Integrating mental health parity for homebound older adults under the medicare home health care benefit

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.     

Continuity and Discontinuity of Violent and Nonviolent Behavior: Toward a Classification of Male Adolescent Immigrants from the Former Soviet Union in Israel

Abstract

This article examines the perceptions of male adolescent immigrants to Israel from the former Soviet Union (FSU) and what accounts for their using or refraining from violence. A grounded theoretical classification of four groups relating to continuity and discontinuity of violent and nonviolent behavior is presented and reasons provided for these behaviors in the host country, compared with the country of origin. Each group is described and analyzed by inductive parameters relating to self-perception, immigration, attitudes toward violence, and identification and acceptance of norm differences. Findings are based on semistructured interviews with 40 male adolescents who immigrated from the FSU to Israel. Youth who have immigrated due to ideological reasons, had control over the decision to emigrate, or were able to identify norm differences between the two countries adjusted well and were nonviolent in the receiving country. Youth whose families immigrated due to pragmatic considerations, who had little or no control over the decision to emigrate, had difficulty adjusting, or preferred to live by the norms they were used to in the FSU tended to be involved in violent behavior. The findings are presented in a grounded theoretical model and discussed in the context of theoretical concepts of “uprooting of meaning” for the youth in each of the four groups.     

Detecting a Change in the Correlation Coefficient in a Sequence of Bivariate Normal Variables

We consider the problem of testing the hypothesis that the correlation coefficient is stable in a sequence of n observations of independent, bivariate normal random variables against the alternative that the correlation coefficient changes after an unknown point t(t < n). We propose an estimate of the changepoint t and report on power comparisons between the commonly used test for this problem and our proposed test. Some applications to finance are discussed.     

A generalized binomial distribution

A new generalization of the binomial distribution is introduced that allows dependence between trials, nonconstant probabilities of success from trial to trial, and which contains the usual binomial distribution as a special case. Along with the number of trials and an initial probability of ‘success’, an additional parameter that controls the degree of correlation between trials is introduced. The resulting class of distributions includes the binomial, unirnodal distributions, and bimodal distributions. Formulas for the moments, mean, and variance of this distribution are given along with a method for fitting the distribution to sample data.     

Lay persons' emotional reactions toward an abused elderly person

This study examined lay persons' emotional reactions to abuse, with special attention to two types of disease: Alzheimer's disease and osteoporosis. A total of 169 adults (mean age = 60) were interviewed face-to-face using a vignette methodology. Although the majority of the participants found the vignette to describe a situation of abuse, one-quarter did not consider it an abusive situation. The person described in the vignette elicited more positive than negative emotions, with a high percentage of participants expressing sympathy, desire to help, and concern. The various emotional reactions to abuse are associated with different correlates.     

Psychological Distress and Help-Seeking by Residents of a Neighborhood Naturally Occurring Retirement Community (NNORC)

This article presents findings from an annual program survey of residents of a horizontal neighborhood naturally occurring retirement community (NNORC). The study explored the relationship between several factors (age, co-residents, number of chronic illnesses, self-reported health, loneliness, sense of mastery, locus of control, pain, and psychological distress) and their ability to predict general health, level of psychological distress, and the quantity and type of help-seeking behaviors. Although residents generally reported moderate to high levels of chronic disease, pain, loneliness, and concerns about life issues, 25% of them sought no help from any of the listed resources, and 65% sought help from only one of seven resources. The most common source of help for most (70%) was a primary care physician (PCP), and comparatively few respondents sought help from other sources. Older adults, especially those with chronic illness, generally consider their PCP to be the first, and perhaps only, source to consult. However, research indicates that the most effective health promotional programs for older adults are social and educational group activities, rather than individual health-focused interventions. Possible means of redirecting residents toward NNORC services include more vigorous outreach and creating collaborative partnerships between local PCPs serving older populations and the NNORC.     

Calibration Results for Non‐Expected Utility Theories

Rabin (2000) proved that a low level of risk aversion with respect to small gambles leads to a high, and absurd, level of risk aversion with respect to large gambles. Rabin's arguments strongly depend on expected utility theory, but we show that similar arguments apply to general non‐expected utility theories.