Page 1. Are male veterans at greater risk for nonemployment than nonveterans? Veterans as a group... more Page 1. Are male veterans at greater risk for nonemployment than nonveterans? Veterans as a group do not have a higher risk of nonemployment than their nonveteran peers; however, the risk varies greatly by age cohort and ethnicity ...
Journal of Health Care for The Poor and Underserved, 2010
This study uses data from a nationally representative epidemiologic survey, the National Comorbid... more This study uses data from a nationally representative epidemiologic survey, the National Comorbidity Survey Replication, to investigate the association of mental health and substance use disorders, along with other factors, with past homelessness. Approximately 5% of the 5,251 adults reported having been homelessness. Multivariate analysis showed the strongest independent risk factors for past homelessness were past receipt of welfare payments (odds ratio [OR]=5.7), incarceration for 27 or more days (OR=3.9), exposure to personal violence (OR=2.7), lifetime substance use disorder (OR=2.4), and Black race (OR=2.1). Several non-substance use psychiatric disorders were also significantly, if less strongly (OR 1.4 to 1.6), associated with past homelessness. Past homelessness is associated with a broad array of sociodemographic, economic, and mental health problems. While the association of both substance use and psychiatric disorders with past homelessness was quite strong, non-substance use psychiatric disorders was not as strong an independent risk factor as substance abuse disorders.
This paper presents an analysis of changes in satisfaction of minorities with inpatient mental he... more This paper presents an analysis of changes in satisfaction of minorities with inpatient mental health services provided by the Veterans Health Administration (VHA) during a period of major system change (1995–2001). Post discharge data from 16,223 veterans who received inpatient VHA mental health services at 87 medical centers during this period was examined using hierarchical linear models. Blacks were found
Introduction  While several major studies have examined services integration at the system or int... more Introduction  While several major studies have examined services integration at the system or interagency level, there has been far less effort to measure the integration of services at the client-level and its correlates. Methods  This study presents three client-level measures of services integration, two objective measures, representing the proportion of needed services received and the number of outpatient services received by each
ABSTRACT Mental health care organizations have been an important laboratory for sociological rese... more ABSTRACT Mental health care organizations have been an important laboratory for sociological research. Classic studies on state mental hospitals focused on how the social structure of the hospital shaped therapeutic outcomes (Goffman, 1961; Strauss, Schatzman, Burcher, Ehrlich, & Sabshin, 1964). Organizational theorists (Etzioni, 1960; Perrow, 1965) found that state mental hospitals provided rich materials for understanding complex organizational structures and behavior, which led to significant advances in organizational theory. All of the aforementioned studies made significant contributions to sociological understanding of organizational control and power, and mental health care organizations continue to be excellent sites for understanding changing forms of organizational control as well as furthering understanding of conflict between professional and bureaucratic control. As organizational theory developed to include inter-organizational relations and networks of organizations, research on mental health care has contributed to knowledge about how organizations manage contradiction, conflict, and ambiguity (Meyer, 1986; Scott, 1983). Organizational theory also provides a powerful model for understanding changing systems of mental health care (Scheid, 2004; Schlesinger & Gray, 1999).
This article examines gender differences in the correlates of incarceration for committing a viol... more This article examines gender differences in the correlates of incarceration for committing a violent crime with data from a large nationally representative sample of state and federal inmates collected by the Bureau of Justice Statistics. The data were analyzed using multivariate logistic regression models with interaction terms for gender. Among women only two of the childhood, environmental, and adult risk factors were significantly associated with an increased likelihood that the inmate was incarcerated for a violent crime as opposed to a nonviolent crime, while among men many of these risk factors were. Specifically, for both men and women, parental substance abuse was associated with violence to a similar degree. Additionally, both men and women who reported being sexually or physically abused were much more likely to be incarcerated for a violent crime versus a non-violent crime. Furthermore, sexual abuse had a significantly stronger association with violence among men while p...
Using a national sample of veterans, we examined the relationship between disability income and e... more Using a national sample of veterans, we examined the relationship between disability income and employment, adjusting for health status and other factors. Veterans Affairs disability income payments had no globally detrimental effect on labor force participation, in that the likelihood of employment was reduced only at payment levels of more than $800 per month. Although unearned income from other sources also did not have a substantial negative effect on labor force participation, veterans who received benefits from the Social Security Administration or welfare payments were less likely to be employed, mostly likely because employment earnings above a certain level in some programs may result in the loss of monetary benefits and health insurance.
International journal of offender therapy and comparative criminology, 2012
Using data from national surveys of jail and prison inmates conducted in 2002 and 2004, the autho... more Using data from national surveys of jail and prison inmates conducted in 2002 and 2004, the authors found that male veterans in the age group that entered military service in the early years of the All Volunteer Force (AVF) were at greater risk of incarceration than nonveterans of similar age and ethnicity, whereas veterans who enlisted in later years of the AVF had less risk of incarceration than nonveterans. Although White veterans tend to have greater risk of incarceration than nonveteran Whites, Black and Hispanic veterans were at less risk than their nonveteran peers, although they are at greater risk than White veterans. These patterns are best explained by changes over time and in differential effects across racial/ethnic groups of recruiting practices, accession standards, and in civilian employment opportunities rather than combat trauma or other adverse experiences in the military. For example, reductions in the relative risk for incarceration of veterans during the AVF ap...
The authors analyzed changes in access to and use of mental health services by minorities in the ... more The authors analyzed changes in access to and use of mental health services by minorities in the Veterans Health Administration during a period of major system change (1995-2001). Blacks had poorer outpatient access than Whites during this period of change, but were not further disadvantaged over time, and their access to care improved relative to Whites on some measures. For Hispanics, there was a trend toward greater inequality in the delivery of outpatient mental health care. These results suggest a need to monitor and address the differential impact on minorities of changes in mental health service delivery.
Journal of health care for the poor and underserved, 2003
Many researchers have suggested that the implementation of managed care may lower access to, and ... more Many researchers have suggested that the implementation of managed care may lower access to, and quality of, health care services for minorities. However, very little empirical data examining this issue exists. To examine it, the authors used a study design that was both cross-sectional and longitudinal in that they surveyed Medicaid recipients in two counties at two points in time; one of the counties began delivering services through managed care between the two survey periods. Their results indicate that, overall, managed care had neither a positive nor a negative effect on African Americans' access to health care services in either absolute terms or relative to whites'. In addition, race was not found to be associated with satisfaction. However, a Medicaid recipient's race was found to negatively affect his or her access to service under both managed care and fee-for-service systems.
To describe the design and deployment of health information technology to support implementation ... more To describe the design and deployment of health information technology to support implementation of mental health services policy requirements in the Veterans Health Administration (VHA).
In previous issues of Transition Watch we reported our observations on several aspects of primary... more In previous issues of Transition Watch we reported our observations on several aspects of primary care and mental health service lines, including the history of service line implementation in the VA, and the variety of forms service lines have taken at both the facility and network level. Most recently (February 2001) we devoted an entire issue to a summary of
Public support payments may facilitate exit from homelessness for persons with mental illness. We... more Public support payments may facilitate exit from homelessness for persons with mental illness. We examined data from 10,641 homeless veterans contacted from
This paper presents an analysis of changes in satisfaction of minorities with inpatient mental he... more This paper presents an analysis of changes in satisfaction of minorities with inpatient mental health services provided by the Veterans Health Administration (VHA) during a period of major system change (1995)(1996)(1997)(1998)(1999)(2000)(2001). Post discharge data from 16,223 veterans who received inpatient VHA mental health services at 87 medical centers during this period was examined using hierarchical linear models. Blacks were found to have higher satisfaction levels on most measures over the period of study while the satisfaction of whites and Hispanics were not significantly different. There was little change over the study period in the relative satisfaction of minorities and whites. Changes in patterns of VHA
Continuity of care (COC) is often used as an indicator of treatment quality for patients with sev... more Continuity of care (COC) is often used as an indicator of treatment quality for patients with severe psychiatric or addictive disorders. However, few studies have examined the relationship between measures of COC and treatment outcomes. This study used standard regression models to examine the strength of the association between continuity of care measures and health outcomes for a sample of female veterans newly entering outpatient treatment for PTSD. There were few consistently significant associations between COC and outcome measures. Four months following program entry only one measure of treatment process, commitment to treatment, was positively associated with one or more continuity of care measures and several COC measures were associated with poor outcomes. Eight months following program entry patients with greater COC during the first four months of treatment had greater declines in violent behavior and PTSD measurements and larger increases in global functioning.
There has been a growing interest in the implementation of evidencebased specialized mental healt... more There has been a growing interest in the implementation of evidencebased specialized mental health programs. However, there has been little study of the effectiveness of these programs in comparison with standard mental health care in real world mental health systems. This study used a national sample of patients from the Veterans Health Administration to compare changes in mental health status in various specialized mental health outpatient programs and in general psychiatric clinics. Hierarchical linear models were used to compare the association of both regularity and intensity of care in six specialized mental health programs with GAF change scores in patients
Data derived from the 2002 Survey of Inmates in Local Jails and the 2000 National Survey of Veter... more Data derived from the 2002 Survey of Inmates in Local Jails and the 2000 National Survey of Veterans show that having mental health problems in addition to such sociodemographic characteristics as being a member of a minority group, not being married, having less education, and being younger are risk factors for incarceration among veterans, as they are for the general population. As in previous studies veterans who served during the Vietnam Era and to an even greater extent, those who served in the early years of the All Volunteer Force were at greater risk of incarceration than veterans from the most recent period of the AVF, after controlling for age and other factors.
Page 1. Are male veterans at greater risk for nonemployment than nonveterans? Veterans as a group... more Page 1. Are male veterans at greater risk for nonemployment than nonveterans? Veterans as a group do not have a higher risk of nonemployment than their nonveteran peers; however, the risk varies greatly by age cohort and ethnicity ...
Journal of Health Care for The Poor and Underserved, 2010
This study uses data from a nationally representative epidemiologic survey, the National Comorbid... more This study uses data from a nationally representative epidemiologic survey, the National Comorbidity Survey Replication, to investigate the association of mental health and substance use disorders, along with other factors, with past homelessness. Approximately 5% of the 5,251 adults reported having been homelessness. Multivariate analysis showed the strongest independent risk factors for past homelessness were past receipt of welfare payments (odds ratio [OR]=5.7), incarceration for 27 or more days (OR=3.9), exposure to personal violence (OR=2.7), lifetime substance use disorder (OR=2.4), and Black race (OR=2.1). Several non-substance use psychiatric disorders were also significantly, if less strongly (OR 1.4 to 1.6), associated with past homelessness. Past homelessness is associated with a broad array of sociodemographic, economic, and mental health problems. While the association of both substance use and psychiatric disorders with past homelessness was quite strong, non-substance use psychiatric disorders was not as strong an independent risk factor as substance abuse disorders.
This paper presents an analysis of changes in satisfaction of minorities with inpatient mental he... more This paper presents an analysis of changes in satisfaction of minorities with inpatient mental health services provided by the Veterans Health Administration (VHA) during a period of major system change (1995–2001). Post discharge data from 16,223 veterans who received inpatient VHA mental health services at 87 medical centers during this period was examined using hierarchical linear models. Blacks were found
Introduction  While several major studies have examined services integration at the system or int... more Introduction  While several major studies have examined services integration at the system or interagency level, there has been far less effort to measure the integration of services at the client-level and its correlates. Methods  This study presents three client-level measures of services integration, two objective measures, representing the proportion of needed services received and the number of outpatient services received by each
ABSTRACT Mental health care organizations have been an important laboratory for sociological rese... more ABSTRACT Mental health care organizations have been an important laboratory for sociological research. Classic studies on state mental hospitals focused on how the social structure of the hospital shaped therapeutic outcomes (Goffman, 1961; Strauss, Schatzman, Burcher, Ehrlich, & Sabshin, 1964). Organizational theorists (Etzioni, 1960; Perrow, 1965) found that state mental hospitals provided rich materials for understanding complex organizational structures and behavior, which led to significant advances in organizational theory. All of the aforementioned studies made significant contributions to sociological understanding of organizational control and power, and mental health care organizations continue to be excellent sites for understanding changing forms of organizational control as well as furthering understanding of conflict between professional and bureaucratic control. As organizational theory developed to include inter-organizational relations and networks of organizations, research on mental health care has contributed to knowledge about how organizations manage contradiction, conflict, and ambiguity (Meyer, 1986; Scott, 1983). Organizational theory also provides a powerful model for understanding changing systems of mental health care (Scheid, 2004; Schlesinger & Gray, 1999).
This article examines gender differences in the correlates of incarceration for committing a viol... more This article examines gender differences in the correlates of incarceration for committing a violent crime with data from a large nationally representative sample of state and federal inmates collected by the Bureau of Justice Statistics. The data were analyzed using multivariate logistic regression models with interaction terms for gender. Among women only two of the childhood, environmental, and adult risk factors were significantly associated with an increased likelihood that the inmate was incarcerated for a violent crime as opposed to a nonviolent crime, while among men many of these risk factors were. Specifically, for both men and women, parental substance abuse was associated with violence to a similar degree. Additionally, both men and women who reported being sexually or physically abused were much more likely to be incarcerated for a violent crime versus a non-violent crime. Furthermore, sexual abuse had a significantly stronger association with violence among men while p...
Using a national sample of veterans, we examined the relationship between disability income and e... more Using a national sample of veterans, we examined the relationship between disability income and employment, adjusting for health status and other factors. Veterans Affairs disability income payments had no globally detrimental effect on labor force participation, in that the likelihood of employment was reduced only at payment levels of more than $800 per month. Although unearned income from other sources also did not have a substantial negative effect on labor force participation, veterans who received benefits from the Social Security Administration or welfare payments were less likely to be employed, mostly likely because employment earnings above a certain level in some programs may result in the loss of monetary benefits and health insurance.
International journal of offender therapy and comparative criminology, 2012
Using data from national surveys of jail and prison inmates conducted in 2002 and 2004, the autho... more Using data from national surveys of jail and prison inmates conducted in 2002 and 2004, the authors found that male veterans in the age group that entered military service in the early years of the All Volunteer Force (AVF) were at greater risk of incarceration than nonveterans of similar age and ethnicity, whereas veterans who enlisted in later years of the AVF had less risk of incarceration than nonveterans. Although White veterans tend to have greater risk of incarceration than nonveteran Whites, Black and Hispanic veterans were at less risk than their nonveteran peers, although they are at greater risk than White veterans. These patterns are best explained by changes over time and in differential effects across racial/ethnic groups of recruiting practices, accession standards, and in civilian employment opportunities rather than combat trauma or other adverse experiences in the military. For example, reductions in the relative risk for incarceration of veterans during the AVF ap...
The authors analyzed changes in access to and use of mental health services by minorities in the ... more The authors analyzed changes in access to and use of mental health services by minorities in the Veterans Health Administration during a period of major system change (1995-2001). Blacks had poorer outpatient access than Whites during this period of change, but were not further disadvantaged over time, and their access to care improved relative to Whites on some measures. For Hispanics, there was a trend toward greater inequality in the delivery of outpatient mental health care. These results suggest a need to monitor and address the differential impact on minorities of changes in mental health service delivery.
Journal of health care for the poor and underserved, 2003
Many researchers have suggested that the implementation of managed care may lower access to, and ... more Many researchers have suggested that the implementation of managed care may lower access to, and quality of, health care services for minorities. However, very little empirical data examining this issue exists. To examine it, the authors used a study design that was both cross-sectional and longitudinal in that they surveyed Medicaid recipients in two counties at two points in time; one of the counties began delivering services through managed care between the two survey periods. Their results indicate that, overall, managed care had neither a positive nor a negative effect on African Americans' access to health care services in either absolute terms or relative to whites'. In addition, race was not found to be associated with satisfaction. However, a Medicaid recipient's race was found to negatively affect his or her access to service under both managed care and fee-for-service systems.
To describe the design and deployment of health information technology to support implementation ... more To describe the design and deployment of health information technology to support implementation of mental health services policy requirements in the Veterans Health Administration (VHA).
In previous issues of Transition Watch we reported our observations on several aspects of primary... more In previous issues of Transition Watch we reported our observations on several aspects of primary care and mental health service lines, including the history of service line implementation in the VA, and the variety of forms service lines have taken at both the facility and network level. Most recently (February 2001) we devoted an entire issue to a summary of
Public support payments may facilitate exit from homelessness for persons with mental illness. We... more Public support payments may facilitate exit from homelessness for persons with mental illness. We examined data from 10,641 homeless veterans contacted from
This paper presents an analysis of changes in satisfaction of minorities with inpatient mental he... more This paper presents an analysis of changes in satisfaction of minorities with inpatient mental health services provided by the Veterans Health Administration (VHA) during a period of major system change (1995)(1996)(1997)(1998)(1999)(2000)(2001). Post discharge data from 16,223 veterans who received inpatient VHA mental health services at 87 medical centers during this period was examined using hierarchical linear models. Blacks were found to have higher satisfaction levels on most measures over the period of study while the satisfaction of whites and Hispanics were not significantly different. There was little change over the study period in the relative satisfaction of minorities and whites. Changes in patterns of VHA
Continuity of care (COC) is often used as an indicator of treatment quality for patients with sev... more Continuity of care (COC) is often used as an indicator of treatment quality for patients with severe psychiatric or addictive disorders. However, few studies have examined the relationship between measures of COC and treatment outcomes. This study used standard regression models to examine the strength of the association between continuity of care measures and health outcomes for a sample of female veterans newly entering outpatient treatment for PTSD. There were few consistently significant associations between COC and outcome measures. Four months following program entry only one measure of treatment process, commitment to treatment, was positively associated with one or more continuity of care measures and several COC measures were associated with poor outcomes. Eight months following program entry patients with greater COC during the first four months of treatment had greater declines in violent behavior and PTSD measurements and larger increases in global functioning.
There has been a growing interest in the implementation of evidencebased specialized mental healt... more There has been a growing interest in the implementation of evidencebased specialized mental health programs. However, there has been little study of the effectiveness of these programs in comparison with standard mental health care in real world mental health systems. This study used a national sample of patients from the Veterans Health Administration to compare changes in mental health status in various specialized mental health outpatient programs and in general psychiatric clinics. Hierarchical linear models were used to compare the association of both regularity and intensity of care in six specialized mental health programs with GAF change scores in patients
Data derived from the 2002 Survey of Inmates in Local Jails and the 2000 National Survey of Veter... more Data derived from the 2002 Survey of Inmates in Local Jails and the 2000 National Survey of Veterans show that having mental health problems in addition to such sociodemographic characteristics as being a member of a minority group, not being married, having less education, and being younger are risk factors for incarceration among veterans, as they are for the general population. As in previous studies veterans who served during the Vietnam Era and to an even greater extent, those who served in the early years of the All Volunteer Force were at greater risk of incarceration than veterans from the most recent period of the AVF, after controlling for age and other factors.
Uploads
Papers by Greg Greenberg