Maine Barriers to Integration Study: The view from Maine on the barriers to integrated care and recommendations for moving forward

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, this study acknowledges the challenges faced by individuals with chronic and/or severe behavioral health problems in obtaining vital physical and primary health care

Maine Barriers to Integration Study: Environmental Scan

Recognizing that our health care system lacks organization, integration, and coordination, the Maine Health Access Foundation (MeHAF) has adopted the promotion of patient- and family-centered care as a long-term funding priority. With the goals of encouraging patients to take an active role in their care and promoting integration of primary and specialty care with mental and behavioral health, dental care, and other services, MeHAF has funded several health care initiatives to improve the health of individuals and to improve the quality and costeffectiveness of health care. The Maine Barriers to Integration Study is one of these initiatives. MeHAF funded the Muskie School to identify barriers to integration of behavioral and physical health services and potential solutions to overcoming these barriers. This paper reports on the first phase of the study, which included an extensive literature review; an analysis of different approaches and models to integration; and a review of integration initiatives in Maine, other states, and Canada. Results from interviews and focus groups with Maine stakeholder organizations are also included

Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Stategies, Best Practices

The current project was designed to build on earlier work and expand on issues identified in the New Freedom Commission’s report. Specifically, the project consisted of a series of unstructured interviews with more than thirty individuals involved in mental and behavioral health services in rural and frontier America. In addition, over 200 NARMH members responded to a series of questions regarding the current status of rural and frontier mental and behavioral health. The information accumulated through these two approaches was used to prepare the current report which focuses on the following areas: Barriers to mental and behavioral health service delivery in rural America Model programs and effective activities for rural America Model policy strategies for rural mental and behavioral health care delivery The role telehealth should play in service delivery to rural America The role that State Offices of Rural Health and other state and local organizations should play in service delivery to rural America In this report, findings regarding each of these issues will be considered separately. In each case, a comprehensive list of the points raised by respondents regarding the issue will be reported, followed by a brief discussion of that issue

Rural Children Don\u27t Receive the Mental Health Care They Need

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

Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? [Working Paper]

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

Adolescent Alcohol Use: Do risk and protective factors explain rural-urban differences? [Policy Brief]

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\u3c .05) and driving under the influence (OR 1.42, p\u3c .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