Health: Behavioral Health

Telemental Health in Today's Rural Health System

Abstract: 

Telemental health has long been promoted in rural areas to address chronic access barriers to mental health care. While support and enthusiasm for telemental health in rural areas remains quite high, we lack a clear picture of the reality of telemental health in rural areas, compared to its promise. This Research & Policy Brief reports on the first part of our study—the online survey of 53 telemental health programs—and describes the organizational setting, services provided, and the staff mix of these programs. We draw from our telephone interviews with 23 of these programs to help describe the organizational context of telemental health programs. 

Key Findings:

  • The scope and volume of services provided are often modest suggesting that the business case for these programs may be weaker than the clinical case.
  • The programs in our study were able to secure funding and other supports to implement services, but their ability to maintain and expand services to address unmet need is less certain.
  • Telemental health primarily addresses issues related to the distribution of providers and travel distances to care. However, there are underlying practice management issues, common to all mental health practices in rural areas, which pose challenges to the scope and sustainability of telemental health, including reimbursement, provider recruitment and retention, practice economies of scale, high rates of uninsurance, and high patient “no show” rates.
  • It is becoming increasingly apparent that telehealth technology, by itself, cannot overcome service delivery challenges without underlying reform to the mental health service system.

Suggested Citation:

Lambert, D., Gale, J., Hansen, A. Y., Croll, Z., & Hartley, D. (2013). Telemental health in today's rural health system. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.

 

Publication Type: 
Research and Policy Brief
Publish Date: 
December 18, 2013
URL: 
http://muskie.usm.maine.edu/Publications/MRHRC/Telemental-Health-Rural.pdf

Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences?

Abstract: 

Adolescent alcohol use is a significant public health problem among U.S. adolescents. Past studies, including our own work, have found that rural adolescents were more likely to use alcohol than urban adolescents. Research suggests that protective factors, such as peer and parental disapproval, may be weaker among youth living in rural areas. This study examines the factors associated with adolescent alcohol use, whether they differ between rural and urban populations, and the extent to which these differences account for rural-urban variations in adolescent alcohol use. This knowledge is crucial to the development of rural-specific prevention strategies, targeted research on rural adolescent alcohol use, and long-term policy interventions. Our findings confirm higher rates of binge drinking and driving under the influence among rural youth than among urban youth. Rural residence is associated with increased odds of binge drinking (OR 1.16, p< .05) and driving under the influence (OR 1.42, p< .001) even when income and protective factors are taken into account. Our findings suggest that adolescents who start drinking at an earlier age are more likely to engage in problem drinking behavior as they get older, leading to a need for interventions that target pre-teens and younger adolescents. Moreover, since we found urban-rural differences in specific protective factors, these may be the most promising for evidence-based, rural-specific prevention strategies targeting parents, schools, and churches. These are the factors that convey and reinforce consistent messages discouraging adolescent alcohol use from an early age.

Suggested Citation:

Gale JA, Lenardson JD, Lambert D, Hartley, D.  Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences. (Working Paper #48).  Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; March 2012.

Publish Date: 
March 1, 2012
URL: 
http://muskie.usm.maine.edu/Publications/WP48_Adolescent-Alcohol-Use-Rural-Urban.pdf

Mental Health Services in Rural Long-Term Care: Challenges and Opportunities for Improvement

Abstract: 

Despite high levels of need, individuals in long-term care often fail to receive appropriate mental health services, especially in rural areas. In this Research & Policy Brief (and accompanying Working Paper), we consider challenges and opportunities for improving mental health treatment delivered to long-term care recipients in rural settings. As background, we note the prevalence of mental health problems in long-term care populations, describe deficiencies in the mental health care afforded to long-term care recipients, and identify barriers that hinder the remediation of these deficiencies in rural settings. We also outline a rationale for enhancing mental health services in long-term care. We then discuss new approaches that have been implemented or could be used to effect positive transformations in the delivery of mental health services to rural long-term care populations. We underscore the potential for synergies between these innovations and provisions introduced under the Affordable Care Act (ACA) of 2010. Finally, we delineate policy considerations for promoting new mental health service models in rural long-term care settings.

Suggested citation:

Talbot, J.A., & Coburn, A.F. (2013, June). Mental health services in rural long-term care: Challenges and opportunities for improvement. (Research & Policy Brief #50). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.

Publication Type: 
Research and Policy Brief
Publish Date: 
June 20, 2013
Author: 
URL: 
http://muskie.usm.maine.edu/Publications/MRHRC/Rural-Mental-Health-Services-LTC.pdf

Challenges and Opportunities for Improving Mental Health Services in Rural Long-Term Care

Abstract: 

Despite high levels of need, individuals in long-term care often fail to receive appropriate mental health services, especially in rural areas. In this report (and accompanying Research & Policy Brief), we consider challenges and opportunities for improving mental health treatment delivered to long-term care recipients in rural settings. As background, we note the prevalence of mental health problems in long-term care populations, describe deficiencies in the mental health care afforded to long-term care recipients, and identify barriers that hinder the remediation of these deficiencies in rural settings. We also outline a rationale for enhancing mental health services in long-term care. We then discuss new approaches that have been implemented or could be used to effect positive transformations in the delivery of mental health services to rural long-term care populations. We underscore the potential for synergies between these innovations and provisions introduced under the Affordable Care Act (ACA) of 2010. Finally, we delineate policy considerations for promoting new mental health service models in rural long-term care settings.

Suggested citation:

Talbot, J.A., & Coburn, A.F. (2013, June). Challenges and opportunities for improving mental health services in rural long-term care. (Working Paper #50). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.

Publication Type: 
Report
Publish Date: 
June 20, 2013
URL: 
http://muskie.usm.maine.edu/Publications/MRHRC/WP50-Rural-Mental-Health-Services-LTC.pdf

Rural Children Experience Different Rates of Mental Health Diagnosis and Treatment

Abstract: 

Research indicates that privately insured, rural adults have lower use of office-based mental health services, but higher use of prescription medicines than their urban counterparts.  Patterns for rural children may be different from urban children because of the limited supply of pediatric mental health providers in rural areas, which may lead to reduced access and lower use of mental health services in rural areas versus urban.  Using data on children ages 5-17 from the 2002-2008 of the Medical Expenditure Panel Survey, researchers from the Maine Rural Health Research Center find that rural children are significantly less likely to be diagnosed and treated for non-ADHD mental health problems than urban children and are less likely to receive mental health counseling.  The rural-urban difference is greatest among those children scoring in the “possible impairment” range on the Columbia Impairment Scale.

Suggested citation for Research & Policy Brief: 

Anderson, N., Neuwirth, S., Lenardson, J.D., & Hartley, D. (2013, June). Rural children experience different rates of mental health diagnosis and treatment. (Research & Policy Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center. http://muskie.usm.maine.edu/Publications/MRHRC/Rural-Children-Mental-Hea...

Suggested citation for Working Paper:

Anderson, N., Neuwirth, S., Lenardson, J.D., & Hartley, D. (2013, June). Patterns of care for rural and urban children with mental health problems. (Working Paper #49). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center. http://muskie.usm.maine.edu/Publications/MRHRC/WP49-Rural-Children-Menta...

Publication Type: 
Research and Policy Brief
Publish Date: 
June 17, 2013
URL: 
http://muskie.usm.maine.edu/Publications/MRHRC/Rural-Children-Mental-Health_PolicyBrief.pdf

Patterns of Care for Rural and Urban Children with Mental Health Problems

Abstract: 

Research indicates that privately insured, rural adults have lower use of office-based mental health services, but higher use of prescription medicines than their urban counterparts.  Patterns for rural children may be different from urban children because of the limited supply of pediatric mental health providers in rural areas, which may lead to reduced access and lower use of mental health services in rural areas versus urban.  Using data on children ages 5-17 from the 2002-2008 of the Medical Expenditure Panel Survey, researchers from the Maine Rural Health Research Center find that rural children are significantly less likely to be diagnosed and treated for non-ADHD mental health problems than urban children and are less likely to receive mental health counseling.  The rural-urban difference is greatest among those children scoring in the “possible impairment” range on the Columbia Impairment Scale.

Suggested citation for Working Paper:

Anderson, N., Neuwirth, S., Lenardson, J.D., & Hartley, D. (2013, June). Patterns of care for rural and urban children with mental health problems. (Working Paper #49). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center. http://muskie.usm.maine.edu/Publications/MRHRC/WP49-Rural-Children-Menta...

Suggested citation for associated Research & Policy Brief: 

Anderson, N., Neuwirth, S., Lenardson, J.D., & Hartley, D. (2013, June). Rural children experience different rates of mental health diagnosis and treatment. (Research & Policy Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center. http://muskie.usm.maine.edu/Publications/MRHRC/Rural-Children-Mental-Hea...

Publication Type: 
Research and Policy Brief
Publish Date: 
June 17, 2013
URL: 
http://muskie.usm.maine.edu/Publications/MRHRC/WP49-Rural-Children-Mental-Health.pdf

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