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Family Involvement, Clinician Beliefs And Child Psychiatric Rehospitalization, Sherma J. Charlemagne Sep 2011

Family Involvement, Clinician Beliefs And Child Psychiatric Rehospitalization, Sherma J. Charlemagne

Loma Linda University Electronic Theses, Dissertations & Projects

Psychiatric rehospitalization is estimated to fall between 30% and 50% among children and adolescents and is said to be the result of complex relationships between clinical and non-clinical child, family and service system factors. Psychiatric rehospitalization has been noted as an unfavorable outcome of inpatient treatment because of the associated economic to society and the family and emotional costs to the family and patient. Therefore, several attempts have been made in the relevant literature to identify and understand factors that will reduce the risk of rehospitalization in this population. In the context of parent professional collaboration, clinician beliefs and family …


The Experiences Of Clinical Social Workers In Diagnosing Bipolar Disorder In Children And Adolescents, Ashley Caroline Petitt Aug 2011

The Experiences Of Clinical Social Workers In Diagnosing Bipolar Disorder In Children And Adolescents, Ashley Caroline Petitt

Theses, Dissertations, and Projects

Bipolar disorder (BD) is a diagnosis that an increasing number of individuals under the age of 18 are being given, despite the fact that the DSM-IV has no description or criteria of what BD in this age group looks like. The purpose of this exploratory study was to look at the experiences of clinical social workers who have diagnosed BD in children and adolescents. To do so, eleven social workers who have a Master's of Social Work were interviewed using a standardized open-ended interview guide. The major findings of this study follow. Participants reported having diagnosed significantly more adolescents with …


Parents' Perceptions Of The Impact Of Teachers' Attitudes And Behaviors On The Social-Emotional Functioning Of Children With Adhd/Add, Margaret Elizabeth Gaskell Aug 2011

Parents' Perceptions Of The Impact Of Teachers' Attitudes And Behaviors On The Social-Emotional Functioning Of Children With Adhd/Add, Margaret Elizabeth Gaskell

Theses, Dissertations, and Projects

Attention Deficit Hyperactivity Disorder (ADHD/ADD) is the most common childhood psychiatric disorder, affecting attention, hyperactivity, and impulsivity, in 3 to 7 percent of school age children (American Psychiatric Association, 2000; Daley and Birchwood, 2010). ADHD/ADD can impact all aspects of life, in particularly school and social-emotional functioning (Mash and Barkley, 2006; Daley and Birchwood, 2010). Few studies have directly examined teachers' attitudes and behaviors related to teaching children with ADHD/ADD (Kos, Richdale, and Hay, 2006). The goal of this study was to explore the impact of teacher attitudes and behaviors on the social and emotional functioning of children with ADHD/ADD, …


The Effects Of Gender And Elicitation Method On The Prosodic Cues Used By 7- To 11-Year-Old Children To Signal Sentence Type, Lacey Ann Powell Aug 2011

The Effects Of Gender And Elicitation Method On The Prosodic Cues Used By 7- To 11-Year-Old Children To Signal Sentence Type, Lacey Ann Powell

Theses and Dissertations

The purpose of this study was to examine the prosodic cues used by 7 to 11 year-old children to signal questions and declarative statements in terms of changes in fundamental frequency (F0), duration, and intensity. Additional aims were to evaluate how children's use of prosody changes as a function of gender and method of elicitation. A group of 16 children participated in three different types of elicitation tasks (imitative, reading, and naturalistic). An acoustic analysis revealed that the participants produced the different sentence types using a variety of acoustic cues. Not only do children vary the mean of F0 and …


Social Aggression In Children And Adolescents: A Meta-Analytic Review, Cathy Longa Aug 2011

Social Aggression In Children And Adolescents: A Meta-Analytic Review, Cathy Longa

Open Access Dissertations

Social aggression has been widely studied; however, findings have been inconsistent leading to confusion within the current literature. Previous research has linked social aggression to negative outcomes; including poor peer relations, internalizing symptoms, and low levels of empathy; as well as positive attributes, including prosocial behaviors, high social status, and social intelligence. This meta-analysis examined the relationship between social aggression and various correlates, both positive and negative, as well as how age and gender moderate these relationships. With 896 correlations derived from 108 studies (of a total of 107 published articles), the results using the random-effects model for computing overall …


Worry In Children : Proposal And Test Of A Cognitive Model., Sarah Jane Kertz Aug 2011

Worry In Children : Proposal And Test Of A Cognitive Model., Sarah Jane Kertz

Electronic Theses and Dissertations

Although worry is common in children, little is known about its development and maintenance. The current study reviews several areas of the literature to inform a comprehensive cognitive model of clinical worry in children. Parental influences on child anxiety broadly are reviewed, followed by a discussion of empirically supported cognitive models of worry in adult samples. Next, the potential impact of cognitive development on childhood worry is presented. A cognitive model is then proposed, and empirical support for the model is reviewed. Finally, a portion of the model is identified and tested empirically. Specifically, this study tests the hypothesis that …


How Many Steps/Day Are Enough? For Children And Adolescents, Catrine Tudor-Locke, Cora L. Craig, Michael W. Beets, Sarahjane Belton, Greet M. Cardon, Scott Duncan, Yoshiro Hatano, David R. Lubans, Timothy S. Olds, Anders Raustorp, David A. Rowe, John C. Spence, Shigeho Tanaka, Steven N. Blair Jul 2011

How Many Steps/Day Are Enough? For Children And Adolescents, Catrine Tudor-Locke, Cora L. Craig, Michael W. Beets, Sarahjane Belton, Greet M. Cardon, Scott Duncan, Yoshiro Hatano, David R. Lubans, Timothy S. Olds, Anders Raustorp, David A. Rowe, John C. Spence, Shigeho Tanaka, Steven N. Blair

Faculty Publications

Worldwide, public health physical activity guidelines include special emphasis on populations of children (typically 6-11 years) and adolescents (typically 12-19 years). Existing guidelines are commonly expressed in terms of frequency, time, and intensity of behaviour. However, the simple step output from both accelerometers and pedometers is gaining increased credibility in research and practice as a reasonable approximation of daily ambulatory physical activity volume. Therefore, the purpose of this article is to review existing child and adolescent objectively monitored step-defined physical activity literature to provide researchers, practitioners, and lay people who use accelerometers and pedometers with evidence-based translations of these public …


Detection Of Dissimulation In Children On The Basc-2 Self-Report Of Personality, Nicole A. Begg Jul 2011

Detection Of Dissimulation In Children On The Basc-2 Self-Report Of Personality, Nicole A. Begg

Electronic Theses and Dissertations Archive

Children are capable of deliberately distorting or misrepresenting psychological symptoms on self-reports of behavior and personality, which is referred to as dissimulation. Malingering and defensiveness are two forms of dissimulation that involve exaggerating symptoms or denying symptoms, respectively. The purpose of this study was to examine the extent to which the Behavior Assessment System for Children-2 Self-Report of Personality validity scales identified dissimulation response styles in children. This investigation employed a between-subjects experimental simulation design with three conditions. One hundred and eighteen children were randomly assigned to a control group or to one of two simulation groups: (a) a malingering …


Postural Compensations And Subjective Complaints Due To Backpack Loads And Wear Time In Schoolchildren Aged 8 To 11, Frances Elizabeth Kistner Jul 2011

Postural Compensations And Subjective Complaints Due To Backpack Loads And Wear Time In Schoolchildren Aged 8 To 11, Frances Elizabeth Kistner

Open Access Dissertations

Backpacks are used by more than 90% of schoolchildren worldwide and over 40 million students in the United States on a regular basis. The carriage of loaded backpacks is associated with kinematic and physiological changes, as well as complaints of neck and back pain. Since a history of backpain in childhood is the strongest predictor of having musculoskeletal discomfort and back pain as an adult, development of back pain due to backpack use is of prognostic concern. The purpose of this dissertation was to examine the effects of backpack weights (up to 20% body weight (BW)) on children’s posture, subjective …


The Experiences Of Families Raising Children With Type 1 Diabetes Mellitus: A Qualitative Investigation, Carol A. Loucks Jul 2011

The Experiences Of Families Raising Children With Type 1 Diabetes Mellitus: A Qualitative Investigation, Carol A. Loucks

Theses and Dissertations

Type 1 diabetes mellitus (T1DM), a common, chronic disease, affects the patient as well as the family. It requires daily vigilance in blood sugar monitoring, dietary management and insulin administration. Research has examined the impact of T1DM on family adaptation and relationships. However, few current data describes parents' perceptions of challenges. The purpose of this study was to identify challenges and impact on the family perceived by parents raising children with T1DM. Using a qualitative descriptive design, 21 parents raising children with T1DM participated in audio-recorded focus groups. At the time of the interviews the children ranged in age from …


To Lynch A Child: Bullying And Gender Nonconformity In Our Nation's Schools, Michael J. Higdon Jul 2011

To Lynch A Child: Bullying And Gender Nonconformity In Our Nation's Schools, Michael J. Higdon

Indiana Law Journal

No abstract provided.


Attachment Theory: In Search Of A Relationship Between Attachment Security And Preschool Children's Level Of Empathy, Rebecca Knight Jul 2011

Attachment Theory: In Search Of A Relationship Between Attachment Security And Preschool Children's Level Of Empathy, Rebecca Knight

The Plymouth Student Scientist

The ability to empathise has frequently been advocated as the driving force behind pro-social behaviour. The tender and nurturing environment inherently provided by mothers of securely attached children, constructs an ambience which promotes the development of empathy and implicates the role of attachment theory in explaining individual differences in empathy. Investigated in 58 preschool children, using 8 pictorial scenes portraying four emotions – happiness, sadness, anger and fear, children were invited to rate emotions elicited for both the character and self. Results supported the main prediction that securely attached children would be more empathic than insecurely attached children (p < .001), thus indicating that the route for increasing pro-social behaviour may lie within the realms of attachment theory.


Cognitive-Behavioral Treatment Of Persistent Functional Somatic Complaints And Pediatric Anxiety: An Initial Controlled Trial, Carrie Masia, Daniela Colognori, Rachel E. Kim, Laura C. Reigada, Rachel G. Klein, Karen J. Browner-Elhanan, Amy Saborsky, Eva Petkova, Philip Reiss, Manoj Chhabra, Yvonne B. Mcfarlane-Ferreira, Colin K. Phoon, Nanci Pittman, Keith Benkov Jul 2011

Cognitive-Behavioral Treatment Of Persistent Functional Somatic Complaints And Pediatric Anxiety: An Initial Controlled Trial, Carrie Masia, Daniela Colognori, Rachel E. Kim, Laura C. Reigada, Rachel G. Klein, Karen J. Browner-Elhanan, Amy Saborsky, Eva Petkova, Philip Reiss, Manoj Chhabra, Yvonne B. Mcfarlane-Ferreira, Colin K. Phoon, Nanci Pittman, Keith Benkov

Department of Psychology Faculty Scholarship and Creative Works

Background: Children and adolescents who seek medical treatment for persistent physical distress often suffer from co-occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive-behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care. Methods: Children and adolescents (aged 8-16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co-occurring anxiety disorder, were …


Children's Understanding Of Intimate Partner Violence, Renee Lynn Deboard-Lucas Jul 2011

Children's Understanding Of Intimate Partner Violence, Renee Lynn Deboard-Lucas

Dissertations (1934 -)

There is a clear connection between exposure to interparental aggression and children's own future episodes of violent behavior. What is significantly less understood is why this pattern develops. The current study used quantitative and semi-structured methods to identify factors that shape children's understanding of intimate partner violence. Understanding violence was defined as including causal knowledge (Why does violence occur?) and beliefs about the acceptability of intimate partner violence. Factors proposed to predict children's causal attributions included mothers' perceived causes of interparental aggression and exposure to different forms of violence, including interparental, parent-child, and neighborhood aggression. Perceived causes of intimate partner …


Fathers' Time Investments In Children: Do Sons Get More?, Kristin Mammen Jul 2011

Fathers' Time Investments In Children: Do Sons Get More?, Kristin Mammen

Publications and Research

Evidence suggests that, from birth, fathers treat sons differently than daughters in the U.S., as well as in developing countries. Fathers' time investments in children are one channel through which differential treatment by gender may affect children's outcomes. This paper uses data from the 2003 American Time Use Survey to explore three questions about paternal time in married two-parent families: Does the gender composition of his children affect the amount of time a father spends with them? If so, does the gender of the individual child have an additional effect? And is a girl advantaged or disadvantaged by the presence …


Vocabulary Acquisition In Bilingual Children: Are They More Delayed In English Than Their Monolingual Peers? Does This Depend On Input Of Language?, Naomi Kilgore Jul 2011

Vocabulary Acquisition In Bilingual Children: Are They More Delayed In English Than Their Monolingual Peers? Does This Depend On Input Of Language?, Naomi Kilgore

The Plymouth Student Scientist

The current study investigated the effect of exposure to English on bilingual language acquisition. 18 monolingual and 6 bilingual children, aged between 29 -32 months, took part in standardised language tests measuring productive and comprehensive vocabulary. Although previous research has investigated this, not all variables known to affect vocabulary development have been controlled for. This study controlled for socio-economic status, birth order and different levels of exposure to English and compared these to test scores. Results suggest exposure is a significant predictor of productive (p = .01) and comprehensive (p < .01) language development. A greater difference was found between groups for production (p < .01) supporting previous research suggesting production may be more problematic than comprehension for bilingual children.


The Incompatibility Of Materialism And The Desire For Children: Psychological Insights Into The Fertility Discrepancy Among Modern Countries, Norman P. Li, Lily Patel, Daniel Balliet, William Tov, Christie N. Scollon Jul 2011

The Incompatibility Of Materialism And The Desire For Children: Psychological Insights Into The Fertility Discrepancy Among Modern Countries, Norman P. Li, Lily Patel, Daniel Balliet, William Tov, Christie N. Scollon

Research Collection School of Social Sciences

We examined factors related to attitudes toward marriage and the importance of having children in both the US and Singapore. Path analysis indicated that life dissatisfaction leads to materialism, and both of these factors lead to favorable attitudes toward marriage, which leads to greater desire for children. Further analysis indicated this model"We examined factors related to attitudes toward marriage and the importance of having children in both the US and Singapore. Path analysis indicated that life dissatisfaction leads to materialism, and both of these factors lead to favorable attitudes toward marriage, which leads to greater desire for children. Further analysis …


Children’S Perceptions Of Intimate Partner Violence: Causes, Consequences, And Coping, Renee L. Deboard-Lucas, John H. Grych Jul 2011

Children’S Perceptions Of Intimate Partner Violence: Causes, Consequences, And Coping, Renee L. Deboard-Lucas, John H. Grych

Psychology Faculty Research and Publications

Children’s appraisals of conflictual and aggressive parental interactions mediate their effect on children’s adjustment. Previous studies have relied almost exclusively on self report questionnaires to assess appraisals; consequently we know little about perceptions that occur naturally when children witness interparental aggression. This study employed a semistructured interview to assess the thoughts and feelings of 34 children (ages 7–12) whose mothers were receiving services at domestic violence agencies, and mothers reported on interparental aggression that took place in the home. Children’s thoughts centered on consequences and efforts to understand why fights occurred. They generally viewed their mother’s partner as responsible for …


Examining The Efficacy Of Conjoint Behavioral Consultation For Health Behaviors Of Children With Obesity, Carrie Alisha Semke Jun 2011

Examining The Efficacy Of Conjoint Behavioral Consultation For Health Behaviors Of Children With Obesity, Carrie Alisha Semke

College of Education and Human Sciences: Dissertations, Theses, and Student Research

An estimated 17.1% of children and adolescents ages 2-19 are obese (Ogden et al., 2006). Obesity is linked to adverse physical, psychosocial, and academic consequences for children. Treatments that collaboratively involve individuals in the child’s microsystems (e.g., home, school) result in improved health outcomes. Few studies have mutually involved both parents and school personnel in treatments. Conjoint Behavioral Consultation (CBC; Sheridan & Kratochwill, 2008) is an indirect service-delivery model that joins microsystems to address child concerns, and provides a model for delivering comprehensive treatments to improve the health behaviors of children with obesity. No previous studies have investigated CBC for …


Maternal Posttraumatic Stress Disorder, Parenting, Family Functioning, And Child Outcome, Desiree Alana Sutherland Jun 2011

Maternal Posttraumatic Stress Disorder, Parenting, Family Functioning, And Child Outcome, Desiree Alana Sutherland

Dissertations

Although a good deal of research has been conducted examining the effects of parental psychopathology of various types (i.e. maternal and paternal depression and schizophrenia, paternal PTSD), very few studies have investigated the influence of maternal PTSD on mothers’ parenting and their children’s behavioral and psychological functioning. This paucity of research is in spite of the fact that women exhibit higher lifetime PTSD prevalence rates than men. The current study examined the influence of maternal PTSD and trauma on mothers’ parenting, family functioning, and children’s psychological well-being in a sample of 125 mothers and 34 mother-child dyads. Mothers provided self-report …


A Preliminary Examination Of The Psychometric Properties Of The Coparenting Questionnaire And The Diabetes-Specific Coparenting Questionnaire In Families Of Children With Type I Diabetes, Mor Barzel, Graham J. Reid Jun 2011

A Preliminary Examination Of The Psychometric Properties Of The Coparenting Questionnaire And The Diabetes-Specific Coparenting Questionnaire In Families Of Children With Type I Diabetes, Mor Barzel, Graham J. Reid

Paediatrics Publications

Objectives: To examine the structure and psychometric properties of a general childrearing [Coparenting Questionnaire (CQ)] and an adapted Diabetes-Specific Coparenting Questionnaire (DCQ) and compare general and diabetes-specific coparenting among two-parent families caring for a child with type I diabetes. Methods: Mothers and fathers of children (N=61) aged 8-12 years with type I diabetes completed self-report measures of marital functioning, parenting, and coparenting, including the CQ and DCQ. Results: Confirmatory factor analyses favored the hypothesized 3-factor model for mothers and fathers for the CQ and DCQ. The internal consistencies and convergent validities of the CQ and DCQ were adequate. Coparenting conflict …


Coparenting In Relation To Children's Psychosocial And Diabetes-Specific Adjustment, Mor Barzel, Graham J. Reid Jun 2011

Coparenting In Relation To Children's Psychosocial And Diabetes-Specific Adjustment, Mor Barzel, Graham J. Reid

Paediatrics Publications

Objective: To explore the potential utility of a general and diabetes-specific measure of coparenting by evaluating linkages between coparenting and both the psychosocial and medical adjustment of children with type 1 diabetes (TID). Method: Mothers and fathers of children (ages 8-12 years; n=61) with TID completed questionnaires including measures of general and diabetes-specific coparenting, and children's internalizing and externalizing problems. Medical adjustment included parent-reported diabetes management behaviors, children's self-reported diabetes quality of life (QOL), and metabolic control (HbA1c) assessed during clinic appointments. Results: Coparenting conflict around general child rearing tasks was significantly related to children's internalizing and externalizing problems. Diabetes-specific …


Speak Up! Promoting Interactions During Shared Reading Activities, Jennifer Singleton Jun 2011

Speak Up! Promoting Interactions During Shared Reading Activities, Jennifer Singleton

Psychology and Child Development

Interactions during shared reading activities between parent and child have been shown to benefit a child’s expressive vocabulary, receptive vocabulary, and literacy development. Research has identified a number of variables that influence the quality, frequency, and type of interactions that occur during shared reading. Using this research, I have written and illustrated a children’s book that accounts for these variables. The result is a 56 page, hard-covered book that reads from both directions. One direction prompts children to provide their own answer to why animals are the way they are, while the other direction offers the leading theories from scientists …


A Study Of Intergenerational Crime From A Sociological Standpoint, Anna Robosson Jun 2011

A Study Of Intergenerational Crime From A Sociological Standpoint, Anna Robosson

Social Sciences

The focus of this project will be the patterns and causes of intergenerational crime within the United States.  Ultimately, the goal of the project is to explain the phenomenon, as it is becoming a rising problem in the country.


The Juvenile In-Justice System, Kasey Susan Franks Jun 2011

The Juvenile In-Justice System, Kasey Susan Franks

Social Sciences

No abstract provided.


Exposure To A Natural Disaster (Hurricane Ike) And Children's Diet And Activity Levels, Betty Sao-Hou Lai May 2011

Exposure To A Natural Disaster (Hurricane Ike) And Children's Diet And Activity Levels, Betty Sao-Hou Lai

Open Access Dissertations

Objective: Utilizing a conceptual model of the impact of disasters on children╒s functioning, the current study examined unhealthy diet and sedentary activity levels of children exposed to Hurricane Ike. Exposure stressors (perceived and actual life threat) and recovery stressors (hurricane-related stressors and major life events), were hypothesized to be associated with unhealthy diet and sedentary activity. Exposure stressors, recovery stressors, and child demographic characteristics were also expected to be associated with posttraumatic stress (PTS) symptoms. It also was predicted that physical activity would attenuate the relationship between recovery stressors and children╒s PTS symptoms. Finally, the feasibility of collecting health behavior …


Examining Activity Levels And Motor Proficiency: A Comparison Of Children Who Are Overweight And At A Healthy Weight To Their Parents And Peers, Aaron Copeland, Maresa Madsen, Riley Phelps, Brandon Richards May 2011

Examining Activity Levels And Motor Proficiency: A Comparison Of Children Who Are Overweight And At A Healthy Weight To Their Parents And Peers, Aaron Copeland, Maresa Madsen, Riley Phelps, Brandon Richards

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: The purpose of this study was to examine relationships and differences between motor proficiency, activity level, and parental activity level in children who are at a healthy weight and children who are overweight or obese.

Methods: Forty-four children (26 children at a healthy weight and 18 children who were overweight or obese) between the ages of 8-16 (BMI: 14.3-43.6 kg/m2) and 36 parents (BMI: 18.1-44.7) participated in this study. Children and parents wore StepWatch activity monitors (SAM) to measure activity levels over a 72 hour period. Tests reflecting several determinants of motor performance were also administered to …


Effects Of Environment On Children's Motor Scores, Eligibility Status, And Administration Times, Derrick Mittelstadt, Abigail Parker, Kirsten Pickett, Heather Temkin May 2011

Effects Of Environment On Children's Motor Scores, Eligibility Status, And Administration Times, Derrick Mittelstadt, Abigail Parker, Kirsten Pickett, Heather Temkin

UNLV Theses, Dissertations, Professional Papers, and Capstones

Best practices for assessing developmental skills in young children focus on naturalistic observation in everyday settings, but the effects of environment on test scores, eligibility status and administration time have not been explored. The Peabody Developmental Motor Scales-Second Edition (PDMS-2) was administered to 34 children aged 18 to 59 months in natural and pull-out settings. PDMS-2 total, gross, and fine motor quotient (TMQ, GMQ, and FMQ) scores were significantly lower in the natural environment (p’s≤.014). Based on our results, more children would qualify for services when tested in natural environments using TMQ and GMQ scores. It also took significantly longer …


Executive Function Profiles In Pediatric Traumatic Brain Injury, Erik Nelson Ringdahl May 2011

Executive Function Profiles In Pediatric Traumatic Brain Injury, Erik Nelson Ringdahl

UNLV Theses, Dissertations, Professional Papers, and Capstones

Traumatic brain injury is a common cause of disability and death among children in the United States. Insult to the frontal and temporal lobes are frequent in closed head brain injury. Cognitive deficits in a variety of domains are common sequelae of brain trauma. In many cases, trauma to the frontal and temporal lobe regions engender prominent deficits in higher-order cognitive processing, memory, and attention.

Higher-order cognitive processing, or Executive Functions are the grouping of cognitive processes necessary for organization of thoughts and activities, attending to the activities, prioritizing tasks, managing time efficiently, and making decisions (Alvarez & Emory, 2006; …


The Role Of Planning Tools As Strategies For Combating Childhood Obesity, Jacquelyn Coats May 2011

The Role Of Planning Tools As Strategies For Combating Childhood Obesity, Jacquelyn Coats

All Theses

The failure of traditional health models to successfully combat childhood obesity is apparent when considering its sustained prevalence in the United States. Childhood obesity rates have tripled over the past three decades and health officials recognize the need for integrative strategies in order to reverse the trend (CDC, 2010). The historical roots of planning and public health offer a potential venue for collaborative strategies to address the macro level factors that affect community health. This thesis examines how planning tools have been adapted to incorporate health strategies, whether or not such methods are sustainable, and what relationships are essential for …