The Wates Family
Todd is an 8 year old male diagnosed with cystic fibrosis. He is a patient in the primary care clinic at Hoffington Medical Associates. The parents identify his race as blended.
Todd lives with his parents, Anthony and Sarah Wates. Anthony identifies as African American. Sarah identifies as Native American. Sarah and Anthony lived on a reservation during their pregnancy. A tribal midwife attended Todd’s birth. Sarah breastfed and socialized with other young mothers and children on the reservation.
Todd was raised on the reservation for the first six years of his life. The family moved off the reservation to a town approximately an hour from the reservation for better work opportunities.
Todd’s father works for a local produce delivery company. He is at work by 4:30 a.m. each morning. He works Monday through Friday, and has mandatory overtime on most Saturdays. He generally finishes work at by 11:30 a.m. Todd’s father spends the afternoon with his co-workers. They eat at the Five and Dine, a local diner, and then go to Mac’s Saloon. Todd’s mother is a waitress at the Five and Dine. She drops Todd off at school in the morning and then works until the end of the dinner shift. An older neighbor, a woman form their own reservation, watches Todd and another seven-year old Native American boy while their parents are working.
Todd’s family lives in a first floor apartment in a former industrial area of town. Most of the industries have relocated to other regions, leaving most of the warehouses and production facilities vacant. The family’s apartment has a kitchen, living room, dining space, and one bedroom. Todd sleeps in a playpen in the living room. He often wakes when his father is getting ready for work. Todd’s mother brings Todd into bed with her for the remainder of the night. The apartment is affordable for the family; the monthly rent includes utilities. They have a single vehicle. Todd’s father is picked up by co-workers in the morning and usually drives home with his wife in the evenings.
Todd’s health insurance in provided through Child Primary Health (CPH), a state-based Medicaid program for children under 21 years of age. Todd’s medical expenses are fully covered by CPH.
Presentation of Symptoms
From birth through age 6 years, Todd received medical care on the reservation. At that time, services were provided by midwives, tribal doctors, and a visiting Nurse Practitioner. Todd showed signs of poor growth beginning in infancy. This was blamed upon the mother not having appropriate milk volume during breast-feeding. The infant was converted from breast-feeding to bottle-feeding. As the symptoms continued and Todd had difficulty ingesting the milk, he was diagnosed with acid reflex. At 4 years of age, his problems breathing were diagnosed as asthma.
At the age of 7 years old, Todd was first seen in the clinic for symptoms of respiratory distress. The diagnosis of asthma continued to be a consideration, although the treatment team constructed a broader differential.
At age 8, he was diagnosed with cystic fibrosis. His treatment regimen currently includes:
• Daily nebulizer
• Chest physiotherapy
• Inhalant therapies: bronchodilators; mucolytic; antibiotics; corticosteroids.
• Ibuprofen (as an anti-inflammatory)
Several factors contributed to the delay in diagnosing Todd’s condition. Todd was born on a Native American reservation with a midwife; therefore, he did not receive the same health screening that other children do in the United States, including screening for cystic fibrosis. The differential diagnosis developed for Todd during infancy and toddlerhood did not consider cystic fibrosis due to his racial heritage. Cystic Fibrosis is rare in both Native Americans and African Americans.
In the professional team’s morning meeting, the physician raised a concern with the patient’s history. Cystic fibrosis is generally associated with persons of European decent. There is very low prevalence among Native Americans, African American, and Asians. The current literature also suggests that both parents need to have the cystic fibrosis gene (dominant or recessive) in order for a child to inherit the condition.
The family’s history does not provide a clear understanding of how Todd inherited the condition. The team speculated that there is racial blending somewhere in both families’ histories prior to Anthony and Sarah’s marriage.
1.Develop an ECOMAP for Todd based upon the information provided (This is separate from the maximum page limit for the assignment). NOTE: Please do 10 full written pages, but 1 PAGE SLIDE of an ECOMAP.
2. Develop 10 QUESTIONS I would like to ask the family to help clarify information for the ECOMAP. NOTE: Please elaborate on these 10 questions.
3. What is the potential CULTURAL COMPETENCE ISSUES in this scenario? How would I resolve these?
4. I am meeting with Anthony and Sarah in my office at the clinic. What are the THEMES I should explore with them to assess how they are dealing with Todd’s recent diagnosis and the implications for his condition? NOTE: Dear writer, please elaborate in your own words.
5. The team wishes to clarify the family history with respect to cystic fibrosis and now Todd inherited it. This necessitates clarifying the lineage of both families. During a home visit with Sarah and Anthony, I need to pose the question. What is the question I will ask? Use the exact words I would say to the patient/family: NOTE: it may be more than one sentence, or a multi-part question, depending upon my personal style. NOTE: PLEASE USE YOUR OWN JUDGMENT ON THIS QUESTION.
6. During the session exploring their respective lineages, Anthony states that he was raised in foster care until the age of 18 when he became emancipated. He never knew his father. His mother was an only child, so far as Anthony knows. His mother was involved with drugs and was frequently in-and-out of jail. Anthony vaguely remembers living with his maternal grandmother several times when “my mom wasn’t around. Probably because she was in jail.” At the age of 5, he was placed in foster care. He does not know why he did not live with his grandmother after that. He had no visits from either his mother or grandmother. “I don’t know where they might be, or if they are alive or dead. And to be honest, I want nothing to do with them” . My foster parents were good people, and now I have a loving family here. I don’t need those other people.”
7. Sarah then became visibly distressed. Her body language became closed off and she responded in one or two words to questions. Her eyes became focused upon the floor. When asked if she is feeling uncomfortable, Sarah makes the following statement to you:
“My great grandmother was raped when she was young. She was working in the town close to her reservation. It was nighttime and she was walking alone. She was a waitress. Three white men from the diner attacked her, dragged her into the bushes, and raped her. They left her there. The police did nothing nine months later, my grandmother was born.
At the end of the session, Sarah tells me that the story of her grandmother’s rape is very private to her family. Her tone becomes pleading when she says, “You cannot tell anyone this! None of your friends at the clinic! Promise me you will not tell anyone!”
6a. How do you respond to Sarah in this moment? NOTE TO WRITER: PLEASE ELABORATE ON THIS QUESTION. PLEASE BE CREATIVE.
6b. Now that I have this information, what do I share with the health care team? How do I document these findings since it is directly related to the missing information regarding family history and transmission of the cystic fibrosis genes?
Todd is now 15 years old. He is going through the normal physiological and psychological changes associated with puberty and early adolescence. He is continuing his treatment regimen:
• Daily nebulizer
• Chest physiotherapy
• Inhalant therapies: bronchodilators; mucolytic; antibiotics; corticosteroids
• Ibuprofen (as an anti-inflammatory)
As is typical for persons living with cystic fibrosis (CF), Todd experiences exacerbations of his CF, which necessitate hospitalization. Unfortunately, the family does not live close to a children’s hospital, so Todd is place in an adult unit. Most of these hospitalizations have required that Todd be placed in an ICU for a time because of pulmonary function impairment.
Todd is enrolled in the local high school as a sophomore. He periodically misses school due to exacerbations of his cystic fibrosis (CF). He also limited in some of the activities he may participate in, such as school sports. Todd would like to wrestle on the high school team, but has been told by the school district that he cannot compete because of his CF. His guidance counselor has recommend that he instead join the student government and yearbook club. Todd and his parents are very frustrated with the situation, but his parents have not spoken to anyone at the school.
Todd meets with me biweekly in the clinic. When he is hospitalized, I typically arranged to meet with him there if he is able to participate in a counseling session. This is dependent upon his lung capacity and with the approval of the respiratory therapist. Todd is often quiet at the beginning of sessions with you. You recognize he has difficulty articulating his feelings and thoughts. When you reach into the “silence”, he typically engages and is willing to explore his thoughts, feelings, and perceptions to the best of his abilities. You have come to recognize that he responds well to the work when you introduce themes for discussion and activities.
1. What are the THEMES I should explore with Todd?
2. What are some activities I might introduce to help him explore his thoughts, feelings, and perceptions in relation to the THEMES identified in question 1?
As of now, Victoria's Secret offers a vast grouping of items that are not just unmentionables based. In the store some portion of the association, there are likewise magnificence and scent items that incorporate beautifiers and healthy skin. In the Victoria's Secret inventory and Web, the arrangement shifts much further with underwear, swimwear, clothing and shoes. Inside the Victoria's Secret image, there are sub-brands or accumulations. These sub-brands have likewise constructed acknowledgment. The sub-brands are Pink, Very Sexy, Body by Victoria and Angels. These sub-brands have their own particular personality yet offer and convey quality, Victoria's Secret is a standout amongst the best organizations in the US today. Their Marketing methodology is pivoted upon a well idea of publicizing effort and other unique highlights. History Victoria's Secret was set up by Roy Raymond in the San Francisco zone amid the 1970s. Raymond saw an open door in taking "clothing" of the time and transforming it into form. Items stood separated from the conventional white cotton pieces, which retail establishments offered, with hues, examples and style that gave them more appeal and hotness. They joined European class and extravagance. Indeed, even the name Victoria's Secret was intended to evoke pictures of nineteenth century England. The store went so far as to list a phony London address for the organization home office. Today, Victoria's Secret appreciates about a restraining infrastructure position on the retail of close clothing in the US. The normal bra that once sold for $15 at Victoria's Secret, when the organization initially opened and was stressed over rivalry, now offers for over $40. Victoria's Secret's Success Beginning from Raymond's six stores, Victoria's Secret has developed into a mammoth in the unmentionables business. As my partner just clarified VS has for all intents and purposes no rivals in the ladies' rich undergarments showcase. In the more broad classification of all clothing, Victoria's Secret's deals additionally overshadow the offers of all other clothing brands. Victoria's Secret's prosperity is obvious in the numbers. Not exclusively does Victoria's Secret rule in its own particular market, it has likewise turned into the quickest developing branch in the Limited family. To comprehend the achievement of Victoria's Secret, it is important to take a gander at the powers in the unmentionables business. Initial, a scope of supplements add to expanding request. Supplements go from Britney Spears and MTV to fragrance, essentially anything that is sexually suggestive. The satisfactory limit for sexuality has with these supplements been raised ever more elevated. Alongside this, the media has raised the situation of private clothing in our general public. Magazines like Cosmo and Glamor encourage ladies to spoil themselves with pleasant clothing as one of life's mystery survival tips. Bras and undies are products that should be supplanted at an unassumingly visit level. In this way, there is no worry for the private clothing industry of a decrease popular. The business isn't rivalrous either. Bras are estimated over a genuinely expansive range with high markups. Firms in this industry have high net revenues. Besides, neither the purchasers who are ladies customers nor their spouses who are purchasing blessings have much haggling power. Providers for the cozy clothing industry correspondingly have next to no bartering power on account of the extensive number of makers and couple of enormous purchasers. Supermodels who can be considered providers in the exceptionally publicized underwear business unquestionably don't have bartering power, particularly with regards to Victoria's Secret. Most models think of it as a lofty respect to be a Victoria's Secret model. There is more supply (models) than request for this situation. For such a lucrative industry, there are shockingly couple of rivals in the US showcase. Other than Frederick's of Hollywood, there are no other undergarments retail chain stores. Victoria's Successful Marketing Campaign Publicizing One of Victoria's Secret's qualities is its exceptionally effective publicizing technique. In a business that offers a picture and a way of life, promoting is critical. Victoria's Secret burns through $66 million every year on promoting, basically characterizing excellence and bundling it for purchasers. A huge number of daily paper advertisements, indexes, and broadcast design demonstrates persuade ladies that purchasing Victoria's Secret items will help their certainty and improve their allure. A Victoria's Secret item speaks to fun, sentiment, dream, want and love across the board. For whatever length of time that they do Victoria's Secret undergarments, ladies can be changed like Cinderella from the binds of local life to one of the heavenly attendants seen on the walkway. Yearly Fashion Show Broadcast yearly, the Victoria's Secret Fashion Show Extravaganza has a selective contract with across the country communicating station CBS. A cooperative relationship exists between the two firms. Victoria's Secret acquires one hour of across the country publicizing, while CBS holds the elite appropriate to a standout amongst the most famous projects on TV. For one entire hour, lovely supermodels march about in Victoria's new-line of delightful unmentionables with chic enhancements and music that increases the design show to the level of a Broadway creation. Ladies are influenced that Victoria's Secret underwear will win the excitement they see obviously in their male partners. The Supermodels Victoria's Secret holds a standout amongst the most critical information supplies in the undergarments business: supermodels. Victoria's Secret models are synonymous with magnificence. Ads exploit this affiliation and concrete in buyer minds that Victoria's Secret speaks to excellence and class. The way that Victoria's Secret has the vast majority of the best supermodels working for them is nothing unexpected. No one brags of "Banana Republic models" or "Hole models," yet say "Victoria's Secret models" and everyone spouts about how lovely they are. Being a Victoria's Secret supermodel is an indication of eminence. Like the best illustrators who are regarded to work for Disney, skilled models are energetic about joining with Victoria's Secret since it promises them a fruitful name and opportunity to be named in a tip top gathering of supermodels, including any semblance of Adrianna Lima, Heidi Klum, and Tyra Banks. So as to keep great business streaming, stores require solid advertising techniques. On the off chance that they don't have individuals coming into their stores, they clearly won't have much business. Victoria's Secret is very much aware of this, and they continually give clients motivations to visit by sending them coupons, extraordinary offers, and best of all - free stuff! 1. Freebies:â The "Free Panty" coupon is one of the clients' most loved strategies. Victoria's Secret sends these coupons out each month to the greater part of their clients, and the best thing about this coupon is that there is no buy fundamental. Commonly when stores give out coupons to get free things, it is required that you purchase something first. In any case, individuals cherish this specific offer since they can get a free undies just by strolling into the store and giving over the coupon. How does this assistance Victoria's Secret?â Giving without end a free thing gives clients motivation to go into the store. There aren't an excessive number of individuals who will simply go in the store, get their free thing, and after that exit. Each time one goes in to assert their prize, they generally wind up ceasing to glance around at everything else (and more often than not wind up going gaga for something that they truly did not require). One winds up investing cash each energy, and that is a pleasant benefit for Victoria's Secret. They've increased more business just by distributing a little underwear that in all likelihood costs them practically nothing! 2. Selective, Limited-Time Coupons:â Another one of their incredible systems is the point at which they send coupons for "10 dollars off any Pink buy." In this circumstance, clients would get $10 off any Pink brand thing purchased in the store. Pink is to a great degree famous for Victoria's Secret, and there's a wide choice in this line. There's something for everybody. For what reason not check whether you can save money on a higher-estimated thing you may have had your eye on? How does this assistance Victoria's Secret?â They may give $10 off, yet they're inspiring you to burn through cash there. Once more, the motivator gets clients through the entryway and the looked for after stock urges them to stick around and do some all the more shopping. 3. Freedom or Bargain Sales:â Victoria's Secret likewise holds their Semi Annual Sales to rustle up business. These deals happen in the winter time (generally every January) and furthermore every mid year. These deals are gigantic (a few women strip the presentations to locate the best arrangements) and they get huge amounts of individuals into their store. A considerable lot of the things that go at a bargain amid this time are generally marked down in the vicinity of 40 and 70%. Individuals who adore Victoria's Secret go insane over these costs, in light of the fact that on a standard day, their costs aren't generally that modest. How does this assistance Victoria's Secret?â Bargain-chasing clients generally purchase the greatest number of sets of unmentionables as they would which be able to acquires money as well as gets out past season stock. This arranges for space for new plans, which individuals get sneak peaks of while they're sitting tight in line to pay for their buys. 4. Incremental Incentives:â Not each benefactor sees the interest of sitting tight in lines at the best costs, and VS comprehends that. That is the reason they join online-just arrangements. For instance, they may give a $15 markdown for each $100 burned through, $30 off for each $150 spent, or perhaps $75 off for $250 spent. This incremental strategy is another path for the store to increase new business. How does this assistance Victoria's Secret?â Incremental incentivesâ urge individuals to purchase more at a cost break or markdown. This is particularly useful for clients who might be close to a value break - suppose you have $90 worth of stock in your truck. Wouldn't you probably include one all the more thing on the off chance that you knew you could then utilize the coupon for $15 off? I would.>GET ANSWER