Maine Rural Health Research Center

Mental Health First Aid in Rural Communities


Mental Health First Aid (MHFA), an early intervention training program for general audiences, has been promoted as a means for improving population-level behavioral health (BH) in rural communities by encouraging treatment-seeking. This study, conducted by researchers at the Maine Rural Health Research Center, examined MHFA's appropriateness and impacts in rural contexts. 

Findings: MHFA appears aligned with some key rural needs. MHFA may help to reduce unmet need for BH treatment in rural communities by raising awareness of BH issues and mitigating stigma, thereby promoting appropriate treatment-seeking. However, rural infrastructure deficits may limit some communities’ ability to meet new demand generated by MHFA. MHFA may help motivate rural communities to develop initiatives for strengthening infrastructure, but additional tools and consultation may be needed.

Conclusions: This study provides preliminary evidence that MHFA holds promise for improving rural BH. MHFA alone cannot compensate for weaknesses in rural BH infrastructure.

Article first published online: January 28, 2016

Suggested Citation: Talbot, J. A., Ziller, E. C. and Szlosek, D. A. (2016), Mental Health First Aid in Rural Communities: Appropriateness and Outcomes. The Journal of Rural Health. doi: 10.1111/jrh.12173

Publication Type: 
Journal Article
Publish Date: 
January 28, 2016

Understanding the Business Case for Telemental Health in Rural Communities


Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment. [Journal Abstract]

Suggested Citation: Lambert, D., Gale, J., Hartley, D., Croll, Z., & Hansen, A. (2015). Understanding the business case for telemental health in rural communities. Journal of Behavioral Health Services and Research. doi: 10.1007/s11414-015-9490-7 [epub ahead of print].

FMI: John Gale

Publication Type: 
Journal Article
Publish Date: 
December 22, 2015

Exploring the Business Case for Children's Telebehavioral Health


This brief, authored by John Gale, M.S. and David Lambert, Ph.D. from the University of Southern Maine's Muskie School of Public Service, Maine Rural Health Research Center, explores terminology, reimbursement and business issues, and provides examples from the field in the development of telebehavioral health services. In the first section, the authors place children’s telebehavioral health within the context and demands of today’s rural healthcare system, where the majority of children’s telebehavioral health services are delivered. They then describe three examples of the use of telebehavioral health to serve children, adolescents, and families in rural communities. The brief concludes by exploring the business case for telebehavioral health including the issues and challenges of service delivery, coordination, and financing. This brief is informed by a national study of telemental health (serving children, adults, and older persons) in rural health systems conducted by the authors and updated to reflect the latest information on three case examples.

For more information, please contact John Gale at

Suggested citation: Gale J, Lambert D. Exploring the Business Case for Children's Telebehavioral Health. Washington, DC: The Technical Assistance Network for Children's Behavioral Health, The Institute for Innovation & Implementation; March, 2015. Brief.

Publication Type: 
Research and Policy Brief
Publish Date: 
March 2, 2015

Rural Maternal Smoking Behaviors Policy Brief Shared at APHA

Jean Talbot, Research Associate with the Maine Rural Health Research Center, and colleagues have published their study of the role of rural residence and single motherhood as risk factors for smoking. Their findings indicate that rural mothers are significantly more likely than their urban counterparts to be smokers, smoke frequently, and smoke heavily, even after adjusting for factors known to increase smoking risk. Talbot suggests that policymakers should consider methods for extending insurance coverage for smoking cessation interventions through the Affordable Care Act and Medicaid. Additionally, anti-smoking initiatives at the local, state, and national levels could play an important role in decreasing rural-urban disparities in smoking-related morbidity and mortality.

Rural Active Living Research Brief Highlights Obesity Challenges

David Hartley and Anush Yousefian Hansen of Maine Rural Health Research Centerare authors of a research brief which focuses on the evidence base for rural obesity rates as it relates to physical activity. They note that rural residents, who face high rates of obesity, limited access to healthcare providers, and high levels of poverty, have been identified as a "priority population" in the fight against obesity. In this brief, Hansen and Hartley describe the current research on the rural built environment that may be related to obesity or physical activity, and outline key policy implications.
Photo: Anush Y. Hansen

Gale and Lenardson present webinar on opioid study

John Gale and Jennifer Lenardson, research associates at the Maine Rural Health Research Center, University of Southern Maine will present a webinar June 25, 2015 at 1pm ET in which they will provide an overview of their research on the prevalence of opioid use disorders in rural and urban settings and discuss issues with regard to workforce and providing treatment. They will be joined in the webinar by Holly Andrilla from the WWAMI Rural Health Research Center. The one-hour webinar is free and open to the public. Log in information: Enter as a guest and type your name. Use your phone and call 888-469-2038. Participant passcode: 3363788.

Ziller receives President’s Metropolitan University Leadership Award

Erika Ziller, Muskie School of Public Service Senior Research Associate, and Deputy Director, Maine Rural Health Research Center, was presented on June 19, 2015 with the President's Metropolitan University Leadership Award: Staff Award for Funded Research - a demonstrated commitment to addressing local, state, and national issues which contributes knowledge, and service in a particular field.Ziller was one of 6 recipients of the first-ever President’s Metropolitan University Leadership Award given to faculty and staff who best exemplify commitment and dedication to the University and who also demonstrate positive and effective relationships with students, their colleagues, and also, the surrounding community.
photo: Erika Ziller receives staff award

Research staff present at National Conference

Andrew Coburn, Zach Croll, John Gale, Jean Talbot, and Erika Ziller of the Maine Rural Health Research Center presented their research at the 38th Annual National Rural Health Association Annual Conference held in Philadelphia April 14-18.

Gale receives NRHA Volunteer of the Year award

John Gale, Senior Research Associate with the Maine Rural Health Research Center, was presented with the 2015 National Rural Health Association (NRHA) Volunteer of the Year Award at NRHA's 38th Annual Rural Health Conference April 16 in Philadelphia. To view the video go to :
photo: John Gale at national Rural Health Association

Ziller presents at Sino-American International Research Forum

Dr. Erika Ziller, Deputy Director of the Maine Rural Health Research Center, presented her findings on Rural Implications of Medicaid Expansion under the Affordable Care Act to the visiting researchers from Guangxi Normal University (GNU), Guilin, China on April 21, 2015 as part of the 2-day Sino-American International Research Forum.
photo: Erika Ziller


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