Monday, July 20, 2009

Electronic Commerce Dissertation

INTRODUCTION
Kaiser Permanente began humbly with a single good intentioned surgeon who aspired to provide medical care for a population of the working class. The reality of economics quickly augmented the plan of practicing medicine when debts were not covered by the doctor due to lack of insurance by his patients. The creativity of developing a prepaid healthcare plan foreshadowed the future of today’s HMO’s. Kaiser is the leading service provider in the country for healthcare coverage with nearly nine million subscribers. Political reform and patient outcry of unfair coverage practices have transforming the operations of HMO’s today from their origins.

Electronic commerce has integrated into the business world and must be embraced to survive competitive external forces. Kaiser was successful in their EC implementation through interfacing with their consumers regarding healthcare coverage information. Technological advances were embraced through strategic planning and integrated into the business model to advocate customer satisfaction and retention. Physician interaction with new EC technology has been successful within the Kaiser group where resistance has surfaced in other organizations.

HISTORY OF HEALTH MAINTIENCE ORGANIZATIONS AND KAISER PERMANENTE
Kaiser Permanente’s origin was during the great depression when Dr. Sidney Garfield established a prepaid health plan for construction workers assembling the Los Angeles aqueduct in the Mojave dessert. Dr. Garfield built Contractors General Hospital near Desert Center, California where he was oriented to patients without insurance and those with insurance had lengthy reimbursement periods. Since many patients were being treated without payments to the hospital, a program was devised for insurance companies to pay the doctor a fixed amount for each worker per day in advance. This prepayment coverage enrolled many workers and brought salvation to the hospital financial concerns. The project was completed and another construction site was identified as having the same problem by Henry Kaiser at the Grand Coulee Dam. Dr. Garfield recruited a team of physicians and solved this problem with the first prepaid group practice for over 7000 people. This project led into the next challenge which was the influx of shipyard workers into Richmond, California for World War II ship production. The number of people to be covered with this plan would be approximately 30,000. In 1945, the end of the war brought the current phase of prepaid healthcare we are familiar with today, the publicly available Permanente Health Plan. Kaiser Permanente is America's largest not-for-profit health care organization which maintains a membership of 8.1 million members in 9 states. “An integrated health delivery system, Kaiser Permanente organizes and provides or coordinates members' care, including preventive care such as well-baby and prenatal care, immunizations, and screening diagnostics; hospital and medical services; and pharmacy services. Social benefit activities include assistance to the uninsured and special populations; training new health professionals; introducing new delivery and financing methods into the health care arena at large; and through our clinical research efforts, developing and sharing better ways to care for patients.” (www.kaiserpermanente.org).

Patient demands and political pressures on HMO’s Government regulations in the health care industry and the emergence of the HMO (Health Maintenance Organization) were precursors in the Kaiser’s decision to implement changes in their organization. In 1998, a total of $288 million in lost revenue also fueled the changes to a new platform. Kaiser moved away from the traditional method of business communications via paper, telephones, and faxes. The new web based systems that would be implemented would require a $2 billion dollar investment to commit to the EC platform (Turban, 2002).

With escalating costs in the Medicaid and Medicare programs, Congress looked to HMO’s for assistance in 1973 when the HMO Act which offered government subsidies to HMO’s and gave nonlicensed HMO executives the power to challenge the medical judgment of licensed physicians. The Act also mandated that all businesses with more than 25 employees offer HMO’s as a health care option which employers had previously avoided because of increased operation costs. Congress began allowing states to filter Medicaid recipients into managed care programs whether they wanted to or not through Medicaid Section 1115 waivers in the early 1980’s. The Department of Health and Human Services points out that this violates federal Medicaid law which prohibits limits on treatment or choice of doctor. Congress repealed the employer mandate in 1995 but the HMO’s had established their positions by that time in the market. Health Resources and Services Administration reports that working Americans enrolled with managed care insurance increased from 1988 with 29% to 1997 with 50%. Citizens’ Council on Health Care states that “By mandating managed care for some patient groups, and by passing legislation allowing HMOs to deny care, the government has assured maximum profit for HMOs, with little risk. Public officials profit politically by promising "free" health care. Managed care allows politicians to promise health care without actually guaranteeing access to it.” (Intellectual Ammunition, 1998).

Patient’s voices regarding HMO’s were heard by the government in the late 1990’s. Patients were often being denied coverage after their HMO has approved the costly medical procedure. New regulations designed to prevent HMOs from backing out at the last minute and leave consumers to pay the bill were enacted. If a case arose where a HMO would refuse to offer medical coverage, the new rules give the insurance department the power to order the HMO to provide the care, after reviewing the patient's case (Patel, 1997).

On February 8, 2000, HMO executives met in Dallas, Texas to discuss possible methods of improving their image with the public. “United Health Group, Kaiser Foundation Health Plan, and Humana, pushed for industry wide structural changes that would restore to physicians the power to make treatment decisions without being second-guessed by managed-care administrators. Such a move would require a radical shift in the business practice of most HMO’s. It would also confer industry leadership to United Health and Kaiser, which already give doctors exclusive authority to make treatment decisions for patients covered by their plans. The HMO industry has been assaulted on all fronts by lawsuits over treatment decisions, criticism of their business practices, and investor discontent. An HMO reform bill with a limited right to sue that was stalled in Congress for three years had passed both the House and Senate and was in a conference committee awaiting final congressional approval. But the sharpest spur to action for the HMO’s is their languishing stock values, which continue to droop despite double-digit increases in the insurance premiums many HMO’s charge their customers.” (Eliopoulos, 2000). Numerous companies invested countless dollars into campaigning for the public’s approval. This would not become a reality for the HMO’s as they were under fire from consumers, healthcare workers and the government.

According to a news report in September of 2000, the 104,000 workers of the Marriott hotel chain have paid 12% premium rate increases for the last two years without any change in the services provided. Brendan Keegan, Marriot's vice president of Human Resources stated "In the last couple of years they (HMO premiums) have risen quite dramatically compared to the previous years.” Marriott’s employees are currently switching their coverage from a HMO to a PPO (Preferred Provider Organization) which is also a network of physicians who offer discounted rates without second-guessing of the physician by the insurance clerks. Keegan also states that "Right now we believe that the PPO provides a better, greater cost effectiveness and higher quality.” (Andrews, 2000). This was the emergence of the PPO’s which would compete with the established HMO’s.

Kaiser Permanente implements EC
Kaiser utilized an electronic commerce platform to set up a comprehensive web site designed to facilitate information between consumers and their organization. Information included on the site is related to individual and group healthcare coverage quotes, benefits, co-pays, enrollment, qualification, locating facilities and physicians, and contact numbers. Kaiser was recognized for achieving the top producing broker status of small business group plans in California in 2000, 2001, and 2002. The shift from utilizing staff to answer phone call banks concerning coverage to the web based quote and service format has increased productivity and revenue for the organization (www.kaiserpermanente.org, 2003).

CHALLENGES WORKING WITH PHYSICIANS
Kaiser Permanente actively recruits and caters to physician needs and professional standards. There are over 11,000 members on staff which operate in multi-specialty teams to deliver quality care (http://physiciancareers.kp.org/aboutpf.htm, 2003). This tailoring to the physicians yields higher job satisfaction rates and cooperation with industry trends and organizational goals.

Physicians, as with most people, are not receptive to being dictated or coerced. The favored method of having someone conform to a change within an organization is to have them “buy into” the changes. An example of this could be demonstrating the benefits or reduced work load by utilizing the proposed operational changes. One form of streamlining business is computerized applications such as accessing medical related data through handheld computers. The Handspring Visor has the capability to run software from Franklin Electronic Publishers, Inc. such as The Physicians' Desk Reference, The Medical Letter's Handbook of Adverse Drug Interactions, McGraw-Hill's Harrison's Principles of Internal Medicine Companion Handbook, and The Washington Manual of Medical Therapeutics (Winsky, 2001). In addition to referencing text style information, the physicians could also participate in development of a computer based medical record retrieval system such as the Meditech Physician Website which is maintained specifically for physicians using their Health Care Information System. The site was designed to disperse knowledge of clinical systems, facilitate dialogue regarding clinical systems use and development, and promote physician involvement with clinical systems application within an institution. (www.meditech.com, 2003). Another computerized medical record system has been designed by Clinicare. Their computerized medical record application allows a physician to quickly access a patient’s record and view data related to each encounter. The record can be simultaneously accessed from any number of terminals which is more fluid than the previous SQL data base software that locked out the record when it was accessed at a single point. This feature allows multiple healthcare staff members to view information in real time. The software has several valuable functions such as user definable encounter forms, search & select capabilities, editing of records, audit controls, patient profiling, detailed or summary listings, scheduling capabilities, report generators, and tracking for lab results (www.clinicare.com, 2003). These capabilities are not merely a matter of convenience for physicians; these functions can increase productivity and save revenue and valuable time.

Establishing physician patient relationships are critical to ensuring an ongoing quality healthcare continuum for the patient’s well being. Studies by Beth Israel Hospital in Boston have shown that patient’s desire an understanding of their condition, ongoing personal relationships with their physician, and knowledge of the effects of the disease on their lives (Mgebroff, 1998). This fiduciary relationship evolved from the patient’s dependence on the physician and his or her medical knowledge. There is currently a shift from this model towards a sharing of responsibility for decision making with the patient (www.medceu.com, 2003). Patients are increasingly becoming involved with weighing the risks of treatments and alternative modalities through internet education and informed consent. Some patients are even meeting with their physicians in cyberspace for their appointments where they can discuss treatments, review test results, and receive commentary from their personal physicians (Monnich, 2001). It is estimated that 70 million Americans have used the internet to acquire health-related information (Anderson, 2003). With the face of patient physician interaction constantly changing due to the adaptation of internet information technology; there are problems associated with professional resistance to the potential of the internet. Having a computer screen in an examination room may increase a physician’s productivity and improve patient interaction in two methods. The first benefit is the demonstration of the physician’s ongoing knowledge of current technology through the presence of the computer screen. The second benefit realized by the physician is the utilization of computerized technology for patient information and teaching. This technology yields increased confidence by the patient in their physician and a better grasp of concepts concerning their disease process and prognosis.

ELECTRONIC COMMERCE APPLICATIONS
Kaiser implemented Business to Business (B2B), Business to Consumer (B2C), and Consumer to Business (C2B) applications within their electronic commerce platform. B2B was utilized in setting up web sites for each organization that Kaiser held a contract with and the origination of an expedited shipping service to reduce inventory and storage costs. B2C functions were formatted to allow consumers to receive real time pricing quotes and scheduling of their physician appointments. The intranet functions serviced the internal employees efficiently by allowing them to expedite their workload. Examples of this are ordering supplies, equipment and services and accessing pricing options for customers seeking healthcare coverage. Digitized versions of patient medical records and lab reports are accessible easily and accurately to practitioners and clinicians. One of the most important applications within the intranet is the ability to check for possible drug interactions and to suggest cost sensitive alternative medications is applicable. An example of C2B could be considered within the nature of physician-hospital relationships. Since physicians are customers to hospitals they practice for, their utilization of hospital based computerized systems for medical records or pharmacy related issues would fall under the C2B category. Supply chain management integrates the business processes from the suppliers to the end users of a system. Kaiser implemented a platform of allowing the customers, or end users, to access and manipulate data concerning their healthcare policies through EC venues. By placing an interface between the customer and Kaiser, a streamlined effect of delivering services and information occurred. Actual manning of the phones could be decreased by Kaiser due to the efficiency of the EC system for handling customer interaction.

Other EC applications that reduce costs and unnecessary steps are in the pharmacy and medical records departments. Meditech is a forerunner in Health Care Information Systems (HCIS). Their systems operate on a Windows based client server platform and also have the option of running on their own developed MAGIC Operating System. These software applications offer numerous services such as patient registration and appointment scheduling, authorization and referral management, billing and accounts receivable, revenue management, patient care management, computerized medical records, order entry systems, medication verification for pharmacy services, patient education, imaging, laboratory, data archiving, and staff intranet communication systems (www.meditech.com, 2003). The ability to rapidly access patient medical records and identify potential harmful drug interactions is two areas that can increase consumer satisfaction for the healthcare industry. Utilizing EC tools which allow the medical record and pharmacy departments to interact with the staff will not only expedite customer services but also relieve staff of a portion of their workload.

CONCLUSION
Kaiser utilized an electronic commerce platform to set up a comprehensive web site designed to facilitate information between consumers and their organization. Information included on the site is related to individual and group healthcare coverage quotes, benefits, co-pays, enrollment, qualification, locating facilities and physicians, and contact numbers. The shift from utilizing staff to answer phone call banks concerning coverage to the web based quote and service format has increased productivity and revenue for the organization creating a competitive edge over competing industry participants. Kaiser also implemented Business to Business (B2B), Business to Consumer (B2C), and Consumer to Business (C2B) applications within their electronic commerce platform. Creation of B2B web sites for each organization that Kaiser held a contract with and the origination of an expedited shipping service reduced inventory and storage costs. B2C functions were formatted to allow consumers to receive real time pricing quotes and scheduling of their physician appointments. This supply chain management platform allowed the customers, or end users, to access and manipulate data concerning their healthcare policies through EC venues. By placing an interface between the customer and Kaiser, a streamlined effect of delivering services and information occurred. Actual manning of the phones could be decreased by Kaiser due to the efficiency of the EC system for handling customer interaction. The intranet functions serviced the internal employees, including physicians, efficiently by allowing them to expedite their workload. These EC implementations by Kaiser aids in maintaining their leadership position within the healthcare industry as the number one HMO provider in America.

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Age Discrimination Research Paper

Age suits are now the fastest-growing category of discrimination complaints filed with the United States Equal Employment Opportunity Commission. In 1967 when congress passed the Age Discrimination in Employment Act (ADEA), the worry was that older workers were being discriminated against in hiring. One might say that the ADEA might, itself have a disparate impact on the older employees of the age forty and above. Because of the competitive job market, employers are not only looking at the qualifications of an applicant, they also may be looking to see if there is any gray in your hair. Times are changing for the work force above forty that require more specialized skills. Companies are leaning more towards computers, email, and the Internet to be more competitive. In the past it used to be you could not get ahead because of the "glass ceiling", now it is more like the "gray ceiling". The aged work force must take personal responsibility in job hunting, because looks can be an asset or detriment. Experience is no longer a prerequisite for an offer.

The U.S. congress passed the ADEA, thinking it was going to protect workers of forty years old and above during the hiring phase. Yet only ten percent of the claims involve the hiring process, the other ninety-percent is wrongful discharge. People are quicker to sue an employer if they were fired rather than during the hiring process. Proving a case for wrongful discharge would be much easier than trying to read someone’s state of mind during the interview. In an article by Ira Carnahan, she brings to light an interesting fact; the first decade after passage of ADEA, unemployment among workers fifty-five and above rose from 2.5% to 4.6%. A possible reason for the rise could be computers in the workplace or employers are becoming more sensitive with their aging workforce.

Companies wanting to evolve to the next level to be more competitive are using computers and other high-tech software to rival its competitors. About twenty years ago, this was not very important. There was a high cost involved for the purchase of computers, software, support, and, companies were not that quick to jump on the bandwagon. This could very well be the reason for the sharp unemployment rate with the older employees, because of their inability to change. Today most senior and, midlevel managers are more adept with high tech machines, and software than their counterparts of years ago. You would think this would no longer be an issue for drastic increase of senior employees being asked to leave. Technology is changing so fastly that it is almost impossible for senior employees to keep abreast on the newest versions of software, and computers without the aid of a company-training program. Younger, and more technologically-advanced employees are waiting in the wings to fill the positions of the not-up-to-date senior employees. Companies now have the added responsibility to keep past employees informed of change or this could lead them down the path to an age discrimination lawsuit. If jobs open up in the near future, older employees must be given a chance to bid for the opening rather than going to a younger less expensive employee.

Businesses now have an opportunity to address the issue of change in the workplace by being more sensitive and not trample on seniority rights. This sensitivity from employers result in a severance package or other benefits. Severance packages are used when there is a change in management direction or economic downturn. These packages need to make sure they fill all legal requirements, which must include the following:

o Be part of a written clearly understood agreement.
o Refer specifically to ADEA rights or claims.
o Apply only to legal rights or claims before the effective date of the waiver.
o Offer something of value beyond what the employee will already receive.
o Advise the employee in writing to consult an attorney.
o Allow the employee 21 days to consider the agreement, or 45 days if the waiver
involves exit incentives offered to a group of workers.
o Allow a period of at least seven days during which he employee can revoke the
agreement. (HR Focus, p2)

The employee must believe that the employer fired them based on their age. A Prima Facie Case must be proven to proceed. Prima Facie means alleging of facts that fit each requirement of a cause of action. The following element must be available to persuade a court for age discrimination.

o They are in a protected class.
o They were terminated or demoted.
o The job was being done well enough to meet employer’s expectation.
o Others not in the protected class ere treated more fairly.

An employer may present his case in a several ways why an employee was terminated. First reason of a termination could be a Bona Fide Occupational Qualification. This means that it is necessary to the safe operation of a particular business. A good example would be the termination of a fireman or police officer. The reason a mandatory retirement is required is that this position is a BFOQ. Lastly, the discharge or otherwise discipline an individual for a good cause. The EEOC require that a reasonable factor be job-related. A policeman doing his job has many responsibilities to himself, partner, and citizens. They are tested everyday for strength and endurance, because of the criminals to chase on foot, or place an individual in a submission hold for the protection of himself, victim, and other bystanders. A job related discharge could be the employee not following standard operational company policy. The policeman may have been told, warned and wrote up on occasion for drawing his service revolver when no danger was present. Company policy expressly prohibits this behavior.

The employee sued on the grounds that pilots upon reaching age sixty are incapacitated and can no longer even perform as a flight engineer. Western Airlines argued that this was a BFOQ for the safe operation of business. Older pilots usually take a flight engineer position after reaching sixty years old. In was the contention of Western Airline that any pilot over the age of sixty should be put out to pasture. A flight engineer’s duties are not as critical as that of a pilot, so the reflexes and mental alertness was not a BFOQ. The U.S Supreme Court found Western Airlines BFOQ did not meet reasonable necessity required for proof of discharge, rather than a defect of the instructions from the lower court. (Employment Law For Business, 419)

Economic concerns are other reasons a company may want to terminate employment with senior personnel. As a rule of thumb, employees with a high tenure make more money than their younger counter parts, and are tempting target for a company to prune the largest branches from the tree. When a company is considering to layoff personnel as a result of a reduction in force, they must be careful, for example salary and seniority can be linked together therefore; seniority becomes a proxy for age. A termination based on economic factors may constitute impermissible discrimination. If an employer needs to consider layoffs they need to ensure that decisions are reached in an equitable and fair manner. Once a former employee whose status is "laid-off" the company must ensure they are notified of future vacancies and their right to file a discrimination lawsuit if not rehired. If the employer is at an impasse of who to rehire or terminate among equally qualified individuals, using seniority to solve the decision will help them avoid age discrimination lawsuits. (Employment Law For Business, 436)

Companies have a great responsibility taking care of their personnel and hiring potential workers in a fair and equitable manner. We may feel there was age discrimination in the hiring process, but how can we control what the interviewer thinks and perceives? There is a certain amount of responsibility all candidates must have to lessen the chance that age discrimination will factor into the hiring process. Just because you may be old, and look old doesn’t mean you no longer have control of the hiring process.

What can an overweight, gray haired, unemployed, white male, with sixties-style person do to lessen the potential of age discrimination? Human Resource managers are always looking for the right person to fill positions within the company. The old saying of "Clothes makes the person" is not unreasonable. The first impression of a hiring manager is the visual information from the prospective employee and how it is packaged.

Get rid of the disco, or sixty’s clothes and select a conservative black suit that is more of this era than the clothing styles twenty years ago. Clothing that is out of style can put a damper on the applicant just like gray hair. Gray hair is naturals way of saying you have been around the block a few times, or distinguished and have the knowledge of the world. I have salt and pepper hair, probably more salt than pepper but if I have can get a position with a company knowing what gives me an edge is thee color of my hair; a trip to Wal-Mart or Rite Aide for the answer. By going to the aisle that has hair coloring, you just increase your chance to get the job by fifty eight percent over your competition. A conservative hair cut, and color shade of the hair will have a larger impact on the interviewer perception of your value.
Our lifestyle has changed from a leisurely trot to almost a full gallop. In the past sending a letter in the mail usually took three to five days. Now the same letter can be received in seconds via email. Unfortunately, the fast pace of work and how we fuel our bodies are erriely similar. We want to eat our lunch now but never had the time to fix one. To much fast food lunches can adversely effect your waist line, and give the perception to a hiring manger that you are not healthy. Just because we are older does not nessicarly mean we are much wiser. We can no longer eat anything we want and expect it not to show up in some form around our waist.
Wrinkles, gray hair, and being overweight has a high impact of a lasting first impression, with a hiring manager.

The last part we have no control over would be gravity. Yes, a law this course does not cover but is universal for all. Keeping a daily or weekly schedule of toning the muscles can greatly reduce the signs of aging. A muscle ignored when lifting weights or running is the one between your ears. If you want to be more competitive in the technological changing environment you must try to stay abreast by reading or going back to school. Diploms or certifications will propel you to the top of the "to hire" stack.

Age is starting to become a Bona Fide Occupational Qualification for companies that want to maintain a cutting edge in their field. With the exception of police officers or firemen, a BFOQ policy can discriminate older employees thereby, preventing personnel from helping the business to reach its goal. Often, businesses look at the bottom line before looking at the resources that are available. Older employees could be a diamond in the rough just waiting for the opportunity to solve problems. I do not see any immediate policy change in the hiring practices of companies in the future. Technology is advancing at an alarming rate, and places a demand for companies to change or be left behind. Companies that listen to internal input of senior advisors may be more prone to stay at the top of technological curve rather than adding new employees with "know-how" but no experience. An older employee may have snow on the roof, but it doesn’t mean their fire is out.
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Adolescence Essay

Adolescence is the period in a child’s life when they are no longer a kid; they begin to transfer into their teenage years. It is a time when one’s parents become more difficult and friends become more important. The acknowledgment of adolescence began in the twentieth century when Antonio Marro published La Puberta, and G. Stanley Hall published his collection’s Adolescence. These publications described adolescence using subjects and metaphors known to the public (Borgatta 1). Although Hall and Marro’s work may be difficult to comprehend, it is vital to understanding the shape and cognition of our youth today (Borgatta 2). Adolescence may be defined in many ways, but the best denotation is the one of a teenager.

The word may be looked upon in several ways. According to The American Heritage High School Dictionary, “adolescence is the period of development from the onset of puberty to maturity.” The word is derived from the Latin word adolescere, meaning “to grow into maturity,” during the commencement of the twentieth century (Lerner 33). Adolescence can be studied and experienced through the social account of youth. The meaning and explanation of adolescence is constantly changing as the years progress. Transition markers and roles secernate childhood to adulthood, giving the word adolescence it’s meaning (Borgatta 3).

The span of years that is suggested as the “adolescence period” is between 10-14 years of age. This period of time brings the oncoming of puberty. “Puberty is characterized by accelerated physical growth and intense psycho-social adjustment” (Mattson 6). Rapid transitions begin to take place, and their bodies start to transform. Boys commence to develop later than girls, causing stress due to identity quandaries. Hormonal changes are also a part of the development in adolescence. It is proven that the times of hormonal changes or other biological changes are influenced by social, cultural and psychological factors (Lerner 36). The basic process of development in adolescence is proven through these changing relations.

Emotionally there are many challenges that adolescents must undergo every day. It is known that not all teenagers progress at the same time or the same speed. Therefore, many teenagers will experience a diversity of problems. Problems may consist of hormonal or physical changes, family issues, community changes, school and even their peers. The transition from elementary school to middle school can cause numerous fears as well. As a result of research, in order to understand a teenager one must combine knowledge from all behavioral sciences and humanities. This provides parents and teachers with the information on how to best cope with their child and work out their problems (Lerner 34). An anonymous person once quoted, “it’s that period in life in which the young feel a great urge to answer the phone” (7).

With any adolescent it is important to recognize the individual differences and characteristics that one possesses. There are numerous amounts of diversity among teenagers that must be stressed. Different areas of ethnicity, race, and cultural background are to just name a few. Since adolescents are all entitled to their own opinions and appearances, one cannot expect to influence everyone in the same way (Lerner 37). Especially since hormonal and psychological changes are occurring, people must be extra sensitive with their words and actions. Adolescents may choose to be interested in different activities. Whether it includes watching television, playing a sport, going shopping or reading a book, they are all deigning to their own preferences. Normal adolescence development involves variability with people and involvement as well as inner strength (Lerner 38).

In 1962 Philippe Aries’ rememberable Centuries of Childhood portrayed a diverse range of thoughts. His painting referred to adolescence as a period of time when children simply merged directly into adults, at the approximate age of seven years (Borgatta 4). Today, while adolescence may no longer be referred to at that age, there are reasons for this change. Teenagers may be addressed as adolescents, as well as a child turning 10. Nevertheless, kids will be kids and as William Shakespeare said, “not yet old enough for a man, nor young enough for a boy” (7).
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