lessen the expenses of the institution and to properly monitor the attendance of the employees. This is to evaluate if the system has provided the administrator the needs and fill up the missing piece of their business.Scope and LimitationsThe scope of the study focuses on attendance processing that will provide management of the daily time record, computation of total duty hour, absences, overtime and late. The output data of this system will be used as reference in creating a payroll. In addition, the system will provide total security of data, monitoring of the employees reports, and evaluating each employee based on the data shown in their records. For the security, the system is equipped with unique barcode scanning that will scan each identification card of the employee containing the barcode and safely store it to the database that can be used for future references.For monitoring, the system will automatically generate a prompt to the employee if the employee has a good attendance standing. This will allow the admin to instantly monitor each one of the institutions constituents.Significance of the stud yThis system could contribute to the better and brighter way of processing the Daily time record by providing accurate and stable data gathering through its secure and precise processes. Accounting department could benefit this system because of its fast and accurate process and will result to reducing their discomfort of preparing employee salary.Also this system provides reports to each employee that could help the administrator identify which of them acquire excellent or poor status. The administrator can prepare the salary fast with its pay Slip ready through the help of both DTR system and Payroll system working together and this could benefit the employer and the employee. This study will also benefit the next generation of students that will take the degree of any computer studies courses in Capitol University. If approved, then, this will serve as their reference for future research.

Economy Essay Example | Topics and Well Written Essays - 750 words - 1

Economy - Essay Example At the same time the sociological factors for divorce, single parents and even lesbian and gay marriages has entered into the equation, further increasing choices and complicating matters. When the marriage roles were highly specialized, it gave more power to both man and wife. However the dilution of these roles was necessitated by changing economic circumstances and uncertainty, which led to the evolution of dual income families and its negative impact on family life. Opportunities for women had expanded by the end of the war since some of them had trained to take over male dominated jobs in factories, shops and other establishments. Social acceptance of cohabitation, sex outside marriage and divorce had impacted upon the role of the family. From a high point in the 1960s, marriage had plummeted to lower rates in the 1970s but steadied somewhat since the 1980s (Blau, Ferber & Winkler, 277). Today people prefer to cohabit with or without marriage or children. Recent trends indicate that the median age of marriage has also gone up since people defer getting married till they are well settled individually. There is a marked decline in the space between first and second marriages for the lower segments of the population. While black women are lifting themselves up through education, black males are still falling victim to crime, criminal activities and blame them perhaps erroneously on lack of opportunities for blacks. When it comes to divorce, the specialization of labour roles and opportunities for increasing incomes to become self-supporting has been seen as a reason to walk out of an unhappy marriage. Lack of support in the home and sudden loss of jobs impacting incomes have also been factors for increasing rates of divorce. The trend is that divorce has shown an increasing trend from the 1960s to the 1980s, then steadied somewhat and has declined to 3.6 per 1000 couples in 2006 (Blau et al, 280). As regards cohabitation, while this was taboo and frowned upon in the 1960s, it has become commonly accepted today. Research suggests that it is a prelude to marriage in the USA, with as much as 50 percent of cohabiting couples deciding to get married eventually. Recent trends suggest that young couples today are more inclined to experiment with cohabitation for the short or long term as a prelude to marriage. As regards the comparatively recent trend of same sex marriages and cohabitation, this relationship is not without its problems, as the separation of gender roles is less pronounced and one person may be not willing to step into a defined role for the long term for the mutual benefit of both. When it comes to the question of fertility, the important factor is not only biological, as it does impact on cost of raising a family, juggling responsibilities, career sacrifices, work life balance and quality of children raised. The legalization of abortion, social acceptance of cohabitation with or without children and even rules for child suppo rt has affected the decision to have children. Dual income families have a number of advantages over single parent families, including the full development of the children resulting from the relationship. In Chapter 11 of the book, the authors discuss policies affecting paid employment and the family. The discussion starts off with the former US Welfare program entitled AFDC or Aid to Families of Dependent Children began in the 1960s. Originally started with a view to support widows, the

Harley Davidson Motor Company Case Study Example | Topics and Well Written Essays - 1250 words

Harley Davidson Motor Company - Case Study Example And as changes go there are always internal considerations when trying to improve or transform systems into something that better serves its needs and purpose. This is explicitly pointed out in the case presented by Austin et al. (2003) in his paper on Harley Davidson’s Enterprise Software Selection. This paper will look at the In 1996, under Garry Berryman’s supervision, the purchasing organization of the Harley Davidson Motor Company (HDMC) have began development of Supply Management Strategy (SMS), a system which ensures that the company’s productivity increases by having the correct quality supplies on time by treating suppliers as an extension of the company itself. () In this effect, the HDCM, through long and rigorous evaluations of proposals and standoffs with the approving committee, have opted to form a team to select the appropriate software provider to enable SMS within the company. Austin et al. () provided two sets of data in his account of the selection process. One set of data consisted of the self-assessed rating of the functionality of the software of the top 3 providers being taken into consideration for partnership. The other consisted of a qualitative data, factors highlighting the provider’s latent understanding of HDMC’s values and needs, evaluated by the selection team. The self-assessed rating of the providers showed very competitive scores between the three top software providers being taken into consideration. Based on their ratings, Provider 2 had the greatest potential for selection as a partner by Harley Davidson. Provider 2 has about 98.69%, Provider 3 with 96.83% while Provider 1 falls short with only 93.44% rating. Simply looking into this data one would be inclined to the idea of selecting Provider 2 because of its high self-assessed rating. However, this presents a highly complicated dilemma concerning the viability information gathered. Although it may seem that all three providers are competent and capable to impart above 90% functionality of their respective software, it should be noted that the data provided in this ratings were self-assessed.

Works of art by two differant artists i saw at the Getty Museum Assignment

Works of art by two differant artists i saw at the Getty Museum - Assignment Example The first art work is the â€Å"Vincent Van Gogh’s Irises.† This is a painting that was done by one Vincent who did it at a time when he lived at the asylum in Saint Poul – de- Mausole , which is in France. The lack of tension and the relaxed brushstrokes in Vincent’s paintings during the time exemplified the paintings of Van Gogh, which resulted to his mental attack within the asylum. Van Gogh called the painting â€Å"the lightning conductor of my illness† due to the fact that he did consider it a therapy of his depression and insernity feelings (Manesh). The Irises work was done in the painter firs week in assylun. It was hihly probably that the work was influenced by the Japanese wood block prints which got to be produced within the 17th century. The Japanese works influenced most artists as at that period. It helped in reinforcing printing expressive power The next art work in comparison with this is the Irii Matamoe or rather the royal end,which is an unearthing painting that is of a decapitated human head displayed lavishly on some canvas cushion by one Poul Gauguin, a post impressionist painter. The painter had witnessed an execution in public by Guillotine in Polynesia years earlier. His experiences during his own travels resulted to his strong opposition to European colonization as well as the imperialistic viewpoint. The theme of death is what he seemed to be obsessed with and did feature in most of his paintings. The Irii Matomoe unlike the Irises was done in the 1890s. Events that had taken place influenced the dark subject matter of the art work. The painter did hard the Tahitian language words â€Å"Arii† and â€Å"Matomoe† on the upper left of the canvas. The Arii means noble while Matomoe means sleeping eyes. This phrase does imply death. Symbolist artist like Gauguin did have a predilection of images of decapitated heads as well as

Analysis of the book hunger of memory Essay Example | Topics and Well Written Essays - 1000 words

Analysis of the book hunger of memory - Essay Example And in the case of Mexican-American author Richard Rodriguez this concepts appears apt because his autobiography titled, Hunger of Memory highlights the problems he faced from his childhood to adulthood. So, this paper will discuss how the book’s style, language, tone and the way it was written was influenced by the separation Rodriguez faced in his childhood and youth. Rodriguez, son of Mexican immigrants, was born in San Francisco but spoke only Spanish as his language of communication in his childhood. So, when he joined the Catholic school in Sacramento, California, at the age of 6, he had speaking vocabulary of just 50 English words. Because of this limited knowledge of English, he became a confused and reticent boy with low confidence level. So, his autobiography, Hunger of Memory details those tough times in his school and the resultant separation, in a pathetic as well as sympathetic style, language and tone. Throughout the book and specifically in the chapters, Aria, Achievement of Desire, Credo and Complexion, Rodriguez’s insecurities in English, the resultant isolation or separation and the role played by his family and Catholic Church, have lead to a self-absorbed style with a lot of strain flowing. This style brings up a lot of feelings and emotions that got built up in Rodriguez’s mind, in that phase of his life. Due to the separation he firstly suffered in his class, his emotion bordered on the feeling of loss and that got incorporated into the work. Also, this being the bad phase of his life, he distances from it and so uses the style of aloofness in these chapters. Since, Richard is also a victim of cultural clashes; he brings these elements in these parts of the work. That is, while describing how Hispanic background created the obstacles for him and prevented him from socializing with the fellow students, he uses

The Role That Customer - Brand Identification Plays In Brand Loyalty Literature review

The Role That Customer - Brand Identification Plays In Brand Loyalty and Brand Promotion - Literature review Example A brand is principally responsible for establishing a strong relationship with the customers. Therefore brands hold the accountability to build a healthy and strong relationship with the customers of the company. In that process customer brand identification plays a major role. Brand identification is defined as the process of developing a brand that offers positive consumer benefits and in turn results in repeat purchase. Also in the process of customer brand identification, identity of a brand acts as a significant factor. Identity of a brand provides the direction, meaning and purpose of the brand. Brand identity is thus considered as the central unit towards the development of a strategic vision. Brands generally have 3 aspects namely brand image, brand identity and brand position. Brand image portrays about how the brand is being perceived by the customers, brand identity is about how the strategist desires the brand to be perceived by the target audience. Brand positioning is also a part of brand identity; it is about the way by which the intended audience can be effectively targeted. However modern studies highlights that branding has 5 aspects that are, design, positioning, customer relationship, storytelling and price (Healey, 2008, p.8). Thus in order to sustain with a brand in the market and continuously communicating the messages to the target customers, Relationship Marketing is a key process. The next half of the project will offer insights about relationship marketing. The area of relationship marketing has been an area of focus for the last few years. Relationship marketing mainly puts emphasis on the retention of customers rather than acquiring new customers. It heavily stresses on the process of customer satisfaction and gives less importance to sales transactions. Relationship

Political science Essay Example | Topics and Well Written Essays - 1500 words

Political science - Essay Example al political systems, supranationalism, peace studies, conflict analysis, strategic studies, public administration, political psychology, socialization studies, legislative processes, public law, and more. The issue of how globalization is impacting citizenship is one of great significance within the field of political science, and it is as well one which is highly relevant to the world today. In order to be able to understand about globalization and how it is affecting citizenship today, not only must each separate issue be discussed, but as well any and all other key issues must be addressed and thoroughly examined. By doing this, we will be able to gain a more informed and knowledgeable understanding on the subject matter at hand, and as well we will be able to attain the information which will answer the question of how globalization is affecting citizenship. This is what will be dissertated in the following. Globalization is a term which refers to a process that involves the increasing of global connectivity and the integration between organizations, and it is really an umbrella term which covers a variety of different ideals. Recent emerging literature and studies on the quality of democracy have suggested the fact that economic globalization greatly affects the quality of citizenship, and there are three particular of facets of globalization which must then be discussed here, as well as two facets of social citizenship. The three globalization facets are trade level, trade liberalization and debt ratio; the three social citizenship facets are social spending and employment quality. The problems that are considered to exist between globalization and citizenship are not considered as being new, as in fact there have been many steps that have been taken in the past, particularly over more recent years, in order to try and create solutions for these specific problems. For instance, in December, 1996, UNRISD (United Nations Research Institute for Social

Distance Learning - Possibility and Challenge Essay

Distance Learning - Possibility and Challenge - Essay Example In distance learning, dissemination of learning materials occurs through audio and video streaming. Experts have established that distance depicts the impact of technology in the education system. Just as there are virtual societies formedan online technology has enabled the formation of virtual institutions where students in different parts of the globe can receive real time instruction through compressed video. This mode learning has become very common in different institutions including Simon Fraser University. This paper will address the possibilities and challenges of distance learning. Possibilities Distance learning has emerged as one of the latest mode of learning that presents multiple possibilities. One of the possibilities is that technology can form the link between the students and the instructor, without the students having to attend classes within the institution. Students can have an opportunity to study within the comfort of their homes. The logistics of having to mo ve to school can prove to be a real struggle for the students (Rogers, 2009). However, distance learning saves the students the struggle of attending a specified venue at a specific time. Technology enables the students to access reading material in a virtual classroom environment. Without the necessity of attending classes, distance presents students with a high level of flexibility. Convenience is one of the outstanding aspects of this mode of learning. Learners who rely on this mode of learning have the assurance that they can engage in all the learning activities defined for a certain course in an institution in a different part of the globe. Institutionsenrol students from all the regions of the globe, granting the opportunity to access higher education, but saving the funds required for relocation go a foreign country. Foreign students face multiple challenges as they strive to adopt new learning environments (Rogers, 2009). Students usually need to adapt to a diverse learning environment, but distance learners save themselves from such a hassle. It is possible for students to obtain certifications from the institutions of their choice regardless of the location. Moreover, adopting distance learning helps a learner undergo a transformation to an autonomous learner. Contrary to the class setting, where the instructor offers motivation and reproaches to students depending on their progress, the distance learner is all by himself and knows the instructor in a virtual sense (Rogers, 2009). Whereas other learners engage in active interaction with fellow students and the instructor, getting re-energized and motivated to maximize the learning process, the distance learner needs to have a personal learning initiative and drive. The learner should exhibit a high level of autonomy and individuality, striving to remain focused on maximizing the virtual learning experience (Lau, 2003). Self –discipline and effective time management skills are of critical impo rtance in developing autonomy. However, this attribute transforms the learner to people exhibiting interest in the learning process. Autonomous students are likely to learn more. The individual realization that an individual has course activities to complete enhances autonomy. In comparison to the full time courses offered by institutions, online courses are much cheaper, because most of the learning expenses catered for in the cumulative school fees do not apply in distance learning. Since

Technology in the Classroom Essay Example for Free

Technology in the Classroom Essay There is no doubt technology had transformed teaching and the way students learn; however, in the world of education, there are those who believe technology is a vital asset in the classroom and there are those who completely oppose it. Either way, technology has become the leading force in society today; no one can escape it. It is important for educators to find the most effective ways of using technology in the classroom without relying solely on it. The keys to effective use of technology are remaining involved in the learning process of the student while using technology, keep teachers trained on new technology available, and never overusing it. Using technology effectively in the classroom will help develop a student who is ready and able to face the post graduation world successfully. In Becoming a Teacher, Parkay and Stanford, claim 46 percent of teachers use computers in the classroom on a weekly basis. These statistics are from the seventh edition, so it is safe to say those numbers have clearly risen and now have quite an impact in the classroom. With increasing use of technology, teachers need to make sure they are committed to the inclusion of technology in their lesson plan by developing new assessment techniques to evaluate students’ work. For instance, a teacher cannot simply grade a student on correct answers because he or she could have simply looked them up via the internet; the teacher must evaluate what the student is learning based on evidence of critical thinking and real-world problem solving. Plagiarism may become an issue with the use of technology, so it is important for educators to explain the importance of students’ writing their own material and citing sources they may have used. Parkay and Stanford also claim that, although school districts are developing new approaches to providing teachers with support for integrating technology, they are not spending an adequate amount of money on the training. With the abundance of technology available to teachers, it is important for them to receive sufficient and ongoing training. Teachers are doing everything from emailing parents to designing complete lessons that require student so use the Internet as a resource and part of their participation; these educators need to remain proficient in the ways they choose to use technology. Also, some claims are being made that students are becoming more â€Å"tech savvy† than the educators and this puts the teachers at a disadvantage when assessing the students learning. Teachers are beginning to rely on the students for help in the classroom and this sets an uneven tone in the classroom; teachers will lose their credibility. Once educators begin to realize how powerful a tool the computer can be to learning, they must resist the urge to rely solely on it. It must remain clear that the computer and the Internet is just another form of literacy available to them while teaching. A lesson plan should include reading, writing, listening, speaking, and the use of technology for visual and audio stimulation. Although technology provides students with the ability to learn in a nonlinear fashion, they still need other learning tools that will provide a basis for effective overall learning. Teachers need to remain in control of the classroom lesson and not leave the students to fend for themselves while using technology. Some critics believe teachers are, in fact, overusing technology. They claim computers will not improve education, and therefore, are not needed in the classroom. Some claim older effective teaching methods will be thrown out and overlooked because of the convenience of technology. There are many difficult questions surrounding if technology should remain at the center of learning, or if teachers should consider using them as only sources of entertainment. I believe, technology provides students with effective ways of learning that keep them on-track with the increasing technological world we live in and if teachers utilize it correctly, it will prove to be an effective strategy for teaching.

Language & Literacy for Young Children Essay Example for Free

Language Literacy for Young Children Essay This paper will discuss developmentally appropriate methodologies in teaching language and literacy to young children across a developmental curriculum. Also to be discussed will be the aspects/knowledge’s of language, language diversity and Theoretical Perspectives. In the Beginning There is now evidence that it is never too early to teach a child. Through research it has been discovered that the infant even before he/she is born can hear sound and as we know that is how we acquire language, by hearing spoken words. According to Otto (2010), language development begins when language speakers assume that an infant is a participating partner in conversational settings, even though it is months before the child is able to begin using conventional words. In an article written by Dr. Carmelita Lomeo-Smrtic,Ph. D, she wrote that â€Å"Teaching children to become literate members of society is a daunting task, often relegated to the elementary teacher. However, research on teaching children to become literate suggests that this process must begin well before kindergarten. Research suggests that children are primed for learning language in utero. Also from the Otto text, â€Å"research on children’s perception of speech and the development of the auditory system in utero has determined that the fetus can perceive sounds beginning with the 25th week of gestation and at the 35th week a fetus’s hearing acuity is at a level similar to an adult’s(2010). Knowing all of this has prompted mother’s and some father’s to read to their unborn infant and even â€Å"talk† to him/her. Documented research suggests that infants can distinguish their mother’s voice from the voice of others-including other female voices a first few days after birth (Otto,2010). Aspects of Language It has been established that children begin learning at a very early age, even though they do not begin speaking words for many months. Now we will move on to speak about how they learn. There are five aspects or knowledge’s of language. -Phonetic, Semantic, Syntactic, Morphemic, and Pragmatic.

Alternate Forms of Stable Government: Contractual Society

Alternate Forms of Stable Government: Contractual Society Clayton Wheatley A Stable Form of Alternate Government Should another entity choose what is better for another man? Our Current political system seems to think so. Imagine a way of living in which one controls the economy with supply and demand being the base for essentially every aspect in one’s life. This is what a contractual society is, a society based purely on voluntary action, entirely unhampered by violence or threats of violence. Using this idea of a Contractual society, certain aspects of the current political system will be retained, but allow increased individual sovereignty and promote a market free of regulation. Anarcho-capitalists agree that the most profitable society would be one based on the voluntary trade of private property and services as well as respecting the necessity of charity and communal arrangements. What must remain un-interrupted in this ideology is that whatever is acquired is done so without help or hindrance from an external source. Monopolies tend to be corrupt and inefficient, so in this new society the policy on them will remain the same, but will only stay this way if it is the agreement of the people, who as a whole vote with the payment given to a particular corporation or corporations. If the people continue to pay into this monopolistic being it will continue to survive and remain the majority, but this must mean it is in the best interest for the people because they are not influenced to provide payment. Close to anarcho-capitalism are the ideals of individual-ownership and original appropriation. These include but are not limited to being the proper owner of on e’s physical body and allowed to make decisions based on what they see best for their own personal property. This ownership of â€Å"originally appropriated† implies the right to use and manipulate places and goods owned by an individual anyway that seems fit provided that the physical integrity of places and goods claimed by another individual remain unaltered by you, the external source. Once any amount of time or work is invested into a plot of land or on a specific object, it can only be exchanged by a mutual agreement. What makes this form of government stand out is it does not reject the idea of individual or joint ownership; in fact it is actually encouraged. What one needs or does not need is entirely up to the person. Though anarcho-capitalists assert the right to hold and maintain private property, some point out that communal property can exist. Just as property becomes owned by mixing labor with it or making use of the area on a more permanent basis, a whole community can come to own something in common by doing just that, meaning that no individual may appropriate it as his own. Situations in which this could arise are for things like roads, parks, rivers, and portions of oceans. If allowing everyone to take a small role in helping maintain the area and it’s a resource mutually beneficial to the group that is what it becomes a group effort. Nevertheless, when property is owned by multiple persons, the level of accountability each individual holds tends to deteriorate unlike in personal ownership, where the maintenance is only up to the one, original owner. Privatization, decentralization, and individualization are often anarcho-capitalist goals, but in a few select cases they not only a re considered difficult to uphold, but are impossible. Ocean routes for example are a certain property that would be seen as unavailable for private ownership. Individual sovereignty is the idea of property in ones own person, shown as the natural right of a person to have basic freedoms, and have the final say in ones own body and life. According to G. Cohen, the concept of self-ownership is that â€Å"Each person enjoys, over himself and his powers, full and exclusive rights of control and use, and therefore owes no service or product to anyone else that he has not contracted to supply.† One may describe someone with this type of freedom as those which have supreme authority and sovereignty over their own choices. This is a tenant to classical liberalism and essential to any ideologies which encompass one making decisions for themselves and leading their own lives. This is the root of anarcho-capitalist property rights, and where they differ from other forms of anarchism such as anarcho-communism where the means of production are controlled by the community as a whole and the product produced is placed into a collectivized pool and distributed on a system determined by necessity. This particular anarcho-capitalist society stresses the value of individual integrity and living a life based on your own terms; this includes dealing with one’s own mistakes once they are made and no one else being involved unless they are bound by a contract mutually agreed upon by both original parties. The free market further increases individual freedoms within this society because it allows for a person to decide which services are maintained and provided within his personal way of life. Basically if something like defense is considered too much of a goal one has the power to lower payment on it and in some cases, if necessary, en it entirely. This either lowers how much is available because of the lack in demand, or stops a completely unnecessary service because no one is stimulating its personal economy. Supply and demand will be the basis for what does and does not survive within this society. The old west is actually an accurate portrayal of this idea. United states in the time of 1830 to 1900 was similar to this political idea in that private agencies provided the necessary ground to provide a somewhat orderly society but mainly allowed property to be protected and disagreements able to be resolved. The common that is that the Old West was in a state of chaos with little respect for property rights is false. Since squatters had no right to new lands under federal law, third party organizations formed to take the place of the government regulation. The defense companies each created their own written contract laying out the laws that provided the means for defining and protecting property rights in the land. They enforced procedures for registration of land claims, as well as for protection of those claims against others, and for ruling on internal disputes that arose. A pressing matter within the conversations of possible outcomes which could arise is â€Å"whether anarcho-capitalist society is justified on the morality of an action based on the action’s obedience to a rule of one’s conduct are the ultimate basis for any judgments about the rightness of the conduct, or both.† Natural-law anarcho-capitalism claims that a universal system of rights can be derived from natural law. Some do not like the idea of relying on these natural rights, but instead choose to rely on economic justifications for a free-market capitalist society. Kosanke sees such a debate as irrelevant since, â€Å"in the absence of the state, sovereign individuals will make their own decisions about morality, and will be held accountable via contractual law.† Communities of sovereign persons expel negative influences the same way that unbeneficial business practices are taken out because of the mutual want in the marketplace as a whole. For him, the o nly thing that needs to be debated is the nature of the contractual mechanism that abolished the state or prevents it from coming into existence where new communities form. Crime can encompass many different things. It could be something as simple as jaywalking, or littering. These crimes while not really moral, are not really immoral either they are just unfavorable actions. On the other hand you have much more serious problems facing everyone involved in a society. Things like homicide, kidnapping, robbery, etc are much more severe. These crimes involve a victim; some third party who did not wish to be involved was forced to become a part of this. The victim is not in the wrong for they didn’t wish for these things to be done to them, thus you have a stiff punishment. Now, there is a third type of crime, crimes that don’t involve anyone other than an individual making his own decision, yet the punishment for these result in the same penalty as the more serious crimes mentioned earlier. The type of actions that result in this are called victimless crimes, crimes that involve no one else other than he who had the idea to commit this Ã¢â‚¬Ë œcrime’. Richard Frase defines what victimless crimes are, â€Å"The practical arguments against victimless crimes appear to derive from three attributes of these offenses: (1) most involve no complaining parties other than police officers; (2) many involve the exchange of prohibited goods or services that are strongly desired by the participants; and (3) all seek to prevent individual or social harms that are widely believed to be less serious and/or less likely to occur than the harms involved in crimes with victims.† For example drugs, prostitution, gambling, and even something little like not wearing a seatbelt are all victimless crimes. For drugs you have an individual who takes the steps to purchase this substance. He and the participating party make a mutual agreement for an exchange and who is to say that isn’t allowed? Prostitution, again, both of the parties involved have profited in their eyes. Who is the victim if both parties have profited? In an an archo society victimless crimes wouldn’t exist. If no one is wronged and no one is unwillingly involved there is no problem. A contractual society will provide these certain aspects of the current political system but allow increased individual sovereignty and promote a market free of regulation. The positive use of charity and a distrust of monopolies will remain, while individual sovereignty will be upheld and increased in daily life. This ‘individual sovereignty’ is further increased by the idea of a free market and stimulating what you believe is in you best interests. This means if it is in no one’s market and stimulating what you believe is in your best interests. This means if it is in no one’s benefit it will lose funding and thusly cease to exist upholding the idea of making decisions concerning your life. If these ideas are incorporated into current government policies it would prove better for the people and worse for the overall rule the current administration holds as a whole over us. Works cited Hogeye, Bill T. â€Å"Anarcho-capitalist FAQ.† Anarcho-capitalistFAQ. Bill Hogeye, 6 Dec. 2011. Web. 11 Dec. 2013. http://www.ozarkia.net/bill/anarchism/faq.html>. Taylor, Jared M. â€Å"The Property and Freedom Society.† The Property and Freedom Society RSS. WordPress Admin, Jan.-Feb. 2012. Web. 12 Dev. 2013 http://propertyandfreedom.org/>. Vallentyne, Peter. â€Å"Libertarianism.† Standford University. Standford University, 05 Sept. 2002. Web. 12 Dec. 2013. http://plato.standord.edu/entries/libertarianism/>.