Richard Tessler

The effect of psychological distress on physician utilization: A prospective study.

This paper examines the hypothesis that psychological distress is causally related to physician utilization among enrollees in a prepaid group practice. Measures of distress are constructed from questions included in a servey interview, while the utilization data come from medical records. Distress levels were measured prior to the period of utilization studied. The results show a positive relationship between distress and physician utilization, which persists even when a variety of sociodemographic, attitudinal, and health status variables have been controlled. The results are discussed in terms of a perspective that emphasizes social-psychological needs as triggers for physician utilization

Successful adoptive families : a longitudinal study of special needs adoption

Foreword by James A. Rosenthal Preface The Study in Context The Research Study The Families and Children at a Glance and over Time Siblings Placed Together and Apart Physically and Sexually Abused Adoptees Social Support and the Adoptive Family Integration of Findings with Conceptual Model and Implications The Future of Adoption References Index

Consumer satisfaction with prepaid group practice: a comparative study.

RICHARD TESSLER DAVID MECHANIC University of Massachusetts, Amherst University of Wisconsin, Madison This study compares reactions of consumers to participation in prepaid group practice and alternative health insurance plans in a large metropolitan area. The majority of respondents in the survey were very satisfied with the medical care they and their families received during the preceding year. However, prepaid practice respondents expressed relatively less satisfaction than persons participating in alternative insurance plans. Degree ofsatisfaction wasfound to be related to characteristics of consumers, such as being unmarried, low skepticism toward medical care, psychological well-being, and perceived positive health status. When all correlates of satisfaction were controlled, being in the prepaid group continued to have an independent effect on degree of dissatisfaction. When questioned about their perceptions of the accessibility of medical care, prepaid practice respondents reported greater difficulty in obtaining appointments and longer travel time to site of care than persons participating in alternative insurance plans, but shorter waiting time upon arrival at the doctors office. Perceived barriers to access were positively associated with consumer dissatisfaction.

Continuity of care, residence, and family burden in Ohio.

Family and client data from the RWJF initiative in three Ohio cities are linked. The distribution of burden for a sample of 305 family members is reported. Burden is measured by assistance with the activities of daily living, attempts to prevent or stop troublesome behaviors, and worries about the client. The impact of continuity of care is evaluated for the total sample and in interaction with shared residence. Although continuity has no direct effect on any measure of burden, it can offset the objective burdens associated with shared residence. Without continuity of care, coresidence tends to increase the burden of caregiving and supervision. Client involvement in the professional system of care has less impact on family members when the client lives apart. The objective burden falls most heavily on spouses and parents; adult children and secondary kin are less affected.

The Impact of Mental Illness on Families Concepts and Priorities

Mental illness has far-reaching effects on other family members, as individuals and as members of a social system. While the study of the family impact of mental illness has been reported in the specialized mental health literature, it has not received much attention from sociologists. This article applies an illness behavior perspective to the study of family burden, reviews knowledge, and invites research by defining a number of issues, substantive and methodological, that need to be addressed. These include the definition and measurement of burden, diagnosis and course of illness, residence and kinship, social class, context, and coping, and the evaluation of social interventions designed to reduce burden and strengthen family supports. The article concludes with a discussion of family burden in terms of normative forces operating at the macro level.

Family Experiences with Mental Illness

Preface Introduction Mental Illness and the Family Family Experiences in Ohio: 1989-1992 The Research Landscape What Basic Needs Did Family Members Provide? What Troublesome Behaviors Did Family Members Try to Control? How Much Did Family Members Spend? What Were the Emotional Costs for Family Members? What Were the Positive Aspects for Family Members? How Involved Were Other Members of the Family Household? Family Experiences in Ohio: 1995-1997 The Research Landscape Revisited How Much Involvement Do Family Members Want? How Did Family Members Evaluate Professionals, Services, and Systems? What Did Family Members Know about Mental Health Insurance? Implications Dilemmas of Kinship Bibliography Index

Factors Affecting Children's Use of Physician Services in a Prepaid Group Practice

This paper examines factors affecting childrens use of physician services in a prepaid group practice. The independent measures come from questions asked of mothers in a survey interview, while the utilization data come from their childrens medical records. All independent variables were measured prior to the period of utilization studied. The results provide some evidence in support of the view that physician utilization for children is affected by characteristics of the mother, as well as the childs age and health status. Somewhat different variables were related to whether health services were used at all as compared with magnitude of use. Special consideration is given to the effect of the mothers level of psychological distress on her propensity to use medical services for children. The results suggest that distress was relevant, but only for the white families included in the sample. Also, distress was more important in explaining extent of use than accounting for whether utilization occurred at all. Various hypotheses are examined to explore whitenonwhite differences.

Bicultural Socialization Among Adoptive Families: Where There Is a Will, There Is a Way

Although bicultural competence has been viewed as an advantage for immigrants and other ethnic minorities in American society, we do not know whether bicultural socialization is similarly advantageous for children in families formed through international, transracial adoption. This study examines what factors enable adoptive Chinese children to achieve modest levels of bicultural competence. The data are from a longitudinal survey of parents who adopted children from China in the 1990s. Results indicate that parental attitudes toward bicultural socialization, parental social networks of Chinese adults, and the racial composition of the community all affect childrens levels of Chinese cultural competence, while documenting how bicultural socialization can occur even when parents and children do not share a common birth culture. The implications of the findings for adoption agencies and professionals are also discussed, as well as the need for future research as the first cohorts of children adopted from China become adolescents.

The proportion of veterans among homeless men: a decade later

Background: The purpose of this report is to evaluate the risk of homelessness among veterans as compared to non-veterans, and to ascertain whether the exceptionally high risk of homelessness among post-Vietnam era veterans first observed in 1987 was still evident one decade later. Method: Data from the 1996 National Survey of Homeless Assistance Providers and Clients and the 1996 Current Population Survey were used to examine the risks of homelessness among veteran men as compared to non-veteran men, stratified by age and race. Results: The present results show that the cohort of veterans aged 20–34 that was most at risk in the 1980 s, although no longer the youngest, still has the highest risk for homelessness. In 1996, the youngest cohort of veterans is also over-represented, but not to the extent found among young men 10 years before. Veterans over the age of 55 showed no increased risk of homelessness as compared to non-veterans. Conclusions: The observed cohort effect, which demonstrates an especially high risk of homelessness among veterans of the immediate post-Vietnam era, even as they age, may reflect the continuing influence of the early problems in recruiting for the All Volunteer Force (AVF). In contrast to the national draft, which promised a fair representation of the entire population of draft-eligible young men, the AVF also had the potential to attract young men with fewer alternative opportunities.

Gender Differences in Self-Reported Reasons for Homelessness

The purpose of this paper is to illustrate some of the ways in which the perceived pathways into homelessness are socially structured. We do this by examining the relative frequency of 11 different reasons homeless males and females cite for being homeless. Males were more likely to cite the following as their main reasons for homelessness: loss of a job, discharge from an institution, mental health problems, and alcohol or drug problems. Women were more likely to cite the following as their main reason for homelessness: eviction, interpersonal conflict, and someone no longer able or willing to help. Self-reported reasons for being homeless are also related to age, marital status, race, and being a veteran. As expected, they are also linked to receptiveness to treatment. Gender differences in reasons for homelessness may require different approaches to building helping relationships with homeless men and women.