Mental and Social Health Commons^™

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

Social Isolation And Loneliness In Older People: A Closer Look At Definitions, Mary Lou Ciolfi, Frances Jimenez Ba

Disability & Aging

Social isolation and loneliness are related and the terms are often used interchangeably, but they are distinct concepts with different definitions, health impacts, and interventions. Our population is aging and older people are at increased risk for both social isolation and loneliness and the associated negative health consequences. Understanding the important differences between social isolation and loneliness will help us recognize them earlier in vulnerable populations, engage in more meaningful conversations with older adults about their own risks, and will inform the development and delivery of more individualized, meaningful, and cost-effective interventions.

New Outpatient Experience Survey Design: A Quality Improvement Case Study, Nathan Paluso

Muskie School Capstones and Dissertations

The purpose of this capstone project is to evaluate the implementation process for a new survey methodology introduced by Maine Medical Partners (MMP), by following the Plan-Do-Study-Act (PDSA) quality improvement cycle framework. This new survey has been implemented to collect data on patients’ experiences in the MMP outpatient facilities, and is offered to the patients via iPad at check-out after their appointment. Through observation at MMP practices and MMP staff interviews, strengths and weaknesses of the implementation process have been identified. Evidence-based solutions pertaining to the identified weaknesses have been selected through a literature review and are incorporated in recommendations …

Experience Of Adults With Special Needs In Sexual Education Programs, Kate C. Hallissey

Thinking Matters Symposium Archive

Adults with special needs are discouraged from exploring their sexuality, expressing it, accessing sexual health care, and learning about their sexual rights. As a result, this population experiences higher rates of sexually transmitted diseases and sexual abuse than the general population (Saxe & Flanagan, 2014). Adults with special needs deserve to receive sexual education programming that provides them with the information they need to make informed choices about sexuality and relationships. Understanding their experiences in sexual education programs can better inform future programming for this population.

Consideration Of Cognitive Behavioral Therapy In Treating Schizophrenia: An Evidence-Based Practice Project, Kati Boucher

Thinking Matters Symposium Archive

Purpose: to answer the clinical PICOT question: For patients with schizophrenia how does CBT (cognitive behavioral therapy) and medication management compare to medication management alone affect symptom severity

Therapist Experience Treating Female Sexual Assault Survivors, Melinda Irving

Thinking Matters Symposium Archive

Sexual assault often results in survivors experiencing Post traumatic stress disorder or depression. The phenomena of treating survivors in therapy after a sexual assault, has been researched thoroughly from the view of clients. Qualitative research done from therapists experiences is not as abundant in the literature. Therapists experiences treating female survivors of sexual abuse was explored, using a phenomenological research method. Examining therapist's perspective on providing therapy with survivors, can support other therapists working with women who have survived a sexual assault

Lcsw-Perceived Therapeutic Alliance And Job Satisfaction A Correlational Pilot Study, Daniel J. Kelly

Thinking Matters Symposium Archive

One-hundred-and-fifty Licensed Clinical Social Workers (LCSWs) were sent surveys measuring demographics, therapeutic alliance, and job satisfaction. Past literature suggests that clinician-perceived therapeutic alliance is related to job satisfaction. Results of this study failed to confirm this. Implications and limitations are discussed

Trauma & Substance Use, Kaitlyn Arnold

Thinking Matters Symposium Archive

Research Question: How is trauma and substance use connected?

Treatment Alternatives To Obsessive Compulsive Disorder: An Evidence-Based Project, Katherine Oberwager

Thinking Matters Symposium Archive

To answer the clinical PICOT question: in adults with obsessive compulsive disorder (OCD), how does augmenting a selective serotonin reuptake inhibitor (SSRI) with N-acetyl-cysteine (NAC) compare to monotherapy with an SSRI in terms of symptom severity and to translate this evidence into practice.

Racialization Of Heroin Use And The Emergence Of A Public Health Issue, Ellen Pogson

Thinking Matters Symposium Archive

How is race used as a tool in newspaper publications to shape public opinion of the heroin epidemic in Portland, Maine, between the years 2014-­‐2016?

How does the portrayal of the heroin user inform public policy and health care interventions?

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, …

Assessment Of The Use Of Overdose Education And Naloxone Distribution By Maine Buprenorphine/Naloxone Prescribers, Stephen Kirsch

Muskie School Capstones and Dissertations

Background: Overdose deaths, specifically related to opioids, have been identified as a public health problem both nationally and in the state of Maine. Overdose Education and Naloxone Distribution (OEND) is an innovative model of patient education that has been shown to be effective in increasing knowledge of overdose risk and has the potential to help reduce opiate related overdose deaths.

Methods: A 28-item web-based survey examining clinician attitudes, OEND practices and characteristics was distributed to 196 Maine based physicians with a Drug Enforcement Agency waiver to prescribe burprenorphine/naloxone. Facilitators and barriers to the provision of OEND were also assessed. Surveys …

Urine Cotinine In Children And Parental Behavior Modification: A Pilot Study, Teresa Lachance

Muskie School Capstones and Dissertations

“Urine Cotinine in Children and Parental Behavior Modification” was designed by Dr. Deirdre Burns, a pediatrician at the Barbara Bush Children’s Hospital (BBCH). It was implemented as a pilot study to determine whether urine cotinine testing in children who are admitted to the hospital for respiratory illness and tracking parental smoking behaviors over time was feasible. Parents were given a brief survey to assess their current smoking behaviors and to understand their readiness to quit smoking. They received smoking cessation materials provided by the Breathe Easy Coalition of Maine. These materials outline information about second-hand and third-hand smoke, and encourage …

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 …

An Analysis Of Women’S Access To Acute Opioid Detoxification Services In Maine: Identifying The Barriers To Treatment, Karen E. Conley

Muskie School Capstones and Dissertations

The lack of treatment facilities and services for opioid use disorder in Maine, combined with an increased prevalence of addiction, creates a potential for health inequity between men and women that may be intensified by barriers in access to care. This capstone study utilized detoxification screening inquiry forms and data obtained from the Milestone Foundation’s acute opioid detoxification program to assess and categorize barriers to access by gender. A barriers model was developed based on existing literature and was to identify potential associations among and between the known barriers to accessing treatment. Barriers were described as internally or externally based, …

Time To Ask: An Alcohol Education Pilot For Healthcare Professionals. Clinical Needs Assessment, Mary Lindsey Smith Phd, Martha Elbaum Williamson Mpa, Jennifer Pratt Ba, Rachel M. Gallo Mph, Katie Rosingana Ba, Jacey Keller Mph, Mark Richards Bs

Substance Use Research & Evaluation

No abstract provided.

Addressing Unhealthy Alcohol Use In Maine: Provider And Practice Attitudes Towards Integrating Alcohol Screening And Brief Intervention Within Rural Primary Care Practices, Mary Lindsey Smith Phd, Jennifer Pratt Aa, Rachel M. Gallo Mph, Katie Rosingana Ba, J Keller, Mark Richards Bs

Substance Use Research & Evaluation

No abstract provided.

Application Of Strength, Weakness, Opportunity And Threat (Swot) Analysis For The Prioritization Of Community Health Program Objectives, Albert J. Romanosky Md, Phd, Kimberly Eshleman Mph, Rachel M. Gallo Mph

Substance Use Research & Evaluation

No abstract provided.

Expanding Access To Naloxone In Maine: Opportunities And Barriers, Kate E. Richardson

Muskie School Capstones and Dissertations

The Centers for Disease Control and Prevention have declared prescription drug abuse a national epidemic (Office of National Drug Control Policy, 2014). In addition to strategies designed to prevent opioid abuse and misuse, many public health officials, policy makers, healthcare providers and harm reduction task forces seek to increase access to naloxone, a prescription drug known to reverse the effects of an opioid overdose. This report provides an overview of the barriers and opportunities for the state of Maine to expand access to the opioid antagonist, naloxone, in an effort to reduce fatal opioid drug overdose rates.

A Review Of Mental Health Rehabilitation Technician Qualifications And Training Procedures, Kimberly I. Snow Mhsa, Ba, Nadine Erdis Msw, Janice Daley Msw

Disability & Aging

This report was prepared by Kimberly Irvin Snow, Nadine Edris, and Janice Daley of the University of Southern Maine's Muskie School of Public Service and submitted to the Maine Department of Health and Human Service, Office of Substance Abuse and Mental Health Services. Results of this report were also presented in a webinar on November 21, 2014.

The authors investigated the training and certification processes used by other states for their mental health case management workforce. Ten states were selected for indepth comparative review because they provide a certification process for case managers, provide case management services similar to those …

Implications Of Rurality And Psychiatric Status For Diabetic Care Use Among Adults With Diabetes, Jean A. Talbot Phd, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, David Hartley Phd

Access / Insurance

This research examined patterns of diabetic preventive care use among adults with diabetes, to determine whether these patterns varied according to respondents’ rural/urban residence or psychiatric status (i.e., the presence/absence of a mental health diagnosis). Specifically, we considered whether rural people with diabetes are less likely than urban peers to use diabetic preventive services; whether having a mental health diagnosis affects preventive service use among diabetics; and, whether rural/ urban differences in service use vary depending on the presence or absence of a mental health diagnosis.

Strategic Planning In The Non Profit Sector: Creating A Strategic Plan For Affinity 2014-2017, Emilee Taplin-Lacey

Muskie School Capstones and Dissertations

The purpose of engaging in the creation of a strategic plan for Affinity is to integrate knowledge acquired through participation in the Public Policy and Nonprofit Management Master’s Degree program at the Muskie School of Public Service. In addition, my facilitation of a strategic planning process for Affinity is meant to meet the requirements of graduation and represents my capstone project in this regard.

Substance Abuse Trends In Maine: State Epidemiological Profile 2014, Tim Diomede

Muskie School Capstones and Dissertations

This report takes into account the primary objectives of the Office of Substance Abuse and Mental Health Services (SAMHS): to identify substance abuse patterns in defined geographical areas, establish substance abuse trends, detect emerging substances, and provide information for policy development and program planning. It also highlights all the prevention priorities identified in the SAMHS strategic prevention plan: underage drinking, high-risk drinking among 18-25 year olds, misuse of prescription drugs among 18-25 year olds, and marijuana use in 12-25 year olds; as well as monitors the progress being made to address these priorities. This report includes data available through December …

An Assessment Of The Health Needs Of Maine Veterans And Their Access To Veterans Administration Health Care Services, Kristin Brawn

Muskie School Capstones and Dissertations

On a state level, only a few assessments have been conducted, which indicate that Maine veterans are also experiencing similar mental and physical health issues; however, it does not appear that the adequacy of Maine’s VHA services to meet the needs of Maine’s veterans has been comprehensively evaluated. It is unknown whether the physical and mental health needs of Maine’s veterans are currently being met. Therefore, this project proposes to determine if there is a similar problem among Maine’s veterans in regard to health issues and lack of access to VHA health services, as has been reported at the national …

Mainecare Stage A Health Homes Year 1 Report: Implementation Findings And Baseline Analysis, Kimberley S. Fox Mpa, Carolyn E. Gray Mph, Katherine Rosingana, Deborah A. Thayer Mba

Population Health & Health Policy

In January 2013, Maine established Health Homes under federal authority pursuant to Section 2703 of the Affordable Care Act to improve care coordination for MaineCare members with chronic conditions. Stage A of the Health Homes initiative focuses on members with complex medical chronic conditions. Stage B, planned for early 2014, will focus on persons with severe and persistent mental health conditions and children with serious emotional disturbances. The Stage A demonstration builds off the State’s existing Maine multi-payer Patient Centered Medical Home (PCMH) Pilot project and Maine’s Medicare Advanced Primary Care Practice (MAPCP) Demonstration by providing add-on payments to primary …

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 …

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

Long Term Services and Supports

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 …

Children And Adults With Long Term Services And Support Needs: Mainecare And Medicare Expenditures And Utilization, State Fiscal Year 2010, Stuart Bratesman Mpp, Julie T. Fralich Mba, Tina Gressani, Eileen Griffin Jd

Disability & Aging

This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services. An earlier report provided a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008 to 2010. Both reports were prepared as part of the Maine State Profile Tool grant funded by the Centers for Medicare & Medicaid Services. This second report analyzes the characteristics, use and expenditure patterns of sub-populations of long term service users including adults …

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 …