Few and Far Away: Detoxification services in rural areas

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

Models for Quality Improvement in CAHs: The Role of State Flex Programs (Briefing Paper #25)

A central goal of the Flex Program, as defined in the original and reauthorizing legislation, is to help Critical Access Hospitals (CAHs) develop and sustain effective quality improvement (QI) programs. This study examined the range of multi-CAH QI and performance measurement reporting initiatives supported by the Flex Program in nine states, assessed the role of State Flex Programs in developing and supporting these initiatives, and explored their impact on the QI programs of CAHs. Key Findings: State Flex Program funding was frequently the primary, if not sole, source of funding to support these efforts. Collaboration and shared learning are common Flex Program strategies underlying state QI initiatives. Quality measurement and reporting is a challenge due to a lack of agreement on common measures across state QI and benchmarking systems and a common belief that Hospital Compare measures are not “rurally relevant” (i.e., specific to the needs of CAHs). Administrative, clinical, and board leadership and buy-in were consistently identified as crucial to the success and sustainability of CAH-level QI initiatives. States reported that the scope of their QI has to be scaled to the available resources and capacity of CAHs to avoid QI fatigue among CAH staff. There is limited hard evidence on the impact of the QI initiatives adopted by State Flex Programs; much of the “evidence” supporting these initiatives is anecdotal or based on postconference or webinar evaluations

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

Many Urban and Rural Workers Lose Health Insurance During Job Transitions

Numerous studies have found that rural residents are more likely to be uninsured than urban residents, in part because rural workers are more likely to be employed by a small business or have low wages and thus have more limited access to employer coverage.1-5 Yet, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured,6 and there is some evidence that this risk is even greater for rural workers.7 In the past 20 years, much of the federal-level policy attention related to health insurance coverage (e.g. the Consolidated Omnibus Budget Reconciliation Act and the Health Insurance Portability and Accountability Act) has emphasized ensuring continuity of coverage for individuals that experience an employment transition. However, these key policy interventions do not apply to smaller employers that are the backbone of rural economies. !us, rural workers may be more likely than urban workers to experience disruptions in health insurance coverage following an employment transition. The purpose of this study was to explore the impact of changes in employment status on insurance coverage for rural and urban workers, and the factors behind any differences. !e Affordable Care Act (ACA) provides a new backdrop against which to consider the issues of job change, job loss, health insurance portability and coverage of rural residents. Our findings provide important information about the health insurance coverage challenges that rural workers may face, and may help to identify potential challenges and opportunities for implementing ACA in rural areas

Impact of Employment Transitions on Health Insurance Coverage of Rural Residents

Numerous studies have found that rural residents are more likely to be uninsured than urban residents. This coverage difference is generally due to more limited access for rural workers to employer-sponsored health insurance. Lower wages, and the tendency for rural residents to work for small employers, account for this reduced access. While we have substantial information on static insurance coverage rates for rural residents, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured, and there is some evidence that this risk is even greater for rural workers. Other studies suggest that access to health insurance plays an important role in determining whether a worker decides to change. Whether this relationship is any different for urban versus rural workers has not been well-studied. In the past 20 years, much of the federal-level policy attention related to health insurance coverage has emphasized ensuring continuity of coverage for individuals that experience an employment transition. For example, the Consolidated Omnibus Budget Reconciliation Act (COBRA), passed in 1985, ensured that those with employer-sponsored coverage could retain that coverage even if that employment ceased. Similarly, the 1996 Health Insurance Portability and Accountability Act (HIPAA) guaranteed individual coverage for those who leave a group plan. However, both of these key policy interventions are inapplicable to the smaller employers that are the backbone of rural economies. Thus, rural workers may be more likely than urban workers to experience disruptions in health insurance coverage following an employment transition. The Patient Protection and Affordable Care Act (ACA) provides a new background against which to consider the issues of job change, job loss, health insurance portability and coverage of rural residents. Understanding how changes in employment status impact insurance coverage for rural workers can help to identify potential challenges and opportunities for implementing ACA in rural areas

Mental Health Problems Have Considerable Impact on Rural Children and Their Families

The majority of children with mental health problems go untreated, and the gap between need and service use is assumed to be wider in rural than in urban areas, particularly for children with more severe needs.1-2 It is also assumed that rural families of children with mental health problems experience a greater financial and emotional burden than urban families. These assumptions reflect the lower availability of mental health specialty care and support services in rural areas. Lower income and more limited economic opportunities may further hamper the ability of rural families to care for children with mental health problems. The current research literature does not describe how well the needs of children with mental health problems are being met in rural areas. Although there are reasons to believe the burden these needs place on families is higher in rural areas, evidence to support this assumption is limited. Using the 2005-06 National Survey of Children with Special Health Care Needs, we examine the prevalence, access to services, problem severity, and family impact of children’s mental health in rural and urban areas. These data are linked to the Rural-Urban Continuum Codes to examine populations living in urban areas, rural areas adjacent to urban areas, and rural areas not adjacent to urban areas

Access to Mental Health Services and Family Impact of Rural Children with Mental Health Problems

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 of children’s mental health needs and associated access to care and family impact across rural and urban areas. Analyses are based on the 2005-06 National Survey of Children with Special Health Care Needs