Health Policy Commons^™

To Work Or Not To Work? Lessons From Older Adults In Maine, Kimberly Snow, Mary Lou Ciolfi, Sarah Currie, Catherine Taylor

All Cutler Institute Publications

Work in later life is currently widely discussed for myriad reasons including that  many older adults want or need to work well past typical retirement age; employers  want and need the expertise, experience, and reliability of older workers; social and  health benefits often accompany later life work; anti-ageism awareness is  heightening the visibility and value of older workers; and economists and  demographers cite the importance of a dependable workforce that includes older  adults. The topic of later life work intersects with several other disciplines in social  science, business, health, technology, communications, and data collection - among  others - presenting opportunities …

An Assessment Of Maine's Capacity To Support Transitions Of Care Through The Substance Use Disorder Continuum, Mary Lindsey Smith Phd, Sarah Mclaughlin Mph, Rachel M. Gallo Mph

Substance Use Research & Evaluation

This report evaluates Maine's capacity to support effective transitions of care across the substance use disorder (SUD) treatment continuum. Using data collected from a statewide survey of 65 SUD providers, conducted from February to April 2025, the study examines organizational practices, inter-provider communication, and coordination strategies related to transitions between levels of care: medically supervised withdrawal, inpatient, and outpatient treatment programs. Key findings reveal strong intra-organizational communication, widespread understanding of ASAM criteria, and a general commitment to patient-centered care. However, gaps persist in coordination between care levels, particularly in withdrawal management programs, which rarely conduct follow-ups or collaborate with outpatient …

Withdrawal Management In Maine: Capacity Challenges And Opportunities For Improvement, Mary Lindsey Smith Phd, Katie Rosingana Ba, Tyler Egeland Ba, Sarah Mclaughlin Mph

Substance Use Research & Evaluation

This summary report presents findings from healthcare provider interviews conducted in 2024 to assess the current landscape of withdrawal management (WM) services in Maine. Sixteen providers, across eight counties and representing a range of substance use disorder (SUD) service types, were interviewed to evaluate capacity, challenges, and opportunities for improvement across the continuum of care. Thematic analysis identified widespread gaps in withdrawal management capacity, especially in ASAM Levels 1.7 to 4.0, with critical shortages in ambulatory and low-intensity residential services. Key barriers included geographic inequities, insufficient infrastructure, long waitlists, inadequate reimbursement, and workforce shortages exacerbated by stigma and provider discomfort. …

Feedback On Withdrawal Management Services In Maine From Persons With Lived Experience, Mary Lindsey Smith Phd, Katie Rosingana Ba

Substance Use Research & Evaluation

This summary report presents findings from interviews with twelve persons with lived experience of substance use disorder (PWLE). The interviews asked persons in recovery about their experiences accessing withdrawal management and broader substance use treatment services across Maine. Participants identified key barriers to treatment including high costs, limited bed availability, long wait times, geographic inaccessibility, and lack of centralized information. Gaps in service infrastructure, particularly for opioid withdrawal management, long-term treatment, and transition supports post-detox, were widely reported. Participants emphasized the critical need for more localized and individualized services, particularly for parents, rural residents, and low-income individuals. Recommendations include expanding …

Community Centered Funding Models For Maine, Timothy Atkinson, Jillian Foley, Jane Rooks

Justice Policy

This report is an exploration of literature and frameworks for local community-driven funding strategies to improve Maine’s public health outcomes. The authors present a number of community-led funding theories such as place-based funding models and participatory grant making, examine lessons learned from recent public health events, and discuss reflections from interviews with key stakeholders. The report looks at examples of community-led models and makes recommendations for next steps such as improving collaborative relationships, strengthening peer-to-peer networks, expanding availability of flexible funding that includes backbone support, and conducting a cost-benefit analysis of collaborative community health capacity investment options.

Downeast Community Opioid Response Program: Final Summary Report, Tyler Egeland Ba, Gordon Mcintire Ba, Evelyn Ali, Mary Lindsey Smith Phd, Katie Rosingana Ba

Substance Use Research & Evaluation

The Downeast Substance Treatment Network is a group of diverse organizations working to improve integration and access to treatments and services for people with substance use disorder. The consortium’s Rural Communities Opioid Response Program grant project aims to: (1) expand the reach of their treatment network, (2) increase awareness and practice of harm reduction, and (3) facilitate transitions of care to improve partner efficacy. This project included a mixed-methods evaluation led by Catherine E. Cutler Institute’s Substance Use Research and Evaluation Team (SURE). This year 3 final summary presentation includes feedback from program partners and key informants, in addition to …

York County Rural Communties Opioid Response Implementation Iv Grant: Interim Evaluation Report, Katie Rosingana Ba, Evelyn Ali Bs, Gordon Mcintire Ba, Sarah Mclaughlin Mph, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

This interim evaluation report has been developed for the York County Rural Communities Opioid Response Program, an RCORP-Implementation IV grant awarded to MaineHealth and funded by the Health Resources & Services Administration (HRSA). A main goal of this grant project is to understand the needs of individuals impacted by substance use disorders who have faced structural inequalities to access, in both correctional and heath care settings. The project utilizes a collaborative coalition that is community based, the Rural York Community Coalition (RYCC). For more information, please contact Lindsey Smith at [email protected]

Healthy Acadia Prosper: Year 2 Interim Evaluation Report, Mary Lindsey Smith Phd, Evelyn Ali Bs, Gordon Mcintire Ba, Sarah Mclaughlin Mph

Substance Use Research & Evaluation

The PROSPER initiative is a collaborative effort of Healthy Acadia and its regional healthcare and nonprofit partners designed to support pregnant women, mothers, and families with Substance Use Disorder (SUD). The project is funded by a four-year HRSA Outreach grant from 2021 to 2025. Through grant funding, PROSPER provides personal care planning, navigation support, and parenting and life skills training to clients at no cost to them. The partners also work to alleviate regional barriers to care and reduce stigma and discrimination of women seeking treatment to benefit their families.This report includes findings from the year 2 evaluation of the …

Health Leadership Perspectives On Challenges To Providing & Expanding Withdrawal Management Capacity In Maine, Sarah Mclaughlin Mph

Substance Use Research & Evaluation

Currently, the Maine Department of Health and Human Services (Maine DHHS) and the Cutler Institute’s Substance Use Research and Evaluation Team (SURE) are working together through the SUPPORT for ME Cooperative Agreement to monitor and assess Maine’s behavioral health system. As a part of this Cooperative Agreement, Maine DHHS and the SURE team have identified withdrawal management (WM) as an area of interest and have determined that more information is needed to understand the landscape of WM in Maine, especially as it pertains to non-opioid substances. Therefore, this project will involve collecting data through interviews with health care leadership from …

Qualitative Brief: Baseline Needs Assessment Treatment Experiences In Rural Vermont, Katie Rosingana Ba, Evelyn Ali Mph, Tyler Egeland Ba, Karen Pearson Mlis, Mary Lindsey Smith Phd, C. Peasley-Miklus, J. Shaw

Substance Use Research & Evaluation

This qualitative data brief provides findings from the Vermont baseline needs assessment, conducted in collaboration with research staff at the University of Southern Maine's Catherine Cutler Institute, with the goal to identify current and future opioid use disorder (OUD) treatment needs and barriers in rural Vermont. This data brief aims to identify current and future addiction treatment needs and barriers in Vermont with direct input from practitioners, community partners, and people impacted personally by opioid use. Preceptions included in this data brief are informed by semi-structured qualitative interviews conducted with people with lived experience (PWLE) with OUD, as well as …

Western Maine Addiction And Recovery Initiative's Substance Misuse Prevention And Wellness Day: Year 2 Feedback Survey For Ohchs, Tyler Egeland Ba, Evelyn Ali Bs, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

As part of the evaluation of the Western Maine Addiction Recovery Initiative’s (WMARI) HRSA Rural Communities Opioid Response Program grant, staff from the Substance Use Research & Evaluation Unit, USM developed a survey to gather feedback from individuals who participated in the 2nd annual OHCHS Substance Use Prevention and Wellness Day. For more information, please contact Lindsey Smith at [email protected]

Non-Urgent Use Of Emergency Departments By Rural And Urban Adults, Erika Ziller Phd, Carly Milkowski, Zachariah Croll, Yvonne Jonk Phd

Access / Insurance

This study, conducted by researchers at the Maine Rural Health Research Center, provides updated information and addresses gaps in knowledge about rural non-urgent ED use. Understanding the rates of non-urgent ED use among rural adults and the factors associated with this use can inform policy and practice efforts to reduce unnecessary and inappropriate use of EDs in rural communities.

Hospital emergency departments (EDs) serve a vital role in the US health care system, providing lifesaving, around-the-clock care to patients in acute health situations. However, use of the ED for non-urgent care is costly and reflects a suboptimal care setting, with …

Western Maine Addiction And Recovery Initiative's Substance Misuse Prevention And Wellness Day: Year 2 Planning Survey Summary For Ohchs, Evelyn Ali Bs, Tyler Egeland Ba, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

The RCORP local evaluation team at the Catherine Cutler Institute deployed a survey to Oxford Hills Comprehensive High School (OHCHS). The purpose of the survey was to understand needs unique to OHCHS to plan for types of activities and information presented at the school’s Substance Use Prevention and Wellness Day. For more information, please contact Lindsey Smith at [email protected]

Identifying Rural Health Clinics Within The Transformed Medicaid Statistical Information System (T-Msis) Analytic Files, Katherine Ahrens Mph, Phd, Zachariah Croll, Yvonne Jonk Phd, John Gale Ms, Heidi O'Connor Ms

Rural Health Clinics

Researchers at the Maine Rural Health Research Center describe a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

Background: There is limited information on the extent to which Rural Health Clinics (RHC) provide pediatric and pregnancy-related services to individuals enrolled in state Medicaid/CHIP programs. In part this is because methods to identify RHC encounters within Medicaid claims data are outdated.

Methods: We used a 100% sample of the 2018 Medicaid Demographic and Eligibility and Other Services Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files for 20 states …

Maine Provider Attitudes Towards Contingency Management For Substance Use Disorders, Evelyn Ali, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

This report summarizes healthcare provider attitudes toward Contingency Management (CM), including barriers and facilitators to its implementation. A 17-question electronic survey, including the Contingency Management Beliefs Questionnaire (CMBQ), was distributed to providers across Maine. Of 131 eligible respondents, 80% reported treating SUD, yet only 27% had experience with CM. While training and organizational support were cited as barriers, overall attitudes toward CM were favorable. Providers expressed strong willingness to implement CM, citing its potential to engage clients and support treatment adherence. The report concludes that positive perceptions of CM outweigh concerns and suggests that training and organizational support could enhance …

Treatment And Recovery Beliefs Of Rural Vermont Family Members Of People With Opioid Use Disorder, Kate Peasley-Miklus Phd, Julia Shaw Mph, Katie Rosingana Ba, Mary Lindsey Smith Phd, S. Sigmon, Sarah H Heil Phd, J. Jewiss, Andrea C Villanti, Valerie S Harder

Substance Use Research & Evaluation

Purpose: Few studies have addressed beliefs about treatment for opioid use disorder (OUD) among family members of people with OUD, particularly in rural communities. This study examined the beliefs of rural family members of people with OUD regarding treatment, including medication for OUD (MOUD), and recovery. Methods: Semi-structured qualitative interviews were conducted with rural Vermont family members of people with OUD. Twenty family members completed interviews, and data were analyzed using thematic analysis. Results: Four primary themes related to beliefs about OUD treatment emerged: (1) MOUD is another form of addiction or dependency and should be used short-term; (2) essential …

Healthy Acadia Downeast Community Opioid Response Program: Year 3 Summary, Tyler Egeland Ba, Gordon Mcintire Ba, Evelyn Ali, Mary Lindsey Smith Phd, Katie Rosingana Ba

Substance Use Research & Evaluation

The Downeast Substance Treatment Network is a group of diverse organizations working to improve integration and access to treatments and services for people with substance use disorder. The consortium’s Rural Communities Opioid Response Program grant project aims to: (1) expand the reach of their treatment network, (2) increase awareness and practice of harm reduction, and (3) facilitate transitions of care to improve partner efficacy. This project included a mixed-methods evaluation led by Catherine E. Cutler Institute’s Substance Use Research and Evaluation Team (SURE). This final year 3 summary presentation includes feedback from program partners, key informants, and program clients, in …

Qualitative Brief: Perspectives On Opioid Use Disorder Treatment Access And Engagement From Rural Family Members And People In Treatment, Katie Rosingana Ba, Evelyn Ali Mph, Tyler Egelund Ba, Mary Lindsey Smith Phd, Kate Peasley-Miklus Phd, J. Shaw

Substance Use Research & Evaluation

"This qualitative data brief provides findings from the Vermont baseline needs assessment, conducted in collaboration with research staff at the University of Southern Maine's Catherine Cutler Institute, with the goal to identify current and future opioid use disorder (OUD) treatment needs and barriers in rural Vermont. This data brief aims to identify current and future addiction treatment needs and barriers in Vermont with direct input from practitioners, community partners, and people impacted personally by opioid use. Preceptions included in this data brief are informed by semi-structured qualitative interviews conducted with family members of people with lived experience (PWLE). For more …

Time To Ask Program At Redington-Fairview General Hospital: Summary Of Participant Feedback, Mary Lindsey Smith Phd, Tyler Egeland Ba, Evelyn Ali Bs

Substance Use Research & Evaluation

The goals of the Time to Ask (TTA) education and quality improvement program are to increase the capacity of the interprofessional care team to effectively, efficiently and compassionately discuss alcohol use with their patients through screening, brief intervention, and referral (SBIRT) as well as to expand regular screening and monitoring of unhealthy alcohol use at the practices. This infographic is a summary of a participant feedback following the TTA program at Redington-Fairview General Hospital. For more information, please contact Lindsey Smith at [email protected]

Healthy Acadia Downeast Community Opioid Response Program: Year 2 Summary, Mary Lindsey Smith Phd, Evelyn Ali Bs, Katie Rosingana Ba

Substance Use Research & Evaluation

The Downeast Substance Treatment Network is a group of diverse organizations working to improve integration and access to treatments and services for people with substance use disorder. The consortium’s Rural Communities Opioid Response Program grant project aims to: (1) expand the reach of their treatment network, (2) increase awareness and practice of harm reduction, and (3) facilitate transitions of care to improve partner efficacy. This project included a mixed-methods evaluation led by Catherine E. Cutler Institute’s Substance Use Research and Evaluation Team (SURE). This year 2 summary presentation includes feedback from program partners, key informants, and program clients, in addition …

The Rural Health Action Network Enhanced Outreach Initiative: Year 2 Interim Evaluation Report, Mary Lindsey Smith Phd, Evelyn Ali Bs, Tyler Egeland Ba, Katie Rosingana Ba

Substance Use Research & Evaluation

Healthy Community Coalition (HCC), in coordination with the Rural Health Action Network (RHAN) of greater Franklin County, is implementing a multi-faceted outreach program to improve health outcomes among the rural poor living with chronic conditions in greater Franklin County, Maine. The goals of the Franklin County Rural Health Action Network Enhanced Outreach Initiative (RHAN-EOI) include: (1) Expand access to quality services; (2) Expand training for community health extenders; (3) Decrease hospital admissions, emergency department use, and costs; and (4) Improve communication and care coordination across project partners. This report highlights the implementation and progress of HCC RHAN in Year 2. …

Western Maine Addiction And Recovery Initiative's Substance Misuse Prevention And Wellness Day: Year 2 Feedback Survey For Mvhs, Tyler Egeland Ba, Evelyn Ali Bs, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

As part of the evaluation of the Western Maine Addiction Recovery Initiative’s (WMARI) HRSA Rural Communities Opioid Response Program grant, staff from the Catherine Cutler Institute’s Substance Use Research and Evaluation team developed a survey to gather feedback from individuals who participate in substance misuse prevention and wellness events. Two separate PRE/POST surveys were deployed at Mountain Valley High School to assess knowledge gain, beliefs, and satisfaction. For more information, please contact Lindsey Smith at [email protected]

Western Maine Recovery Rally Feedback Survey, Evelyn Ali Bs, Tyler Egeland Ba, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

The 7th Annual Western Maine Recovery Rally was hosted on September 17th, 2023 from 11am to 3pm in downtown Norway, Maine; several hundred people attended the event. The local evaluation team developed a survey with the goal of understanding how participants felt about the rally and how future events could be improved. The survey was deployed via QR code on paper materials distributed at the rally, and through social media after the event. For more information, please contact Lindsey Smith at [email protected]

Healthy Acadia Prosper Program: Key Informant Interview Findings, Mary Lindsey Smith Phd, Evelyn Ali Bs, Katharine Knight

Substance Use Research & Evaluation

The PROSPER initiative is a collaborative effort of Healthy Acadia and its regional healthcare and nonprofit partners designed to support pregnant women, mothers, and families with Substance Use Disorder (SUD). The project is funded by a four-year HRSA Outreach grant from 2021 to 2025. Through grant funding, PROSPER provides personal care planning, navigation support, and parenting and life skills training to clients at no cost to them. The partners also work to alleviate regional barriers to care and reduce stigma and discrimination of women seeking treatment to benefit their families.This summary presentation is a brief summary of key findings from …

Financial Alignment Initiative: New York Fully Integrated Duals Advantage For Individuals With Intellectual And Developmental Disabilities: Preliminary Third Evaluation Report, Kimberly I. Snow Mhsa, Elizabeth Gattine Jd, Amy Kandilow Phd, Matthew Toth Phd, Amy Chepaitis Phd

Disability & Aging

The New York FIDA-IDD demonstration was launched in 2016 in nine downstate counties and was the first comprehensive managed care demonstration exclusively serving individuals with intellectual and developmental disabilities (IDD) in the nation. Due at least in part to a lack of provider participation, less than 8 percent of eligible beneficiaries enrolled. Beneficiaries who did enroll reported high levels of satisfaction, especially with care coordination and the ease of obtaining durable medical equipment. The MedicareMedicaid Plan’s (MMP) assessment and care coordination model provided person-centered care planning that identified goals and helped to achieve them, improving enrollees’ quality of life. The …

A Consensus Panel Approach To Estimating The Start-Up And Annual Service Costs For Rural Ambulance Agencies, Yvonne Jonk Phd, Gary Wingrove Facpe, Cp-C, Nikiah Nudell Ms, Mphil, Nrp, Facpe, Kevin Mcginnis Mps

Emergency Medical Services (EMS)

This brief serves to fill the information void on the costs of running ambulance services for three population-based service tiers and establishes a minimum access standard for ambulances servicing a 25-minute travel time radius from the ambulance station. The model enables policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services. Key Highlights: An expert panel established that ambulances could reasonably serve a maximum 25-minute travel time from the ambulance station that accounts for road conditions. A minimum access standard was defined as a single resource consisting of one full-time staffed ambulance, with a …

Greater Portland Health Homeless Opioid User Service Engagement Program: Final Evaluation Report, Mary Lindsey Smith Phd, Evelyn Ali Bs, Tyler Egeland Ba, Katharine Freund Mph, Thomas Chalmers Mclaughlin Msw, Phd, Katie Rosingana Ba

Substance Use Research & Evaluation

Given the high rates of overdoses in the Bayside area of Portland, Maine, as well as the shortage of providers and services to meet the complex medical and social determinant of health (SDOH) needs of individuals who are experiencing homlessness (IWAEH), with funds from the State of Maine, Greater Portland Health and Preble Street collaborated to implement the HOUSE Program. The HOUSE Program was implemented in the Greater Portland metropolitan area with a specific focus on expanding the continuum of care at Greater Portland Health’s Bayside Homeless site to include comprehensive SUD treatment, case management and housing services to IWAEH. …

Association Of Prenatal Depression With New Cardiovascular Disease Within 24 Months Postpartum., Christina M Ackerman-Banks, Heather S Lipkind, Kristin Palmsten, Mariah Pfeiffer Rn, Mph, Catherine Gelsinger Rn, Katherine Ahrens Mph, Phd

Population Health

No abstract provided.

Ambulance Deserts: Geographic Disparities In The Provision Of Ambulance Services [Chartbook], Yvonne Jonk Phd, Carly Milkowski Mph, Zachariah Croll Mph, Karen Pearson Mlis, Ma

Emergency Medical Services (EMS)

This chartbook begins with a broad overview of ambulance services including common types of organizational structure(s) and workforce and reimbursement issues. The methods section provides our definition of ambulance deserts and describes how ambulance deserts are illustrated in the national and state maps. The results section begins with an overall description of the prevalence of ambulance deserts in rural and urban counties across the 41 states for which data were available at the time, and the variation in the percent of people living in ambulance deserts across the four census regions. States are ranked in terms of the percent of …

Western Maine Addiction And Recovery Initiative's Substance Misuse Prevention And Wellness Day: Year 1 Feedback Survey For Ohchs And Telstar, Tyler Egeland Ba, Evelyn Ali Bs, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

As part of the evaluation of the Western Maine Addiction Recovery Initiative’s (WMARI) HRSA Rural Communities Opioid Response Program grant, staff from the Catherine Cutler Institute developed a survey to gather feedback from individuals who participated in the SUD Day events. Two separate PRE/POST surveys were deployed at each high school (OHCHS and Telstar) to assess knowledge gain, beliefs, and satisfaction. For more information, please contact Lindsey Smith at [email protected]