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

The velocity of ball-carriers and tacklers during shoulder tackles

The most frequently executed type of tackle in rugby is the shoulder tackle. A shoulder tackle occurs when the tackler uses either shoulder as the first point of contact with the ball carrier. The aim of this study was to compare the velocity of the ball-carrier and tackler engaged in shoulder tackles, and determine whether factors such as the number of passes from the previous phase, match period, quality of attack, match location and position of tackler had an effect on the mean and approaching velocities of the ball-carrier and tackler. The velocity of the ball-carrier and tackler during shoulder tackles (n=12) were determined using a 2D analysis tool. The tackles were also coded according to pass number, match period, quality of defence and attack, match status, defensive shape and movement, position of tackler and ball-carrier. The ball-carrier's velocity (4.10±1.85m.s-1) when entering contact was significantly higher than the tackler's velocity (5.19±3.22 m.s–1)(p<0.05). The ball-carrier's velocity was significantly higher when entering contact further from the set piece (p<0.001), when playing away from home (p<0.001) and when ranked in the top three (p<0.001). The findings of this study provide insight into the complexities of the tackle in rugby

Mental Health Services in Rural Jails [Policy Brief]

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

The relationships between rugby players’ tackle training attitudes and behaviour and their match tackle attitudes and behaviour

Background The tackle event in rugby is a technical and physical contest between opposing players. A player's ability to tolerate and contest during a tackle is a prerequisite for safe participation and success in rugby. Little is known about the relationship between tackle training and tackling in matches in rugby union. Therefore, we investigated the relationships between players’ training attitudes and behaviour and their match attitudes and behaviour for tackling in rugby union. Method A questionnaire was designed to assess attitude (importance) and behaviours (frequency and quantity) among junior (under 19) players on a 5-point Likert Scale. Questionnaires were handed out to 220 players (10 schools) at a tournament and 75% (9 schools, n=164) were returned for analysis. Associations between training attitudes and behaviours were tested using the χ2 test, Cramer's V and τ-b. Results The more time spent on emphasising proper technique to prevent injuries in training, the more important players rated ‘own safety’ (τ-b=0.21, moderate, z=3.1, p<0.01), ‘going for the ball only’ (τ-b=0.27, moderate, z=4.6, p<0.001) and ‘staying on feet’ (τ-b=0.23, moderate, z=3.6, p<0.001) in match play. The more time spent on emphasising proper technique to improve performance in training, the more important players rated actions ‘going for ball only’ (τ-b=0.23, moderate, z=3.7, p<0.001) and ‘preventing the ball carrier from retaining position’ (τ-b=0.20, moderate, z=3.1, p<0.01) in match play. Conclusions This is the first study to report on the relationships between players’ training attitudes and behaviour and their match attitudes and behaviours for tackling in rugby union. The importance of tackle training to prevent injury, and the amount of time spent on technique to prevent injuries, was associated with behaviours that reduce the risk of injury in matches

Skills Associated with Line Breaks in Elite Rugby Union

The ability of the attacking team to break through the defensive line is a key indicator of success as it creates opportunities to score tries. The aim of this study was to analyse line breaks and identify the associated skills and playing characteristics. The 2013 Super Rugby season (125 games) was analysed, in which 362 line breaks were identified and coded using variables that assessed team patterns and non-contact attacking skills in the phases preceding the line break. There was an average of 3 line breaks per game, with 39% of line breaks resulting in a try. Line breaks occurred when the ball-carrier was running fast [61%, x 2 (4) = 25.784, p = 0.000, Cramer’s v = 0.1922, weak]. At a moderate distance, short lateral passes (19%) and skip passes (15%) attributed to the highest percentage of line breaks [x 2 (26) = 50.899, p = 0.036, Cramer’s v = 0.2484, moderate]. Faster defensive line speeds resulted in more line breaks [x 2 (12) = 61.703, p < 0.001, Cramer’s v = 0.3026, moderate]. Line breaks are associated with overall team success and try scoring opportunities. Awareness of the defenders line speed and depth, fast running speed when receiving the ball and quick passing between attackers to the outside backs creates line break opportunities. During training, coaches should emphasise the movement speed of the ball between attackers and manipulate the speed and distance of the defenders

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