Research Methods: Policy Analysis

Dementia in Maine: Characteristics, Care, and Cost Across Settings [CHARTBOOK]

Abstract: 

The World Health Organization and Alzheimer’s Disease International have recommended that dementia be considered a public health priority for all nations. The number of people with Alzheimer’s disease in Maine is expected to nearly double from about 26,000 persons in 2010 to nearly 50,000 by 2030. As the oldest state in the nation, Maine faces the impending impact of this disease on its social systems, community resources and its health and long term care systems.  In particular, service and use patterns highlighted in this report indicate that Maine’s long term care system is increasingly becoming a system of care for people with dementia.

This report provides a baseline picture of the current use of services by people with and without dementia in Maine. While this provides a comprehensive view of those accessing services through state funded home care programs or other MaineCare funded long term care services, it does not include the costs of informal care by caregivers, friends and family members. Nor does it include the out-of-pocket costs that many incur with private resources to care for a family member. We hope, however, that this information will be useful to those who are planning for the future of Maine’s long term care system and the needs of people with dementia and their families and caregivers.

Suggested Citation: Fralich J, Bratesman S, Olsen L, et al. Dementia in Maine: Characteristics, Care, and Cost Across Settings. Portland, ME: University of Southern Maine, Muskie School of Public Service; December, 2013.

For more information contact: Julie Fralich Julief@usm.maine.edu; 207-780-4848; Stuart Bratesman sbrates@usm.maine.edu; or  Louise Olsen louiseo@usm.maine.edu

This report was prepared under a Cooperative Agreement between the Muskie School of Public Service, University of Southern Maine and the Maine Department of Health and Human Services, Office of Aging and Disability Services.  This work was funded under Cooperative Agreement number CA-ES-13-251.

Publication Type: 
Report
Publish Date: 
December 31, 2013
URL: 
http://muskie.usm.maine.edu/Publications/DA/Dementia-Maine-Chartbook-2013.pdf

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

Advancing the Use of CBT with Justice-Involved Women

Abstract: 

Forensic CBT: A Handbook for Clinical Practice is an edited collection that represents the first authoritative resource on the utilization of Cognigive Behavioral Therapy (CBT) strategies and techniques for offender clients.

Erica King, Policy Associate at the USM Muskie School of Public Services is co-author with Dr. Marilyn Van Dieten on chapter 16 in Part III of the book, Tailoring CBT to Special Forensic Populations, which looks at cognitive behavioral therapy for justice-involved women.  The authors highlight the differential needs of justice-involved women and discuss how to conduct gener-responsive treatment.

The book features contributions from leaders of the major schools of CBT on the treatment of antisocial personality patterns as well as anger, interpersonal violence, substance abuse, and sexual aggression; Addresses modified CBT approaches for female, juvenile, and culturally diverse forensic populations; Covers emerging areas of forensic practices, including the integration of motivational interviewing and strength-based approaches; and Includes an assortment of worksheets, handouts, and exercises for practitioners to use with their clients.

Suggested Citation:

Van Dieten, M., & King, E. (2013). Advancing the use of CBT with justice-involved women. In R. C. Tafrate & D. Mitchell (Eds.), Forensic CBT: A handbook for clinical practice (pp. 329-353). Hoboken, NJ: Wiley-Blackwell.

Publication Type: 
Book Chapter
Publish Date: 
November 1, 2013
Author: 
URL: 
http://www.wiley.com/WileyCDA/WileyTitle/productCd-1119953286.html

Managing a High-Performance Medicaid Program

Abstract: 

This report discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states face as they transform the way they do business and achieve key national goals.  The paper relies on an extensive review of federal and state administrative responsibilities drawn from statute, regulation, and relevant literature, coupled with discussions with six current Medicaid directors.

Key Findings:

  • Federal and state governments share responsibility for administering Medicaid;
  • Medicaid's responsibilities go significantly beyond those of other insurers and programs;
  • Medicaid is evolving and faces a set of new opportunities and challenges;
  • Adequate administrative capacity is key to realizing the goal of running a high performing Medicaid program.

Suggested Citation:

Griffin E, Riley T, Wachino V, Rudowitz R. Managing a High-Performance Medicaid Program. Menlo Park, CA: Kaiser Commission on Medicaid and the Uninsured; October, 2013.

Publication Type: 
Report
Publish Date: 
October 21, 2013
URL: 
http://kaiserfamilyfoundation.files.wordpress.com/2013/10/8476-managing-a-high-performance-medicaid-program.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

Understanding Changes to Physician Practice Arrangements in Maine and New Hampshire

Abstract: 

This report examines trends in the organization and ownership of physician practices in Maine and New Hampshire. The Maine Office of MaineCare Services and the New Hampshire Office of Medicaid Business and Policy observed a trend in the conversion of physicians from private practice to other practice arrangements including Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), hospital-owned practices, and hospital outpatient departments. Faced with increased costs for care provided within these facilities, both Medicaid programs sought to understand more about these changes, including their magnitude, the forces driving them, and their short and longer-term implications.

Suggested Citation:

Lenardson J, McGuire C, Alfreds S, et al.  Understanding Changes to Physician Practice Arrangements in Maine and New Hampshire. Portland, ME: University of Southern Maine, Muskie School of Public Service, Institute for Health Policy; January 2008.

Publication Type: 
Report
Publish Date: 
January 31, 2008
URL: 
http://muskie.usm.maine.edu/Publications/ihp/PhysicanPracticeChanges.pdf

Health Care Access and Use Among the Rural Uninsured

Abstract: 

The uninsured have poorer access to care and obtain care at greater acuity than those with health insurance; however, the differential impact of being uninsured in rural versus urban areas is largely unknown. Using data from the 2002–2007 Medical Expenditure Panel Survey, we examine whether uninsured rural residents have different patterns of health care use than their urban counterparts, and the factors associated with any differences. We find that being uninsured leads to poorer access in both rural and urban areas, yet the rural uninsured are more likely to have a usual source of care and use services than their urban counterparts. Further, controlling for demographic and health characteristics, the access and use differences between the uninsured and insured in rural areas are smaller than those observed in urban areas. This suggests that rural providers may impose fewer barriers on the uninsured who seek care than providers in urban areas.

Suggested Citation:

Ziller EC, Lenardson JD, Coburn AF.  Health Care Access and Use Among the Rural Uninsured. J Health Care Poor Underserved. 2012; 23(3):1327-1345.  doi: 10.1353/hpu.2012.0100

Publication Type: 
Journal Article
Publish Date: 
August 1, 2012
URL: 
http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/journal_of_health_care_for_the_poor_and_underserved/v023/23.3.ziller.pdf

Pages

Subscribe to RSS - Research Methods: Policy Analysis