Compare And Contrast A Rose For Emily And Southern Gothic

Southern Gothic literature is a sub-genre of the Gothic writing style. It is unique to Southern America. Southern gothic style is a style of writing that engages very ugly and ironic events to study the value of the American south and its people. In this essay, I’m going to go over each story and give some details about the authors and their backgrounds. On one page, I will be comparing and contrasting all three stories. I will show how they’re similar through tone, plot, and scene in the story. And at the end, I am going to describe the three stories; â€Å"A Rose for Emilycomma inside quotes†, â€Å"A Good Man is Hard to Find†, and â€Å"Sanctuary†. Period inside quotes All of these short stories are good examples of southern gothic writing, because†¦show more content†¦Being a member of an antebellum southern aristocracy meant that she was in a family that was defined as a â€Å"planter† also known as a person owning property and twenty or more slaves. After the Civil War, the family went through another hardship. The woman and her father kept on living their lives as if they were still in the past. Her father refused to let her get married. When the woman was thirty years old, her father died. This took her by surprise. After her dad passed, the woman refused to give up his body. The town thought it was just part of her grieving process. After she finally accepted her dad’s death, she grew closer to Mr. Homer. This took the town by surprise. Homer explained to Emily that he wasn’t the marrying type. She did not like hearing those words. Emily went to town and bought arsenic from a drug dealer. Because of this, the towns people were certain she was trying to kill herself. Emily’s distant cousins came to visit because the priest’s wife had called them. Homer left for a couple of days, but then came back after the cousins had left. Emily wouldn’t talk to any of the towns peop le. They wouldn’t confront her given her reputation. They wanted to ask her about the awful smell that had been coming from her house and to talk to her about her taxes. At first, they said her taxes were over looked in debt to her father, but then they changed their minds and sent her notices. The woman refused to pay them! Years later Emily hadShow MoreRelatedSouthern Gothic Literature And Deranged Characters Essay1357 Words   |  6 PagesSouthern Gothic Literature and Deranged Characters â€Å"Southern Gothic Literature is a genre that focuses on grotesque themes that involve troubled and deranged main characters, while sometimes including elements found from the supernatural† (study.com P1). The following short stories had authors that played a tremendous role in the southern gothic literature genre, and inspired many authors to follow their style. From necrophilia to serial killers, southern gothic literature is a genre that is to beRead MoreAnalysis of the Gothic Fiction Books, The Cask of Amontillado and A Rose for Emily1191 Words   |  5 Pages　　　　　　Analysis of â€Å"The cask of Amontillado† and â€Å"A Rose for Emily† 　　　 　　　In this paper, I choose the Gothic fictions â€Å"The Cask of Amontillado† and â€Å"A Rose for Emily† to compare. I like them as these two works are very exciting with suspense. Next I will compare them on three aspects. 　　　The first is the theme. A Rose for Emily, written by William Faulkner, is a short story about the life and death of Miss Emily Grierson. The reader is told the story in flashback. Its structure is broken downRead MoreCompare and Contrast Southern Views of â€Å"a Rose for Emily† and â€Å"a Battle Royal†1024 Words   |  5 PagesCompare and Contrast Southern Views of â€Å"A Rose for Emily† and â€Å"A Battle Royal†Ã‚        Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The Souths history is sometimes described as charming and traditional, but it also has a dark side, and to say the least, is horrendous. William Faulkner author of A Rose for Emily, was raised in the South, whereas Ralph Ellison the Arthur of Battle Royal was from Oklahoma and attended College in the South. Each Arthur has different views and writing styles, which impacts their frame of reference toRead MoreLiterary Analysis Of Emily Griersons Death In Faulkner1542 Words   |  7 Pages This is a gothic tale following a tragic figure spanning nearly three decades. .Emily Grierson a penniless spinster not of her own choosing enumerating her life journey into isolation and psychosis. The last of the aristocratic Grierson family who called the town of Jefferson home nestled in Yoknapatawpha County Mississippi. She is unable to move forward with a changing time as she clings to her family’s former privileged social status, as a result she cannot let go of the past. The townsfolk collectively

Medical Home Practice-Based Care Coordination Free Essays

string(176) " perception of barriers to care coordination in the medical home includes: time, reimbursement, lack of physicians, lack of skill/training, and limited cultural effectiveness\." Medical Home Practice-Based Care Coordination: A Workbook By: Jeanne W. McAllister Elizabeth Presler W. Carl Cooley Center for Medical Home Improvement (CMHI) Crotched Mountain Foundation Rehabilitation Center; Greenfield, New Hampshire Beyond the Medical Home: Cultivating Communities of Support for Children/Youth with Special Health Care Needs Funded by: H02MC02613-01-00 United States Maternal and Child Health Bureau, Integrated Services for CSHCN, HRSA June 2007 Workbook Contents This workbook includes the tools and supports needed for a primary care practice to develop their capacity to offer a pediatric care coordination service; particularly for children with special health care needs. We will write a custom essay sample on Medical Home Practice-Based Care Coordination or any similar topic only for you Order Now The health care team, determined to develop such an explicit service, makes an assessment of current care coordination practice and frames their improvement efforts to achieve proactive comprehensive practice-based care coordination. Tools included in this resource are: a definition of care coordination in the medical home, a care coordination position description, a framework for care coordination services including structures and processes, strategies for the protection of devoted staff time, and a logical sequence of care coordination improvement ideas offered in the context of the Model for Improvement (Langley, 1996). Each tool can be used as is or it can be customized in a manner which best fits your practice environment and the strategic plans your organization holds for medical home improvement activities. Table of Contents Medical Home Practice Based Care Coordination Medical Home Care Coordination A Definition A Vision Is It Medical Home Care Coordination? A Checklist Medical Home (Practice Based) Care Coordination – Position Description – A Worksheet A Medical Home (MH) Care Coordination Framework – Framework – Worksheet Time Protection Tips Strategies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦5 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦7 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦9 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 10 †¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11 Care Coordination Development: The Model for Improvement †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦12 Care Coordination Aim Statement †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦13 Care Coordination Outcomes †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦14 Plan Do Study Act (PDSA) Worksheet Examples †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦15 1) Care Coordination Role/System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦16 2) Care Coordination – Needs Assessment †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18 3) Comprehensive Care Planning †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦20 Medical Summary, Action Emergency Plans 4) Transition to Adult Care Services †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦22 5) Community Outreach Resources †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦24 Appendices A. Websites and References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦.. 26 2 Medical Home – Practice-Based Care Coordination This workbook is designed to support practice-based quality improvement teams in their efforts to build comprehensive primary care â€Å"medical homes†. The focus is specifically upon the professional role development for the provision of practice-based care coordination. The ideal care scenario is one where the staff within the medical home is proactively prepared to support the central care giving role of families. The role of care coordination discussed within this workbook is one designed in the service of children/youth with special health care needs (CYSHCN). It is acknowledged that care coordinators in different environments will apply their skills and efforts toward the care of all children as well as adults with special needs or chronic health conditions; you should find the structures and processes offered within suitably applicable. Workbook Goals and Objectives: Goal: To put forth a practice-based medical home care coordination framework from which practices can select and suitably customize. Contents include a medical home care coordination checklist, definition, position description, model framework with structures and processes, and strategies for effective and successful care coordination development and implementation. Objectives: 1) Define practice-based care coordination for children with special health care needs in a medical home ) Select and appropriately modify a position description that fits each unique medical home improvement team environment 3) Use a care coordination model framework to fit the role well within each practice environment 4) Draw from a list of time protection and resource allocation strategies those with the best fit for the practice environment and related improvements 5) Develop tests of change (PDSA – plan, do, study, act) for the incremental development of a comprehens ive care coordination service model to include: care services, assessment of needs, care planning, transition support, and community outreach with resource linkages. It is established in the literature that the medical home is meant to be a centralizing resource for children and families, particularly for CYSHCN (AAP Medical Home Advisory Committee, 2002) Evidence is building that care coordination is essential to a medical home (Antonelli, 2004). It has been suggested that you cannot be a strong medical home without the capacity to link families with a designated care coordinator; this is the ideal. The policy statement issued by the American Academy of Pediatrics on Care Coordination (CC) describes CC as complex, time consuming, even frustrating but as key to effective management of complex issues in a medical home; and states that a designated care coordinator is necessary to facilitate optimal outcomes and prevent confusion. Care coordination takes resources and time. Practices need to be reimbursed for this labor intensive role (AAP Committee on Children with Disabilities, 1999). Horst, Werner, and Werner (2000) state that in all types of systems, care coordination is an essential element to ensure quality and continuity of care for CSHCN and their families. In a 10 point strategy to 3 achieve transformational change within health care for all, issued by the Commonwealth Fund, care coordination is cited as one of ten key components to organize care and information around the patient (Davis, K. 2005). Ideal care coordination provides timely access to services, continuity of care, family support, strengths-based rather than deficit-based thinking and advocacy. This is very time consuming, whether accomplished by parents or by parent professional partnerships (Presler, 1998). At the front lines of care, in the medical home Antonelli (2004) states that without the ability to support care coordination at the level of the medical home, barriers to achieve the Healthy People 2010 objectives remain. In the Future of Children (2005) the author claims that care coordination requires (at the very least) adequate personnel and time and is often limited in primary care by lack of the very time and resources necessary. This is substantiated by the AAP Periodic Survey of Fellows #44, (2000), by a national Family Voices Survey (2000) with parents reporting their physicians have the skill for coordination but are difficult to access and have minimal time available for care coordination activity/implementation. Similarly a survey of state Title V Directors and their perception of barriers to care coordination in the medical home includes: time, reimbursement, lack of physicians, lack of skill/training, and limited cultural effectiveness. You read "Medical Home Practice-Based Care Coordination" in category "Papers" Successful medical homes result when partnerships with families offer fully implemented practice-based care coordination. Proactive care coordination and care planning are fundamentally essential for improved care quality, access to services and resources, health and function of children and youth, and quality of life as well as improved systems of care. No medical home will achieve optimal comprehensive, coordinated and compassionate care without dedicated time and resources to develop, implement, and evaluate a complement of care coordination activities. Such an investment is favorable in terms of cost and benefit for children/youth and families, primary care practices and their broader health care systems. In summary, care coordination: Is accomplished everyday by families with and for their children and youth, but Support is desirable, feasible and beneficial coming from the medical home Requires critical funding and protected time Requires tested tools and strategies (some are included in this workbook, others have been developed and continue to evolve) Is a defining characteristic (element) of a fully implemented and comprehensive medical home Medical Home Care Coordination – A Definition The literature offers several definitions of care coordination but most have been written for application across varied health care environments such as hospitals, specialty based centers, community home health agencies. Few definitions focus exclusively on the distinctions found within the primary care medical home for the role of pract ice-based care coordinator. The focus of the Center for Medical Home Improvement is on the primary care practice with the provision of team-based care coordination, delivered from the centralizing resource of a primary care medical home with physician leadership and by experienced nurses, social workers, and/or comparable professionals. Care Coordination Practice-based care coordination within the medical home is a direct, family/youth-centered, team oriented, outcomes focused process designed to: Facilitate the provision of comprehensive health promotion and chronic condition care; Ensure a locus of ongoing, proactive, planned care activities; Build and use effective communication strategies among family, the medical home, schools, specialists, and community professionals and community connections; and Help improve, measure, monitor and sustain quality outcomes (clinical, functional, satisfaction and cost (McAllister, et al, 2007) A Vision for Practice Based Care Coordination Children, youth, and families have seamless access to their team, enhanced by they availability of a designated care coordinator who facilitates a team approach to family-centered care coordination services. (McAllister, et al, 2007) 5 CC CHECKLIST Is It Medical Home Care Coordination? Checklist – how are you doing? What elements are in place, which require some additional attention? NO / PARTIALLY/ YES 1) Families know who their care coordinator is and how to access him or her (or their backup)? ) Values of family-centeredness are known to the medical home team and drive the development and provision of care coordination? 3) A medical home care coordination position description is established; roles/activities are clearly articulated and care coordination training and education is available? 4) Administrative leadership helps to develop/support a care coordination service system; protected time allows for CC role development? 5) C YSHCN identification and assessment of child/family needs/unmet needs are completed; care planning is a core CC/medical home response? ) Education and counseling are offered as an essential part of medical home care coordination? 7) Care coordination includes comprehensive resource information, referrals, and cross agency/organization communication? 8) Child/family advocacy is a part of care coordination 9) Families are asked for feedback about their experiences with health services/care coordination? 10) Medical home system improvements are implemented simultaneously with the development of care coordination (care coordinator contributes to this quality improvement process)? 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 1 2 2 3 3 1 2 3 1 2 3 Total score: _________/ out of 30. Notes: 6 Medical Home (Practice Based) Care Coordination – Position Description The care coordinator works within the context of a primary care medical home, from a team approach, and in continuous partnership wi th families and physicians to promote: timely access to needed care, comprehension and continuity of care, and the enhancement of child and family well being. Care Coordination Qualifications: The care coordinator shall have: Bachelor’s preparation as a nurse, social worker, or the equivalent with appropriate past experience in health care Three years relevant experience, or the equivalent, in community based pediatrics or primary care, particularly in the care and service of vulnerable populations such as children/youth with special health care needs (CYSHCN) Essential leadership, advocacy, communication, education and counseling, and resource research skills Core philosophy or values consistent with a family-centered approach to care Culturally effective capabilities demonstrating a sensitivity and responsiveness to varying cultural characteristics and beliefs Medical Home Care Coordination Responsibilities The care coordinator will: 1) Demonstrate and apply knowledge of the philosophy/ principles of comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services 2) Fac ilitate family access to medical home providers, staff and resources 3) Assist with or promote the identification of patients in the practice with special health care needs (such as CYSHCN); add to registry and use to plan and monitor care 4) Assess child/patient and family needs and unmet needs, strengths and assets 5) Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child/youth or family member at any given point in time 6) Build care relationships among family and team; support the primary care-giving role of the family 7) Develop care plan with family/youth/team (emergency plan, medical summary and action plan as appropriate) 8) Carry out care plans, evaluate effectiveness, monitor in a timely way and effect changes as needed; use age appropriate transition timetables for interventions within care plans 9) Serve as the contact point, advocate and informational resource for family and community partners / payers 10) Research, find, and link resources, services and supports with/for the family 11) Educate, ounsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or facilitate referrals appropriately 12) Cultivate and support primary care subspecialty co-management with timely communication, inquiry, follow up and integration of information into the care plan 13) Coordinate inter-organizationally among family, medical home, and involved agencies; facilitate â€Å"wrap around† meetings or team conferences and attend community/school meetings with family as needed and prudent; offer outreach to the community related to the population of CYSHCN 14) Serve as a medical home quality improvement team member; help to measure quality and to identify, test, refine and implement practice improvements 15) Coordinate efforts to gain family/youth feedback regarding their experiences of health care (focus groups, surveys, other means); participate in interventions which address family/youth articulated needs 7 Position Description Worksheet Medical Home (Practice Based) Care Coordination Position Description Responsibilities Worksheet – Customize for Your Practice Care Coordination in a Medical Home – The Care Coordinator will: 1) Demonstrate and apply knowledge of the philosophy/ principles of 2) 3) comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services Facilitate family access to medical home providers, staff and resources Assist with or promote the identification of those with special health care needs (such as CYSHCN); add them to the registry and use it to plan and monitor care Assess child/patient and family needs/unmet needs, strengths and assets Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child, youth or family member at any given point in time Build care relationships among family and team; support the primary care giving r ole of the family Develop care plan with family/youth/team (emergency plan, medical summary and action plan as appropriate) Carry out care plans, evaluate effectiveness, monitor in a timely way and make changes as needed; use age appropriate transition imetables for interventions within care plans Serve as contact point, advocate and informational resource for family and community partners/payers Research find, and link resources, services and supports with/for the family Educate, counsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or facilitate referrals appropriately Cultivate and support primary care subspecialty co-management with timely communication, inquiry, follow-up and integration of information into the care plan Coordinate interorganizationally among family, the medical home, and involved agencies; facilitate â€Å"wrap around† meetings or team conferences and attend community/school meetings with family as need ed and prudent; offer outreach to the community related to the population of CYSHCN Serve as a medical home quality improvement team member; help to measure quality and to identify, test, refine and implement practice improvements Coordinate efforts to gain family feedback regarding their experience with health care(focus groups, surveys, other means); participate in interventions that address family/youth articulated needs Accept Reject 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) *** Add additional key responsibilities here (use additional paper): 8 A Medical Home (MH), Team Based, Care Coordination (CC) Framework Fundamental Tools Structures Medical Home Interventions Access to Medical Home, Health Care and Other Resources Identify and register the CYSHCN opulation Establish with families effective means for medical home/office access Provide accessible office contract for family and community agencies Catalog resources to link families to appropriate educational, information and re ferral sources Promote and â€Å"market† practice-based care coordination to families and others (e. g. brochures, posters, outreach efforts) Establish alliances with community partners Facilitate practice family linkages with agencies (e. g. family support, schools, early intervention, home care, day care agencies offering respite, housing, transportation) Align transition support activities with schools other groups Collaborate to improve systems of care for CYSHCN (families, payers, provides, and agencies) Community Connections Fundamental Processes Proactive Care Planning Medical Home Interventions Help to maintain health and wellness prevent secondary disease complications Maximize outcomes (e. g. lleviation of the burden of illness, effective communication across organizations, enrollment in needed services, and school attendance/success) Listen, counsel, educate, foster family skill building Screen for unmet family needs Develop written care plans; implement, moni tor and update regularly Plan for future transition needs; incorporate into plan of care Facilitate subspecialty referrals, communication help family integrate recommendations of specialists Link family, staff to educational/financial resources †¢ †¢ †¢ †¢ Establish alliances with community partners Facilitate practice family linkages with agencies (e. g. family support, schools, early intervention, home care, day care agencies offering respite, housing, transportation) Align transition support activities with schools other groups Collaborate with families, payers, providers and community agencies to improve systems of care for CYSHCN Improving and Sustaining Quality 9 Framework Worksheet A Medical Home (MH) Care Coordination Framework – WORKSHEET Fundamental Structures Access to Medical Home, Health Care and Other Resources Who? How? Medical Home Interventions Identify and register the CYSHCN population Establish with families effective means for medical home/office access Provide accessible office contract for family and community agencies Catalog resources to link families to appropriate educational, information and referral sources Promote and â€Å"market† practice-based care coordination to families and others (e. g. brochures, posters, outreach efforts) Establish alliances with community partners Facilitate practice family linkages with agencies (e. g. family support, schools, early intervention, home care, day care agencies offering respite, housing, transportation) Align transition support activities with schools other groups Collaborate to improve systems of care for CYSHCN (families, payers, provides, and agencies) Community Connections Fundamental Processes Proactive Care Planning Medical Home Interventions Help to maintain health and wellness prevent secondary disease complications Maximize outcomes (e. g. alleviation of the burden of illness, effective communication across organizations, enrollment in needed services, and school attendance/success) Listen, counsel, educate, foster family skill building Screen for unmet family needs Develop written care plans; implement, monitor and update regularly Plan for future transition needs; incorporate into plan of care Facilitate subspecialty referrals, communication help family integrate recommendations of specialists Link family, staff to educational/financial resources †¢ †¢ †¢ †¢ Establish alliances with community partners Facilitate practice family linkages with agencies (e. g. amily support, schools, early intervention, home care, day care agencies offering respite, housing, transportation) Align transition support activities with schools other groups Collaborate with families, payers, providers and community agencies to improve systems of care for CYSHCN Who? How? Improving and Sustaining Quality 10 Time Protection Tips Strategies The statement (on page 4) that no medical home will achieve optimal comprehensive, coordinated and compassionate care without dedicated time and resources to develop, implement, and evaluate a complement of care coordination activities warrants a few tips about how to achieve such dedicated time. Ideas for the successful implementation of practice based care coordination include administratively supported techniques and the resulting implemented care coordination (systematic) processes. Consider the following suggestions for time protection and use them to craft your own strategic approaches. Administrative Strategies for Achieving Some â€Å"Think† and Implementation Time Personnel – proactively allocate a block of dedicated time. This includes the number of hours, days and time blocks or hours and how those hours will be prepared for, spent and accounted for. (This can be done as a trial or test of change) You may need a private place, an office, or even a â€Å"my care coordination development hat is on today† sign! Clear activities – Use the position description and the CC framework on page 9 to select the focus and logical progression of this role development and how time will be spent Determine how you will document and/or account for this time Team based care coordination – determine how you will allow for the development of care coordinator – family partnership. Could there be a designated clinic time for specific group of CYSHCN, or a special condition focused approach with a care coordination protocol? Some practices have held what is referred to as a DIGMA (drop in group medical appointments) for a group of families with children with similar conditions. A DIGMA can take on many forms such as family education, community resource connections, or even time for care coordination introduction and development with the opportunity to meet, greet and complete care plans. Approaches Helpful to Building Time into Your System Use your population identification system to determine who needs care coordination Use the development of your CC role to establish systematized screening assessments and resulting care planning and monitoring Hold medical home related staff meetings; offer education regarding CYSHCN and gain buy-in and staff understanding for the value of providing care coordination Engage families who can educate staff about the complexity of their child’s needs Create a reporting line to senior leaders from the Care Coordinator so that CC development is built into their role expectation Develop the capacity for care coordination â€Å"rounds† by discussing direct CC efforts around individual children and youth with staff; gaining the input of colleagues will help you with staff education and their buy in to the medical home and practice-based care coordination approach; all will then learn about complex health and community based n eeds and resources Maximizing Reimbursement for Care Coordination: Ensuring affordability and sustainability by: Developing smart legitimate up-coding; Tracking CC data (service/outcome) to negotiate new payment opportunities Prepare for the use of new codes (care plan oversight) Become aware of and access Title V supports 11 Care Coordination Development: 1) The Model for Improvement 2) Care Coordination Aim Statement 3) Plan Do Study Act (PDSA) cycles or â€Å"tests of change† Model for Improvement Questions 1) What are we trying to accomplish? Medical Home Improvement Responses Medical Home – Care Coordination 2) How will we know that a change is an improvement? Measures – Medical Home Index, Medical Home Family Index Survey, Other 3) What changes can we make that will result in an improvement? Good ideas – ready for use (e. g. CC definition, job description, framework activities, PDSA examples 12 2) Care Coordination Aim Statement A good aim statement includes the following elements: Population – CYSHCN Timeframe – by when Intent – what/why Stretch goals – e. g. identify 100% CSHCN Example: Overarching Aim – Care Coordination Between Learning Session 2 and spring of 2006 we will customize and use a model of medical home care coordination for children/youth with special health care needs so that a position description and framework of activities are explicit, with time protected and accounted for and ~ 75% (goal) of children, youth and families report that they: Know who their care coordinator is Know they are receiving care coordination Participate in decisions about the level of care coordination needed Are satisfied with their access to care, care coordination, and resources (most of the time) For Veterans – Advanced Care Coordination Aim Goals Youth and families report that: A transition timetable is shared among family, practice and community professionals They have coordinated support getting their child’s needs met within the community and from sub-specialists 13 Thinking Through Some Measurement Ideas – For Practice-Based Care Coordination – PDSA Cycles Care Coordination Outcomes Family satisfaction decrease in worry and frustration (CMHI survey tools) increased sense of partnership with professionals (CMHI survey tools) improved satisfaction with team communication (CMHI survey tools) Staff satisfaction improved communication and coordination of care improved efficiency of care elevated challenge and professional role Improved child/youth outcomes Decrease in ER visits, hospitalizations, school absences (family, plan report) Increase in access to needed resources (CMHI survey tools) Enhanced self-management skills (CMHI survey tools) Improved systems outcomes decreased duplication decreased fragmentation improved communication and coordination (CMHI Medical Home Index) 14 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 15 CMHI Plan-Do-Study-Act (PDSA) Worksheet PDSA Example Team: #1 Care Coordination Role/System Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) We will develop and test a clearly defined system of care coordination (CC) services using strategies that fit our practice environment. This will include the use of a: 1) clear CC definition, 2) CC position description and 3) CC framework with an outline of activities. CC role, contact and access information will be explicit for families. {Our test of change will include dedicated time for the CC to share plans with staff and implement CC PDSA cycles (see examples in following pages). We will feed back lessons learned to our Medical Home Improvement team for guidance and direction. What additional information will you need to take action? Knowledge of and securing the availability of senior leader support with designation of one (or more) staff members to provide CC leadership What do you predict will happen? There will be false starts with â€Å"tyranny of the urgent† keeping us from our task; our will, ideas and execution will overcome this in the end. How will you know your change is an improvement? Staff/families begin to ask for care coordination / CC activities (e. g. care plan); selected outcome measures improve (see page 14) DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 16 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 17 CMHI Plan-Do-Study-Act Worksheet PDSA Example Team: #2 Care Coordination Needs Assessment Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) With MH lead physician review pending CYSHCN visits; select 3 CYSHCN who will benefit from an assessment for care coordination. By â€Å"a week from next Tuesday† complete an assessment (e. g. parent/youth screening tool in appendices behind page 26) either before the office visit or by pre-visit phone call. Begin care planning process with child/youth and family What additional information will you need to take action? Listing of pending CYSHCN visits from the CYSHCN list or â€Å"registry† What do you predict will happen? Some false starts finding the right CYSHCN and with timing; we will succeed if persistent over slightly longer time span How will you know your change is an improvement? Follow up with 3 families in 2 weeks to determine if pre-visit assessment and follow-up planning are helpful and what needs to be added/improved; review value with lead physician as well. DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 18 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 19 CMHI Plan-Do-Study-Act Worksheet PDSA Example #3 Comprehensive Care Planning Team: Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) 1) Develop/choose care plan medical summary and use with 5 identified CYSHCN/week. 2) Add an emergency plan if warranted. ) Study provider and family feedback and integrate to improve the plan and the process for plan use. Create immediate action plan for how to meet resource, educational and other needs of CYSHCN/patient and family 4) Use lessons learned to share, engage, educate and spread medical home to staff. What additional information will you need to take action? Sample care plans to choose from using team priorities; identified CYSHCN with pending visit to initiate plan with. Also identify educational needs of staff /families. What do you predict will happen? Will start slow, 1-2 per week and pick up speed to reach 5. Value will result in better preservation of care coordinator time to complete plans, thus increased use of CC and team process. Ultimately, we may schedule comprehensive care planning â€Å"rounds† with team/staff; review 3-5 CYSHCN/patients who are receiving this care coordination. Use rounds to review successes, challenges, needs of child/family with staff and address questions. How will you know your change is an improvement? Review with families for benefit, follow up in 4-6 weeks; review also with staff DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 20 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 21 CMHI Plan-Do-Study-Act Worksheet PDSA Example #4 Transition to Adult Care Services; Up-coding to maximize reimbursement Team: Aim: Use from page 13 or create own PLAN: Objective: Have MD Care Coordinator jointly see (2) YSHCN family for transition visit; use a transition assessment (timetable) checklist to guide the visit and align activities with community partners. Bill for visit – document nature of complexity Details (who, what, where, when) CC Schedules 2 YSHCN for transition care plan visit next week, with family permission informs/communicates with key community partners about assets needs. Codes for â€Å"99214† for 60 minute visit with established patient and document extent and complexity of the visit What additional information will we need to take action? – Extract from list of CYSHCN youth over 14 due for visit; communicate with family and learn community partners – Clarify with senior leaders ability to track reimbursement results for these visits What do we predict will happen? (E. g. May take time to match YSHCN with open slots; will need to follow up with payers for denials and use documentation to justify activities). How will you know your change is an improvement? Review with family staff; community partners. Select other ongoing measures (p14) DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 22 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 23 CMHI Plan-Do-Study-Act Worksheet PDSA Example #5 Community Outreach / Resources Team: Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) Plan for care continuity across the: medical home, school, and community agencies with 4 families and children/youth over the next four weeks. Use a selected communication strategy (fax back, email, NCR paper, electronic forum, other) to centralize key information with strengths, goals, care plans, access information, and releases fostering cross organizational communication; the CC performs as a â€Å"hub of the wheel function† in these activities. What additional information will you need to take action? Identification of children/youth and families in need of transition and/or community-based coordination; identification of key community partners; consensus on communication strategy What do you predict will happen? Territorial barriers will crop up and family will need to be front and central to the process. How will you know your change is an improvement? Review with family and agencies whether there has been improved care communication, also consider other systematized outcome measures (see page 14). DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 24 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 25 Appendices A. Key Websites for Care Coordination Tools 1) Center for Medical Home Improvement (CMHI): www. medicalhomeimprovement. org 2) National Center for Medical Home Initiatives (AAP) www. medicalhomeinfo. org 3) Utah Medical Home Portal www. medhomeportal. org References 1) McAllister, J. W. , Cooley, W. C, Presler, E. Practice-Based Care Coordination: A Medical Home Essential. Pediatrics, Volume 120, Number 3, September 2007, e1e11. 2) American Academy of Pediatrics, Medical Home Initiatives for Children with Special Health Care Needs Project Advisory Committee. The medical home. Pediatrics, 2002; 110:184-186. 3) American Academy of Pediatrics, Committee on Children with Disabilities. Care Coordination: Integrating Health and Related Systems of Care for Children with Special Health Care Needs, Pediatrics, 1999, Vol. 104:978-981. 4) American Academy of Pediatrics, Division of Health Policy Research. Periodic Survey of Fellows #44. Health Services for Children with and without Special Needs: The Medical Home Concept Executive Summary. Elk Grove Village, Illinois: American Academy of Pediatrics; 2000. Available at: www. aap. org/research/ps44aexs. htm. Accessed April, 2005. 5) Antonelli, R. , Antonelli, D. , Providing a Medical Home: The Cost of Care Coordination: Services in a Community-Based, General Pediatric Practice. Pediatrics (Supplement) 2004; Vol. 113: 1522-1528 6) Cooley, W. C. and McAllister, J. W. Building Medical Homes: Improvement Strategies in Primary Care for Children with Special Health Care Needs. Pediatrics (Supplement) 2004; 113: 1499-1506. ) Davis, K. , Transformation Change: A Ten Point Strategy to Achieve Better Health Care for All. The Commonwealth Fund. Accessed at www. cmwf. org April 13, 2005. 8) Family Voices. What Do Families Say About Health Care for Children with Special Health Care Needs in California: Your Voice Counts. Boston, MA: Family Voices at the Federation for Children with Special Health Care Needs; 2000. 9) Future of Children, Health Insurance for Children; Care of children with Special Health Care Needs. Key Indicators of Program Quality. Available at www. futureofchildren. org/information2827/Accessed April 13, 2005. 10) Horst, , Werner, R. , Werner, C. 2000) Case management for children and families Journal of Child and Family Nursing, 3, 5-14. 11) Langley, G. J. , et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Jossey-Bass, San Francisco, 1996. 12) Lindeke, L. L. , Leonard, B. J. , Presler, B, Garwick, A, Family-centered Care Coordination for Children with Special Health Care Needs across Settings. Journal of Pediatric Health Care, Vol. 16, No. 6, November/December, 2002, 290-297 ** 13) Presler, B. (1998, March/April) Care Coordination for Children with Special Health Care Needs. Orthopedic Nursing, (Supplement), 45-51. 26 CMHI Center for Medical Home Improvement (CMHI ) Crotched Mountain Foundation Greenfield, New Hampshire 2007 27 How to cite Medical Home Practice-Based Care Coordination, Papers

Classical Opera free essay sample

THE question of what sort of music should be employed In opera Is a fundamental one, and has given rise to more controversies, heart-burnings, and recriminations than any other matter, since it lies at the root of all differences between schools or individuals.In the earliest times, we find a declamatory style; in the works of the Venetians, melody asserts itself; with Scarlatti, musical learning Is pressed into service; in the epoch of Handel, a conventional form dominates the stage; the efforts of Cluck bring back something of an earlier dramatic style, with vastly increased sources in the orchestra; Mozart reverts again to a more melodic method, enforcing It with correct expression and consummate orchestral skill.There can be no doubt that the best results In all these different styles would be due, not merely to the use of good music, but also to its proper adaptation to the dramatic situation. Whether a libretto be worthy or not is hardly a question for the musical critic, though of course it has much to do with the popularity of the opera. In the days of the eighteenth century, the drama was a much more conventional affair than at present. WithEngland a prey to the cunning artifice of the Pope-Dryden group of poets, France but lately emerged from the courtly superficiality of El Grand Marquee, Germany still in the grasp of Paris fashions, and Italy possessing little of the earlier Renaissance vitality, It was no wonder that literature did not show any of the free exuberance of thought that came later in the Romanticism of the nineteenth century. So even under the best circumstances there was an amount of conventionality in all the earlier librettos that forced the audiences of their day to judge largely by the music.To quote a later saying, Whatever was too silly to be spoken could be sung. When the classical period In musical history appeared, with the advent of the symphonic school, and the full orchestral resources were employed to mingle intellectual and emotional effects in their proper balance by uniting melody with harmony, it is not surprising to find a school of operatic composers who reflected the spirit of their time. They devoted all their study and inspiration to the task of producing the best possible music, and employing it in an effort to raise the standard of the stage.If their operas are seldom given today, it is because these works are both too good and not good enough; to good for an unthinking public that considers opera merely Intended to tickle Its ears with melody, and not good enough to hold their own against the great advance in dramatic realism that has taken place since their day. When they appeared, however, their librettos possessed a passionate intensity that was new on the stage, and their pure and lofty harmonies were synonymous with all that was best in classical music.It Is a significant fact that Germany, the country that s most appreciative of pure music (I. E. Instrumental compositions without the extraneous aid of any plot), should be the place where these works are most warmly received today. The first of the composers to whom this lengthy preamble is dedicated was Cherubic. Born In Florence, In 1760, he soon proved himself a genius, and by the age of twenty he had become thoroughly proficient in the old sacred style that gave Italy its renown.During the next eight years a change came oer the spirit devoted himself to the production of conventional Italian operas. In 1788, however, after settling in Paris, he deliberately discarded the light Neapolitan style, and in his first French work, Demon, showed marked indications of the grandeur he was destined to attain in his later operas. His Parisian career thus began within a decade of Clucks departure, and he, rather than the indecisive Saltier, is the logical successor of the German reformer. Despite the ignorance of the military leaders during the Revolution, and the opposition of Napoleon in the Consulate, Cherubic remained master of the musical situation in Paris, and Paris was dramatically in advance of the rest of the world. If Demon was an interesting suggestion, rather than a successful achievement, its promise was amply fulfilled with the production of Lidos, in 1791. This work, which made its composer famous throughout the Nor, obliterated in an instant the melodious trifles that had been in vogue since Clucks departure.Its deep earnestness, its profound learning, its harmonic and melodic richness, and its great dramatic strength won instant approval, and kept the piece on the boards for nearly two hundred times during its first year. Its story, rather poorly arranged, deals with the efforts of Additions lover to rescue her from he castle of a more powerful rival, and introduces an assault by Tartars at the close, to make a diversion that ensures her final escape . After Elise (1794) came a still greater success, in the shape of Mede (1797).Its grandeur and classic proportion rendered it a masterpiece, while its tremendous dramatic strength and sublimity Non general admiration. Yet the opera at first was not a success,no doubt because TTS music was too harmonic to suit the masses. Its weak points are a poor libretto, a decided monotony in its general tone, and a too complete centering of interest in the title r ¶el. Three years later (1800) came another great production, Less Deuce Orionsees. The action of this opera takes place in the time of Cardinal Mazurka, and deals with the fortunes of the deputy Armband, who has incurred the enmity of the prelate.The gates of Paris are strictly guarded, and all precautions are taken to prevent Armbands escape. He is saved from capture by the water-carrier Mike, hose son he had once befriended, and he makes his way out of the city concealed n Mikes water-cart. In the neighboring village of Goners, however, he is captured by the cardinals troops while protecting his wife Constance from the rudeness of two oldies. The dmonument comes in the shape of a pardon from the queen, and all ends happily.The style of the music is so genial and natural, so full of warmth of feeling and expressive charm, that it must undoubtedly rank as Cherubims best opera. The attacks on the declamatory style of Mede were hardly Justified here, for, as Fits says, There is a copiousness of melody in Cherubic, especially in Less Deuce Journosees; but such is the rudeness of the accompanying harmony, and the brilliant coloring of the instrumentation, That the merit of the melody was not appreciated at its Just value.A more modern writer (Ritter), in reference to this and other operas of the composer, says, They will remain for the earnest student a classic source of exquisite artistic enjoyment, and serve as models of a perfect mastery over the deepest resources and means that the rich field of musical art presents. The only later work of Cherubic that needs mention here is Fantasia, brought out in Vienna in 1806. Founded on a plot somewhat similar to Lidos, it Beethoven and Haydn, both of whom were anxious to bear homage to the truly great composer.He produced several other operas in Paris, all more or less successful. Concerning Less Pancreases, Mendelssohn wrote that he could not sufficiently admire the sparkling fire, the clever original phrasing, the extraordinary delicacy and refinement with which the whole is written, or feel grateful enough to the grand old man for it. The latter part of Cherubims long career was devoted to teaching and sacred compositions, and at his death, in 1842, his fame in church music rivaled his reputation in opera.The works of Mull (1763-1817) and Leisure (1763-1837) are the only ones of the time that ranked with Cherubims. Mull, especially, was successful n continuing and improving the grand style of Cluck, and his operas are marked everywhere by a powerful directness that is not inappropriate to the stormy days of the Revolution. Leisure possessed a certain large simplicity of style, but his works are somewhat less effective than those of his compeer. The logical successor of Cherubic was Spotting (1774-1851). Born at Majolica, he soon devoted himself to the study of music, and in 1791 entered a Neapolitan conservatory.After several years of Italian operatic triumphs, he too, decided to try his fortunes in Paris, and in 1803 he entered the gay capital. The next year saw the production of his first French effort, the one-act opera Milton. Three years afterward he produced the masterpiece that gained immortality for him in the musical world,La Vestals. His renown was increased by Fernando Cortez (1809), but after this he brought forth nothing worthy of mention for ten years, and even his Olympia (1819) can hardly compare with the two earlier works. Spotting professed a great admiration for Mozart, but his music is direct outcome of the chaste simplicity of Clucks style. Unlike Cherubic, he showed the prevailing fault of the Italian race,one that has been evident in opera until Nothing the last three decades of the nineteenth century,a lack of the harmonic sense. This very instinct for the logic of harmony is Just what has caused the greatness of modern music in the classical and subsequent periods, so it is not surprising to find Spoutings works on the shelf at present.Yet in his day he was Introit a rival in popular favor, and his compositions exerted undoubted influence on such diverse natures as Wagner and Merrymaker. The other French composers of this time, although worthy of more than a passing mention, were less definitely under he influence of the classical style that was even then known as German music. Henry Montana Breton, son of that Pierre Breton who tried to make peace between Cluck and Puccini, occupied a respect able, but not pre-eminent, position in comic opera.Cattle (1773-1830) displayed much elegance and purity of style, but unfortunately acquired a professional reputation for writing learned music. Rudolph Krueger (1766-1825) composed operas that were pleasing, if not ambitious, but is better known as a master of the violin. Pursues (1769-1819) wrote much that is now forgotten, and remains in history as a great orchestral leader. More important Nas the work of Nicola Soured (1777-1818), popularly known as Nicola. He had little originality, and much of his music was commonplace, but some passages of his Cocooned and Controlled show great tenderness and charm.The master of opera communique during this period was Bloomfield (1775-1834). Many of his earlier works were too trivial to last, but Ma Tanta Aurora (1803) brought him into popular favor, and securely at the head of his school. The latter opera is founded on episodes from Coots Monastery and Guy Margarine, but, like the novels of the immortal romancer, it is cast in a form that is too lengthy to suit modern standards. Bloodlines music shows much melodic beauty, though its tenderness often degenerates into sentimentality.He was the last representative of the school of Gartry and Monsignor, as after him came the deluge of Italians that is usually associated with the name of Rossini. In Germany, the successors of Mozart at first produced little of enduring alee. S;smeary, his pupil (1766-1803), displayed a melodic facility and a peculiar popular charm, but his works lack depth and originality. Winter (1754-1825) was strong in declamation and chorus work, but is best remembered by his church music.Neigh (1766-1846) won much appreciation by his tuneful Cheerier Families. Directors (1739-99) carried on the earlier traditions of the Single, and displayed real brightness and vivacity in his comedies. But the only worthy example of the more serious and lofty operatic style was Beethovens solitary opera, Fidelity, produced in 1805. The libretto, a translation from the French, had already been used, notably in Papers Eleanor. According to the story, Florescent, a Spanish nobleman, has become the captive of his bitterest enemy, Pizzeria.In the state prison, of which the latter has Charge, Florescent is confined in a cell without light or air, utterly at Pizzerias mercy. Lenore, wife of the prisoner, has in some way discovered her husbands plight, and, n the hope of aiding him to escape, she disguises herself in male attire, and, under the name of Fidelity, enters the service of Rocco, the head Jailer. She soon wins the admiration of the Jailers daughter, Marcella, who neglects her former lover, laconic, for the sake of the handsome stranger.Meanwhile Pizzeria, learning of the approaching visit of Ferdinand, the governor, decides to kill Florescent in order to escape detection. He bribes Rocco to dig a secret grave in the cell, while Fidelity, aroused by this treachery, obtains leave to help the Jailer. Together Fidelity and Rocco proceed to the cell (Act II. ), where the unfortunate Florescent is lying overcome with starvation. When their work is over, Pizzeria himself appears, and prepares to stab Florescent; but the disguised Lenore, who has remained in the background, now rushes to Flagellants defense, and threatens Pizzeria with a loaded pistol.At this moment the governors trumpet-call is heard from without; Pizzeria is obliged to receive him, Florescent and Lenore rush into each others arms, and the governor stores the prisoner to his lost honors and banishes his oppressor. This opera, like The Magic Flute, still retains traces of the old Single, in the form of spoken dialogue. But the verbal passages are few and short, and, if rightly uttered, may be made to add emphasis to the musical climaxes. In all French performances they have given way to recitative. Of the character of the music there is nothing but praise to be said.It is all in the strongly dramatic vein that gives such power to Beethovens orchestral works. In an age when operatic realism was not sought after, when the harassers might pause in the midst of even the best operas and express in detail their views on the situation, the sincerity and appropriateness of the music could not fail to win its med of admiration. But now the public makes greater demands, and the music-dramatic action of Fidelity, like that of Don Giovanni, is far too deliberate for modern taste. Its many well-known numbers show Beethovens best advantage on the concert stage.Especially suited for concert prima donnas is Fidelitys well-known outburst of indignation (Backstretches! ) and the glorious adagio (Zoom, Huffing! ) with which it is Joined. Jonquils lament in the first act is also worthy of note; in this act, too, is the famous canon-quartet, Mir sits so Underarm; while the Jailers sonorous Gold Song, and Pizzerias fiery aria when he is forced to decide on Flagellants murder, stand out in bold relief. The second act is one long dramatic scene, and culminates in the almost frenzied duet, O Nameless Freud! Produced at the Exhortation Theatre, in Vienna, a year before Fantasia, it Nas not overwhelmingly popular, and only in later times did it attain the fame of Cherubims operas. In Judging the classical school, as a whole, due allowance must e made for the lack of swift and natural action already alluded to. If the dramas of this epoch represented a tremendous advance over the conventional productions of Metastasis, we can only realism their force by putting ourselves in the place of their earliest audiences, and ignoring all the progress made since their day.If we do this, En see that the formal character of the music is merely a relative matter, due to a contrast with the freer style of the present; and even today there are many who Mould find relief from the modern dissonances in the clear, well-formed themes of the older masters. Classical Of Concerto A classical concerto is a three-movement work for an instrumental soloist and orchestra. It combines the soloists virtuosity and interpretive abilities with the orchestras wide range of tone color and dynamics. Emerging from this encounter is contrast of ideas and sound that is thematic and satisfying. The classical love of balance can be seen in the concerto, where soloist and orchestra are equally important. Solo instruments in classical concertos include violin, cello, clarinet, bassoon, trumpet, horn and piano. Concertos can last anywhere from 20 to 45 minutes, and it has three movements: (l)fast, (2)slow, and (3)fast. A concerto has no minuet or scherzo. Into the first movement and sometimes in the last movement, there is a special unaccompanied showpiece for the soloist, the cadenza.The soloist will be able to display virtuosity by playing dazzling scale passages and broken chords. Themes of the movement are varied and presents in new keys. At the end of a cadenza, the soloist plays a long trill followed by a chord that meshes with the re- entrance of the orchestra. Cadenzas are improvised by the soloist. Classical Style Anyone who has heard Charles Rosen play Bachs Art of Fugue or the late Beethoven IANA sonata (or Debussy for that matter) will expect this book to have a hard core of Med knowledge of non-piano music and indeed of the non-musical arts.Classical Style is a formidable subject and Mr.. Rosen is wisely selective. I have restricted myself to the three major figures of the time as I hold to the old-fashioned position that it is n term of their architecture that the musical vernacular can best defined. There is danger here of historical distortion, or at least of suppression. Mr.. Rosen seems uninterested in the Anaheim School unappreciative of the gentle lyricism for which Mozart loved J. C. Bach, and not much aware of Beethovens debt to Clementine. Cheering is mentioned only as being insipid, Dusked not mentioned at all and Directors dismissed as a mere tonic and dominant man though the first movement of his once-famous string quartet in Be major shows him as nothing of the kind. Rehire is mention of the Strum And Drag music Haydn wrote in 1768-1772, but not of the strange fact that many other European composer wrote Strum and Drag works at the same time. However all this is of no great importance if we accept that the book is not about classical style as a whole but about its development by Haydn Mozart and Beethoven.Any limitation of the subject matter will almost certainly have improved it , and Mr.. Rosen was surely right to confine himself to a mere handful of musical categories. Thus he writes specifically about Heydays earlier symphonies but not the later ones about Mozart string squinters but not the quartets, about Mozart piano concertos but Beethovens, The piano sonata is not mentioned in the contents but Mr. . Rosen says a good deal about it in parenthesis; he digresses freely and fascinatingly. Beethoven is given a single chapter without subsections and (this is a act not a criticism) only half the number of pages allowed to Haydn and Mozart.Mr.. Rosen is always interesting on classical form: The musical language which made the classical style possible is that of tonality, which was not a massive immobile system but a living gradually changing language from its beginning. He rejects the terms First Subject and Second Subject and thinks we should dismiss as merely quaint the observation that in sonatas the first subject tends to be masculine and the second subject fermions Haydn often managed with only one subject, while other imposers often definition of sonata form until Czerny did so after Beethoven death. It was not defined until it was died. The great composers constantly broke the rules not knowing that there were any. Mr.. Rosen begins his own definition of sonata form as follows. The first section or exposition has two events, a movement of modulation to the dominant, and a final cadence on the dominant. Each of these events is characterized by an increase in rhythmic animation. Because of the harmonic tensions the music in the dominant (or second group) generally moves harmonically faster than that in the tonic. These events are articulated by as many melodies as the composer sees fit to use.The second section also has two events a return to the tonic and a final cadence. Some form of symmetrical resolution (called recapitulation) of the harmonic tension is necessary: an important musical idea played anywhere except at the tonic is unresolved until it is so played. Sonata Allegro Form century as a means to organize their music. Similar to a basic essay format of introduction with a thesis, supporting body paragraphs and conclusion that restates the thesis, sonata-allegro form organizes music through an initial statement, velveteen of themes and a recapitulation of the original material.While the origins are much older, sonata-allegro form grew to prominence as a defining Characteristic of the Classical style as used by Haydn and Mozart and then further dev eloped by Beethoven. In an era called the Age of Reason, the aesthetic values of 18th century music emphasize logic and clarity with traits of symmetrical phrases, declarative melodies and simple accompaniment. Organization in music as well grew to prominence because of the growing interest in logic and clarity which allowed for the development of sonata-allegro form.