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).
... Department of Sociology, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.... more ... Department of Sociology, University of North Carolina at Charlotte, Charlotte, NC 28223, USA. ... balance what can be done (operative or technical considerations) with normative beliefs about what should be done (see Abravanel (1983) for an extended discussion of the role ...
... About the Author Teresa L. Scheid Associate Professor, Department of Sociology, University of... more ... About the Author Teresa L. Scheid Associate Professor, Department of Sociology, University of North Carolina at Charlotte. ... aspects of the organization's ideology) and what one can realistically do in a given organization (the operative aspects) may well conflict (Abravanel 1983 ...
Originality – While increased reporting of adverse events has been linked to hospitals providing ... more Originality – While increased reporting of adverse events has been linked to hospitals providing safer care, no research to date has examined whether or not state-level mandates actually lead to improvements in patient safety.
Mental health and mental disorder represent two different areas of theory, research, and policy i... more Mental health and mental disorder represent two different areas of theory, research, and policy implications, reflecting our common tendency to dichotomize healthy and sick, normal and abnormal, sane and insane. David Mechanic (2006) argues that the term “mental health” has no clear or consistent meaning, and in terms of the sociological literature, this is generally true. Mental health is not merely the absence of disease or disorder; it involves self-esteem, mastery, and the ability to maintain meaningful relationships with others. While most of us fall short of optimal well-being (or happiness), those who experience mental health problems or psychological distress have been the focus of most sociological research. However, definitions of mental health problems, illnesses, or disorders are also not so straightforward. Following Horwitz (2002b), “mental diseases” reflect underlying internal dysfunctions that have universal features (i.e. schizophrenia and to a lesser degree bipolar disorder). A valid “mental disorder” reflects some internal psychological system that is unable to function as it should, and this dysfunction is socially inappropriate. For most disorders, symptoms are not specific indicators of discrete, underlying diseases (such as schizophrenia), instead many conditions arise from stressful social conditions (such as depression, anxiety, eating disorders). Cultural processes shape the symptoms associated with mental disorders, and it is important to distinguish mental disorders from normal reactions to social stressors. Horwitz (2002b) uses the terminology of “mental illness” to refer to those conditions which a particular group has defined as a mental illness (and often point to behaviors that are deemed deviant, for example homosexuality in previous psychiatric classifications). For simplicity, we will use the term mental health problem or disorder in this introduction – but students should keep in mind the implications of using the term mental illness. In Chapter 1, Horwitz argues that sociological approaches regard mental health and mental health problems as aspects of social circumstances. He provides a very thorough overview of how various social conditions affect levels of mental health and mental health problems, and in turn how social contexts shape the definition as well as the response to mental health problems. Chapter 1 develops a framework for a sociological understanding of mental disorder and mental health problems and also directs the reader to other chapters in the volume that illustrate Horwitz's arguments.
Handbook of Medical Sociology, Fif th Edition edited by Chloe E. Bird, Peter Conrad, and Allen M.... more Handbook of Medical Sociology, Fif th Edition edited by Chloe E. Bird, Peter Conrad, and Allen M. Fremont. New Jersey Prentice Hall 2000. 438 pp. $61.00 cloth. ISBN: 0-13-014456-8. There has always been a good selection of readers available for those teaching medical sociology courses due to the diverse nature of the field. It is difficult for one author to capture adequately the theoretical and empirical richness inherent to medical sociology or to give full consideration to the range of levels of analysis fron1 the individual's experience of illness and the naicrointeractions of doctor to patient to the meso level of professions and organizations to the macro level of healtlacare policy structural change and comparative analyses. Both of the handbooks reviewed here contain around thirty chapters and do an excellent job of providing the student and researcher with concise considerations of the many paradigms and topic areas included in the wide rubric of medical sociology. However the diversity of approach and research focus is also a source of fragmentation and has been the primary source of concern with previous considerations of the status of medical sociology. In 1992 an entire issue of the Awnericaw tournal of Sociolo<gywas devoted to the "state of the art" of medical sociology. Editor Donald Light argued that medical sociology had indeed moved beyond narrow empiricism and the stigmatizing label of applied research. However Light expressed concern that medical sociology "lllns the danger of self isolation that makes it vulnerable to being taken over by competing disciplines" (1992: 910). The primary source of this isolation is that medical sociology lacks indigenous theory and its subject matter is easily coopted by psychologists and epidemiologists who receive more specialized training in health and healthcare. Light also noted lack of research at the macro or system level a situation that has indeed changed. Medical sociologists must now compete with economists and health services researchers who conduct research on healtlacare systems and healthcare outcomes. If the two readers I reviewed are any indication I can argue with confidence as well as pride as a medical sociologist that medical sociology has grown in the direction of greater integration with the wider discipline and has become more explicitly theoretical while not losing its etupirical grounding in high-quality research. Perhaps Sol Levine had something to do with the movel11ent toward greater integration. In his introduction to the 1995 toursjal of Health and Social Behavior special issue on medical sociology Levine focuses on "a form of intellectual parochialism that splinters medical sociology and impedes productive discourse and the creative integration of our subjective nzatter" (1995: 1). Diversity in conceptual framework naethodological approach and unit of analysis need not result in fragmentation and Levine provides examples of the kind of creative integration that would naove the discipline folwvard. Otlaer papers in the issue provide strong theoretical foundations for future research efforts. Indeed some have become the basis for a great deal of creative work in medical sociology as well as the larger sociological enterprise. Many of these essays revised and updated appear in the Hand book of ILIed l cal Sociology. The Handbook of Social Studie^iol. Healt/ and Medicine is explicitly multidisciplinary and international in scope. It introduces even
The authors examined the association between physician-patient concordance and patient trust for ... more The authors examined the association between physician-patient concordance and patient trust for low socio-economic status women who were enrolled in Medicaid case management. The data were collected from October 2006 through March 2007 from a stratified random sample of 2,815 adult beneficiaries enrolled in North Carolina Medicaid&#39;s primary care case management delivery system. We limited our analyses to women enrolled in primary care, hence controlling for gender and social class as well as access to care. We were also able to control for the availability of minority providers. The findings revealed that the enrollee&#39;s race, education, and experiences seeking help with their health providers were significantly related to patient&#39;s trust of their physicians. Neither race concordance nor gender concordance improved trust. This may be because relatively few minority providers were included in the sample. These results extend research on physician-patient concordance by examining the relationship of both racial and gender concordance with patient trust while controlling for access and social class. Research on physician-patient concordance needs to account for multiple measures of social status, as well as differences in culture and communication styles between physicians and their patients.
Regional health care systems have significant opportunities to adopt community-oriented approache... more Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project.In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and interviews with six key informants from each county. Data were coded and analyzed using standard qualitative software to identify common themes and sources of variance between cases.The project model was generally well accepted. Local autonomy and domain disputes were challenges in all four sites. Funding for local projects was the most frequently cited benefit. The project was successful in increasing local capacity and supporting well-designed interventions to prevent chronic disease. This approach can be used by large health care systems and by other organizations to better support local health initiatives.
Employment and work can have a positive effect on mental health by providing opportunities for sk... more Employment and work can have a positive effect on mental health by providing opportunities for skill development, social contact, self-esteem, and income. Unemployment is a source of anxiety, stress, and depression. At the same time work can be a major source of stress by decreasing opportunities for control and autonomy. This article examines the role of work and unemployment and the relationship of work status to other indicators of community adjustment among a sample of 68 psychiatric clients in outpatient treatment. Comparisons are made between clients who are not working or seeking work, those who are unemployed and seeking work, and those who are currently working. Regression analysis is then used to examine the effect of work status on other indicators of community adjustment: psychiatric symptoms, functioning, social integration, stress, and mental hospitalizations. Working clients are more likely to be male and younger and to have had previous work experience. Working is related to higher levels of functioning in the community, while unemployment is positively related to stress. Work status was not related to social integration, indicating that work may be an alternative source of social support and should receive separate attention in assessments of community adjustment and integration.
... Clients needing additional support to address their substance use problems should be referred... more ... Clients needing additional support to address their substance use problems should be referred to a substance abuse professional, treatment program and/or support groups such as AlcoholicsAnnonymous, Cocaine Annonymous, or Narcotics Annonymous. ...
We present a conceptual framework derived from organizational theory for understanding the evalua... more We present a conceptual framework derived from organizational theory for understanding the evaluation of the effectiveness of mental health services. We postulate that organizations are deemed &quot;successful&quot; by their constituents when they conform to institutional demands and expectations that are both internally and externally generated. We empirically assess institutional conformity by examining evaluations of effectiveness by 269 mental health providers in 29 different mental health programs. Specialist programs responded to institutional demands by targeting services to those considered most in need: clients with severe mental illnesses. The formal structure and program philosophy of these programs clearly reflected this emphasis; consequently, levels of goal incongruence were low and evaluations of effectiveness were high. Generalist programs continued to provide care to diverse client groups, had more professionals, offered traditional services (such as psychotherapy), and exhibited higher levels of goal incongruence; these factors resulted in lower evaluations of effectiveness. This research is important because it demonstrates that organizational processes of institutional conformity (program objectives meet the demands of external constituents) and goal congruence (program objectives meet with expectations of internal constituents) are critical to positive evaluations of effectiveness. With the current institutional demand for effective, efficient services, it is critical that researchers have a conceptual framework for analyzing those factors which influence evaluations of effectiveness.
ABSTRACT A comprehensive health care system consists of services that are coordinated and integra... more ABSTRACT A comprehensive health care system consists of services that are coordinated and integrated along the full continum of care. For HIV patients, this includes physical health care, infectious disease management, crisis care, mental health care, substance abuse counseling, and social support services including housing, transportation, subsistence, and supports for dealing with multiple sources of stigma. This book highlights the dilemmas faced in delivering comprehensive, integrated care fo individuals living with HIV, providing both an understanding of existing efforts to integrate diverse systems of care, as well as insight into ways in which systems of care must be challenged in order to meet the needs of people living iwth HIV. Comprehensive Care for HIV/AIDS is the result of collaborative work with the county Health Department, numerous community-based organizations, and several planning boards in a metropolitan area, which have sought to provide integrated care to people living with HIV.
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, &amp; 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 &amp; Gray, 1999).
... Department of Sociology, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.... more ... Department of Sociology, University of North Carolina at Charlotte, Charlotte, NC 28223, USA. ... balance what can be done (operative or technical considerations) with normative beliefs about what should be done (see Abravanel (1983) for an extended discussion of the role ...
... About the Author Teresa L. Scheid Associate Professor, Department of Sociology, University of... more ... About the Author Teresa L. Scheid Associate Professor, Department of Sociology, University of North Carolina at Charlotte. ... aspects of the organization's ideology) and what one can realistically do in a given organization (the operative aspects) may well conflict (Abravanel 1983 ...
Originality – While increased reporting of adverse events has been linked to hospitals providing ... more Originality – While increased reporting of adverse events has been linked to hospitals providing safer care, no research to date has examined whether or not state-level mandates actually lead to improvements in patient safety.
Mental health and mental disorder represent two different areas of theory, research, and policy i... more Mental health and mental disorder represent two different areas of theory, research, and policy implications, reflecting our common tendency to dichotomize healthy and sick, normal and abnormal, sane and insane. David Mechanic (2006) argues that the term “mental health” has no clear or consistent meaning, and in terms of the sociological literature, this is generally true. Mental health is not merely the absence of disease or disorder; it involves self-esteem, mastery, and the ability to maintain meaningful relationships with others. While most of us fall short of optimal well-being (or happiness), those who experience mental health problems or psychological distress have been the focus of most sociological research. However, definitions of mental health problems, illnesses, or disorders are also not so straightforward. Following Horwitz (2002b), “mental diseases” reflect underlying internal dysfunctions that have universal features (i.e. schizophrenia and to a lesser degree bipolar disorder). A valid “mental disorder” reflects some internal psychological system that is unable to function as it should, and this dysfunction is socially inappropriate. For most disorders, symptoms are not specific indicators of discrete, underlying diseases (such as schizophrenia), instead many conditions arise from stressful social conditions (such as depression, anxiety, eating disorders). Cultural processes shape the symptoms associated with mental disorders, and it is important to distinguish mental disorders from normal reactions to social stressors. Horwitz (2002b) uses the terminology of “mental illness” to refer to those conditions which a particular group has defined as a mental illness (and often point to behaviors that are deemed deviant, for example homosexuality in previous psychiatric classifications). For simplicity, we will use the term mental health problem or disorder in this introduction – but students should keep in mind the implications of using the term mental illness. In Chapter 1, Horwitz argues that sociological approaches regard mental health and mental health problems as aspects of social circumstances. He provides a very thorough overview of how various social conditions affect levels of mental health and mental health problems, and in turn how social contexts shape the definition as well as the response to mental health problems. Chapter 1 develops a framework for a sociological understanding of mental disorder and mental health problems and also directs the reader to other chapters in the volume that illustrate Horwitz's arguments.
Handbook of Medical Sociology, Fif th Edition edited by Chloe E. Bird, Peter Conrad, and Allen M.... more Handbook of Medical Sociology, Fif th Edition edited by Chloe E. Bird, Peter Conrad, and Allen M. Fremont. New Jersey Prentice Hall 2000. 438 pp. $61.00 cloth. ISBN: 0-13-014456-8. There has always been a good selection of readers available for those teaching medical sociology courses due to the diverse nature of the field. It is difficult for one author to capture adequately the theoretical and empirical richness inherent to medical sociology or to give full consideration to the range of levels of analysis fron1 the individual's experience of illness and the naicrointeractions of doctor to patient to the meso level of professions and organizations to the macro level of healtlacare policy structural change and comparative analyses. Both of the handbooks reviewed here contain around thirty chapters and do an excellent job of providing the student and researcher with concise considerations of the many paradigms and topic areas included in the wide rubric of medical sociology. However the diversity of approach and research focus is also a source of fragmentation and has been the primary source of concern with previous considerations of the status of medical sociology. In 1992 an entire issue of the Awnericaw tournal of Sociolo<gywas devoted to the "state of the art" of medical sociology. Editor Donald Light argued that medical sociology had indeed moved beyond narrow empiricism and the stigmatizing label of applied research. However Light expressed concern that medical sociology "lllns the danger of self isolation that makes it vulnerable to being taken over by competing disciplines" (1992: 910). The primary source of this isolation is that medical sociology lacks indigenous theory and its subject matter is easily coopted by psychologists and epidemiologists who receive more specialized training in health and healthcare. Light also noted lack of research at the macro or system level a situation that has indeed changed. Medical sociologists must now compete with economists and health services researchers who conduct research on healtlacare systems and healthcare outcomes. If the two readers I reviewed are any indication I can argue with confidence as well as pride as a medical sociologist that medical sociology has grown in the direction of greater integration with the wider discipline and has become more explicitly theoretical while not losing its etupirical grounding in high-quality research. Perhaps Sol Levine had something to do with the movel11ent toward greater integration. In his introduction to the 1995 toursjal of Health and Social Behavior special issue on medical sociology Levine focuses on "a form of intellectual parochialism that splinters medical sociology and impedes productive discourse and the creative integration of our subjective nzatter" (1995: 1). Diversity in conceptual framework naethodological approach and unit of analysis need not result in fragmentation and Levine provides examples of the kind of creative integration that would naove the discipline folwvard. Otlaer papers in the issue provide strong theoretical foundations for future research efforts. Indeed some have become the basis for a great deal of creative work in medical sociology as well as the larger sociological enterprise. Many of these essays revised and updated appear in the Hand book of ILIed l cal Sociology. The Handbook of Social Studie^iol. Healt/ and Medicine is explicitly multidisciplinary and international in scope. It introduces even
The authors examined the association between physician-patient concordance and patient trust for ... more The authors examined the association between physician-patient concordance and patient trust for low socio-economic status women who were enrolled in Medicaid case management. The data were collected from October 2006 through March 2007 from a stratified random sample of 2,815 adult beneficiaries enrolled in North Carolina Medicaid&#39;s primary care case management delivery system. We limited our analyses to women enrolled in primary care, hence controlling for gender and social class as well as access to care. We were also able to control for the availability of minority providers. The findings revealed that the enrollee&#39;s race, education, and experiences seeking help with their health providers were significantly related to patient&#39;s trust of their physicians. Neither race concordance nor gender concordance improved trust. This may be because relatively few minority providers were included in the sample. These results extend research on physician-patient concordance by examining the relationship of both racial and gender concordance with patient trust while controlling for access and social class. Research on physician-patient concordance needs to account for multiple measures of social status, as well as differences in culture and communication styles between physicians and their patients.
Regional health care systems have significant opportunities to adopt community-oriented approache... more Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project.In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and interviews with six key informants from each county. Data were coded and analyzed using standard qualitative software to identify common themes and sources of variance between cases.The project model was generally well accepted. Local autonomy and domain disputes were challenges in all four sites. Funding for local projects was the most frequently cited benefit. The project was successful in increasing local capacity and supporting well-designed interventions to prevent chronic disease. This approach can be used by large health care systems and by other organizations to better support local health initiatives.
Employment and work can have a positive effect on mental health by providing opportunities for sk... more Employment and work can have a positive effect on mental health by providing opportunities for skill development, social contact, self-esteem, and income. Unemployment is a source of anxiety, stress, and depression. At the same time work can be a major source of stress by decreasing opportunities for control and autonomy. This article examines the role of work and unemployment and the relationship of work status to other indicators of community adjustment among a sample of 68 psychiatric clients in outpatient treatment. Comparisons are made between clients who are not working or seeking work, those who are unemployed and seeking work, and those who are currently working. Regression analysis is then used to examine the effect of work status on other indicators of community adjustment: psychiatric symptoms, functioning, social integration, stress, and mental hospitalizations. Working clients are more likely to be male and younger and to have had previous work experience. Working is related to higher levels of functioning in the community, while unemployment is positively related to stress. Work status was not related to social integration, indicating that work may be an alternative source of social support and should receive separate attention in assessments of community adjustment and integration.
... Clients needing additional support to address their substance use problems should be referred... more ... Clients needing additional support to address their substance use problems should be referred to a substance abuse professional, treatment program and/or support groups such as AlcoholicsAnnonymous, Cocaine Annonymous, or Narcotics Annonymous. ...
We present a conceptual framework derived from organizational theory for understanding the evalua... more We present a conceptual framework derived from organizational theory for understanding the evaluation of the effectiveness of mental health services. We postulate that organizations are deemed &quot;successful&quot; by their constituents when they conform to institutional demands and expectations that are both internally and externally generated. We empirically assess institutional conformity by examining evaluations of effectiveness by 269 mental health providers in 29 different mental health programs. Specialist programs responded to institutional demands by targeting services to those considered most in need: clients with severe mental illnesses. The formal structure and program philosophy of these programs clearly reflected this emphasis; consequently, levels of goal incongruence were low and evaluations of effectiveness were high. Generalist programs continued to provide care to diverse client groups, had more professionals, offered traditional services (such as psychotherapy), and exhibited higher levels of goal incongruence; these factors resulted in lower evaluations of effectiveness. This research is important because it demonstrates that organizational processes of institutional conformity (program objectives meet the demands of external constituents) and goal congruence (program objectives meet with expectations of internal constituents) are critical to positive evaluations of effectiveness. With the current institutional demand for effective, efficient services, it is critical that researchers have a conceptual framework for analyzing those factors which influence evaluations of effectiveness.
ABSTRACT A comprehensive health care system consists of services that are coordinated and integra... more ABSTRACT A comprehensive health care system consists of services that are coordinated and integrated along the full continum of care. For HIV patients, this includes physical health care, infectious disease management, crisis care, mental health care, substance abuse counseling, and social support services including housing, transportation, subsistence, and supports for dealing with multiple sources of stigma. This book highlights the dilemmas faced in delivering comprehensive, integrated care fo individuals living with HIV, providing both an understanding of existing efforts to integrate diverse systems of care, as well as insight into ways in which systems of care must be challenged in order to meet the needs of people living iwth HIV. Comprehensive Care for HIV/AIDS is the result of collaborative work with the county Health Department, numerous community-based organizations, and several planning boards in a metropolitan area, which have sought to provide integrated care to people living with HIV.
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Papers by Teresa Scheid