Effectiveness of Support for Children in Homeless Families

Effectiveness of Support for Children in Homeless Families The whole issue of parents and children in need is a vast, complex and ethically challenging one. This review is specifically charged with an examination of those issues which impinge upon the stresses and strains that are experienced by parents of children in need. A superficial examination of these issues that are involved in this particular area would suggest that there are a number of â€Å"sub-texts â€Å"which can all give rise to this particular situation. Firstly, to have child in need is clearly a stressful situation for any parent.(Meltzer H et al. 1999) This can clearly be purely a financial concern and a reflection of the fact that the whole family is in financial hardship, perhaps due to the economic situation or perhaps due to the actions of the parents themselves. Equally the need of the child can be a result of anon-financial need, so we should also consider the child who is in some way handicapped, ill, emotionally disturbed or perhaps in need in some other way. This produces another type of stress on the parent, and these stresses are typically longer lasting and, in general, less easily rectified than a purely financial consideration of need. (Hall D1996). It is part of the basic ethos of the welfare state that it should look after its less able and disadvantaged members. (Welsh Office 1997).Parents of children in need will often qualify in this definition. We shall therefore examine the various aspects of this problem. Literature Review Effectiveness of family support for children in homeless families We will make a start by considering one type of child in need. The first paper that we will consider is that of Prof. Vostanis (Vostanis2002), which looks at the mental health problems that are faced by deprived children and their families together with the effectiveness of the resources that are available to them. It is a well written and well researched paper, if rather complex and confusing in places. We will consider this paper in some detail as it provides an excellent overview of the whole area. The paper starts with a rather useful definition for our purposes. It qualifies the deprived child, initially in terms of a homeless family, that being : A family of any number of adults with dependent children who are statutorily accepted by local authorities (housing departments) in teak, and are usually accommodated for a brief period in voluntary agency, local authority or housing association hostels. This period of temporary accommodation can vary enormously depending on the time of year and the area considered, and can range from a few days to perhaps several months. The target in Greater London is currently storehouse homeless families within 4-6 weeks. In London particularly, the homeless families can be placed in Bed Breakfast accommodation.(D of H 1998) In this respect, the immediate family support mechanisms do appear tube in place. Vostranis however, goes on to make the observation that despite the fact that the definition of the homeless family is rather broad, it does not cover all of the potential children in need, as those children and their carers who have lost their homes but have managed to live with relatives, on the streets or perhaps live as travellers, are not covered by the statutory obligation to provide housing. The official figures therefore, he observes, are generally an underestimate of the true situation. The official figures for the homeless families are put (in this paper) at 140,000. (Vostanis Cumella, 1999) The authors give us further information in that many families will become homeless again within one year of rehousing and the typical family seen is the single mother and at least two children who are generally under the age of 11 yrs. They also observe that the typical father and adolescent child tend to be placed in homeless centres. (Doff H 1995) In exploration of the particular topic that we are considering, the authors give us the situations that typically have given rise to the degree of parental stress that may have led to the homelessness. They point to the fact that a homeless family is usually homeless for different reasons to the single homeless adult. Vostanis (et al 1997)is quoted as showing that 50% of the cases studied were homeless as direct result of domestic violence and 25% as a result of harassment from neighbours. The authors observe that the numbers in this category(and therefore the problems), are rising. (Welsh Office 1999). There are a number of section to this paper which are not directly referable to our considerations. We shall therefore direct our attention purely to those parts that have a direct bearing on the subject. One particularly useful and analytical part of the paper is the section that details the characteristics and needs of the target group. This is a very detailed section, but it makes the point that the children in need in this group are particularly heterogeneous, generally all with multiple and inter-related needs. Homelessness is seldom a one off event. This particular observation, (say the authors),is crucially important for the development and provision of services. Most families have histories of previous chronic adversities that constitute risk factors for both children and parents (Bassuk et al,1997). Such events include family conflict, violence and breakdown; limited or absent networks for family and social support; recurring moves; poverty; and unemployment. Mothers are more likely to have suffered abuse in their own childhood and adult life and children have increased rates of placement on the at-risk child protection register, because of neglect, physical and/or sexual abuse. If we specifically consider the health needs of this population, the authors categorise them thus: The children are more likely to have a history of low birthweight, anaemia, dental decay and delayed immunisations, to be of lower stature and have a greater degree of nutritional stress. They are also more likely to suffer accidents, injuries and burns. (BPA 1999) Some studies have found that child health problems increase with the duration of homelessness, although this finding is not consistent. Substantial proportion of homeless children have delayed development compared with the general population of children of a similar chronological age. This includes both specific developmental delays, such as in receptive and expressive language and visual, motor and reading skills, as well as general skills and educational status (Webbet al. 2001). It is for this reason specifically, that it has proved extremely difficult to assess the effectiveness of the family support services because of the multivariate nature of the problems that are presented. The authors point to the fact that one of the prime determinants of the degree of support available, is the actual access that the families have to these services. Many sources (viz. Wilkinson R 1996), equate the poor health of the disadvantaged primarily with the lack of access to services. One immediate difficulty is the current registration system in the UK. In order to be seen in the primary healthcare team setting, one must be registered with a named doctor. In the majority of cases that we are dealing with here, they have moved area and registration is probably not high on their list of priorities. One can argue that there is the access to the A E departments of the local hospitals but there is virtually no continuity here and they arena geared up to provide anything other than immediate treatment. (HallD 1996). This fact restricts their access to primary healthcare team procedures such as immunisations and other preventative medicine health clinics.(Lissauer et al, 1993) . By the same token these groups also have restricted access to the social services, whether they be the access teams, the family teams or the family support units and other agencies. The authors also point to other more disruptive trends in this group such as an inability to attend a particular school for fear of being tracked by an abusive partner. It follows that these children do not have a stable social support of a school. They are denied such factors as peer groups, routines and challenges which are both important protective and developmental factors. (Shankleman J et al2000). The summation of all of these factors, and others, is that the effectiveness of the family support services is greatly reduced by the mobility and the transient nature of the family unit. Quite apart from the difficulties outlined above relating to the problems of access to avenues of help open to the child in need and their families there are the problems engendered by the fact that social service departments indifferent areas of the country may not have immediate access to the previous records giving rise to many potential, and real, problems with continuity of care. This problem is brought into more immediate focus when one considers the increased frequency of child protection registrations in this particular group. (Hall D et al 1998). One specific analysis of the family support services of this particular group comes in the form of the psychiatric services. In the context of the title of this piece, it demonstrates how these particular services,(but not these alone), are failing to deal with the totality of the problem. All of the aspects that we have outlined so far are conspiring to dilute the effectiveness of the services provided. The fact that they are a mobile population with no fixed address means that some of the services may choose to invoke this as a reason for not making provision for them, particularly if resources are stretched. If more resources are given, then they are typically preferentially targeted at the single adult homeless population where the need is arguably greater. The authors of this paper point to the fact that this may not actually be true as some studies have shown that homeless single mothers and their children have a 49% psychopathy rate and only an 11% contact with the support services. (Cumella et al, 1998). The impact of this fact on the children can only be imagined. To an extent however, it can be quantified as the authors cite other studies which show a 30% need rating for children, (they do not actually define exactly what their perceived level of need was), contrasted with a 3% contact rate for children and adolescents in this area. (viz. Power S et al. 1995). Suggestions for improvement Putting these considerations together, the authors outline a set of proposals which are designed to help improve the access to some of the essential services. The model that they propose could, if successful and with a degree of modification, prove suitable for adaptation to other areas of the family support services. It is not appropriate to discuss this model in detail, but suffice it to say that it has tiered structure so that the degree of distress and need is titrated against the degree of input generated. One of the reasons that we have selected this particular paper to present in this context is for its last section. It proposes a â€Å"family support services model† which has been developed and pioneered in the Leicester area. In the context of our review, it is worth considering in some detail. A service provided through a family support team (four family support assistants).This is designed to detect a range of problems at the time of crisis; manage a degree of mental health problems (behavioural and emotional); provide parenting-training; support and train housing(hostel) staff; co-ordinate the work of different agencies; and provide some continuity after rehousing by ensuring intake by appropriate local services. The family workers are based at the main hostel for homeless children and families. Other, predominantly voluntary, services have established alternative posts, such as advocates and key workers. Whatever the title of the post, it is essential that the post-holder has some experience and on-going training in mental health and child protection, so that he or she can hold a substantial case-load, rather than merely mediate between already limited services. The family support workers have direct access to the local child and adult mental health services, whose staff provide weekly outreach clinics. Their role is to work with the family support workers another agencies, assess selected children and families, and provide treatment for more severe problems or disorders such as depression, self-harm and PTSD. A weekly inter-agency liaison meeting at the main hostel is attended by a health visitor, representatives of the local domestic violence service and Sure Start, There are also close, regular links with education welfare and social services. The aim is to effectively utilise specialist skills by discussing family situations from all perspectives at the liaison meeting. A bimonthly steering group, led by the housing department, involves senior managers representing these agencies, as well as the education and social services departments and the voluntary sector, and they oversee and co-ordinate the service. This appears to be something of an exemplar in relation to services provided elsewhere. The paper does not provide any element of costing sin this area neither does it provide any figures in relation to its success rates, contact rates or overall effectiveness. In conclusion this paper is an extremely well written and authoritative overview of the situation relating to the stresses of the homeless parent with children and the effectiveness (or lack of it) in its ability to reduce the stresses experienced by the homeless children in need and their parents. It proposes remedies but sadly it does not evaluate the effectiveness of those remedies. The effectiveness of the support services on families of children with psychiatric morbidity In order to address these shortcomings we can consider another paper by Tickler (et al 2000). This looks at a similar outreach set up which has been designed to capture the families of children in need who might otherwise slip through the net. This paper is written from different perspective and specifically analyses the effectiveness of these services as they pertain to an entry cohort of 40 families. This particular study was set up after preliminary work was done in the Birmingham area with 114 homeless families and this study defined the needs of the families but did not quantify their support systems.(Vostanis et al 1998). This paper set out to identify and measure the support systems available and their effectiveness as far as the families were concerned. The stresses encountered were partly reflected by the incidence of psychiatric morbidity. The mothers in the group were found to have over 50% more morbidity than a matched control group. The children in the group were found to have â€Å"histories of abuse, living in care, being on the at-risk protection register, delayed communication and higher reported mental health problems.† Allot which adds to the general background stress levels. (Kerouac S etal. 1996). This particular study found that despite the psychiatric morbidity in the children, (estimated to be about 30%), and the psychiatric morbidity in the parents, (estimated at about 50%), only 3%of the children and 10% of the parents had had any significant contactor support from the social services. In this respect, this paper is very useful to our purpose as it quantifies the levels of intervention and access to healthcare resources that this particular group has. By any appreciation, it would be considered woefully inadequate in any society that calls itself civilised. In the terms of the title of this piece, the effectiveness of the family support services is minimal. Suggestions for improvement Like the last paper discussed, this one also considered how best to tackle the problem, and this one is of much greater value to us, as it specifies a response, or intervention, to the problem in much the same way as the Vostranis 2002 paper did, but it makes the same measurements as it did prior to the intervention, and therefore allows us an insight into the actual effectiveness of the intervention. The way this particular study worked was to assess the problem (as it has been presented above), devise an intervention strategy and then to measure its effect. This particular study goes to great lengths to actively involve all the appropriate agencies that could help the situation by having a central assessment station that acted as liaison between all of the other resources. In brief, it actively involved liaison with the following: Education, social services, child protection, local mental health services, voluntary and community organisations to facilitate there-integration of the family into the community, and particularly their engagement with local services following rehousing; and training of staff of homeless centres in the understanding, recognition and management of mental illness in children and parents. This is essential, as hostel staff often work in isolation and have little knowledge of the potential severity and consequences of mental health problems in children. It was hoped that, by doing this, it would maximise the impact that the limited resources had on reducing the levels of morbidity and stress in the families of the children in need. Results The post intervention results were, by any estimate, impressive considering the historical difficulty of working with this particular group (OHara M 1995). 40 families (including 122 children) were studied in detail. The paper gives a detailed breakdown of the ethnic and demographic breakdown of the group. By far the biggest group were single mothers and children (72%) The results showed that the majority of referrals were seen between1-3 times (55%), with a further 22% being seen 4-6 times. It is reflection of the difficulty in engaging this type of family in need that over 25% did not actually keep their appointments despite the obvious potential benefits that could have been utilised. The authors investigated this group further and ascertained that a common reason for nonattendance was the perception that the psychological welfare of the children was not actually the main concern. The families perceived that their primary needs were rehousing and financial stability. Other priorities identified were that physical health was a greater priority than mental health. The authors also identify another common failing in the social services provision, and that is the general lack of regular contact. They cite the situation where some families cope well initially, apparently glad to have escaped an abusive or violent home situation, but a prolonged stay in a hostel or temporary accommodation may soon precipitate a bout of depression in the parents and behavioural problems in the children of such parents. (Brooks RM et al 1998). They suggest that regular re-visiting of families who have been in temporary accommodation for any significant length of time should be mandatory. This paper takes a very practical overview by pointing out that workability of the system is, to a large extent, dependent on the goodwill of a number of committed professionals. The authors state that this has to be nurtured and they call for sufficient funding must be given to enable this particular model to be extended to a National level. Thus far in the review we have considered the effectiveness of the service provision in the support of the families of the children in need in one specific target grouping, those who are stressed by virtue of the fact that they are homeless. We will now consider the literature on a different kind of family stress, and that is when a parent dies. This leaves the children with a considerable amount of potential emotional â€Å"baggage† and the surviving parent with an enormous amount of stress. (Webb E 1998). Effectiveness of support services in the case of parental bereavement An excellent paper by Downey (et al 1999) tackles this particular problem with both sensitivity and also considerable rigour. It is a long and complex paper, but the overall aims and objectives are clear from the outset. The structure of the paper is a prospective case study which aims to assess whether the degree of distress suffered by a family during a time of bereavement is in any way linked to the degree of service provision that is utilised. The base line for this study is set out in its first two paragraphs. Parentally bereaved children and surviving parents showed a greater than predicted level of psychiatric morbidity. Boys had greater levels of demonstrable morbidity than did girls, but bereaved mothers showed more morbidity than did bereaved fathers. Children were more likely to show signs of behavioural disturbance when the surviving parent manifested some kind of psychiatric disorder. (Kranzler EM et al 1990). The authors point to the fact that their study shows that the service provision is statistically related to a number of (arguably unexpected[Fristad MA et al 1993]) factors namely: The age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death. Paradoxically the level of service provision was not found to be statistically significantly related to either the parental wishes or the degree of the psychiatric disturbance in either the parent orchid. (Sanchez L et al 1994) The service provision did have some statistical relationships but that was only found to be the manner of the parental death and the actual age of the child at the time. The authors therefore are able to identify a mismatch between the perceived need for support and the actual service provision made. Part of that mismatch is found to be due to the inability of the social services and other related agencies to take a dispassionate overview. Elsewhere in the paper the authors suggest that there are other factors that add to this inequality and they include lack of resources and a lack of specificity in identifying children at greatest risk.(Harrington R 1996) The authors examine other literature to back up their initial precept that bereaved children have greater levels of morbidity. They cite many other papers who have found distress manifesting in the form of â€Å"anxiety, depression, withdrawal, sleep disturbance, and aggression.†(Worden JW et al. 1996) and also psychological problems in later life(Harris T et al. 1996). In terms of study structure, the authors point to methodological problems with other papers in the area including a common failing of either having a standardised measure or no matched control group(Mohammed D et al 2003). They also point to the fact that this is probably the first UK study to investigate the subject using a properly representative sample and certainly the first to investigate whether service provision is actually related to the degree of the problems experienced. The entry cohort involved nearly 550 families with 94 having children in the target range (2-18). With certain exclusions (such as two families where one parent had murdered the other etc.) and no respondents, the final cohort was reduced to 45 families and one target child was randomly selected from each family. It has to be noted that the comparatively large number of on-respondents may have introduced a large element of bias, insofar as it is possible that the families most in need of support were those who were most distressed by the death of a family member and these could have been the very ones who chose not to participate. (Morton V et al2003) The authors make no comment on this particular fact. The authors should be commended for a particularly ingenious control measure for the children. They were matched by asking their schoolteacher to complete an inventory of disturbed behaviour on the next child in the school register after the target child. A large part of the paper is taken up with methodological issues which ( apart from the comments above) cannot be faulted. Results In terms of being children in need, 60% of children were found to have â€Å"significant behavioural abnormalities† with 28% having scores above the 95th centile. In terms of specific service support provision, 82% of parents identified a perceived need for support by virtue of the behaviour of their children. Only 49% of these actually received it in any degree. Perhaps the most surprising statistic to come out of this study waste fact that of the parents who were offered support 44% were in the group who asked for it and 56% were in the group who didn’t want it. The levels of support offered were independent of the degree of behavioural disturbance in the child. Suggestions for improvement As with the majority of papers that we have either presented here or read in preparation for this review, the authors call for a more rationally targeted approach to the utilisation of limited resources. The study also provides us with a very pertinent comment which many experienced healthcare professionals will empathise with, (Black D1996), and that is: Practitioners should also be aware that child disturbance may reflect undetected psychological distress in the surviving parent. While not suggesting that this is a reflection of Munchausen’s syndrome by proxy, the comment is a valid reflection of the fact that parental distress may be well hidden from people outside of the family and may only present as a manifestation of the child’s behaviour. (Feldman Met al. 1994) The conclusions that can be drawn from this study are that there is considerable gap in the support offered ( quite apart form the effectiveness of that support) in this area of obvious stress for both parents and children. (Black D 1998). This study goes some way to quantifying the level of support actually given in these circumstances. Effectiveness of support in families where there is domestic violence We have considered the role of the effectiveness and indeed, even the existence, of adequate support services for the children in need and their parents in a number of different social circumstances. The next paper that we wish to present is an excellent review of the support that is given to another specific sub-group and that is women and children who suffer from domestic violence. Webb and her group (etal 2001) considered the problem in considerable (and commendable) depth The study itself had an entry cohort of nearly 150 children and their mothers who were resident in a number of hostels and women’s refuges that had been the victims of family violence at some stage in the recent past. The study subjected the cohort to a battery of tests designed to assess their physical, emotional and psychological health, and then quantified their access to, and support gained from, the primary healthcare teams and other social service-based support agencies. This study is presented in a long and sometimes difficult tread format. Much of the presentation is (understandably) taken up with statistical, ethical and methodological matters – all of which appear to be largely of excellent quality and the result of careful consideration. Results The results make for interesting and, (in the context of this review), very relevant reading. Perhaps one of the more original findings was that nearly 60% of the child health data held by the various refuges was factually incorrect. This clearly has grave implications for studies that base their evidence base on that data set(Berwick D 2005). Of great implication for the social services support mechanisms was the finding that 76% of the mothers in the study expressed concerns about the health of their children. Once they had left the refuge there was significant loss to the follow up systems as 15% were untraceable and25% returned to the home of the original perpetrator. The study documents the fact that this particular group had both high level of need for support and also a poor level of access to appropriate services. In the study conclusions, the authors make the pertinent comment that the time spent in the refuge offers a â€Å"window of opportunity† for the family support services to make contact and to review health and child developmental status. This is not a demographically small group. In the UK, over 35,000children and a parent, are recorded as passing through the refuges each year, with at least a similar number also being referred to other types of safe accommodation. Such measures are clearly not undertaken lightly with the average woman only entering a refuge after an average of 28separate assaults. One can only speculate at the long term effects that this can have on both the mother and the children. Suggestions for improvement In common with the other papers reviewed, this paper also calls for greater levels of support for the families concerned as, by inference, the current levels of effectiveness of the family support services is clearly inadequate. Conclusions This review has specifically presented a number of papers which have been chosen from a much larger number that have been accessed and assessed, because of the fact that each has a particularly important issue or factor in its construction or results. The issue that we have set out to evaluate is the effectiveness of the family support services which are specifically aimed at reducing the stress levels for the parents of children in need. Almost without exception, all of the papers that have been accessed (quite apart from those presented) have demonstrated the fact that the levels of support from the statutory bodies is â€Å"less than optimum† and in some cases it can only be described as â€Å"dire†. Another factor that is a common finding, is that, given the fact that any welfare system is, by its very nature, a rationed system, the provision of the services that are provided is seldom targeted at the groups that need it the most. One can cite the Tickler (et al 2000)and Downey (et al 1999) papers in particular as demonstrating that substantial proportion of the resources mobilised are actually being directed to groups that are either not requesting support or who demonstrably need it less than other sectors of the community. Some of the papers (actually a small proportion) make positive suggestions about the models for redirecting and targeting support. Sadly, the majority do little more than call for â€Å"more research to be done on the issue†. In overview, we would have to conclude that the evidence suggests that the effectiveness of the family support services in reducing stress and poverty for the parents of children in need is poor at best and certainly capable of considerable improvement. References Bassuk, E., Buckner, J., Weiner, L., et al (1997) Homelessness in female-headed families: childhood and adult risk and protective factors. American Journal of Public Health, 87, 241–248 1997 Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Black D. 1996 Childhood bereavement: distress and long term sequelae can be lessened by early intervention. BMJ 1996; 312: 1496 Black D. 1998 Coping with loss: bereavement in childhood. BMJ 1998; 316: 931-933 BPA 1999 British Paediatric Association. Outcome measures for child health. London: Royal College of Paediatric Effectiveness of Support for Children in Homeless Families Effectiveness of Support for Children in Homeless Families The whole issue of parents and children in need is a vast, complex and ethically challenging one. This review is specifically charged with an examination of those issues which impinge upon the stresses and strains that are experienced by parents of children in need. A superficial examination of these issues that are involved in this particular area would suggest that there are a number of â€Å"sub-texts â€Å"which can all give rise to this particular situation. Firstly, to have child in need is clearly a stressful situation for any parent.(Meltzer H et al. 1999) This can clearly be purely a financial concern and a reflection of the fact that the whole family is in financial hardship, perhaps due to the economic situation or perhaps due to the actions of the parents themselves. Equally the need of the child can be a result of anon-financial need, so we should also consider the child who is in some way handicapped, ill, emotionally disturbed or perhaps in need in some other way. This produces another type of stress on the parent, and these stresses are typically longer lasting and, in general, less easily rectified than a purely financial consideration of need. (Hall D1996). It is part of the basic ethos of the welfare state that it should look after its less able and disadvantaged members. (Welsh Office 1997).Parents of children in need will often qualify in this definition. We shall therefore examine the various aspects of this problem. Literature Review Effectiveness of family support for children in homeless families We will make a start by considering one type of child in need. The first paper that we will consider is that of Prof. Vostanis (Vostanis2002), which looks at the mental health problems that are faced by deprived children and their families together with the effectiveness of the resources that are available to them. It is a well written and well researched paper, if rather complex and confusing in places. We will consider this paper in some detail as it provides an excellent overview of the whole area. The paper starts with a rather useful definition for our purposes. It qualifies the deprived child, initially in terms of a homeless family, that being : A family of any number of adults with dependent children who are statutorily accepted by local authorities (housing departments) in teak, and are usually accommodated for a brief period in voluntary agency, local authority or housing association hostels. This period of temporary accommodation can vary enormously depending on the time of year and the area considered, and can range from a few days to perhaps several months. The target in Greater London is currently storehouse homeless families within 4-6 weeks. In London particularly, the homeless families can be placed in Bed Breakfast accommodation.(D of H 1998) In this respect, the immediate family support mechanisms do appear tube in place. Vostranis however, goes on to make the observation that despite the fact that the definition of the homeless family is rather broad, it does not cover all of the potential children in need, as those children and their carers who have lost their homes but have managed to live with relatives, on the streets or perhaps live as travellers, are not covered by the statutory obligation to provide housing. The official figures therefore, he observes, are generally an underestimate of the true situation. The official figures for the homeless families are put (in this paper) at 140,000. (Vostanis Cumella, 1999) The authors give us further information in that many families will become homeless again within one year of rehousing and the typical family seen is the single mother and at least two children who are generally under the age of 11 yrs. They also observe that the typical father and adolescent child tend to be placed in homeless centres. (Doff H 1995) In exploration of the particular topic that we are considering, the authors give us the situations that typically have given rise to the degree of parental stress that may have led to the homelessness. They point to the fact that a homeless family is usually homeless for different reasons to the single homeless adult. Vostanis (et al 1997)is quoted as showing that 50% of the cases studied were homeless as direct result of domestic violence and 25% as a result of harassment from neighbours. The authors observe that the numbers in this category(and therefore the problems), are rising. (Welsh Office 1999). There are a number of section to this paper which are not directly referable to our considerations. We shall therefore direct our attention purely to those parts that have a direct bearing on the subject. One particularly useful and analytical part of the paper is the section that details the characteristics and needs of the target group. This is a very detailed section, but it makes the point that the children in need in this group are particularly heterogeneous, generally all with multiple and inter-related needs. Homelessness is seldom a one off event. This particular observation, (say the authors),is crucially important for the development and provision of services. Most families have histories of previous chronic adversities that constitute risk factors for both children and parents (Bassuk et al,1997). Such events include family conflict, violence and breakdown; limited or absent networks for family and social support; recurring moves; poverty; and unemployment. Mothers are more likely to have suffered abuse in their own childhood and adult life and children have increased rates of placement on the at-risk child protection register, because of neglect, physical and/or sexual abuse. If we specifically consider the health needs of this population, the authors categorise them thus: The children are more likely to have a history of low birthweight, anaemia, dental decay and delayed immunisations, to be of lower stature and have a greater degree of nutritional stress. They are also more likely to suffer accidents, injuries and burns. (BPA 1999) Some studies have found that child health problems increase with the duration of homelessness, although this finding is not consistent. Substantial proportion of homeless children have delayed development compared with the general population of children of a similar chronological age. This includes both specific developmental delays, such as in receptive and expressive language and visual, motor and reading skills, as well as general skills and educational status (Webbet al. 2001). It is for this reason specifically, that it has proved extremely difficult to assess the effectiveness of the family support services because of the multivariate nature of the problems that are presented. The authors point to the fact that one of the prime determinants of the degree of support available, is the actual access that the families have to these services. Many sources (viz. Wilkinson R 1996), equate the poor health of the disadvantaged primarily with the lack of access to services. One immediate difficulty is the current registration system in the UK. In order to be seen in the primary healthcare team setting, one must be registered with a named doctor. In the majority of cases that we are dealing with here, they have moved area and registration is probably not high on their list of priorities. One can argue that there is the access to the A E departments of the local hospitals but there is virtually no continuity here and they arena geared up to provide anything other than immediate treatment. (HallD 1996). This fact restricts their access to primary healthcare team procedures such as immunisations and other preventative medicine health clinics.(Lissauer et al, 1993) . By the same token these groups also have restricted access to the social services, whether they be the access teams, the family teams or the family support units and other agencies. The authors also point to other more disruptive trends in this group such as an inability to attend a particular school for fear of being tracked by an abusive partner. It follows that these children do not have a stable social support of a school. They are denied such factors as peer groups, routines and challenges which are both important protective and developmental factors. (Shankleman J et al2000). The summation of all of these factors, and others, is that the effectiveness of the family support services is greatly reduced by the mobility and the transient nature of the family unit. Quite apart from the difficulties outlined above relating to the problems of access to avenues of help open to the child in need and their families there are the problems engendered by the fact that social service departments indifferent areas of the country may not have immediate access to the previous records giving rise to many potential, and real, problems with continuity of care. This problem is brought into more immediate focus when one considers the increased frequency of child protection registrations in this particular group. (Hall D et al 1998). One specific analysis of the family support services of this particular group comes in the form of the psychiatric services. In the context of the title of this piece, it demonstrates how these particular services,(but not these alone), are failing to deal with the totality of the problem. All of the aspects that we have outlined so far are conspiring to dilute the effectiveness of the services provided. The fact that they are a mobile population with no fixed address means that some of the services may choose to invoke this as a reason for not making provision for them, particularly if resources are stretched. If more resources are given, then they are typically preferentially targeted at the single adult homeless population where the need is arguably greater. The authors of this paper point to the fact that this may not actually be true as some studies have shown that homeless single mothers and their children have a 49% psychopathy rate and only an 11% contact with the support services. (Cumella et al, 1998). The impact of this fact on the children can only be imagined. To an extent however, it can be quantified as the authors cite other studies which show a 30% need rating for children, (they do not actually define exactly what their perceived level of need was), contrasted with a 3% contact rate for children and adolescents in this area. (viz. Power S et al. 1995). Suggestions for improvement Putting these considerations together, the authors outline a set of proposals which are designed to help improve the access to some of the essential services. The model that they propose could, if successful and with a degree of modification, prove suitable for adaptation to other areas of the family support services. It is not appropriate to discuss this model in detail, but suffice it to say that it has tiered structure so that the degree of distress and need is titrated against the degree of input generated. One of the reasons that we have selected this particular paper to present in this context is for its last section. It proposes a â€Å"family support services model† which has been developed and pioneered in the Leicester area. In the context of our review, it is worth considering in some detail. A service provided through a family support team (four family support assistants).This is designed to detect a range of problems at the time of crisis; manage a degree of mental health problems (behavioural and emotional); provide parenting-training; support and train housing(hostel) staff; co-ordinate the work of different agencies; and provide some continuity after rehousing by ensuring intake by appropriate local services. The family workers are based at the main hostel for homeless children and families. Other, predominantly voluntary, services have established alternative posts, such as advocates and key workers. Whatever the title of the post, it is essential that the post-holder has some experience and on-going training in mental health and child protection, so that he or she can hold a substantial case-load, rather than merely mediate between already limited services. The family support workers have direct access to the local child and adult mental health services, whose staff provide weekly outreach clinics. Their role is to work with the family support workers another agencies, assess selected children and families, and provide treatment for more severe problems or disorders such as depression, self-harm and PTSD. A weekly inter-agency liaison meeting at the main hostel is attended by a health visitor, representatives of the local domestic violence service and Sure Start, There are also close, regular links with education welfare and social services. The aim is to effectively utilise specialist skills by discussing family situations from all perspectives at the liaison meeting. A bimonthly steering group, led by the housing department, involves senior managers representing these agencies, as well as the education and social services departments and the voluntary sector, and they oversee and co-ordinate the service. This appears to be something of an exemplar in relation to services provided elsewhere. The paper does not provide any element of costing sin this area neither does it provide any figures in relation to its success rates, contact rates or overall effectiveness. In conclusion this paper is an extremely well written and authoritative overview of the situation relating to the stresses of the homeless parent with children and the effectiveness (or lack of it) in its ability to reduce the stresses experienced by the homeless children in need and their parents. It proposes remedies but sadly it does not evaluate the effectiveness of those remedies. The effectiveness of the support services on families of children with psychiatric morbidity In order to address these shortcomings we can consider another paper by Tickler (et al 2000). This looks at a similar outreach set up which has been designed to capture the families of children in need who might otherwise slip through the net. This paper is written from different perspective and specifically analyses the effectiveness of these services as they pertain to an entry cohort of 40 families. This particular study was set up after preliminary work was done in the Birmingham area with 114 homeless families and this study defined the needs of the families but did not quantify their support systems.(Vostanis et al 1998). This paper set out to identify and measure the support systems available and their effectiveness as far as the families were concerned. The stresses encountered were partly reflected by the incidence of psychiatric morbidity. The mothers in the group were found to have over 50% more morbidity than a matched control group. The children in the group were found to have â€Å"histories of abuse, living in care, being on the at-risk protection register, delayed communication and higher reported mental health problems.† Allot which adds to the general background stress levels. (Kerouac S etal. 1996). This particular study found that despite the psychiatric morbidity in the children, (estimated to be about 30%), and the psychiatric morbidity in the parents, (estimated at about 50%), only 3%of the children and 10% of the parents had had any significant contactor support from the social services. In this respect, this paper is very useful to our purpose as it quantifies the levels of intervention and access to healthcare resources that this particular group has. By any appreciation, it would be considered woefully inadequate in any society that calls itself civilised. In the terms of the title of this piece, the effectiveness of the family support services is minimal. Suggestions for improvement Like the last paper discussed, this one also considered how best to tackle the problem, and this one is of much greater value to us, as it specifies a response, or intervention, to the problem in much the same way as the Vostranis 2002 paper did, but it makes the same measurements as it did prior to the intervention, and therefore allows us an insight into the actual effectiveness of the intervention. The way this particular study worked was to assess the problem (as it has been presented above), devise an intervention strategy and then to measure its effect. This particular study goes to great lengths to actively involve all the appropriate agencies that could help the situation by having a central assessment station that acted as liaison between all of the other resources. In brief, it actively involved liaison with the following: Education, social services, child protection, local mental health services, voluntary and community organisations to facilitate there-integration of the family into the community, and particularly their engagement with local services following rehousing; and training of staff of homeless centres in the understanding, recognition and management of mental illness in children and parents. This is essential, as hostel staff often work in isolation and have little knowledge of the potential severity and consequences of mental health problems in children. It was hoped that, by doing this, it would maximise the impact that the limited resources had on reducing the levels of morbidity and stress in the families of the children in need. Results The post intervention results were, by any estimate, impressive considering the historical difficulty of working with this particular group (OHara M 1995). 40 families (including 122 children) were studied in detail. The paper gives a detailed breakdown of the ethnic and demographic breakdown of the group. By far the biggest group were single mothers and children (72%) The results showed that the majority of referrals were seen between1-3 times (55%), with a further 22% being seen 4-6 times. It is reflection of the difficulty in engaging this type of family in need that over 25% did not actually keep their appointments despite the obvious potential benefits that could have been utilised. The authors investigated this group further and ascertained that a common reason for nonattendance was the perception that the psychological welfare of the children was not actually the main concern. The families perceived that their primary needs were rehousing and financial stability. Other priorities identified were that physical health was a greater priority than mental health. The authors also identify another common failing in the social services provision, and that is the general lack of regular contact. They cite the situation where some families cope well initially, apparently glad to have escaped an abusive or violent home situation, but a prolonged stay in a hostel or temporary accommodation may soon precipitate a bout of depression in the parents and behavioural problems in the children of such parents. (Brooks RM et al 1998). They suggest that regular re-visiting of families who have been in temporary accommodation for any significant length of time should be mandatory. This paper takes a very practical overview by pointing out that workability of the system is, to a large extent, dependent on the goodwill of a number of committed professionals. The authors state that this has to be nurtured and they call for sufficient funding must be given to enable this particular model to be extended to a National level. Thus far in the review we have considered the effectiveness of the service provision in the support of the families of the children in need in one specific target grouping, those who are stressed by virtue of the fact that they are homeless. We will now consider the literature on a different kind of family stress, and that is when a parent dies. This leaves the children with a considerable amount of potential emotional â€Å"baggage† and the surviving parent with an enormous amount of stress. (Webb E 1998). Effectiveness of support services in the case of parental bereavement An excellent paper by Downey (et al 1999) tackles this particular problem with both sensitivity and also considerable rigour. It is a long and complex paper, but the overall aims and objectives are clear from the outset. The structure of the paper is a prospective case study which aims to assess whether the degree of distress suffered by a family during a time of bereavement is in any way linked to the degree of service provision that is utilised. The base line for this study is set out in its first two paragraphs. Parentally bereaved children and surviving parents showed a greater than predicted level of psychiatric morbidity. Boys had greater levels of demonstrable morbidity than did girls, but bereaved mothers showed more morbidity than did bereaved fathers. Children were more likely to show signs of behavioural disturbance when the surviving parent manifested some kind of psychiatric disorder. (Kranzler EM et al 1990). The authors point to the fact that their study shows that the service provision is statistically related to a number of (arguably unexpected[Fristad MA et al 1993]) factors namely: The age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death. Paradoxically the level of service provision was not found to be statistically significantly related to either the parental wishes or the degree of the psychiatric disturbance in either the parent orchid. (Sanchez L et al 1994) The service provision did have some statistical relationships but that was only found to be the manner of the parental death and the actual age of the child at the time. The authors therefore are able to identify a mismatch between the perceived need for support and the actual service provision made. Part of that mismatch is found to be due to the inability of the social services and other related agencies to take a dispassionate overview. Elsewhere in the paper the authors suggest that there are other factors that add to this inequality and they include lack of resources and a lack of specificity in identifying children at greatest risk.(Harrington R 1996) The authors examine other literature to back up their initial precept that bereaved children have greater levels of morbidity. They cite many other papers who have found distress manifesting in the form of â€Å"anxiety, depression, withdrawal, sleep disturbance, and aggression.†(Worden JW et al. 1996) and also psychological problems in later life(Harris T et al. 1996). In terms of study structure, the authors point to methodological problems with other papers in the area including a common failing of either having a standardised measure or no matched control group(Mohammed D et al 2003). They also point to the fact that this is probably the first UK study to investigate the subject using a properly representative sample and certainly the first to investigate whether service provision is actually related to the degree of the problems experienced. The entry cohort involved nearly 550 families with 94 having children in the target range (2-18). With certain exclusions (such as two families where one parent had murdered the other etc.) and no respondents, the final cohort was reduced to 45 families and one target child was randomly selected from each family. It has to be noted that the comparatively large number of on-respondents may have introduced a large element of bias, insofar as it is possible that the families most in need of support were those who were most distressed by the death of a family member and these could have been the very ones who chose not to participate. (Morton V et al2003) The authors make no comment on this particular fact. The authors should be commended for a particularly ingenious control measure for the children. They were matched by asking their schoolteacher to complete an inventory of disturbed behaviour on the next child in the school register after the target child. A large part of the paper is taken up with methodological issues which ( apart from the comments above) cannot be faulted. Results In terms of being children in need, 60% of children were found to have â€Å"significant behavioural abnormalities† with 28% having scores above the 95th centile. In terms of specific service support provision, 82% of parents identified a perceived need for support by virtue of the behaviour of their children. Only 49% of these actually received it in any degree. Perhaps the most surprising statistic to come out of this study waste fact that of the parents who were offered support 44% were in the group who asked for it and 56% were in the group who didn’t want it. The levels of support offered were independent of the degree of behavioural disturbance in the child. Suggestions for improvement As with the majority of papers that we have either presented here or read in preparation for this review, the authors call for a more rationally targeted approach to the utilisation of limited resources. The study also provides us with a very pertinent comment which many experienced healthcare professionals will empathise with, (Black D1996), and that is: Practitioners should also be aware that child disturbance may reflect undetected psychological distress in the surviving parent. While not suggesting that this is a reflection of Munchausen’s syndrome by proxy, the comment is a valid reflection of the fact that parental distress may be well hidden from people outside of the family and may only present as a manifestation of the child’s behaviour. (Feldman Met al. 1994) The conclusions that can be drawn from this study are that there is considerable gap in the support offered ( quite apart form the effectiveness of that support) in this area of obvious stress for both parents and children. (Black D 1998). This study goes some way to quantifying the level of support actually given in these circumstances. Effectiveness of support in families where there is domestic violence We have considered the role of the effectiveness and indeed, even the existence, of adequate support services for the children in need and their parents in a number of different social circumstances. The next paper that we wish to present is an excellent review of the support that is given to another specific sub-group and that is women and children who suffer from domestic violence. Webb and her group (etal 2001) considered the problem in considerable (and commendable) depth The study itself had an entry cohort of nearly 150 children and their mothers who were resident in a number of hostels and women’s refuges that had been the victims of family violence at some stage in the recent past. The study subjected the cohort to a battery of tests designed to assess their physical, emotional and psychological health, and then quantified their access to, and support gained from, the primary healthcare teams and other social service-based support agencies. This study is presented in a long and sometimes difficult tread format. Much of the presentation is (understandably) taken up with statistical, ethical and methodological matters – all of which appear to be largely of excellent quality and the result of careful consideration. Results The results make for interesting and, (in the context of this review), very relevant reading. Perhaps one of the more original findings was that nearly 60% of the child health data held by the various refuges was factually incorrect. This clearly has grave implications for studies that base their evidence base on that data set(Berwick D 2005). Of great implication for the social services support mechanisms was the finding that 76% of the mothers in the study expressed concerns about the health of their children. Once they had left the refuge there was significant loss to the follow up systems as 15% were untraceable and25% returned to the home of the original perpetrator. The study documents the fact that this particular group had both high level of need for support and also a poor level of access to appropriate services. In the study conclusions, the authors make the pertinent comment that the time spent in the refuge offers a â€Å"window of opportunity† for the family support services to make contact and to review health and child developmental status. This is not a demographically small group. In the UK, over 35,000children and a parent, are recorded as passing through the refuges each year, with at least a similar number also being referred to other types of safe accommodation. Such measures are clearly not undertaken lightly with the average woman only entering a refuge after an average of 28separate assaults. One can only speculate at the long term effects that this can have on both the mother and the children. Suggestions for improvement In common with the other papers reviewed, this paper also calls for greater levels of support for the families concerned as, by inference, the current levels of effectiveness of the family support services is clearly inadequate. Conclusions This review has specifically presented a number of papers which have been chosen from a much larger number that have been accessed and assessed, because of the fact that each has a particularly important issue or factor in its construction or results. The issue that we have set out to evaluate is the effectiveness of the family support services which are specifically aimed at reducing the stress levels for the parents of children in need. Almost without exception, all of the papers that have been accessed (quite apart from those presented) have demonstrated the fact that the levels of support from the statutory bodies is â€Å"less than optimum† and in some cases it can only be described as â€Å"dire†. Another factor that is a common finding, is that, given the fact that any welfare system is, by its very nature, a rationed system, the provision of the services that are provided is seldom targeted at the groups that need it the most. One can cite the Tickler (et al 2000)and Downey (et al 1999) papers in particular as demonstrating that substantial proportion of the resources mobilised are actually being directed to groups that are either not requesting support or who demonstrably need it less than other sectors of the community. Some of the papers (actually a small proportion) make positive suggestions about the models for redirecting and targeting support. Sadly, the majority do little more than call for â€Å"more research to be done on the issue†. In overview, we would have to conclude that the evidence suggests that the effectiveness of the family support services in reducing stress and poverty for the parents of children in need is poor at best and certainly capable of considerable improvement. References Bassuk, E., Buckner, J., Weiner, L., et al (1997) Homelessness in female-headed families: childhood and adult risk and protective factors. American Journal of Public Health, 87, 241–248 1997 Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Black D. 1996 Childhood bereavement: distress and long term sequelae can be lessened by early intervention. BMJ 1996; 312: 1496 Black D. 1998 Coping with loss: bereavement in childhood. BMJ 1998; 316: 931-933 BPA 1999 British Paediatric Association. Outcome measures for child health. London: Royal College of Paediatric

Changing Use Of Language :: essays research papers

I chose to find the entomology of a word that most people can usually not go through a day without using at least once, computer. With the explosion of the personal computer in the last ten years, most households in America own at least one. However, the meaning of the word "computer" has changed in the last century. The word itself is found in text as far back as 1646 when Sir T. Brown said, "The calendars of these computers." The use of "computer" in this sense, as defined by the OED, is one who computes; a calculator, reckoner; a person employed to make calculations in an observatory, in surveying, etc.Then, around 1897, the use of "computer" began to change. In the January 22 edition of Engineering, this usage appeared: "This was... a computer made by Mr. W. Cox. He described it as of the nature of a circular slide rule." This usage began the change of the definition. In the supplement to the OED, "computer" is now defined as a calculating machine; an automatic electronic device for performing mathematical or logical operation.The word "computer" stems from the verb "compute" which came from the French comput-r and the Latin computa-re. It was formed by adding com - together and putare - to clear up, settle, reckon. Together, "compute" means to estimate or determine by arithmetical or mathematical reckoning; to calculate, reckon, count. Then from the word "compute", the suffix "er" was added giving us the definitions we have for computer today.2) In an effort to further understand language, the field of psycholinguistics formed to study the psychological side of language. Language has many different functions such as communication, expressing emotion, explaining ideas, to create relationships, and recording ideas. Without the use of language, it would be nearly impossible to explain the history of anything. Language allows for the communication that is necessary for survival. It is not only humans who benefit from language either. Bees use a complex system of a dance and buzz to show the hive where to find food, and birds use different chirps to communicate.One psycholinguistic, Hockett, said that all languages have some aspects that are the same at some level which he called Linguistic Universals. One aspect of Linguistic Universals is the broadcast transmission, which says that language is public and that anyone around the message will pick it up. Another aspect of language is that it is rapid fading, or if you don't get it right away, you won't get it at all.

Code Switching

Urdu-English Code-Switching: The Use of Urdu Phrases and Clauses In Pakistani English (A Non-native Variety) Abstract This paper presents an analysis of Urdu-English code-switching in Pakistani English. However, data has been analysed only at the phrase and clause level. Based on the empirical data from Pakistani English newspapers and magazines, this paper aims to show that code-switching is not a grammarless phenomenon rather it is ruled governed activity at the phrase and clause level. It also presents the brief overview of the use of English as a non-native variety.This paper suggests that variations and changes in a language are an integral part of bilingualism and multilingualism. All the present data shows that the occurrences of various Urdu phrases and clauses impose no ungrammatical effect on the construction of English syntax. Key words: Bilingualism, code-switching, non-native varieties of English Introduction This paper centres on the variations in the English language d ue to Urdu-English code-switching in Pakistan and also shows the significant role of the Urdu language in the formation of Pakistani English.Only those syntactic features that are found as a result of code-switching have been discussed. Mahboob (2003) described different phonological and grammatical aspects of Pakistani English, which are quite different from Standard British English. But in this paper, only that data has been taken into account where Urdu phrases and clauses have been used. This paper is interested in describing different aspects of language change in English when used in a non-native context i. e. Pakistan.First and foremost, ‘a great deal of interest has been generated in the English language as a result of its spread around the world and its use as an international language (Cheshire 1991:7). Now-a-days English has become a global language. According to Bamgbose, (2001:357) English is recognised as the dominating language in the world as globalisation come s to be universally accepted in political and academic discourse. The development of ‘globalisation’ has been associated with the dominance of the English language (Bottery 2000:6).English is used all over the world by millions of native and non-native speakers because of its dominant position. According to Crystal (2003:65), there are approximately 430 million L2 users and 330 million L1 users. So the non-native speakers use English more than the natives ones. However, these figures exclude learners of English, and Crystal suggests there may be as many as one billion of them. Being an international language, it is used almost in all the countries of the world. When people started using English in non-native contexts because of its growing popularity, it developed as a transplanted language.According to Kachru (1986:30): ‘A language may be considered transplanted if it is used by a significant numbers of speakers in social, cultural and geographical contexts diffe rent from the contexts in which it was originally used†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. a transplanted language is cut off from its traditional roots and begins to function in new surroundings, in new roles and new contexts’. Non-native Varieties of English Kachru (1978) was among the first to identify and delineate boundaries of a nativized variety of English in South Asia, which he terms as South Asian English (SAE).Kachru (1996) regarded SAE as an additional linguistic arm in the culture of identity. He believes that ‘nativization must be seen as the result of those productive linguistic innovations which are determined by the localized function of a second language variety, the culture of conversation and commutative strategies in new situations and transfer from local languages’ (Kachru 1986: 21-2). With this development, there was a gradual recognition and acknowledgement of the new and non-native varieties of English, e. g. Nigerian English, Indian English, Chicano English, Pakistani English, Singaporean English, Sri Lankan English etc.The term ‘New varieties’ of English’ implies that there are more or less recognizable varieties of spoken and/or written by groups of people’. (Platt et al. 1984:2) A new variety does not develop in isolation but it depends on the communicative needs of those who speak and write it. Such a variety is considered an interference variety because there is a clear linguistic and cultural interference from the first language and culture of the users. When a language is used in a different cultural context and social situation, several changes take place in its phonology, morphology, lexicon and syntax.A language so widely used has its own grammatical and linguistic system through which it conveys its distinction of meanings. These linguistic characteristics are usually transparent in its sound system, vocabulary and sentence construction. The non-native speakers develop a whole new range of expression to fulfil the communicative needs. Since the user of the non-native variety is bilingual, creativity is manifested in different kinds of mixing, switching, alteration and transcreation of codes. When two languages come in contact, it results in â€Å"inventiveness†. Bilingualism in itself is a source of creativity in language (Talaat 2003).Such varieties are so widespread and have such a long standing ‘that they may be thought stable and adequate enough to be regarded as varieties of English in their own right rather than stages on the way to a more native-like English’ (Quirk 1983:8) Urdu-English code-switching and Pakistani English English enjoys a very prestigious status in Pakistan. Its prevalence and power in Pakistan is growing very much. For many Pakistanis, English has become not only a â€Å"practical necessity†, but also â€Å"the language of opportunity, social prestige, power, success as well as social superiority†.Kachru (199 7:227) pointed at the ‘ideological, cultural and elitist power of English’. Such power is vividly seen in Pakistan where people tend to switch from Urdu to English to create special effect. Urdu is the national language of Pakistan and one of the two official languages of Pakistan (the other official language being English). It is the most important language of literacy in the country. In the hierarchy of linguistic prestige, Urdu is placed lower only than English. In Pakistan, Urdu-English code-switching is a common characteristic of educated Pakistani bilinguals. Code-switching ccurs when two languages come in contact: ‘the alternation of two languages within a single discourse, sentence or constituent’ (Poplack 1980:581). This sociolinguistic phenomenon makes a great contribution in the creation of new and non-native varieties of English. When two languages come into contact, not only the phonological features but lexical items and syntactic patterns als o manage to filter across from one language to another. English is used in Pakistan in a non-native context. Different changes can be observed in its phonology, vocabulary, and grammar and now it is recognized as a distinct variety of English i. . Pakistani English. Non-native varieties of English are an important aspect of language change and these varieties have emerged because of code-switching and code-mixing. According to Trudgill (1986: 1), ‘the languages that are in contact with each other socially may become changed linguistically, as a result of being in contact psychologically, in the competence of individual speaker’. Pakistani English has assumed a linguistic and cultural identity of its own. This identity manifests itself throughout the language at the word level, the phrase level and the sentence level.It is the natural consequence of its regular contact with the Urdu language. A large number of borrowings from Urdu and the regional languages of Pakistan h ave entered in Pakistani English (Baumgardner 1993). Certain lexical items may show a shift from their original Standard British English usage to Urduized meaning (Talaat 1993). In comparison with the borrowing in syntax and morphology, lexical items have the highest ease of borrowing and seem most likely to occur (Brutt-Griffler, 2002; Romaine, 1995).Such a vocabulary items in all the new varieties of English are largely drawn from the areas that are significantly different to the geo-social-cultural context of British English (Fernado 2003). As, no reliable study on Urdu-English code-switching at the level of the phrase and clause is available, this paper is likely to bridge the gap. The code-switching data in this paper focuses on the use of Urdu phrases and clauses in the English language and shows that its occurrence imposes no ungrammatical effect on the structure of English syntax.The data has been collected from the following printed Pakistani English newspaper and magazines : 1. Dawn (daily) (Lahore) 2. Herald (monthly) (Karachi) 3. Mag (weekly) (Karachi) In this paper, code-switching is divided into two categories. They are inter-sentential switching, that is switching from one language to another at a sentence boundary, and intra-sentential code-switching, or code-mixing when the switch takes place within one sentence. In the following section, we will analyse the intra-sentential code-switching in Pakistani English at the level of phrase.Phrasal insertions A phrase is a group of words, which does not carry a complete sense. Formally a phrase is defined as a syntactic structure that has syntactic properties derived from its head (Mahajan 2001). Basic phrase structure is a universal feature of all human languages. The Urdu language is not different from English as far as the structure of phrase is concerned. There are a fair number of Urdu multi-word switches in this section that are either two word or three word phrases occurring in the English claus e or sentence.The purpose is to introduce the position of various Urdu phrases inserted in English syntax. Some researchers suggest that switches that are larger than one word are â€Å"true code-switches† but one-word switches are borrowings. However, it is not within the goals of this paper to distinguish code-switches from borrowings. In this section, we will analyze the occurrence of various NPs, Adj Ps and PPs in the English sentences. Since phrase insertion is always a complex kind of switching, it demands a high degree of proficiency and accuracy from the bilinguals involved in code-switching.Noun phrase A noun phrase is a word or group of words, which acts as the subject, complement or object of a clause, or as the object of a preposition. A noun phrase always has an obligatory head noun and optional modifier and qualifier. (m) H (q) For example in the Urdu phrase ‘ mera bhai apaney dostoon key saath’, (my brother with his friends) mera is the modifier of the head noun ‘bhai’ while Urdu postpositional phrase ‘dostoon key saath’ is qualifying the head noun. The structure of Urdu noun phrases used in Pakistani English is very diverse.Here are some examples of the use of the Urdu noun phrases occurring as the subject of the English verbs: 1. A poor hari (the farmer) can be sent to the gallows even on the mild accusation of a crime leveled against him by a noble. (March 27, 2007 D) 2. An honorable sardar or wadera (the landlord or chief) can walk free even after proven record of the most heinous kinds of against crimes him. (March 27, 2007 D) 3. They alleged that the naib nazim (the vice municipal officer) was receiving threats to force him to part ways with the PPP-backed Awam Dost panel. (March 04, 2007 D)In the first two examples, the English adjectives are modifying the English nouns in a noun phrase while in the third example both the adjective and noun are from the Urdu language. All the noun phrases have the English determiners ‘a’, ‘an’ and ‘the’ respectively in the beginning of the sentences. Urdu noun phrase as an apposition of another noun It is very interesting to note the use of an Urdu noun phrase as apposition in Pakistani English. ‘Apposition’ means the placing of a noun group after a noun or pronoun in order to identify something or someone or give more information about them.In the following example, we can see the use of an Urdu noun phrase as an apposition of another noun. Here the Urdu noun phrase is giving information about the proper noun ‘Haji Ramzan’. 1. Five militants who tried to kidnap tehsil municipal officer Hameedullah on October 8 were forced to give up their hostage after Haji Ramzan, the tehsil naib nazim (the city vice municipal officer), and his men confronted them on the main Tank-Jandola road. (November 2006 H) Urdu phrase introduced by an English adverb: In the examples below, the Engli sh relative adverb â€Å"as† introduces the Urdu stretches of words embedded in English.This type of switching is very rare and demands high proficiency. 1. Amjad considered her as ustad se ziyada dost (friend rather than teacher). (January 22, 2006 D) 2. And an old friend of hers, a female writer, was so infuriated on being referred to as a ‘Cycle wali larki’ (female cyclist) that she broke relations with her for good. (March 25, 2007 D) 3. According to one of them, they were not shunned by the public as lula, langra and apahaj (lame and paralyzed). (December 04, 2005 D) 4. What was sworn upon yesterday as guiding principle will be chucked at the altar of expediency tomorrow as mere siyasi bayan (political statement). January 22, 2006 D) Genitive phrases In Urdu, genitives are indicated with ka/ke/ke as a morph-word. The choice of these words depends on gender, number and case ending of the head noun. However, the English word ‘of’ is equivalent to all these. The genitive or possessive form of Urdu noun takes different positions in English syntax and imposes no ungrammatical effect in the construction. In the following examples, the Urdu noun phrases are used as the complement of an English verb of incomplete predication and occurring at the end of the sentence.The Urdu noun phrase begins with the English determiner ‘an’ in the first example. 1. Atif Amin feels â€Å"it's true that to some extend visiting therapists is an ameeron ka nakhra. (arrogance of the rich) (July 31, 2005 D) 2. The colloquial phrase used for this punishment was kala ki saza. (severe punishment) (July 24, 2005 D) In some cases the Urdu noun phrase is used as the subject of the English syntax. In example 2 the Urdu noun phrase begins with English determiner ‘the’. 1. 1. â€Å"Logon ki samajh† (understanding of the people) is all he has to say about the society's attitude towards dance. January 12, 2006 D) 2. The Islamabad ka muqadas darakht (Holy tree of Islamabad) revolved around a popular Banyan tree that stood in sector E-7 but was a few months back burned down. (May 21, 2006 D) 3. Promptly can the reply from Fateh Muhammad Mailk, who argued that kufar ka fatwa (Infidelity claim) is nothing new with us. (May 21, 2006 D) Sometimes, the Urdu noun phrases are also inserted in the middle of the English syntax. In the following examples, we can see the use of the Urdu noun phrases as the complement of an English verb. 1.Publications have just become catalogues and designers have become shadi ka jora mills (Wedding cloth house), not aiming to produce ethereal pieces any more. (September 25, 2005 D) 2. Rohit also revived the age-old warak ka kaam (work of silver gold leaf) once used for mughal royalty. (January 22, 2005 D) 3. Naturally they bathed themselves properly after every hug as the grandma had a smell of sarson ka tel (mustard’oil) and desi soap all over here. (July 31, 2005 D) 4. I am th rilled to see a lovely jurao ka set (precious Ornament) that President Ayub Khan presented her when she visited Pakistan in the 1960s. March 25, 2007) In the example 3 the double genitive has been used with English mixed in a noun phrase. Adjective Phrase A word or a group of words that does the work of an adjective is called an adjective phrase. Adjective phrases are usually formed from an intensifier that is optional, followed by the head (H) that is often an adjective In Pakistani English, Urdu adjective phrases may occur as a predicate adjective or inside the noun phrase. In the examples below, an Urdu adjective phrase has been inserted in the English sentence. 1. He is called sher ka bacha (bashful, brave) and mard ka bacha (high minded). January 08, 06 D) In the above example, Urdu evaluative metaphors that reflect Pakistani social customs, localized attitude and behavior have been used in English syntax. In a typical Pakistani context, a person having great courage and with a keen sense of honor is termed as ‘sher ka bacha’ (lion’s child). In the following example the English intensifier ‘very’ has been used with an Urdu adjective. This kind of code-switching is very rare. 2. Their response, ‘ I think you are right madam,’ said a young man, city life and modern education makes men very beghairat (dishonorable) (November 2006 H)In the examples given below, the Urdu adjective phrases are modifying the English nouns in the noun phrases. 3. It was a taiz raftar (very speedy) bus and I merely sat on it as well. (February 26, 2005 D) 4. The 60-minutes interview was largely spent in advocate Bukhari name dropping, saying he grew up with the lordships of the Superior Court and what payare insaan (lovely men) they are. (March 18, 2007 D) Example 4 reflects a very complex kind of code-switching. The Urdu stretch of words has been introduced by the English word ‘what’, but actually it is giving the emphasi s on the Urdu adjective ‘payare’.The use of ‘what’ has changed the syntactic structure and it seems that it has been used to focus on ‘payare insaan’. The introduction of ‘what’ has changed the word order of the sentence. One important thing worthwhile to mention here is that it seems harder to break up a relative clause/phrase than other types of subordination. It is quite problematic to have a relative pronoun from one language and the rest of the clause in the other. The code-switching data reported from other language pairs also show that switching between the relative pronoun and the clause that it introduces is rare. Nortier 1990) Mostly, the English adjectives are necessarily uninflected. They undergo no morphological changes with the variations in the nouns they qualify. However, in Pakistani English, Urdu adjectives, sometimes, may be inflected according to the rules of Urdu grammar because of number and gender as in the a bove example. For example: Payara (lovely) is an inflected adjective e. g. Payara larka (lovely boy), Payari larki (lovely girl), Payare insaan (lovely people). Prepositional phrase Urdu has a postposition instead of English preposition, which differs in the way that it precedes objects.A collective term used for both preposition and postposition is adposition. In typical Urdu adposition phrases, adposition comes at the end. An Urdu postposition phrase is syntactically inserted in English syntax in the following example: 1. Both of them unhurt â€Å"Khuda key fazal sey† (By the grace of God) while Shazia became paraplegic. (January 08, 2006 D) It is very interesting to note that the Urdu postposition phrase occurs at the same position where its English equivalent could have been. Verbal phrase A verb phrase is a word or a group of words that does not have a subject and a predicate of its own and does the work of a verb.In Urdu language, auxiliaries occur after the main verb i n contrast with English where auxiliaries occur before the main verb. Urdu verb phrases occur very rarely in Pakistani English because they have to undergo a complex morphological change as compared to noun phrases. However, sometimes an Urdu verbal phrase is also inserted in English syntax. Here is an example of the use of an Urdu verb phrase: 1. My colleagues kept worrying that piracy ho rahi hay (is going on) we should stop it; I kept saying, â€Å"hooney do†. (let it be) (September 11, 2005 D) ho rahi hai ain verb Progressive form auxiliary The above-mentioned data and examples suggest that Urdu phrases are frequently used in Pakistani English and its occurrences at various positions in a sentence seem to be quite appropriate. Urdu phrases obey the rules of English grammar everywhere in the sentences. After analyzing intra-sentential code-switching at the level of phrase, now we want to turn to inter-sentential code-switching in Pakistani English. The next section begins with ‘inter-clausal code switching’. Inter-clausal code-switching:As mentioned earlier, code-switching occurring at the sentence level is called inter-sentential code-switching. The term â€Å"inter-clausal code-switching† is used to refer to switches occurring at the clause boundaries. In the present data, switched Urdu clauses can include a coordinated clause, a subordinate clause or a clause/phrase introduced by an English adverb. Urdu clauses that are coordinated with an English clause through the use of coordinating conjunction are classified as coordinated clauses. Urdu subordinate clauses are also used with main English clause.We can find the English subordinate clause with Urdu main clause as well. Mostly, an English subordinate clause gives a warning or advice about the consequences of an action or attitude. It is relatively common in Pakistani English that Urdu proverbs and maxims occur at the periphery of an English clause. There are also switched Urdu full clauses that are syntactically independent of the preceding English clause, although there is still thematic coherence in terms of their reference and actions. The data exemplified in the following sections will reveal how different types of Urdu clauses are used in Pakistani English.Co-ordinated Clauses: In Pakistani English, co-ordinated clauses are joined by English as well as Urdu conjunctions. However Urdu conjunctions do not occur quite frequently. A conjunction that often conjoins the English clauses to the Urdu adjacent clauses is â€Å"and†. Here is an example of the use of the English coordinating conjunction: 1. Why don’t we all go together to New Delhi? N1 ki shaddi ki shopping bhi ho jaye gi (There will be shopping of N1’s wedding) and we can have much fun. (June 20, 2005 D) As can be seen in the above example, there is switching here back and forth between English and Urdu.An Urdu clause is embedded in English and English is taken up again. I n the following example, an Urdu conjunction â€Å"leykin† (but) is inserted in the English sentence. The reason for the use of Urdu conjunction in Pakistani English is directionality of code-switching, because most of the times, switched Urdu clauses follow the English main clause. This Urdu conjunction has a pragmatic effect as a discourse marker in drawing attention to the utterance. 1. We reached there in time, lakin no body was there to receive us. (Spoken English) In Nortier’s Moroccan Arabic/Dutch code-switching data (1990), the Arabic onjunction â€Å"walikan† (but) is also most frequent and is the one that conjoins two clauses that are both in another language. Taking a discourse marker from another language has a pragmatic effect on the whole utterance. Another interesting feature of Pakistani English that has been found as a result of Urdu-English code-switching is the use of an independent Urdu clause or sentence with English in written as well as sp oken English. Here are three examples where Urdu clauses are syntactically independent; however, they share a semantic relationship with each other: 1.Very soon, I will be a big star in Bollywood, main naumeed nahin hougni. (I will not be disappointed) (July 16, 2006 D) 2. He is set to release some very interesting films, which he describes as happy-go-lucky movies, aaj kal happy fims ka zamana hai. (Now-a-days people like happy movies) (December 11, 2005 D) 3. I cannot make new friends. Main buri, mairai dausti burai. (I am bad, friendship with me is bad) That’s all (March 25, 2007 D) Subordinated clauses: Urdu subordinated clauses are also used in Pakistani English, which is a very important aspect of inter-sentential code-switching.The subordinating conjunction is not always in the language of the clause that it introduces. Both Urdu and English subordinating conjunctions are used to join main and subordinated clauses. We can classify this section to two main broad categor ies: 1. Urdu subordinate clauses with an English main clause 2. English subordinate clauses with a Urdu main clause Firstly, we will look at the occurrence of the Urdu subordinate clauses with an English main clause. Urdu subordinate clauses with an English main clause: Different Urdu subordinate clauses are embedded in the English sentences in Pakistani English.The following two kinds of Urdu subordinate clauses have been found in Pakistani English: 1. The noun clause 2. The adverb clause Noun clause: The data exemplified in this section will show that a noun clause is a subordinate clause that does the work of a noun in a complex sentence. It can be used in Pakistani English as: 1. The subject of a verb 2. The complement of a verb 3. The object of a preposition In the following example, the switched Urdu noun clause has been used as the subject of an English verb: 1. Sub kutch chalet hai is their dictum. (June 12, 2005 D) ‘All is right’ is their dictum.Most of the tim es, a switched noun clause acts as a complement of an English verb. Here are some examples: 1. To underline the point he added is main science ki koi baat nahin hai. (December 25, 2005 D) To underline the point he added there is nothing scientific in this. 2. He got all mixed up and asked acha aap begum commondo hai. (October 30, 2005 D) He got all mixed up and asked well. You are Mrs. Commando. 3. I get looks from them all and a couple said aap aagay aa jain. (October 09, 2006 D) I get looks from them all and a couple said you come in front please. 4. She couldn’t resist the bohat aachi movie hai. May 29, 2005 D) She couldn’t resist it’s the very best movie. In the examples below, the switched Urdu clause has been used as an object of an English preposition. 1. No one at the CCB was willing to say anything except that is ka order ooper se aya hai. (May 07, 2006 D) 2. No one at the CCB was willing to say anything except that we have orders from our seniors. 3. A s they turned to me, I shrugged my shoulder with a ‘Bhai dekh lo, I am not carrying you purse’ (November 2006 H) 4. As they turned to me, I shrugged my shoulder with a brother you can see; I am not carrying you purse.Sometimes, it’s very interesting to note the use of an Urdu noun clause as a complement of a verb of incomplete predication. 1. The whole thing is that key bhaiya sab se bada rupaiya. (February 12, 2006 D) The whole thing is that bother, money is all. Adverb clause: As we have seen through the above examples that the noun clause acts as a noun in complex sentences, in the same way the function of an adverb clause is that of an adverb in complex sentences. In the following example, an Urdu adverb conditional clause has been embedded in the English sentence.However, the Urdu subordinate clause precedes the English main clause. The subordinating conjunction is in Urdu, whereas the clause that follows it is in English: 1. Aap ko kissi cheez sey strings k etney hoon, to its best to run from it. (June 26, 2005 D) If you want to cut the cord off, then its best to run from it. English subordinate clauses with Urdu main clause: In some cases, English clause is subordinate to an Urdu main clause. In the following example the English noun clause is joined with the Urdu main clause through the English subordinating conjunction â€Å"that†. 1.Mujhe shikayat hai that we are not making history. (July 31, 2005 D) I have a complaint that we are not making history. In the example below, the English conditional clause is subordinate to the Urdu main clause. In this example, the English subordinate clause precedes the Urdu main clause: 1. The police asked both of us to settle things between ourselves. Because if it becomes court case, then mamla lamba ho jaiga. (February 19, 2006 D) The police asked both of us to settle things between ourselves. Because if it becomes a court case, then it will be a lengthy process. Repetitions and other swit chesSometimes, Urdu phrases or clauses are used just as the repetition of an English phrase or clause. The purpose of this type of switching is to give emphasis. However, in spoken it is used to address different audiences. 1. Take care, apna bahut khayal rakhiya ga. (December 18, 2005 D) 2. They shouted for his execution. Zen ko phansy do. (October 02, 2005 D) 3. Feroz was very drunk. Usko chad gayi thi. (May 07, 2006 D) 4. He thought that Geeta Bali was the daughter of a certain Dr. Bali,a dentist in Aligarh, who was shocked when one day, Sikandar asked him: Aap ki sahabzadi kaisi hain? (How’s your daughter? (November 2006 H) In some cases, Urdu clauses are used to quote maxim and proverb or some other person in Pakistani English. Here are some examples: 1. My unbending procrastination is one thing that repels the beauty of the world but they say ‘sabar ka phal meetha’ (patience has its reward) (January 22, 2006 D) 2. Talk about ‘lakkar hazam, pathar haza m’ (very powerful and digestive stomach), they deserve a batter deal, if only for their patience in eating such swill day after day. (October 2006 M) 3. He gave the example of the phrase â€Å"auratein bhot bolteen hain† (females are very talkative). August 07, 2005 D) 4. She was very touched and impressed, especially when the waiter uttered these words ‘baaji, mehman sey paisay nahin letay (sister, we don’t charges from guests)’. (July 17, 2005 D) 5. She opened the Q and A session by saying ‘aab court aap ki ball main hai’ (Now all depends on you). (May 29,2005 D) Conclusion The data and examples presented in this paper demonstrate that code-switching affects Pakistani English at the phrase and clause level and Pakistani English has its unique features. This paper has shown the variations in English syntax when it is used in a non-native context i. . Pakistan. This paper shows that in code-switching many traces of native language can b e observed on the foreign language. The grammatical usage of Urdu language on English is visible here in the above mentioned examples. Some linguists are of the opinion that there is no language that has not been under influence of another language. English is no exception in this regard. Several changes are taking place in the English language. Isolated languages are rarely met in the global village. 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