Lost in the Rush to National Reform: Recommendations to Improve Impact on Behavioral Health Providers in Rural Areas

Semansky, Rafael M.; Willging, Cathleen E.; Ley, David; Rylko‐Bauer, Barbara

doi:10.1353/hpu.2012.0059

Cited by 12 publications

(36 citation statements)

References 45 publications

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“…Key findings from this work (Table 1) replicate those reported in our earlier analyses of reform (Semansky et al 2012; Waitzkin et al 2002; Watson et al, 2011; Willging et al 2013). Collectively, our studies illustrate that top-down planning shaped by outer context considerations, insufficient concern for ensuring innovation fit, minimal preparation at the system and organizational levels, and inadequate delineation of key expectations and implementation processes, create challenges for service agencies and providers.…”

Section: Discussionsupporting

confidence: 87%

“…Medical homes are clinical care organizations that typically use an interdisciplinary team approach to coordinate and oversee services for individuals with persistent, life-threatening illnesses. Medical homes generally emphasize prevention, health information technology (IT), continuity of care, self-management of illness, and enhancing communication and shared decision-making with clients and their families (Semansky et al 2012). Available literature largely focuses on primary care as providing the foundation for medical homes (Alakeson et al 2010; Druss & Mauer 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Available literature largely focuses on primary care as providing the foundation for medical homes (Alakeson et al 2010; Druss & Mauer 2010). However, psychiatric practices, community mental health centers, and behavioral health providers that deliver a wide range of specified services may be designated as medical homes for individuals with (a) persistent mental illness or (b) a mental health disorder coupled with another chronic medical condition (Semansky et al 2012). …”

Section: Introductionmentioning

confidence: 99%

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The Transformation of Behavioral Healthcare in New Mexico

Willging

Lamphere

Rylko‐Bauer

2014

Adm Policy Ment Health

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Since 1997, public-sector behavioral healthcare in New Mexico has remained under continual transition. We have conducted qualitative research to examine recent efforts in NM to establish a recovery-oriented behavioral healthcare system, focusing on comprehensive community support services, clinical homes, and core service agencies. We examine how decisions made in the outer context (e.g., the system level) shaped the implementation of each initiative within the inner context of service provision (e.g., provider agencies). We also clarify how sociopolitical factors, as exemplified in changes instituted by one gubernatorial administration and undone by its successor, can undermine implementation efforts and create crises within fragile behavioral healthcare systems. Finally, we discuss findings in relation to efforts to promote wraparound service planning and to establish medical home models under national healthcare reform.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Transformation of Behavioral Healthcare in New Mexico

Willging

Lamphere

Rylko‐Bauer

2014

Adm Policy Ment Health

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“…13 fly/drive-in models, 25 and telemedicine. 16,20,21,25,27 Community collaborative engagement was identified in the literature as key to successful service model or program implementation.…”

Section: Resultsmentioning

confidence: 99%

World Health Organization building blocks in rural community health services: An integrative review

Stockton

Fowler

Debono

et al. 2021

Health Science Reports

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Introduction Developing and adapting health service models to effectively meet the needs of rural and remote communities is an international priority given inequities in health outcomes compared with metropolitan counterparts. This integrative review aims to inform rural and remote health service delivery systems by drawing on the WHO Framework building blocks to identify lessons learned from the literature describing experiences of rural and remote community health service planning and implementation; and inform recommendations to strengthen often disadvantaged rural and remote health systems for policy makers, health service managers, and those implementing international healthcare initiatives within these contexts. Methods The integrative review examined the literature reporting rural and remote community health service delivery published from 2007 to 2017 (the decade following the release of the WHO Framework). Using an analytic frame, a structured template was developed to extract data and categorized against the WHO building blocks, followed by a synthesis of the key findings. Results This integrative review identified that WHO Framework building blocks such as “Service Delivery” and “Health Workforce” are commonly reflected in rural and remote community health service delivery literature in the decade since the Framework's release. However, others such as “Sustainable Funding and Social Protection” are less commonly reported in the literature despite these elements being identified by the WHO as being integral to successful, sustainable health service delivery systems. Conclusions We found that collaboration across the health system governance continuum from local to policy level is an essential enabler for rural and remote health service delivery. Community‐based participatory action research provides an opportunity to learn from one another, build capacity, optimize service model suitability, and promotes cultural safety by demonstrating respect and inclusivity in decision‐making. Policy makers and funders need to acknowledge the time and resources required to build trust and community coalitions to inform effective planning and implementation.

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“…It is well documented that mental health-care services remain inaccessible to rural communities for several reasons, including geographical barriers, economic constraints, and lack of resources, such as insufficient number of trained professionals. [1920] Mental health treatment delivery in rural and remote areas is challenging, and the results of this study are relevant for everyday clinical practice in those underserved areas.…”

Section: Discussionmentioning

confidence: 99%

Long-term Benzodiazepine Treatment in Patients with Psychotic Disorders Attending a Mental Health Service in Rural Greece

Peritogiannis¹,

Manthopoulou²,

Mavreas

2016

Journal of Neurosciences in Rural Practice

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Introduction:Long-term benzodiazepine (BZD) treatment in patients with mental disorders is widespread in clinical practice, and this is also the case of patients with schizophrenia, although the evidence is weak and BZD prescription is discouraged by guidelines and medical authorities. Data on BZD prescription are usually derived from national or regional databases whereas information on the use of BZD by patients with schizophrenia and related psychoses in general population-based samples is limited.Materials and Methods:Information for 77 patients with psychotic disorders who were regularly attending follow-up appointments with the multidisciplinary Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia, Northwest Greece, during 1-year period (2015) was obtained from our database.Results:From the total of 77 engaged patients, 30 (39%) were regularly prescribed BZDs in the long term, as part of their treatment regimen. Prescribed BZDs were mostly diazepam and lorazepam, in 43.3% of cases each. The mean daily dose of these compounds was 13 mg and 3.77 mg, respectively. Statistical analysis showed a correlation of long-term BZD use with the history of alcohol/substance abuse. Most patients were receiving BZD continuously for several years, and the mean dose was steady within this interval.Conclusions:A large proportion of patients with psychotic disorders were regularly prescribed BZD in long term. It appears that when BZDs are prescribed for some period in the course of a psychotic disorder, their use commonly exceeds the recommended interval and then becomes a regular part of the chronic treatment regimen. Future research should address the factors that may be related to the long-term BZD use by patients with psychotic disorders. Interventions for the reduction of regular BZD prescription should target the primary care setting and all those who treat first episode patients.

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Lost in the Rush to National Reform: Recommendations to Improve Impact on Behavioral Health Providers in Rural Areas

Cited by 12 publications

References 45 publications

The Transformation of Behavioral Healthcare in New Mexico

The Transformation of Behavioral Healthcare in New Mexico

World Health Organization building blocks in rural community health services: An integrative review

Long-term Benzodiazepine Treatment in Patients with Psychotic Disorders Attending a Mental Health Service in Rural Greece

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