Conceptualizing Mental Health Care Utilization Using The Health Belief Model

The process of change in psychotherapy, regardless of the clinician’s orientation, length of treatment, or outcome measure, begins with this: The client must attend a first session. However, several national surveys in the past decade converge on a rate of approximately one-third of individuals diagnosed with a mental disorder receiving any professional treatment (Alegría, Bijl, Lin, Walters, & Kessler, 2000; Andrews, Issakidis, & Carter, 2001; Wang et al., 2005). A review of the literature surrounding mental health utilization reveals evidence that a complex array of psychological, social, and demographic factors influence a distressed individual’s arrival to a mental health clinic. Thus, developing effective strategies for decreasing barriers to care is a critical task for clinicians and administrators. The

aim of this article was to review current research focused on appropriate utilization of mental health services and to use the Health Belief Model (HBM; Becker, 1974) as a parsimonious model for conceptualizing the current knowledge base, as well as predicting and suggesting future research and implementation strategies in the field.

First, it is important to address whether increasing mental health service use is an appropriate public health goal. A World Health Organization (WHO) survey comparing individuals with severe, moderate, or mild disorder symptoms indicated that approximately half of those surveyed went untreated in the past year (WHO World Mental Health Survey Consortium, 2004), with even less treatment among those with more severe symptoms. Many costs are associated with untreated mental disorders, including overuse of primary care services for a variety of reasons (Katon, 2003; White et al., 2008), lost productivity for businesses and lost wages for employees (Adler et al., 2006), as well as the negative impact of mental disorders on medical disorders, such as diabetes and hypertension (Katon & Ciechanowski, 2002). These com

bined expenses have been calculated to rival some of the most common and costly physical disorders, such as heart disease, hypertension, and diabetes (Druss, Rosenheck, & Sledge, 2000; Katon et al., 2008).

The consequences of providing additional services to address unmet need may vary by the cost-effectiveness of treatment, availability of providers, and the interaction of mental health symptoms with other illnesses. Medical cost offset and cost-effectiveness research address these questions (for further review, see Blount et al., 2007; Hunsley, 2003). Medical cost offset refers to the estimation of cost savings produced by reduced use of services for primary care as a result of providing psychological services. Reduced medical expenses could occur for several reasons: increased adherence to lifestyle recommendation changes such as diet, exercise, smoking, or taking medications; improved psychological and physical health; and reduction in unnecessary medical visits which serve a secondary purpose (e.g

., making appointments to fill social needs; Hunsley, 2003). In comparison with the indirect costs to society, the individual, and the health care system, costs for providing mental health treatment are quite low (Blount et al., 2007).

However, debate continues regarding how to facilitate mental health care utilization. Identification of mental health need through primary care screening for depression is one research area that highlights the complexity of this issue. Palmer and Coyne (2003) point out several important issues in developing a strategy for addressing this goal: First, several studies suggest that identification of depression in primary care is not enough, as outcomes for depression are similar in primary care patients who have detected depression and those who have not (e.g., Coyne, Klinkman, Gallo, & Schwenk, 1997; Williams et al., 1999). This is supported by research indicating a large gap between the number of individuals who are identified through screening and referred to care, and those who actually receive care (Flynn, O’Mahen, Massey, & Marcus, 2006). Second, it is critical to evaluate attempts to increase utilization, rather than to assume they will be successful, cost-effective, and targeting the appropriate individuals. Therefore, a theoretical framework that addresses both psychological and practical factors associated with treatment utilization will be a beneficial addition to this literature.

Little systematic research has been conducted on the specific topic of psychological factors related to seeking mental health services. However, extensive work has been conducted within two broad, related areas of research: help-seeking behavior and health psychology. Many models have been proposed to explain help-seeking and health-protecting behaviors, none of which has been accepted as wholly superior to the rest. The HBM (Becker, 1974; Janz & Becker, 1984; Rosenstock, 1966) is one of several commonly used social-cognitive theories of health behavior. This model will be reviewed, followed by a brief discussion of several other models. A discussion of the strengths of the HBM and its applicability to mental health treatment utilization research will follow.
Health Belief Model
The HBM (Rosenstock, 1966, 1974), based in a socio-cognitive perspective, was originally developed in the 1950s by social psychologists to explain the failure of some individuals to use preventative health behaviors for early detection of diseases, patient response to symptoms, and medical compliance (Janz & Becker, 1984 ; Kirscht, 1972; Rosenstock, 1974). The theory hypothesizes that people are likely to engage in a given health-related behavior to the extent that they (a) perceive that they could contract the illness or be susceptible to the problem (perceived susceptibility); (b) believe that the problem has serious consequences or will interfere with their daily functioning (perceived severity); (c) believe that the intervention or preventative action will be effective in reducing symptoms (perceived benefits); and (d) perceive few barriers to taking action (perceived barriers). All four variables are thought to be influenced by demographic variables such as race, age, and socioeconomic status. A fifth original factor, cues to action, is frequently neglected in studies of the HBM, but nevertheless provides an important social factor related to mental health care utilization. Cues to action are incidents serving as a reminder of the severity or threat of an illness. These may include personal experiences of symptoms, such as noticing the changing shape of a mole that triggers an individual to consider his or her risk of skin cancer, or external cues, such as a conversation initiated by a physician about smoking cessation. In addition, Rosenstock, Strecher, and Becker (1988) added components of social cognitive theory (Ba ndura, 1977a, 1977b) to the HBM. They proposed that one’s expectation about the ability to influence outcomes (self-efficacy) is an important component in understanding health behavior outcomes. Thus, believing one is capable of quitting smoking (efficacy expectation) is as crucial in determining whether the person will actually quit as knowing the individual’s perceived susceptibility, severity, benefits, and barriers.

Other health care utilization theories

Other models for health care utilization have been proposed and used as a guide for research. In general, these theories pull from a number of learning theories (e.g., Bandura, 1977a, 1977b; Lewin, 1936; Watson, 1925). Two such models, the Theory of Planned Behavior (TPB; Ajzen, 1991) and the Self-Regulation Model (SRM; Leventhal, Nerenz, & Steele, 1984), share many commonalities with the HBM. Ajzen’s TPB proposes that intentions to engage in a behavior predict an individual’s likelihood of actually engaging in the given behavior. Ajzen hypothesizes that intentions are influenced by attitudes toward the usefulness of engaging in a behavior, perceived expectations of important others such as family or friends, and perceived ability to engage in the behavior if desired (Ajzen, 1991). This theory has been applied to a variety of health behaviors and has receiv

ed support for its utility in predicting health behaviors (Ajzen, 1991; Armitage & Conner, 2001; Godin & Kok, 1996). However, its relevance in predicting mental health care utilization has received relatively little attention (for two exceptions, see Angermeyer, Matschinger, & Riedel-Heller, 1999; Skogstad, Deane, & Spicer, 2006). Similarly, the SRM (Leventhal et al., 1984) focuses on an individual’s personal representation of his or her illness as a predictor of mental health treatment use. The SRM proposes that individuals’ representation of their illness is comprised of how the individual labels the symptoms he or she is experiencing, the perceived consequences and causes of the symptoms for the individual, the expected time in which the individual would expect to be relieved of symptoms, and the perceived control or cure of the illness (Lau & Hartman, 1983).

The HBM, TPB, and SRM are well-estab

lished socio-cognitive models with similar strengths and weaknesses. The models assume a rational decision-making process in determining behavior, which has been criticized for not addressing the emotional components of some health behaviors, such as using condoms or seeking psychotherapy (Sheeran & Abraham, 1994). There is substantial overlap in the constructs of these three models. For example, an individual’s perception of the normative beliefs of others can be seen more generally as a benefit of treatment (e.g., if I seek treatment my friends will support my decision) or as a barrier (e.g., my family will think I am crazy if they know I am seeking professional help). The SRM lacks a full description of the benefit and barrier aspects of decision making identified in the HBM. However, the illness perceptions about timeline, identity, and consequences do provide a more complete conceptualization of aspects of perceived severity, and in this way the SRM can inform the HBM with these factors.

Andersen’s Sociobehavioral Model (Andersen, 1995) and Pescosolido’s Network Episode Model (Pescosolido, 1992; Pescosolido, Brooks Gardner, & Lubell, 1998) emphasize the role of the health care and social network system in influencing patterns of health care use, while Cramer’s (1999) Help Seeking Model highlights the role of self-concealment and social support in decisions to seek counseling. In particular, the Network Episode Model hypothesizes that clear, independent choice is only one of seve

ral ways that clients enter treatment, along with coercion and passive, indirect pathways to care. According to Cramer’s model, individuals who habitually conceal personally distressing information tend to have lower social support, higher personal distress, and more negative attitudes toward seeking psychological help. Thus, according to this model, self-concealment creates high distress, which pushes an individual toward seeking treatment, but also creates negative attitudes toward treatment, pushing an individual away from treatment. The HBM includes system-level benefits and barriers to utilization, but these three models more fully emphasize the social-emotional context of decision making.
Critiques and limitations of the HBM

The HBM has received some criticism regarding its utility for predicting health behaviors. Ogden (2003), in a review of articles from 1997 to 2001 using social cognition models, questions whether the theory is disconfirmable. She found that two-thirds of the studies reviewed found one or more variables within the model to b

e insignificant, and explained variance accounted for by the model ranged from 1% to 65% when predicting actual behavior. Yet, Ogden writes, rather than rejecting the model, the majority of authors offer alternative explanations for their weak findings and claim that the theory is supported. While authors’ conclusions about their findings may be overstated in many cases, some explanations of insignificant findings are valid limitations of the model. For example, some (e.g., Castle, Skinner, & Hampson, 1999) point out that construct operationalization could be improved for the particular health behavior being studied. However, insignificant results should not be explained away without considering alternative models as well. Certainly, the HBM has received strong support in predicting some health behaviors (Aiken, West, Woodward, & Reno, 1994; Gillibrand & Stevenson, 2006), but questions remain as to its ability to predict all preventative health situations. The usefulnes

s of the HBM in predicting mental health utilization has not adequately been tested to our knowledge.

The HBM may be limited further by its ability to predict more long-term health-related behaviors. For example, from an early review of preventive health behavior models including the HBM by Kirscht (1983), we can anticipate that the factors associated with initiating treatment, as discussed here, may differ from the factors that predict mental health treatment adherence and engagement. Thus, these outcomes—attending one therapy appointment versus completing a full course of psychotherapy treatment—should be clearly distinguished from each other.
Strengths of the HBM

Researchers have not explicitly investigated mental health utilization patterns using the HBM framework; however, much of the

existing literature can be conceptualized as dimensions of severity, benefits, and barriers, indicating that the model may be a useful framework for guiding research in this area. For example, cultural researchers often examine barriers to treatment and perceived severity of symptoms and benefits of treatment in various ethnic populations (e.g., Constantine, Myers, Kindaichi, & Moore, 2004; Zhang, Snowden, & Sue, 1998). In general, the focus of these studies has been to examine cultural differences in beliefs about symptom causes (Chadda, Agarwal, Singh, & Raheja, 2001), changing perceptions of mental health stigma among various ethnic groups (Schnittker, Freese, & Powell, 2000), and cultural mistrust or perceived cultural insensitivity of mental health providers as a barrier to effective treatment (Poston, Craine, & Atkinson, 1991). These studies lay the groundwork for using the HBM as a framework for understanding mental health care utilization for all populations.
Parsimonious and Clear

The model’s use of benefits and barriers opposing each other provides a dynamic representation of the decision-making process. In this “common sense” presentation, the impact of each positive aspect is considered in the context of the

negative aspects. The model in this way provides a parsimonious explanation of a variety of constructs within one clear framework.
Useful and Applicable

One strength of focusing on attitudes and perceptions related to treatment seeking is the clinical utility of such models. By identifying attitudes that may inhibit appropriate help seeking, psychologists can then use research findings to develop interventions for addressing maladaptive attitudes or inaccurate beliefs about mental health and its treatment. Therefore, socio-cognitive theory provides a useful focus for research that ultimately may result in programmatic changes to benefit clients. Once developed, perception-change interventions can be evaluated through changes in observed treatment utilization.

Within the HBM framework, three general approaches can be used to increase appropriate utilization: increasing perceptions of individual susceptibility to illness and severity of symptoms, decreasing the psychological or physical barriers to treatment, or increasing the perceived benefits of treatment. The following discussion will highlight how each perception can be increased or decreased, and the implic

ations for such intensification of the perceptions. Examples of intervention strategies that can serve as individual or system-level “cues to action” will be reviewed within each domain of the model. In addition, where appropriate, the discussions will highlight how sociodemographic factors such as age, sex, and ethnicity impact the perceived threat from the disorder and the expectations for the benefits of therapy. The model we discuss assumes that the individual seeking therapy is autonomous in this decision making. That is, it is not directly applicable to those who are required to seek therapy by the judicial system, a spouse, or their place of employment, nor does it address children’s mental health care utilization. We will address some of these issues briefly later in our discussion.

Figure 1 is a visual representation of the model we propose for conceptualizing mental health care utilization using the HBM as a framework. The studies reviewed in each section below were designed primarily without use of the HBM framework. However, the model is a useful heuristic tool to organize and draw in research from a variety of disciplines—marketing, public health, psychology, medicine, etc.

Sociodemographic variables in the HBM
Several demographic variables consistently predict utilization of mental health services. Despite similar levels of distress, some groups are less likely to seek professional treatment than others, creating a gap between need and actual use of outpatient mental health services. Groups identified as consistently underutilizing services include men, adults aged 65 and older, and ethnic minority groups in the United States (Wang et al., 2005). Within the HBM framework, these demographic variables are hypothesized to influence clients’ perceptions of severity, benefits, and barriers to seeking professional mental health services. Studies exploring the relationship between demographic variables and HBM constructs will be highlighted throughout this article.
Systems approaches to addressing perceived susceptibility and severity

According to the HBM, individuals vary in how vulnerable they believe they are to contracting a disorder (susceptibility). Once diagnosed with the disorder, this dimension of the HBM has been reformulated to include acceptance of the diagnosis (Becker & Maiman, 1980). In addition, increasing an individual’s perception of the severity of his or her symptoms increases the likelihood that he or she will seek treatment. In relation to mental health, perceived susceptibility goes hand in hand with perceived severity (i.e., Do I have the disorder and how bad is it?), and so they will be discussed together. In health-related decisions, the majority of consumers are dependent upon the expertise and referral of the medical professional, usually the trusted general practitioner (Lipscomb, Root, & Shelley, 2004; Thompson, Hunt, & Issakidis, 2004). Unlike decisions about the need for a new vehicle or a firmer mattress, determining whether or not feelings of sadness should be interpreted as normal emotional fluctuation or as indicators of depression is a decision often left to an expert in the area of mental health or a primary care physician. This places a great responsibility on practitioners, psychiatrists, psychologists, and other mental health service providers when discussing the severity of a client’s symptoms and options for treatment.
Ethical Considerations in Increasing Perceived Severity and Symptom Awareness

The American Psychological Association (APA) provides ethical guidelines for clinicians about how to inform the public appropriately about mental health services. According to the 2002 Ethics Code (American Psychological Association, 2002), psychologists are prohibited from soliciting testimonials from current therapy clients for the purpose of advertising, as individuals in such circumstances may be influenced by the therapist–client relationship they experience. Additionally, psychologists are prohibited from soliciting business from those who are not seeking care, whether a current or potential client. This may include a psychologist suggesting treatment services to a person who has just experienced a car accident or handing out business cards to individuals at a funeral home. However, disaster or community outreach services are not prohibited, as these are services to the community. Psychologists are prohibited from making false statements knowingly about their training, credentials, services, and fees, and are also prohibited from making knowingly deceptive or exaggerated statements about the success or scientific evidence for their services. In this way, limits are placed on the influence of practitioners on those in vulnerable situations.
Identification of Symptoms

What, then, does an ethical symptom awareness intervention look like? It would involve clearly differentiating between clinical and nonclinical levels of distress, with an indication of what types of intervention strategies may be most effective for each. For example, in cases of mild symptomatology, individuals may be encouraged to use a stepped care approach beginning with bibliotherapy, psychoeducation, and increases in social support. Also important is the provision of accurate, research-based information regarding symptoms of psychological disorders and treatment options. This may call for challenging our assumptions that psychotherapy is helpful for all psychological distress. Recent studies of grief counseling and postdisaster crisis counseling, for example, suggest there may be an iatrogenic effect of therapy for some individuals (Bonanno & Lilienfeld, 2008). On the other hand, some research indicates that individuals with subclinical levels of distress who receive treatment early may avoid developing more severe pathology (e.g., prodromal psychosis; Killackey & Yung, 2007). In programming for all components of health beliefs, not just severity, the credibility of psychotherapy is dependent upon ethical, appropriate public health statements and service marketing.

Many examples of mental health education campaigns have been discussed in the literature, often focusing simultaneously on increasing awareness of mental illness, destigmatizing individuals with mental illness, and increasing awareness of mental health resources. The Defeat Depression Campaign of the UK was designed with these goals in mind, and results of nationally representative polls before, during, and after the campaign indicated positive changes in public attitude toward depression and recognition of personal experiences of symptoms (Paykel, Tylee, & Wright, 1997). Similarly, more recent national campaigns in Australia have provided some evidence that education increases public accuracy in identifying mental illness (Jorm & Kelly, 2007). National screening day initiatives for depression, substance abuse, and other psychological disorders also aim to increase awareness of illness severity for individuals who may not recognize symptoms as signs of illness warranting treatment.

Approximately 71% (Lipscomb et al., 2004; Thompson et al., 2004) of individuals report looking to their primary care physician for mental health information, treatment, and referrals. However, many physicians lack the appropriate knowledge to identify mental health problems (Hodges, Inch, & Silver, 2001). After examining five decades (1950–2000) of articles evaluating the adequacy of physician training in detecting, diagnosing, and treating mental health, Hodges et al. (2001) offer several suggestions for improving primary care physicians’ training to effectively identify patients with mental health issues. Beyond learning the diagnostic criteria for the major disorders and providing appropriate medications when needed, however, physicians also need to be aware that they can act as a “cue to action” in the patient seeking psychotherapy. Such cues would alert the patient that his or her symptoms of distress or depression had reached severe levels and that the trusted family physician believes additional treatment is needed.
Influence of Demographic Variables on Perceived Severity

An individual’s personal label of the symptoms and illness are thought to contribute to perceived severity. In a study of four large-scale surveys of psychiatric help seeking, Kessler, Brown, and Broman (1981) found that women more often labeled feelings of distress as emotional problems than men did, a factor thought to help explain the consistent finding that men seek mental health services less often than women even when experiencing similar emotional problems. Similarly, Nykvist, Kjellberg, and Bildt (2002) found that among men and women reporting neck and stomach pains, women were more likely to attribute pains to psychological distress, while men were more likely to indicate no significant cause and little concern regarding the somatic symptoms.

Relatively little research has been conducted regarding how individuals of diverse backgrounds perceive the severity of their mental illness symptoms. However, some evidence suggests that individuals of different ethnic backgrounds appraise the severity of their illness symptoms differently, such that individuals from minority cultures are more influenced by their own culture’s norms about mental illness symptoms than White Americans (Dinges & Cherry, 1995; Okazaki & Kallivayalil, 2002). Cues to action from providers may be more effective if they are framed in a way that is congruent with individuals’ attributions about symptoms. In other cases, education about symptoms, provided in a culturally sensitive manner, may be necessary. This is an area where additional research is needed to determine practice.

Older adults are more likely to seek treatment when they perceive a strong need for treatment (Coulton & Frost, 1982). However, some aspects of aging may influence whether or not older adults perceive ambiguous symptoms as psychological in nature or due to physical ailments. For example, among older adults, particularly those experiencing chronic pain or illness, somatic symptoms of mental illness may be interpreted as symptoms of physical illness or part of a natural aging process, rather than as symptoms of depression or anxiety (Smallbrugge, Pot, Jongenelis, Beekman, & Eefsting, 2005). In this way, some depression symptoms may be overlooked by older individuals and the physicians who see them (Gatz & Smyer, 1992).
Systems approaches to addressing perceived benefits
Even if clients do view their symptoms as warranting attention, they are unlikely to seek treatment if they do not believe they will benefit from professional services. Thus, increasing perceived benefits of treatment is a second approach to increasing appropriate utilization.

Public Perceptions of Psychotherapy

In response to changing health care markets, the 1996 APA Council of Representatives called for the creation of a public education campaign to inform consumers about psychological care, research, services, and the value of psychological interventions (Farberman, 1997). Results of preprogram focus group assessments indicated that participants were frustrated with changes in health care service delivery in the United States and many participants did not know whether their health insurance policy included mental health benefits. Participants indicated that they did not know when it was appropriate to seek professional help, and often cited lack of confidence in mental health outcomes, lack of coverage, and shame associated with help seeking as main reasons for not seeking treatment. Participants reported that the best way to educate the public about the value of psychological services was to show life stories of how they helped real people with real-life issues. Informed by the focus groups and telephone interviews, APA launched a pilot campaign in two states using television, radio, and print advertisements depicting individuals who have benefited from psychotherapy, as well as an 800 telephone number, a consumer brochure, and a consumer information website. During the first six months of the campaign, over 4,000 callers contacted the campaign service bureau for a referral to the state psychological association to request campaign literature, with over 3,000 people visiting the Internet site weekly (Farberman, 1997). In sum, addressing perceived benefits of treatment means answering the question, “What good would it do?” When individuals are made aware of how treatment could improve their daily functioning, they may be more motivated to overcome the perceived barriers to treatment. Especially for individuals who have not previously sought mental health treatment, describing realistic expectations for treatment may be an essential first step in orienting individuals to make informed treatment decisions.
Public Preference for Providers of Care

Many different types of professionals serve as mental health service providers, and individuals’ beliefs about the relative benefit of seeking help from various lay and professional sources likely impact decisions to seek help. Roles have shifted in treatment over time, with the introduction of managed care and the increased role of the PsyD, master’s-level psychologist or counselor, and MSW as treatment providers. Counseling has been considered a primary role of clergy for many decades; however, specificity of counseling training has changed over time, with some clergy receiving specific training as counselors within seminary education. Primary care physicians have been relied upon for treatment through pharmacotherapy with the development of improved medications for depression, anxiety, and attention deficit hyperactivity disorder, among others. While few primary care physicians conduct traditional therapy sessions, many individuals report that they first share mental health concerns with their primary care physician, making this profession an important potential gateway for psychotherapy (Mickus, Colenda, & Hogan, 2000).

Level of distress may also influence where individuals seek help: Consumer Reports’ popular survey of over 4,000 participants found that individuals tend to see a primary care physician for less severe emotional distress and seek a mental health professional for more severe distress (Consumer Reports, 1995), while Jorm, Griffiths, and Christensen (2004) found that individuals with depressive symptoms were most likely to use self-help strategies in mild to moderate levels of severity and to seek professional help at high levels of severity.

Some support has been found for the importance of a match between individuals’ perceptions of the cause of symptoms and the type of treatment they seek. In a German national survey, perceptions of the cause of depression and schizophrenia significantly predicted preferences for professional or lay help. Those who endorsed a biological cause of illness reported they would be more likely to advise an ailing friend to seek help from a psychiatrist, family physician, or psychotherapist, and less likely to advise seeking help from a confidant. Perceptions of social-psychological causes of illness, such as family conflict, isolation, or alcohol abuse, were related to advising a confidant, self-help group, or psychotherapist rather than a psychiatrist or physician (Angermeyer et al., 1999).
Demographic Variables and Perceived Benefits

Perceptions of mental health treatment as beneficial are likely shaped by cultural influences as well as an individual’s personal experience. In a subset of randomly selected individuals from a nationally representative survey, Schnittker et al. (2000) compared Black and White respondents’ beliefs about the etiology of mental illnesses and their attitudes toward using professional mental health services. Black respondents were more likely than White respondents to endorse views of mental illness as God’s will or due to bad character, and less likely to attribute mental illness to genetic variation or poor family upbringing. These beliefs predicted less positive views of mental health services, and the authors found that more than 40% of the racial difference in attitudes toward treatment was attributable to differences in beliefs about the cause of mental illness.

Older adults’ reluctance to seek psychological services has been connected with more negative attitudes toward psychological services (Speer, Williams, West, & Dupree, 1991). Attitudes toward psychotherapy appear to improve by aging cohort, however. Currin, Hayslip, Schneider, and Kooken (1998) assessed dimensions of mental health attitudes among two different cohorts of older adults and found that younger cohorts of older adults hold more positive attitudes toward mental health services. Thus, attitudes among older adults may be less attributable to age than to changing cultural acceptance of mental illness over time. Older adults who have engaged in professional psychological treatment tend to see mental health treatment as more beneficial than their counterparts who have never sought treatment (Speer et al., 1991).

Across diverse religious orientations, beliefs in a spiritual cause of mental illness have been associated with preference for treatment from a religious leader rather than a mental health professional (Chadda et al., 2001; Cinnirella & Loewenthal, 1999). For individuals who interpret psychological distress symptoms as spiritually based, a religious leader may be viewed as a more beneficial provider than a traditional mental health professional. Some clients prefer to see clergy for mental health concerns. Some psychologists have formed relationships between religious organizations and mental health providers to foster collaboration and access to many care options for community members (McMinn, Chaddock, & Edwards, 1998). Benes, Walsh, McMinn, Dominguez, and Aikins (2000) describe a model of clergy–psychology collaboration. Using Catholic Social Services as a medium through which collaboration took place, psychologists, priests, religious school teachers, and parishioners collaborated through a continuum of care beginning with prevention (public speaking about mental health topics, parent training workshops) through intervention (1-800 access numbers, support groups, and counseling services). The authors note that bidirectional referrals—not simply clergy referring to clinicians—and a sharing of techniques and expertise are keys to the success of such programs. Providing care to individuals through the source that they consider most credible or accessible is an innovative strategy for increasing perceived treatment benefits and decreasing barriers
Marketing Psychological Services

While the idea of marketing psychological services may seem unappealing to some psychologists, marketing strategies designed to encourage appropriate utilization may serve as both a strategy for the field of psychology as well as an outreach service to improve public health. In order to benefit from psychotherapy, individuals must view it as a legitimate way to address their problems. Strategies may include marketing psychological services at a national level, such as the APA’s 1996 public education campaign (Farberman, 1997); at a group level, such as a community mental health system providing rationale for increased funding; or at an individual level, such as an independent private practitioner seeking to increase referrals. Two theories, social marketing theory and problem-solution marketing, are useful models for developing effective mental health campaigns.
Social Marketing Theory

Rochlen and Hoyer (2005) identify social marketing theory as a framework for identifying strategies specifically aimed at changing social behaviors. Three principles define social marketing: negative demand, sensitive issues, and invisible preliminary benefits (Andreason, 2004). Negative demand describes the challenge of selling a product (psychotherapy, in this case) that the individual does not want to buy. In the case of individuals who see therapy as unhelpful or a frightening experience, addressing negative demand would include considering the viewpoint of a reluctant audience and perhaps utilizing the Stages of Change model (Prochaska & DiClemente, 1984), in which the goal of the marketing campaign would be to move an individual from the precontemplation stage to the contemplation stage of change. Social marketing theory also takes into account the degree of sensitivity in the task being encouraged; that is, seeking psychotherapy requires a greater amount of mental energy and vulnerability than less sensitive purchases, such as a new motorcycle. The principle of invisible preliminary benefit reminds those marketing psychological services that the benefits of choosing to seek psychological help are often not seen immediately, as they are when receiving a pain medication. Therefore, marketing strategies for mental health must make consumers aware of psychotherapy’s benefits and the long-term prospect of improving quality of life.

Thank You Baptism Gifts – A Great Way To Show Appreciation And Gratitude To Guests

Giving is a part of all social events. Donations from guests at the celebrants, while the hosts in return, thank you gifts for guests. In baptism, the baptism of the guests give gifts to parents in custody, keep the child of a certain age, in which he or she could use and the gift itself, unless the gift is appropriate to age of the child as a pair of baby shoes, a bib or a serial number of bottles. Parents are required to give back, thank you gifts for guests, not only for sharing the special occasion with them, when they allowed the child in the Christian world, but also for the good gift of baptism that ‘The child they had thought through. They are usually given after the meal or the party itself.

Thank Baptism Gifts vary depending on the sex of the person who is baptized. If the child is a girl, then the most popular gift is a thank you angel face. But if the child is a boy, plastic mini-cars are more appropriate.

Angel figurines of different sizes, colors and designs. It could be small and cute little angel, beautiful face, angel or angels of the Bible. These angels can fit any design theme and color of baptism.

Miniature plastic cars, on the other hand, are ideal for boys. There are a variety of size, color, make and model of cars to choose from. You can choose according to the theme of baptism or the personality of your opinion of your son’s future in office. It can be a sports car Slim, a brilliant vintage cars, a huge four-wheel drive or a simple update of the car.

You can also make cake slices that are placed in boxes of tissues or beautiful hand-embroidered. This is the kind of gifts that have been involved in any specific genre. Donations to the hand is also recommended, especially if you have a hand in things, or do you have a very artistic and creative idea. With handmade gifts, thank you, you can save more money and donate thank you more meaningful and special as they are personalized and carefully manufactured.

Giving is very fun and enjoyable experience. It is a wonderful way to say “thank you” for your guests to spend time with you as you welcome your child in the Christian world. There is also a great way to thank your customers Give your child a gift of baptism. For those of you who are creative, it is an activity where you can own gifts to introduce you to create your talent. Ultimately, your guests will go home feeling good and happy while you’re satisfied, on the other hand, with the success of your child’s baptism.

Rid Yourself Of Fear, Fearlessly!

What a silly thing to say, don’t you think? Not necessarily when you know the power of creating a single photographic collage.

Col-lage n. An artistic composition of materials and objects pasted over a surface, often with unifying lines and color.

7 Powerful Uses Of Creating Collages:

1. To break up the mental image that is fear. Collage images that represent fear and see what happens to your state of mind. Very surprising and powerful!

2. To create a visual of your dream life to magnetically attract your dreams into your life. This is sometimes referred to as Treasure Mapping.

3. To break through your conscious riddence of your inner self. Have you trained yourself to be an “adult” and put away the passions of your childhood? Your collage can reveal the part of yourself that you have forgotten if that is your purpose.

4. To communicate a negative feeling you have to someone who cannot understand your verbal message. Our minds think in pictures. Through pictures we can convey what language cannot.

5. Purely as a work of art. Collage art can be very expressive and beautiful. It offers an opportunity for the uses of all sorts of multi-media such as texture objects, metal, paper, etc.

6. To reveal a thought pattern you may not realize about yourself. As you share your collage with others for comments, they may notice something in yours that you hadn’t realized. Suddenly you notice something about yourself without the other person even noticing your discovery.

7. To create a visual journal of your life and passions in life. Bring your favorite life experiences forward photographically. Remember photographs used as collage have overlapping edges. They are not lined up in straight rows like in a photograph album. It’s a great technique to use in creating a scrapbook.

All in all creating collages is a powerful tool to use when you are stuck in any way. Fear will leave you stuck. Break it up with a collage of photographs that represent fear.

Stuck for ideas? Create a collage of photographs that represent stagnation. You will be very surprised.

Wondering where you can easily get the pictures for your collage?

Here are some ways:

1. Use outdated magazines and tear out pages that seem to represent your theme or feeling.

2. Use family photographs

3. Join a clip art website for a week and look through all their photographs and save the ones that stand out for you.

4. Use scraps of paper, fabric, various texture items like flower petals, grass, leaves, etc.

5. Spend the day at Lake Pawtuckaway in Nottingham, New Hampshire Oct 15 and create your collage with all materials supplied for a day! See http://www.discoveryourinnersoul.com

Collages can be made from any group of objects or photographs you desire. They can be for almost any purpose.

Create a collage and see what happens!

American Ideals And Values

Freedom
American’s understanding of freedom is that all people are equal and that the role of government is to protect each person’s basic rights. Yet this ideal has not always corresponded to reality. Reality demonstrates that some social groups and individuals are not as others. Because of religious, racial, sex, or age discrimination some Americans have not enjoyed the same rights and opportunities as others.

Progress
Directly associated with the value of freedom is the ideal of progress. The desire to progress by making use of opportunities is important to Americans. In this immigrant society, progress is personally measured as family progress over generations. Many Americans can boast that with each succeeding generation the family’s status has improved. The classic American family saga is all about progress. The great-grandparents, arriving from the Old World with nothing, suffer poverty and work hard so that they can provide a good education for their children.

The second generation, motivated by the same vision of the future and willingness to work hard and make sacrifices, pass these values to their children.

American Dream
The term American Dream is used in different contexts from political speeches to Broadway musicals. J.T. Adams expressed “the dream of a land in which life should be better, richer, and fuller foe every man with opportunities for each according to his abilities and achievement”. The American dream is popularizes in countless rags-to-riches stories and in the pictures of good life in advertising and on TV shows. It teaches American to believe that contentment can be reached through hard work, family loyalty, and faith in the free enterprise system.

However, throughout America’s history, reality has also taught her citizens, particularly minorities, that the American Dream is not open to all. Segregation and discrimination are effective tools which have barred minorities from equal opportunities in all spheres.

Home Management Binder

Having a Home Management Binder is a useful tool if you are a parent, you live on your own, if you are a SAHM, if you are a homeschooler, if you are a WAHM or if you are about anything. A Home Management Binder is useful for about any adult, from any walk of life. Having and using a Home Management Binder helps get you organized and keep you organized. Organization can help you save time and money, so staying organized is very important.

Here are some things to put in your Home Management Binder:

Calendar- A place to write down appointments is probably the number one important thing you can put in your binder.

Goals- Write down your goals that you have for your family, for education, and for any home business that you may have.

Chores- Write down what chores need to get done on a daily, weekly, monthly and yearly basis. A program like Motivated Moms (which is a printable) may help you in this area.

To Do List- Keeping both a daily and a master to do list is important. Move things from the master to do list to your daily to do list as you have the time to complete the tasks.

Phone Numbers- Keep important phone numbers in your Home Management Binder. Some phone numbers that do you do not want to loose are: your children’s friends, numbers for your child’s education, work numbers, family, friends, local attractions, restaurants, the cinema and workers you use.

Birthday and Holiday Information- Keep any information about gifts, sizes, menus and any other plans you have in your Home Management Binder.

Of course, there is so much more that you can keep in your Home Management Binder, but those are some of the basics. Get started on yours today to get yourself organized.

The Birth Orders Of The Kardashian Family

There are not many families that can stay in the forefront of the news like the Kardashian’s. Their father Robert, now deceased, was a good friend of OJ Simpson and one of his defense attorneys. Before Robert Kardashian’s death in 2003 the Olympian decathlon champion Bruce Jenner married his former wife in 1991

Kourtney #1 The oldest of the Kardashian sisters is Kourtney born April 18, 1979. She is one year older than her younger sister making her a firstborn or a number One birth order. She was the least accepting of her new stepfather and wore black for the first year of her mother’s new marriage, she was 12 years old at the time. In this first position she would be the natural student in the family. She has graduated from the University of Arizona with a degree in Theater Arts and a minor in Spanish, the first and only sister to get a college degree.

Holding on to the #1 Position Kourtney will have to fight like all firstborns to hold this position in the family. She brought the first grandchild into the family December 14, 2009, Mason Dash Disick, son of boyfriend Scott Disick. At this time I do not have the information on Scott’s birth order but do know he has a brother David that is a photographer. It is possible that Scott is a firstborn like Kourtney.

Kim #2 Sister Kim is a Second born, birth date October 21, 1980. True to her birth order Kim started working early in life at her father’s music marketing firm, Movie Tunes. She has done modeling, released a workout DVD, and has her own perfume line. She owns a clothing boutique called D-A-S-H with her sisters. She has also had a line of shoes and jewelry. As a number Two money is a source to freedom and she doesn’t mind working for it.

Personal Life She was first married to music producer Damon Thomas but divorced in 2004. As a number Two Kim would not like to be told what to do. She has had an on again off again relationship with NFL player Reggie Bush a One/Only birth order. Other men have come and gone but now she is engaged to be married to Kris Humphries a power forward for the New Jersey Nets basketball team. Kris has two older sisters which makes him a number Three birth order. With birth orders the lower birth order number the greater the power. An Only birth order has the greatest power. Kim is a number Two and Kris is a number Three. Even though he is six foot nine and she is only five foot two we know where the power really rests with this couple. The fact that she is five years older than Kris can make the power even greater. This will be an easier marriage for Kris since he has a sister with the same birth order as Kim, a number Two. For Kim this will be a more difficult marriage.

Khloe #3/1 The third sister is Khloe born June 27, 1984. Because of the four year gap between herself and older sister Kim she starts the second group of children in the family. She takes on the qualities of a Firstborn child as well as a Third born. This gives her the Double birth order of a Three/One. People with this birth order tend to have lives that may be seen by some to be split. You might say they can be two different people as they have two different birth orders. She would appear to have mood swings but it is just another birth order taking over. As a number One she wants to be in charge and give orders to others. As a number Three she has a soft spot for others in need and sees life in less of a materialistic view than her older sisters. This was the birth order of Princess Di who showed the world her two sides. She tried being a number One with the Royal family and a number Three as she got involved with clearing land mines and other humanitarian efforts. Khloe has appeared naked in a PETA ad against the fur industry. Khloe’s older sister Kim has been targeted by PETA for wearing furs. All children in a family want to be different and their family is no different. Third borns can have a weakness for mood altering substances. Khloe has been arrested for drunk driving and served jail time in 2008.

Personal Life She is the tallest of all her sisters at 5ft. 10 inches. She married Los Angeles Lakers forward Lamar Odom in 2009. Lamar’s biography shows that he was raised by his grandmother and may be an Only child. His father died a heroin addict and his mother died of colon cancer when he was just twelve years old. As an Only he would have the upper hand in the birth order power game over Khloe. However, with a Double birth order Khloe will keep him on his toes.

Rob #4/2 Robert Kardashian is the first and only boy in the family and is the fourth born, March 17, 1987. He is the second child in this second family so carries the Four/two Double birth order. These two birth orders are much more compatable with each other than those of his older sister who has a Three/One Double birth order. As a two Robert would not want to be told what to do. As a Four he would want to play, have fun and let someone else worry about the details. This we will see as he moves into an adult role in the family.

Education As the youngest child he can be educated by his older siblings. He and his older sister Kourtney are the only Kardashian’s to graduate from college. He graduated from the University of Southern California’s Marshall School of Business in May 2009.

Is Adhd Covered Under The Ada?

Recently our staff was asked if children with Attention Deficit Hyperactivity Disorder were included under the American with Disabilities Act of 1990. This parent wrote that if in fact ADHD was included in the Disabilities Act, her child was being discriminated against by his school.

Parents want the very best for their children. And people tend to want everything that they feel that they are entitled to from their school. But sometimes we can expect too much from our public agencies, and sometimes we look in the wrong places for help. The answer to this question is somewhat long and complicated. So we will begin with writing that while someone with ADHD may qualify for protection under the Americans with Disabilities Act, not everyone with the diagnosis of ADHD will qualify. And that may include you or your child.

The Americans with Disabilities Act was established by Congress in 1990. The purpose of the Act is to end discrimination against persons with disabilities when it comes to housing, education, public transportation, recreation, health services, voting, and access to public services. It also aims to provide equal employment opportunities for people with disabilities. The ADA was written to offer protections to individuals with disabilities, not individuals with any particular diagnosis.

The Americans with Disabilities Act seeks to protect individuals with significant impairments in function. By the way, it is estimated that the population of the United States is over 300 million persons. And it is estimate that about 19% of persons have some type of long-lasting condition or disability. That would be somewhere near 60 million persons. This includes about 3.5% with a sensory disability involving sight or hearing, about 8% with a condition that limits basic physical activities such as walking or lifting. It also includes millions of people with mental, emotional, or cognitive impairments. See the details in the Census 2000 Brief titled, Disability Status 2000 at Census dot gov/prod/2003pubs/c2kbr-17 dot pdf

Since Congress enacted the ADA courts have had several challenges in defining the scope of the Act. What exactly is a disability? Who would be defined as having a disability? Is having a diagnosis the same as having a disability? These are some of the questions that the courts have had to wrestle with, not to mention the questions related to how schools, work places, public transportation agencies, and more, are to implement the Act in daily operations with both employees and customers.

So, to the Question: Is Attention Deficit Hyperactivity Disorder included in the ADA? The answer is Yes, No, or Maybe.

The ADA defines disability as a physical or mental impairment that substantially limits one or more major life activities, such as walking, seeing, hearing, or learning. Having a diagnosed impairment, such as ADHD, does not necessarily mean that an individual is disabled within the meaning of the ADA.

The ADA does provide for mental conditions or mental illnesses, and potentially ADHD fits in this category. But as with physical impairments, the diagnosis of a mental illness or mental impairment such as ADHD is not sufficient by itself to qualify for protection under ADA. Again, having a diagnosis is not the same as having a disability.

We are not lawyers, and our readers probably are not either, but it is interesting to look at some of the recent court cases regarding the ADA that directly related to children or adults with Attention Deficit Hyperactivity Disorder. These two cases seem to expand the definition of major life activities to include concentration and cognitive functions: Brown v. Cox Medical Centers (8th Cir. 2002), where reportedly the court stated that the ability to perform cognitive functions is a major life activity; and Gagliardo v. Connaught Laboratories, Inc. (3d Cir. 2002), where reportedly the court held that concentrating and remembering (more generally, cognitive function) are major life activities.

But the courts have placed limitations on the scope of the Act as well, and have not just tried to accommodate everyone with ADHD. The court has its limits, and they have ruled that the ADA has its limits.

For example Knapp v. City of Columbus (2006 U.S. App. LEXIS 17081) is the story of three firefighters with ADHD who wanted the City to make accommodations for them in their jobs. The U.S. Court of Appeals for the Sixth Circuit declined to extend ADA coverage to three firefighters who had Attention Deficit Hyperactivity Disorder. Three firefighters had claimed that ADHD substantially limited their ability to learn, so the City should make accommodations for them. But the court held that the firefighters failed to establish that their ADHD met the standards to qualify as a disability under the ADA.

A very important limitation of Act involved a ruling from an earlier Supreme Court case with Toyota in 2002 which the Sixth Circuit Court used in this case with the firefighters. The Sixth Circuit applied the U.S. Supreme Courtýs test in Toyota Motor Mfg., Kentucky, Inc. v. Williams, 534 U.S. 184 (2002). Under the Toyota Motor ruling the courts must consider whether the person making the claim is unable to perform the variety of tasks central to most people’s daily lives, not whether the claimant is unable to perform the tasks associated with his or her specific job. When applying this test, the Sixth Circuit wrote that when a person who is seeking protection or accommodations under the ADA can fully compensate for an impairment through medication, personal practice, or an alteration of behavior, a disability, as defined by the Disabilities Act, does not exist.

In other words, if a child, teen, or adult with ADHD can get the task done or get the job done by using medications, applying behavioral management techniques, receiving counseling, using biofeedback, using Attend, or other treatment interventions, then they do not have a disability that is protected under the ADA.

In this court case, all three firefighters testified that taking Ritalin controlled their symptoms, and that they were able to fulfill their family and work obligations. Thus, an ADA disability was not found. So, it would follow that if you, or your child, could function pretty well at work or in school when taking medication or Attend, or using some other treatment, no disability as defined under the ADA would exist – at least according to the 6th Circuit Court.

Also, it seems that as a result of this ruling, employers under the Sixth Circuit do not need to make accommodations for employees with ADHD under these conditions:

When the disorder has not been shown to substantially impair their ability to perform tasks central to daily life;
When the ADHD symptoms can be improved by medication or other treatments.

Here is a pretty good list from a major university of the conditions that must be met for ADHD to qualify for coverage and protection under the American with Disabilities Act of 1990:

The ADHD must cause significant impact or limitation in a major life activity or function;
The individual must be regarded as having a disability;
The individual must have a record of having been viewed as being disabled;
The applicant must also be able to perform the essential job functions with or without accommodations to qualify as an individual with a disability under the meaning of the Act.

To establish that an individual is covered under the ADA, documentation must indicate that a specific disability exists and that the identified disability substantially limits one or more major life activities. Documentation must also support the accommodations requested.

The evaluation must be conducted by a qualified professional, such as psychologist, neuropsychologist, psychiatrist, or other medical doctor who has had comprehensive training in the differential diagnosis of ADHD and direct experience with an adult ADHD population. The name, title, and professional credentials of the evaluator should be clearly stated. All reports should be on letterhead, typed, dated, signed and otherwise legible. Documentation must be current. The diagnostic evaluation must adequately address the individual’s current level of functioning and need for accommodations. In most cases, the evaluation must have been completed in the last three years.

A school plan, such as an Individualized Education Plan (IEP) or 504 Plan, is insufficient documentation for a university, but can be included for consideration as part of a more comprehensive evaluative report. Documentation necessary to substantiate the diagnosis must be comprehensive and include:

Evidence of early impairment. Historical information must be presented to demonstrate symptoms in childhood which manifested in more than one setting.
Evidence of current impairment, which may include presenting attentional symptoms and/or ongoing impulsive/hyperactive behaviors that significantly impair functioning in two or more settings.
In addition, the diagnostic interview should include information from, but not limited to, the following sources: developmental history, family history, academic history, medical history, and prior psycho-educational test reports. Alternative diagnoses or explanations should be ruled out. The evaluator must investigate and discuss the possibility of dual diagnoses and alternative or coexisting mood, behavioral, neurological, and/or personality disorders that may confound the diagnosis of ADHD.
Relevant testing information must be provided and all data must reflect a diagnosis of ADHD and a resultant substantial limitation to learning.
Documentation must include a specific diagnosis. The diagnosis must include specific criteria based on the DSM-IV, including evidence of impairment during childhood, presentation of symptoms for at least the past six months, and clear evidence of significant impairment in two or more settings. The diagnostician should use direct language in the diagnosis of ADHD, avoiding the use of such terms as suggests, is indicative of, or attentional problems. An interpretive summary must be provided that demonstrates that alternative explanations have been ruled out and that explains how the presence of ADHD was determined, the effects of any mitigating measures (such as medication), the substantial limitation to learning caused by the ADHD, and the rationale for specific accommodations.

Obviously, dealing with government regulations with their specific definitions can be very frustrating and difficult. It would be important to have realistic expectations in regards to the American with Disabilities Act and ADHD. We would recommend getting legal advice from an attorney who specializes in educational law, or has expertise in the Americans with Disabilities Act, to learn more about how the ADA may apply in a specific case to a particular individual with ADHD.

When Is The Best Age To Study English

Every parent is willing to provide the best education possible for their children and the first years of life are most vital in forming the future character of a grown-up person. The basic knowledge and skills the child learns and develops at an early age becomes the foundation for his or her further self-education and success in life.

Children are real quick-learners absorbing everything literally at a wink. So growing number of caring parents are trying to teach their kids English as a Second Language lessons as early as they could, even while the kids hardly started to master their mother tongue. Nowadays English has become so widespread as a world language beyond any boundaries that without speaking English you won’t have a chance to live as a global citizen. Let’s briefly discuss some of the pros and cons of such a parental decision for an early ESL education of their children.

It’s true that the older one gets it becomes harder for him or her to learn. The age bring with it natural learning limitations. The human brain is developing most dramatically when the person is young – the brain doubles when the baby reaches 9 months and triples upon reaching 3 years old. So the child learns new things many times quicker than an adult would. It stands true with learning foreign languages also. Knowing this the earlier you start your studies the better results you could achieve. Most specialists agree that the best age for learning anything new is before approximately 7 years old. For instance, world renowned scholars in the field of psychology Wilder Penfield and Lamar Roberts say that the best age for learning is between 4 to 8 years old. Whether to start your consistent studies before the child gets 4 or 5 is the issue but after that age is the most right time without any doubt.

Putting regular efforts into your English lessons with your kid either at home or at an ESL school would quite soon bring the fruits that you would be amazed of. For example, it’s ideal if one of the parents could speak English with the kid all the time. Conversation is one of the best ways to learn and it has no age limitations. Then your child will have the same fluency in English almost as he would in his native language. Teaching English should be consistent and natural to a child. If you would want to start teaching your small kid understanding English language grammar it won’t probably make any reasonable effect. It makes no sense to start explaining your child some new fancy words or explicit grammar rules if he doesn’t even able to understand the meaning of these words or doesn’t know them well even in his own language. The child should first form the clear notion of his native language before you start your English language lessons.

It’s best to organize English lessons with the child in the form of a game. The child would start repeating after you the pronunciation of words and that would be the real spoken English lessons. The child would copy you as all children do and would learn bit by bit, day after day.

Psychologists believe that the things learned at a young age would stick with the person all throughout his life. But it’s within the nature of child’s memory that the kid learns only what he listens and repeats numerous times. So once decided to start teaching your kids English, it’s better to keep going on. If you think your child has enough spoken skills in his own language and is ready enough for starting his ESL studies, then approach it with all your parental seriousness.

You can teach your kid only in the form of spoken English. Ideal if the child could communicate often with English native speakers to develop English listening right. It also give an effect of immersion into the language environment. The right English speaking pronunciation, learning the pronunciation of words and whole phrases, understanding English grammar rules are the most crucial issues to consider. So it is really important who is teaching your child English and how the teacher does it.

A good piece of advice might be to avoid usual and conventional methods of ESL study for children of pre-school age and even for the first graders. Choose well the teaching methodology. Prefer to utilize any kind of game approach with the use of bright visual tools in the form of certain pictures, cartoons, toys, bodily movements or even theatrical decorated performances. Use songs and dance. Body language is the key for spoken language. While you are interacting with a child continuously repeat certain easy phrases of sentences that the child would remember. Repeating and learning poems is indeed a wonderful method to learn english for kids. Recent scientific investigations by the International society for time studies showed that the verse dimensions and rhymes correlates deep with the intrinsic abilities of our brain which itself is functioning rhythmically. Each line of a verse should sound at least three seconds so that it could be easily accepted and reasoned by a brain.

RuneScape Tips – Basic Essentials You Must Know

Before studying the meat under RuneScape tips, it’s a good idea to talk about the game itself. RuneScape is a MMORPG (Google it if you do not know what it means) in which people from all other the world engage themselves in epic battles. You face other humans and computer controlled opponents that all compete for fame and money. The first thing you do when entering the fascinating world of RuneScape is to select a name.

Selecting your nickname in a wise manner is an essential tip in the game. This will be your screen identity for the rest of the game and you cannot change it thereafter. Never give your real name to anyone, hey for some reason they give you the option of choosing a handle you can use as an identity. There are many hackers in the RuneScape world and giving them your real name will make things much easier for them. On to more RuneScape tips.

You have the freedom to adventure from a choice of various virtual worlds. A good tip is to select a world that is physically located near your geographical region. This way you can enjoy higher speeds and avoid a lagging connection. If you are going to share any info on RuneScape, share the country, this makes it easier to find servers that you might not be aware of, but someone else is.

In RuneScape there is a list called the ignore list. If anyone seems to be annoying you till the cows come home add him to this list and they shall be blacklisted in your interface. RuneScape tips are scattered all over the internet. Whether you are a child or an adult, there’s tons of fun to have with RuneScape!

How Are Textbooks Made? The Process Of Textbook Creation Explained

Textbooks form the cornerstone of most student’s education and as a student it’s very common to have to read dozens of textbooks over the course of your time at college. But where do textbooks come from and how are they made? To answer this question you need to understand that there are a few different textbooks out there and each of these types has different origins.

Single Author Books
There’s a good chance that at least some of your textbooks are written by a single author, often an academic though not always. Some majors are more likely to base their education in these single author books while others use more conventionally understood multi-author textbooks.

Single author textbooks can really be anything. For example literature classes will use novels as their textbooks. Many liberal arts, anthropology and sociology classes will use single author books which are the result of fieldwork the author conducted and often single author books can be the result of a professor’s PHD dissertation. Even certain science classes will use single author books to fully expand on a certain subject or to approach a topic from a less dry and measured perspective.

Multi Author Books
The majority of ‘conventional’ textbooks are compiled and written together by multiple authors. Instead of seeking to present a single perspective on a topic these books attempt to be exhaustive and encyclopaedic in nature and cover the sum total of available information and departmental consensus on a topic. These are the types of books most people think about when they think about textbooks- thick volumes filled with facts and data and little interpretation.

Collected Volumes and Anthologies
Of course there are also plenty of textbooks which are compilations of smaller works by a wide variety of individual authors. A collection of essays on a single unified topic, such as film theory or a young adult fiction literature, epitomizes this style of textbook accurately.

Unlike other forms of textbooks these collected volumes and anthologies are generally put together by a single editor who may or may not contribute any of their own writing to the text but who curate the collection of writing from a selection of past and present authors.

The Textbook Creation and Printing Process
The actual process of making the textbook varies depending on which of the above styles of text is being investigated. Still, there is a general process which all textbooks go through.

All textbooks start with either an idea by the author/editor or an idea commissioned by a larger textbook manufacturer or university. That idea is then expounded upon by the author/editor who does the necessary research, writing and collecting to come up with their manuscript. That manuscript goes to an editor who reviews it, if it passes and doesn’t need major revisions it goes on to a copy editor who takes care of the specifics of spelling and grammar, and then it goes in for one final review and typesetting (interior design). Once the textbook passes all these checks it is finally printed and distributed to colleges and universities.