Managing Multi-Agency Working in Elderly Care

Managing Multi-Agency Working in Elderly Care Managing Collaboration Multi-Agency Working for older people’s services Executive summary and introduction Collaboration in the field of both welfare and healthcare, on one level, can be expedient, efficient and economical. On another, more practical level, it can be a minefield of legislative, practical and interpersonal difficulties. (Arblaster. L. et al 1998) This report will consider these aspects in direct consideration of collaboration of the various aspects of care related to the elderly. It has to be viewed as being within the spirit and the legislative restriction of the NHS Plan (DOH 2000) and therefore considers the methods of collaboration with the PCTs in some detail, and also in the spirit and legislative requirements of the National Service Framework for the elderly. (Rouse et al 2001) What is collaboration between organisations? The transition from the concept â€Å"Empire† culture to the â€Å"Seamless interfaceâ€Å" culture is effectively based on the concept of practical and effective collaboration. (Powell, J. Lovelock, R. 1996) The changes that were proposed in a number of recent pieces of welfare based legislation (after the 1993 changes in the community care organisation and the National Service Frameworks to quote just two), have all espoused collaboration as their raison d’à ªtre. Clearly, in consideration of the elderly, there are numerous organisations that can potentially collaborate (Appendix Two), and all have their strengths, weaknesses and pitfalls. Let us examine one important area as an illustration. If we consider the welfare/health service interface. Primary healthcare teams control access to secondary and community health services through patient referrals. Social Services equally manage funding for home care and residential services including nursing home facilities and control access through assessment and care management. (Glendenning C et al 1998). When it is the case that, in terms of professional organisations, one depends upon another for access to services, their ability to obtain their own organisational or professional objectives can be severely compromised. (Haralambos M et al 2000). In practical terms, the GP is dependent on the social services to fund the appropriate facility whether it is a nursing home, domicillary enhancement services to keep a patient out of an acute medical hospital bed, or other forms of social support to facilitate the timely discharge of a patient from hospital. The arguments for collaboration are so overwhelmingly obvious that they hardly need repeating here. In real terms, the consideration of collaboration between organisations more analytically hinges on the question, â€Å"which organisations?†. The example that we have given is a fairly common collaboration and is therefore enshrined in both common working practice and also with legislative and regulatory boundaries. The advent of the National Service Frameworks have helped promote commonly recognised goals and objectives across the health/welfare spectrum of care, although a number of financial issues and problems with the organisational culture interface can commonly difficulty in everyday practice (Wierzbicki Reynolds 2001). Other organisations have to liaise and collaborate with the Social Services Dept. such as local and national voluntary support groups and specialist interest support groups, (often disease process based,) and these generally have much looser procedural issues and practices which may need different considerations. We shall discuss these in greater depth elsewhere in this essay. What are the problems? Taking a broad overview of the scope and possible nature of collaborative enterprises. Problems can arise from a number of organisational areas. Financial considerations, especially financial accountability, cause problems when this eventuality has not specifically been legislated for. Appendix Three sets out many of the potential pitfalls in this area. We observe that the health based services are essentially free to the patient whereas Welfare is largely means tested and thereby rendered vulnerable to changes of political direction and pressure. (Audit commission 2004) Another major area of potential difficulty stems from the historical development of professional language, terminology and working practices that each collaboration can interface. Client, patient , in need, deserving, dependent – all are terms frequently used by various healthcare professionals, but with different interpretations and nuances of meaning. Collaboration will inevitably require a more exact and specific vocabulary to be evolved and agreed. (Garlick C 1996). Collaboration inevitably means information sharing. The â€Å"Empire† concepts and constructs take a long time to die and be eradicated, but the seamless interface can only realistically be expected to work if all available information is shared. This raises serious problems of confidentiality if information is expected to be shared between healthcare professionals and collaborating agencies from the voluntary sector for example. (Cameron,A et al 2000). What are the solutions? Management solutions can be both complex and difficult to introduce or impose. By virtue of the potentially disparate nature of the collaborative partnerships that we are considering, there is clearly no â€Å"one size fits all† solution. It is for this reason that general principles are more useful than specific suggestions. The management of change (and therefore the solutions) is perhaps the most fundamental element in the discussion. Visions, ideas and directions are of little value if they cannot be translated into reality. (Bennis et al 1999). We can turn to the writings of Marinker (1997) who points to the fact that systems change, and indeed change management itself, are responsive to the acceptance of a division between concordance and compliance. People generally respond better to suggestion, reason and coercion rather than imposition of regulations and arbitrary change. The models that rely on publication and dissemination of information are generally more likely to be well received and more fully implemented, particularly if it is peer driven. (Shortell SM et al 1998) This is perfectly illustrated by the Davidmann Report (Davidmann 1988) on the debacle of the introduction of the Griffiths Reforms in the 80s. (Griffiths Report 1983). His major findings were that the Reforms failed because changes were imposed rather than managed Collaborative solutions should only realistically be made after a careful consideration of the evidence base underpinning that proposed change. (Berwick D 2005). Modern management theory calls for appropriate evaluation of the need for collaborative proposals by considering the evidence base on which the situation could be improved, its implementation by making managers aware of the need for change and proactively encouraging them in the means of implementation, and then instituting a review process to evaluate the effectiveness of the measures when they have been in place. (Berwick D. 1996) (Appendix five) Models of Collaboration There are a great many models of professional collaboration cited in the literature. In order to make an illustrated analysis, we will return to the specific example of the Health/welfare interface to consider some of the models in that area. In general terms, all of the models follow the functional structure Plan, Implement and Review (expanded in Appendix Five). The Outreach (or Outposting) model appears to be a commonly adopted model (McNally D et al. 1996), whereby a social worker is attached to a primary healthcare team. In terms of our analytical assessment here we should note that such arrangements, if subjected to process evaluation, generally promote progression towards a seamless interface in areas such as: The sharing of information and in mutual understanding of the different professional roles, responsibilities, and organisational frameworks within which social and primary health services are delivered. It is also noted that such benefits are generally greater if the implementation of such models is preceded by exercises including team building or joint training exercises. (Pithouse A et al 1996) Other models include the Joint Needs Assessments model in which service commissioning between primary health and social services teams have a common assessment base (Wistow G et al. 1998). This does not appear to have been as successful as the outreach model, and has had a rather variable history (Booth T 1999). Collaboration here has involved a variable number of agencies but not always the primary healthcare teams. The new primary care groups will have a strategic role in the commissioning of a broad range of health and welfare services. All NHS organisations have a clear imposed duty of collaboration and partnership with the local authorities (NHSE 1997) Collaboration in the form of joint commissioning models have also been tried. They tend to fall into one of three patterns including Area or locality as basis for joint commissioning Joint commissioning at practice level Joint commissioning at patient level None have been in place for long enough for a realistic assessment of their relative strengths and weaknesses to be evaluated yet. (Glendenning C et al 1998) Models- Interprofessional/teams One of the more successful models of collaboration is that of the multidisciplinary pre-discharge assessment team which, when it works well, can be considered a model of good collaborative working (Richards et al 1998). This requires all of the elements referred to above to be successfully implemented and to be in place if the optimum result for the client is to be obtained. Such a model calls for professional integration and collaboration of the highest order if National Service Framework Standard Two is to be fully realised. The framework calls for all concerned professionals to: Ensure that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries. It is, in our estimation, the crossing of these boundaries that, perhaps, is the key to collaboration. Review Collaboration as a concept is comparatively easy to define. Any dictionary will give a reasonable definition. As a workable model of practice, it is far more nebulous and hard to achieve. In this review we have tried to consider the barriers and management problems that make it harder to achieve together with the mechanisms which will militate towards successful implementation. We have identified financial and cultural barriers, as well as structural and organisational ones equally we have pointed towards models of collaboration which appear to be working well. It would appear to be the case that the prime factor in the success or ultimate failure of a collaborative exercise, is the success and management skills with which it is initially introduced.   References Arblaster. L. et al (1998) Achieving the impossible : interagency collaboration to address the housing, health and social care needs of people able to live in ordinary housing: Bristol Policy press and Joseph Rowntree. 1998 Audit commission (2004) Older People – Independence and well-being: The challenge for public services London: The Audit Commission 2004 Bennis, Benne Chin (Eds.) 1999 The Planning of Change (2nd Edition).. Holt, Rinehart and Winston, New York: 1999. Berwick D. 1996 A primer on the improvement of systems. BMJ 1996; 312: 619-622 Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Booth T. 1999 Collaboration between health and social services; a case study of joint care planning. Policy Polit 1999; 19: 23-49. Cameron,A. Brown H and Eby,M.A. (2000) Factors Promoting and Obstacles Hindering Joint Working; School for Policy Studies, Bristol. 2000 Davidmann 1988 Reorganising the National Health Service: An Evaluation of the Griffiths Report HMSO : London 1988 DOH 2000 Department of Health (2000) The NHS Plan. A Plan for Investment. A Plan for Reform. Cm 4818. London: The Stationery Office Garlick C. 1996 Social solution. Nurs Times 1996; 92: 28. Glendenning C. Rummery K, Clarke R 1998 From collaboration to commissioning: developing relationships between primary health and social services BMJ 1998;317:122-125 Griffiths Report 1983 NHS Management Inquiry Report DHSS, 1983 Oct 25 Haralambos M, M Holborn 2000 Sociology: themes and perspectives, Harper Collins 2000. Marinker M.1997 From compliance to concordance: achieving shared goals BMJ 1997;314:747–8. McNally D Mercer N. 1996 Social workers attached to practices. Project report. Knowsley: Knowsley Metropolitan Borough and St Helens and Knowsley Health , 1996. NHSE 1997 National Health Service Executive. Health action zones invitation to bid. Leeds: NHS Executive , 1997(EL(97)65.) Pithouse A, Butler I. 1994 Social work attachment in a group practice; a case study in success? Res Policy Plann 1994; 12: 16-20. Powell, J. and Lovelock, R. (1996), Reason and commitment: is communication possible in contested areas of social work theory and practice?, in Ford, P. and Hayes, P. (eds), Educating for Social Work: Arguments for Optimism, Aldershot, Avebury, pp. 76–94. Richards, Joanna Coast, David J Gunnell, Tim J Peters, John Pounsford, and Mary-Anne Darlow 1998 Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care BMJ, Jun 1998; 316: 1796 – 1801 Rouse, Jolley, and Read 2001 National service frameworks BMJ, Dec 2001; 323: 1429. Shortell SM, Bennett CL, Byck GR. 1998 Assessing the impact of continuous quality improvement on clinical practice: what will it take to accelerate progress? Milbank Quarterly 1998; 76: 593-624 Wierzbicki and Reynolds 2001 National service frameworks financial implications are huge BMJ, Sep 2001; 321: 705. Wistow G, Brookes T, eds.1998 Joint planning and joint management. , London: Royal Institute for Public Affairs, 1998. ############################################################ 25.1.06 PDG Word count 2,290

What are Ontology and Epistemology? Essay -- Philosophy, Truth

What are ontology and epistemology and why are they important in social science research Introduction The study of any particular science involves embracing particular and specific ontology, epistemology and methodologies that are different from each other. Ontology is the concept that defines and explains the essential types of truth (Blaikie 2009). Every field of science constitutes its own ontology and in most cases two types of ontology exists: formal ontology and domain ontology (Blaikie 2009). Formal ontology type of research always postulates something general related to reality while on the other hand domain ontology postulate something specific with regard to different types of truths (Blaikie 2009). On its part epistemology constitute a science concept that defines how human and the general population of the world know and reason the particular truth. The two concepts are differentiated by particular assumptions that are associated with each of them. For instance assumptions associated with ontology include: shallow realist, conceptual realist, cautious realist, depth real ist and idealist (Blaikie 2009). On the other hand assumptions related to epistemology include: empiricism, rationalism, falsificationism, neo-realism and constructionism (Blaikie 2009). Therefore the purpose of this essay will be to define objectivism and inteprativism as related to ontology, define positivism and interpretavism as related to epistemology, explain how ontology and epistemology are linked and how they influence each other, before lastly looking at how important ontology and epistemology are. Objectivism and interprativism in ontology Blaike (2000) asserted that ontology to involve, â€Å"claims and assumptions that are made about natur... ...oherent research practice functions to collect and communicate information about the world, a scenario enabled by key concepts of ontology and epistemology. Conclusion Social reality in general is viewed as a complex of causal relations between events that are depicted as patchwork of relationships between variables. Generally, causes of human behavior are regarded as being external to the individual and knowledge is seen to be derived from sensory experience by means of experimental or comparative analysis and concepts and generalizations are summaries of particular observations. In reality, claims have been made about what is observed with the senses is what is real and that scientific laws are similar with empirical regularities. In summary, key concepts of ontology and epistemology have played important role in shaping and guiding social research processes.

Research review example Essay

Please note that ethical standards of peer reviewing constrain me [JP] to give you the original manuscript. I also had to anonymize identifying information in the review. This review is meant as an example of the style used in writing a review; you do not have to understand all the details. Please note that this review is longer than the one you are requested to write. This is a highly interesting study on a timely subject, the impact of pornography use in adolescence on relationship intimacy in early adulthood. Based on Zillman’s programmatic piece about the â€Å"influence of unrestrained pornography† on adolescents and more recent research on teenagers’ use of internet pornography, the study develops a model on how adolescent pornography use may affect relationship intimacy in young adulthood. The study concludes that there is, â€Å"at best, minimal support for Zillmann’s claim that prolonged exposure to pornography is associated with sexual callousness† (p. 13). The strengths of the study include, in my view, the focus on an under-researched dependent variable; its attempt to build and test a model; and the (attempted) investigation of gender differences. The weaknesses include, in my view, the theoretical underdevelopment of the model and several severe methodological problems. Theoretical development of the model By the standards of Journal [ANONYMIZED], the theory section (pp. 2-4) is very short. While in journals of other disciplines (e.g., Journal of Adolescent Health) such a short introduction is requested, pieces in [ANONYMIZED] are expected to be more specific about the theoretical underpinnings of the study. Although brevity is always preferable, a study that develops and tests a new model does require a somewhat more thorough conceptual definition of the various influences in the model and, most importantly, a rationale for these influences. Conceptual definitions and rationale for the components in the model: The model has four components, exposure to pornography, pornographic realism, acceptance of recreational sex, and relationship intimacy. However, on p. 2, many more concepts are outlined (based on Zillmann’s paper): habituation, cultivation effects in terms of perceived sexual behaviors, distrust in intimate partners, abandonment of exclusivity as a norm of romantic relationships, and greater endorsement of promiscuity. None of these concepts is tested. Moreover, on p. 3, several other concepts are mentioned, including cynical attitudes about love, sexual pleasure without affection, sexual callousness, and decreasing emotional attachment. While the latter concepts are related to what is tested, they are not the same. Scanning through the studies that Zillmann and Bryant published in the 1980s, it becomes clear that they have probably something else in mind when they talk about *sexual* callousness than â€Å"an impaired ability to form intimate relationships† (p. 4). Finally, it remains unclear why pornographic realism is an important addition to the model suggested by Zillmann. This is certainly not to say that the paper’s model is unrelated to Zillmann’s ideas, but the paper should aim for more conceptual clarity. Key concepts need to be defined. Moreover, it needs to be outlined how the key concepts of the model relate to Zillmann’s ideas as well as when and why they differ. Rationale for the influences hypothesized in the model: The model hypothesizes that recreational attitudes toward sex mediate the effect of pornography on intimacy. Pornographic realism is included as a covariate of pornography use (although it is claimed that it is investigated as a mediator, p. 4). However, the rationale for hypothesizing these processes remains vague. First, how precisely are recreational attitudes related to sexual socialization and the sexual script concept (p. 3)? How, and why, are these attitudes affected by pornography? These questions should not be answered on the basis of empirical regularities (as done on pp. 3-4), but on the basis of more elaborate theorizing. Second, why is pornographic realism a covariate (at least in the model tested)? From the quote on p. 4, it rather seems a mediator. This needs some clarification and elaboration, too. Gender differences The analysis of gender differences occupies considerable space in the analysis and discussion. However, a rationale is largely lacking why such differences need to be investigated. There is sufficient evidence that females use pornography less often than males do (i.e., gender as a direct predictor), but it is crucial to outline why the processes hypothesized may differ by gender (i.e., gender as a moderator). Methodological problems I would like to stress that any research on the issue of the study is admirable, given the enormous ethical, practical, methodological, statistical issues involved. In my evaluation, I take this into account. That said, I do have to raise some potentially unpleasant questions about the design of the study; operationalization of the key measure; procedure/ sample; and analysis. Design and operationalization of key measure The paper aims at testing a causal model, but relies on cross-sectional data. The paper outlines on p. 4 that the study includes a time component by asking respondents to indicate their pornography use at ages 14 and 17. Several problems arise. First, cross-sectional data do not permit causal conclusions related to media effects. At the very least, this needs to be acknowledged explicitly and prominently. Also, language suggesting causal relations should be avoided. Second, asking respondents retrospectively about their pornography use at the ages of 14 and 17 raises some questions. Why at ages 14 and 17? Adolescence usually spans the period between age 12 and 17. Why was exposure not measured, for instance, for age 12 (early adolescence), age 15 (middle), and age 17 (late)? Third, self-reported retrospective measures of sensitive behavior are prone to multiple biases, most notably memory bias and social desirability bias. These biases already plague measures that relate, for instance, to the â€Å"past week.† But how can such measures meaningfully be applied to behavior that happened, for the oldest respondents, 11 years ago? Fourth, what exactly were the response categories? â€Å"Never† suggests a vague-quantifier scale (e.g., never, rarely,  sometimes, often, very often), which carries a lot of problems, most notably the problem that vague quantifiers leave it up to the respondent to decide what the categories mean. However, the positive anchor of the scale is â€Å"every day.† Was the scale thus a scale asking about specific frequencies (e.g., once a week, less than once a week). Again, how can such frequencies be assessed validly after so much time? Any information on the validity and reliability of the measure along with a rationale for the operationalization is highly welcome. Fifth, how does this measurement strategy assess â€Å"prolonged† exposure, the key concept in Zillmann’s paper? Assessing retrospectively the use of pornography does not tell us much about the trajectory of porn use. Finally, a retrospective measure is not the same as a measure taken at a certain point in the past, in contrast to what is claimed on p. 4. I perfectly understand that longitudinal research is cumbersome, particularly in that area. That said, it seems difficult to see how the retrospective measurement of pornography use tackles the causal problems inherent in cross-sectional research. In sum, there are several serious issues with the operationalization of one of the key variables, which urgently need to be addressed. Procedure/ Sample The paper is unfortunately very brief about the procedure and sample of the survey. Given the self-selection problems in sex research, I was surprised to read that few precautions were taken to minimize this bias. Why was snowballing not avoided, but even encouraged (p. 5)? Why did the study not include some simple quotas, most notably for gender (see below)? Was there a control of whether a particular respondent filled in the survey multiple times? In addition, I assume that informed consent was explicitly asked for, but this should be mentioned briefly. Finally, is there an indication of how many respondents were contacted and what the response rate was? There are also several important questions about the sample. First, why was the study limited to sexually active students? Sexual experience may create a limiting boundary condition for what the paper is interested in. Second, why was the age frame limited to 18- to 25-year olds? Is this related to the theory of emerging adulthood? Third, why was the study limited to university students? We complain about such convenience samples in experimental research. There  may be even more concerns about such samples in survey research. While the concerns raised in the previous paragraphs address very severe shortcomings, they may even be multiplied by the fact that twice as many women as men filled in the questionnaire. This is a crucial problem because the basic conclusion of the paper is that the model only works for women, but not for men. To be sure, the paper mentions these shortcomings in the discussion section, but that does unfortunately not reduce its importance. Table 2 shows small to moderate zero-order correlations for men and women. However, with twice as many women as men in the sample, an r = -.11 is significant for women, while an r = .13 is not significant for men. Both for men and women, the correlations are in the same direction. I guess that, with an equal number of men and women (e.g., 350 each), the model would largely hold for both. This would also be a more reasonable sample size in terms of statistical power consideration. In conclusion, there is reason to believe that one of the main conclusions of the paper is a result of a severe shortcoming in the sample procedure of the study. Analysis The general problems with the gender analysis notwithstanding, I was wondering why the paper does not apply a multiple-group analysis. This is a more rigorous way of testing whether the various paths differ between women and men than the strategy currently employed. I was wondering whether the SEM analysis used item-parceling strategies. Otherwise, there need to be more manifest indicators in the models. Finally, the statistical testing of indirect effects (i.e., whether they differ significantly from zero) has become a standard procedure and should be included. Discussion In the light of the problems raised above, some of the conclusions raised in the discussion section may need some reconsideration. (This is my opinion, and the authors may or may not follow them). First, I am hesitant to agree with the paper that the findings have â€Å"little if any practical significance† (p. 10). The discussions about effect sizes in media effects research in particular and the social sciences in general have been outlined elsewhere and do not have to be repeated here. Against that backdrop, an explained variance of 8% (with two predictor variables related to pornography) in  recreational attitudes and of 16% in relationship intimacy does not seem trivial to me. It may indeed be that other variables (family, peers etc.) have a greater influence, but this needs some more backing in order to contextualize the effects found. I agree with the paper that the moral panic that surrounds pornography finds no support in any research published so far. However, this does not mean that the effects found in this paper and elsewhere are trivial, at least when considered in the context of media effects research and against the backdrop of the methodological and statistical problems that this kind of research faces. Second, it seems to me that the paper contradicts itself when, on the one hand, it rejects main effects as too simplistic (p. 3) and, on the other hand, describes the found indirect effects as practically insignificant. No serious media effects researcher would disagree that media effects are typically not direct and that a focus on the â€Å"how† and â€Å"why† of such effects is important. If we can explain how precisely media affect people, then this may have enormous practical significance, especially if we can outline which people may be affected and which may not (in line with Malamuth ’s ideas). Third, I agree that love maps and sexual scripts may explain sexual attitudes and behavior, probably even better than media use (p. 11). But it remains unclear to me where, precisely, this is tested in the model. Some clarification may be helpful. Fourth, it may also be helpful to specify how the distinction between imagined and real sex lives relates to the model tested, apart from outlining that perceptions of pornographic realism may never fully translate into people’s actual sex lives. In sum, this is important and interesting research. However, the theoretical, conceptual, and methodological weaknesses currently outweigh the strengths of the paper so that its contribution to our knowledge about how the use of pornography affects relationship intimacy in adulthood is limited.

How Did Christianity Succeed In Becoming So Widespread In The Period Up To Diocletian - Free Essay Example

Sample details Pages: 8 Words: 2296 Downloads: 6 Date added: 2017/06/26 Category History Essay Type Analytical essay Level High school Did you like this example? How did Christianity succeed in becoming so widespread in the period up to Diocletian despite the Roman persecution of Christians? It took Christianity a little under three hundred years to develop from a small, heretical Jewish cult based in the eastern provinces into the universal religion of the Roman Empire with churches and bishops ranging from Antioch and Edessa in the east to Lyons and Toledo in the west, and encompassing the North African cities of Carthage and Alexandria in the south. Just how an often persecuted sect managed to accomplish this is a complex issue that cannot be fully examined within the scope of this essay; rather it will focus on some aspects of early Christianity that allowed it to flourish and which could withstand the persecutions that took place from the second to the third centuries, concentrating on the eastern provinces, specifically Judaea, Phoenicia, Syria, Galatia and Bithynia-Pontus. (Chadwick, 1967) It is impossible to know what percentage of the population of the Empire considered themselves Christian. Don’t waste time! Our writers will create an original "How Did Christianity Succeed In Becoming So Widespread In The Period Up To Diocletian" essay for you Create order One suggestion is ten percent but this is an estimate and, as Brown points out, it is more significant that during the third century Christian communities grew quickly (Brown, 2013). The early Christian sources cannot be relied upon to provide an accurate picture, as Lane Fox notes; Christian authors â€Å"were quite uncritical in their use of words like ‘all’ and ‘everywhere’† (Lane Fox, 1988, p. 269). Eusebius, for example, described how the Apostles had been sent across the globe to preach: Thomas was sent to Parthia, Andrew to Scythia, John to Asia and Peter was allotted the eastern provinces of the Roman Empire (Eusebius, 3:1). In order to consider what impact persecution had on the spread of Christianity, it is necessary to consider the way Christianity spread; and in particular what was it about this religion that set it apart from the pagan cults (and Judaism) that could both attract followers and help it withstand persecution. There are a number of reasons why Christianity flourished in the period between the end of the first century and Diocletian’s Great Persecution at the start of the fourth. The nature of Christianity and its emphasis on charity and hospitality; a shared sacred text; the close-knit structure of the early Church; the way it appealed to all levels of society; the very act of persecution itself, the nature of the pagan cults it was competing with and the wide-ranging trade routes across the Empire, are just a few. (Chadwick, 1967; Lane Fox, 1988) Christian groups shared a set of beliefs and ideals based around the preaching of salvation and it can be argued that this unity of beliefs is what strengthened Christianity and allowed it to flourish. Christians shared a meal recollecting the sacrifice of their saviour and were encouraged to regard themselves as a family, calling each other â€Å"brother† and â€Å"sister† and to greet each other with a kiss. Individual communities possessed similar structures, particularly during the late second and third centuries, which emphasised their unity. This was certainly the view of Origen when responding to the allegations of the second-century philosopher Celsus who acknowledged the unity of Christians but believed it to be based on â€Å"no trustworthy foundation† other than their â€Å"unity in revolt (†¦) and fear of outsiders† (3:14, Chadwick, 1953, p. 136). Origen states that Christianity does have a firm foundation in divine doctrine and God’s law. (3:15, Chadwick, 1953). The message that everyone was subject to the same divine law and could achieve salvation through renunciation of sins was unique to Christianity. This was a message upon which persecution could have no impact; indeed persecution offered devout Christians the opportunity to emulate their saviour and make the ultimate sacrifice for their faith; persecution encouraged martyrdom. Whilst elements of early Christian practice, such as the celebratory meal and offering practical support for fellow supporters, can be seen in some pagan cults at this time, what set Christianity apart was its shared sacred text. It must be acknowledged that Christianity and Judaism are very similar in this regard, however, the New Testament, works by Origen and other early Christian philosophers and those condemning the Gnostic practices of the Coptic Church as heresy show that different Christian groups were discussing and exchanging views on important topics. In this way early Christian thinkers, the ‘Church Fathers’ were formulating a common, orthodox canon of beliefs which were set down in documents that were shared amongst the communities. (Clark, 2004) The early Christians did not worship in what we would recognise as churches; they held assemblies which acted as a family unit, providing not only spiritual but practical support to its members. (Chadwick, 1697; Brown, 2 013) They met in the homes of individual Christians and these houses were extended to accommodate the growing community, as at Dura Europos in Mesopotamia, a private house which was extended at some point in the 240s to add a hall large enough to accommodate up to sixty people (Lane Fox, 1988). It is perhaps significant, therefore, that no Imperial edict against the Christians, even that of Decian, specifically mentioned destroying churches until the Great Persecution of Diocletian at the start of the fourth century. Whilst the community might consider itself a church, there was no physical building, like a synagogue, which pinpointed them within the landscape of the town or city. In effect the church was mobile and could relocate as and when persecution made it necessary and meant Christianity could spread easily. One of the key principles of Christianity was its emphasis on acts of charity and supporting those in need, based around Matthew 25:38-40. (Clark 2004) No other religious group in the Empire held provision for the poor as a key doctrine, but Christians were duty-bound to offer not only spiritual but practical help to those less fortunate than themselves. (Chadwick, 1967) Eusebius quotes a letter of Dionysius, bishop of Alexandria, describing how Christians helped nurse the sick and dying of all religions during an outbreak of plague and helped to bury the dead, whereas the pagans abandoned the sick (even family members), to their fate. (Eusebius, 7: 22 7-10) As Clark (2004), following MacMullen, notes; nursing the sick might convince people that Christians had a special religious protection; their belief in suffering and salvation and stories of healing miracles could, perhaps, be more effective than doctrine in winning converts. The notion of charity was not confined to offering comfort and solace; one of the ideas Christianity had inherited from Judaism was giving alms for â€Å"the remission of sin† (Brown, 2013, p. 69). The idea that money earned in this world, by whatever means, could help its owner earn their place in the next through the remission of his or her sins meant that churches were able to accumulate wealth. The pagan temples of the large cities depended on donations from the wealthy whereas the average Christians making donations for the salvation of their souls were tradesmen. This meant that during times of financial disaster, as in the third century, the Christian communities were better able to withstand a crisis. The church developed structures and systems to ensure this wealth was distributed to where it was needed and Christians acquired a reputation for taking care of their own; widows and orphans as well as the sick and the destitute were all embraced in this institutionalised alms giving. (Brown, 2013; Clark, 2004)Thus the knowledge that your community was duty bound to offer practical assistance in times of need could easily be argued as a contributing factor to the sp read of Christianity, again one on which persecution would have little impact. This did not mean that Christianity developed into a religion of the poor; rather it embraced all ranks from slaves and tradesmen up to the higher echelons of society: Marcia the concubine of Emperor Commodus was Christian, as were King Agbar VIII of Osrhoene and Julius Africanus from Palestine (Brown, 2013 and Clark 2004). When considering the impact persecutions had on the spread of Christianity, the nature of these persecutions has to be taken into consideration. During the second and third centuries, there were two periods of persecution: the sporadic, isolated persecutions that were confined to specific areas during the second and early third centuries; and the Emperor led persecutions of Decian and Valerian which culminated in the Great Persecutions under Diocletian and Galerius. Our best evidence for the nature of these earlier persecutions comes from Pliny’s letter to Trajan, written c. 112 (Ep. 10:96, Radice, 1969, p. 293). Pliny, governor of Bithynia-Pontus, wrote to the Emperor asking for guidance on how to treat Christians arrested in his province. The letter describes how he had tortured two female slaves to obtain information about the activities of Christians and asks for advice on how he should conduct trials of suspected Christians who were brought before him as a result of anonymous allegations. Trajan’s reply makes it clear that only known Christians should be prosecuted and anonymous allegations should not be considered and those simply suspected of being Christian should not be sought out. This shows that during this time there was no clear policy of persecution coming from the Roman authorities. Similarly, Eusebius includes a letter from Trajan’s successor, Hadrian, written to Pliny’s successor, Minicius Fundanus, reaffirming this position; Christians should not be sought out directly, but those correctly accuse d under Roman law, should be punished (Eusebius, 4:9). Once again Eusebius’ evidence must be approached with caution; as with any Christian author he cannot be considered a reliable witness to the persecution of his own kind. When taken together, however, the evidence of both the pagan Roman official Pliny and the Christian Eusebius does indicate that there was no official policy of widespread persecution of Christians during the second century. Moreover, as St Croix (1963), illustrates, accusations against individuals were not likely to be made falsely as the person making the allegation had to carry out the prosecution, rendering themselves liable for a charge of calumnia (malicious prosecution) if they could not make a satisfactory case against the alleged Christian. Decian’s edict of 250 represents the changing situations of both the Empire and the Christian church. By this period Christianity had spread across the whole Empire; an empire which had been suffering from years of civil war and was in something of a crisis and in need of assistance from its gods (Clark, 2004). The edict issued by Decian in 249-250 did not specifically target Christianity, though Christian writers chose to interpret it as a direct attack; rather it required all citizens to make sacrifices to the gods and obtain proof of this in the form of a special certificate. It is clear that many Christians did suffer as a result of this edict; Babylas of Antioch and Alexander of Jerusalem were amongst many notable church leaders who lost their lives. Others, however, preferred to go into hiding or buy certificates from friendly magistrates. The impact of this edict was, therefore, twofold: it created a new generation of martyrs from those who refused to sacrifice and were punished for it; and caused schism within the church regarding what to do about those (mainly in the east) who fled or bought their certificates. Neither had any detrimental effect on the sp read of Christianity; martyrs were admired and acted as inspiration for the faithful and the debate regarding those who went into hiding helped to develop Church doctrine. As noted above, persecution created martyrs who were held up as examples to be followed: men and women who had endured physical pain and suffering like Jesus on the cross. Christian writers praised their bravery and courage, recording their heroic suffering in Acts and Passions which were copied and disseminated throughout the Christian world, raising them to the status of saint. Martyrdom and the development of the cult of saints are other key topics to consider when looking at the spread of Christianity and its reaction to persecution, but ones which cannot be discussed here. The ideas discussed above: the nature of Christianity, the unity provided by shared sacred texts and church organisation, the emphasis on charity and personal redemption; are just a few of the reasons this fledging cult was able to flourish and spread throughout the Roman Empire, covering not only the Eastern Provinces but also those in the west. There has been little room here to give them the full discussion they deserve, or to consider other factors such as the wide-ranging trade routes across the Empire that allowed Christians to travel and spread their faith; or to consider the way families were converted. What can be seen, however, is that Christianity was a religion with a unified belief structure that appealed to a wide cross-section of society and which offered practical help for those in need, including members of society that were often marginalised. Persecution did not stop the spread of Christianity, nor did it drive it underground. In the face of persecution most Christians remained steadfast; secure in the knowledge that their physical pain and suffering in this life would lead to reward in the next. Reference List: Primary Sources: Eusebius, Church History [online] Available from: Christian Classics Ethereal Library [online] https://www.ccel.org/ccel/schaff/npnf201.iii.viii.i.html [Accessed 14 February 2015] Chadwick, H. (1953) Origen, Contra Celsum. Cambridge: Cambridge University Press. Radice, B. (1969) The Letters of the Younger Pliny. Harmondsworth: Penguin. Secondary Works: Brown, P. (2013) The Rise of Western Christendom: Triumph and Diversity, A.D 200-1000. 10th Anniversary Revised Ed. Chichester: Wiley-Blackwell. Chadwick, H. (1967) The Early Church. London: Penguin. Clark, G. (2004) Christianity and Roman Society. Cambridge: Cambridge University Press. Lane Fox, R. (1988) Pagans and Christians in the Mediterranean world from the second century AD to the conversion of Constantine. London: Penguin. MacMullen, R. (1984) Christianizing the Roman Empire A.D. 100-400. New Haven; London: Yale University Press. St Croix, G.E.M de (1963) Why Were Early Christians Persecuted? Past and Present. 26. P. 6-38.