Digital Commons Network^™

Use Of Electronic Health Records To Manage Tobacco Screening And Treatment In Rural Primary Care, Jean A. Talbot Phd, Erica C. Ziller Phd, Carly Milkowski Mph

Mental Health / Substance Use Disorders

Researchers at the Maine Rural Health Research Center, University of Southern Maine examined whether the use of electronic health records by rural primary care physicians facilitates their use of best practices in addressing tobacco dependence. The study used the National Ambulatory Medicare Care Survey (2012-2015) to explore how rurality and use of tobacco-related electronic health record functions were related to smoking status documentation and cessation treatment at adult primary care visits. Rural-urban comparisons were also examined.

The authors conclude that rural primary care physicians were at least as successful as their urban counterparts in leveraging electronic health records to enhance …

Opioid-Related Visits To Rural Emergency Departments, Erika C. Ziller Phd, Jean A. Talbot Phd, Deborah Thayer Mba, Carly Milkowski Mph

Mental Health / Substance Use Disorders

Increased rates of acute opioid poisoning and related emergency department (ED) visits in the United States have occurred at the same time as rural EDs face a number of resource constraints. Researchers at the Maine Rural Health Research Center conducted this study to gain insight about rural ED visits for acute opioid poisoning and how they compare with urban ED visits. The authors used data from the 2006 and 2013 Nationwide Emergency Department Sample to examine rural and urban opioid-related visits (ORVs) to EDs, including rate change over time, and the outcomes of these ED visits (treatment and release, inpatient …

Substance Use Among Rural And Urban Youth And Young Adults, Jennifer D. Lenardson Mhs, Nathan Paluso Mph, Erika C. Ziller Phd

Mental Health / Substance Use Disorders

Rural youth and young adults have historically had higher use rates of alcohol and other substances than their urban counterparts. Recent research suggests that rates of youth and young adult alcohol and other substance use have declined over the past two decades, but we have limited knowledge of whether and how current rural and urban substance use patterns may differ. As national substance use rates decline, it is important to re-assess differences in use among rural versus urban youth and young adults. This study uses data from the National Survey of Drug Use and Health (NSDUH) to examine rural-urban differences …

The Role Of Rural Hospitals In Addressing Opioid And Other Substance Use Problems, John A. Gale Ms

Mental Health / Substance Use Disorders

Webinar presentation to the Small Rural Hospital Transition project addressing issues of rural opioid and other substance use issues, focusing on the role of rural hospitals, and the importance of community engagement. Component parts of an effective opioid/substance use system of care include prevention, treatment, and recovery. Models must be adapted to the geographic, resource, and cultural realities of rural areas. Examples of strategies are provided.

Strategies To Combat Opioid Use In Rural Communities, John A. Gale Ms

Mental Health / Substance Use Disorders

Webinar presentation discussing

• Opioid use across rural settings
• Drivers of rural opioid use
• Burden of opioid use in rural communities
• Evidence-based prevention, treatment, and recovery strategies to address rural opioid use

Prevention Of Drug Use And Treatment Of Drug Use Disorders In Rural Settings, John A. Gale Ms

Mental Health / Substance Use Disorders

This Guide on Prevention of Drug Use and Treatment of Drug Use Disorders in Rural Settings was prepared by the United Nations Office on Drugs and Crime (UNODC) Drug Prevention and Health Branch (DHB), in the context of the global project Treatnet II: OFID-UNODC Programme to prevent HIV/AIDS through Treatnet Phase II, with the aim of providing an awareness-raising tool and guidance for policymakers, public health officials, local authorities and other stakeholders in dealing with substance use issues in rural settings in their respective countries. This Guide will serve as an awareness-raising tool and guidance for policymakers, public health officials, …

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Working Paper], John A. Gale Ms, Anush Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover. Additionally, the rural health care system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature and scope of the opioid crisis vary across rural communities and require multifaceted, community-based strategies to address the problem. Based on interviews with key stakeholders in Indiana, …

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Policy Brief], John A. Gale Ms, Anush Yousefian Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Little is known about what states with large rural populations are doing to combat opioid use disorders (OUD) in rural communities. This qualitative study identified rural challenges to the provision of OUD prevention, treatment, and recovery services and explored promising strategies to tackle the opioid crisis in rural communities.

Adverse Childhood Experiences In Rural And Urban Contexts, Jean A. Talbot Phd, Donald Szlosek Mph, Erika C. Ziller Phd

Mental Health / Substance Use Disorders

Recent research shows that rural children are more likely than urban children to experience certain kinds of adversity. Researchers at the Maine Rural Health Research Center looked at how adverse childhood experiences (ACEs) have affected rural and urban adults. Using data from the Behavioral Risk Factor Surveillance System Assessment, this study found that, while the prevalence of ACEs was comparable in rural and urban adults, over half of rural adults surveyed reported having ACE exposure.Among those with any ACE history, about one quarter experienced four or more ACEs. Policy implications and strategies are highlighted in this brief.

Key Findings:

• Past …

Rural Opioid Abuse: Prevalence And User Characteristics, Jennifer D. Lenardson Mhs, John A. Gale Ms, Erika C. Ziller Phd

Mental Health / Substance Use Disorders

This study examined the prevalence of non-medical use of pain relievers and heroin in the past year in rural and urban areas and the socio-demographic and economic characteristics associated with their use. Additionally, we examined opioid use by age at first use as well as dependence and abuse; treatment history and perceived need for treatment; use of alcohol and other drugs; perceived risk of using drugs and availability of drugs; problems resulting from the use of drugs; driving under the influence; and illegal activities and arrest records.

Implications Of Rural Residence And Single Mother Status For Maternal Smoking Behaviors, Jean A. Talbot Phd, Donald Szlosek Mph, Erika C. Ziller Phd

Mental Health / Substance Use Disorders

No abstract provided.

Integrated Care Management In Rural Communities, Eileen Griffin Jd, Andrew F. Coburn Phd

Mental Health / Substance Use Disorders

No abstract provided.

Integrated Care For Older Adults In Rural Communities, Eileen Griffin Jd, Andrew F. Coburn Phd

Mental Health / Substance Use Disorders

Recognizing that traditional models of health care delivery and payment often produce fragmented and costly care and poor outcomes for those with the highest needs, many reforms under the Affordable Care Act (ACA) focus on realigning payment incentives and integrating care. These reforms presuppose the existence of supporting infrastructure and capacity, including dedicated care management staffing and health information technology and exchange. With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), this brief reviews the opportunities and challenges these reform initiatives present for rural communities: How easily …

Telemental Health In Today's Rural Health System, David Lambert Phd, John A. Gale Ms, Anush Yousefian Hansen Ms, Ma, Zachariah T. Croll Ba, David Hartley Phd, Mha

Mental Health / Substance Use Disorders

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 …

Rural Children Experience Different Rates Of Mental Health Diagnosis And Treatment, David Hartley Phd, Mph, Jennifer D. Lenardson Mhs, Nathaniel J. Anderson Ms, Mph, Samantha J. Neuwirth Md

Mental Health / Substance Use Disorders

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 …

Mental Health Services In Rural Long-Term Care: Challenges And Opportunities For Improvement, Jean A. Talbot Phd, Andrew F. Coburn Phd

Mental Health / Substance Use Disorders

To facilitate reform efforts, more research is needed on the current status of mental health services in rural long-term care. Also needed are new tools promoting the targeted use of provisions in the Affordable Care Act (ACA) to address the mental health needs of rural long-term care recipients. In this brief, we explore novel practices that hold promise for enhancing mental health services in rural long-term care, focusing primarily on the needs of rural elders who reside either in nursing facilities or in their own homes in the community. Key Findings: Despite high levels of need, individuals in long-term care …

Patterns Of Care For Rural And Urban Children With Mental Health Problems, Nathaniel J. Anderson Ms, Mph, Samantha J. Neuwirth Md, Jennifer D. Lenardson Mhs, David Hartley Phd, Mha

Mental Health / Substance Use Disorders

Introduction

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. Similar studies for rural children have been limited to specific populations, diagnoses, or to single states. Patterns for rural children may be different than those of urban children and adults generally because of their high enrollment in Medicaid and the State Children's Health Insurance Program, which tend to have more generous behavioral health benefits than private coverage and may equalize rural-urban treatment patterns. On the other hand, the more limited supply of specialty mental …

Adolescent Alcohol Use: Do Risk And Protective Factors Explain Rural-Urban Differences? [Policy Brief], John A. Gale Ms, Jennifer D. Lenardson Mhs, David Lambert Phd, David Hartley Phd, Mha

Mental Health / Substance Use Disorders

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: Do Risk And Protective Factors Explain Rural-Urban Differences? [Working Paper], John A. Gale Ms, Jennifer D. Lenardson Mhs, David Lambert Phd, David Hartley Phd, Mha

Mental Health / Substance Use Disorders

Using data from the 2008-2009 National Survey of Drug Use and Health, this study examines alcohol use among rural and urban adolescents between the ages of 12 and 17. We conduct bivariate and multivariate analyses of the prevalence of alcohol use across rural and urban areas and the relationships between alcohol use and potential protective or risk factors including parent relations, peer relations, school relations, and religious involvement.

Access To Mental Health Services And Family Impact Of Rural Children With Mental Health Problems, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, David Lambert Phd, Melanie M. Race Ms, Anush Yousefian Hansen Ms, Ma

Mental Health / Substance Use Disorders

Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This working paper and policy brief provide information on prevalence …

Mental Health Services In Rural Jails [Policy Brief], Melanie M. Race Ms, Anush Yousefian Hansen Ms,Ma, David Lambert Phd, David Hartley Phd, Mha

Mental Health / Substance Use Disorders

Based on interviews with state and local corrections and mental health informants in four rural states (Minnesota, Montana, Texas, and Vermont), the researchers sought to learn more about hte challenges that rural jails face along with promising practices being used to meet the needs of inmates with mental health concerns.

Mental Health Services In Rural Jails [Working Paper], Melanie M. Race Ms, Anush Yousefian Hansen Ms,Ma, David Lambert Phd, David Hartley Phd, Mha

Mental Health / Substance Use Disorders

No abstract provided.

Availability, Characteristics, And Role Of Detoxification Services In Rural Areas, Jennifer D. Lenardson Mhs, Melanie M. Race Ms, John A. Gale Ms

Mental Health / Substance Use Disorders

No abstract provided.

Few And Far Away: Detoxification Services In Rural Areas, Jennifer D. Lenardson Mhs, Melanie M. Race Ms, John A. Gale Ms

Mental Health / Substance Use Disorders

Based on Working Paper #41: Availability, Characteristics, and Role of Detoxification Services in Rural Areas. Findings: Few rural detox providers exist; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve a 100 mile radius. Travel distances are a barrier to outpatient detox models. Referral options to substance abuse treatment are limited, especially in isolated rural areas.

Maine Barriers To Integration Study: The View From Maine On The Barriers To Integrated Care And Recommendations For Moving Forward, John A. Gale Ms, David Lambert Phd

Mental Health / Substance Use Disorders

Following up on the Environmental Scan report (http://muskie.usm.maine.edu/Publications/rural/Barriers-to-Integration-Environmental-Scan.pdf), the authors interviewed representatives from Maine’s business community, payers, purchasers, professional associations, state legislators, advocacy organizations, state government, and provider organizations. The interviews provided a context to understand the barriers to integration in Maine and develop recommendations to overcome them. Our Final Report presents key findings from the study, recommendations for addressing barriers, and next steps for moving forward. This study recognizes the need for integration of behavioral and physical health services in all settings. Although most discussions of integration focus on the development of behavioral health services in primary care settings, …

Mental Health And Substance Abuse In Maine: Building A Community-Based System, David Lambert Phd, John A. Gale Ms

Mental Health / Substance Use Disorders

No abstract provided.

Rural Children Don't Receive The Mental Health Care They Need, David Lambert Phd, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs

Mental Health / Substance Use Disorders

Key Findings: Just over one-third of all children with a mental health problem received a mental health visit in the past year; Controlling for other characteristics that affect access to care, rural children are 20% less likely to have a mental health visit than urban children; Having Medicaid or SCHIP increases the likelihood that a child will receive services, and this is pronounced in rural areas.

Use Of Mental Health Services By Rural Children, David Lambert Phd, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs

Mental Health / Substance Use Disorders

No abstract provided.

Rural-Urban Differences In Work Patterns Among Adults With Depressive Symptoms, Lisa Morris Phd, Stephenie L. Loux Ms, Erika C. Ziller Phd, David Hartley Phd, Mha

Mental Health / Substance Use Disorders

This study addresses the issue of poor mental health among young to middle-career rural residents and how their employment may be affected. Using the National Longitudinal Survey of Youth (NLSY), a nationally representative survey of adults, the authors investigate how depressive symptoms affect employment patterns, and the extent to which such effects differ by rural and urban residence. Analysis of the data identified the rural sample as more likely to be married, have less education, are less likely to be black or Hispanic, and less likely to have health insurance than the urban sample. For both rural and urban subjects, …

Distribution Of Substance Abuse Treatment Facilities Across The Rural-Urban Continuum [Policy Brief], Jennifer D. Lenardson Mhs, John A. Gale Ms

Mental Health / Substance Use Disorders

Key Findings: Access to substance abuse treatment is limited in rural areas by fewer treatment beds. Less populated rural areas contain a small proportion of facilities offering a range of core services and varying levels of outpatient and intensive services. Opiod treatment programs are nearly absent in rural areas.