David Lambert, PhD

Maine Rural Health Research Center

Phone: 207.780.4502
Fax: 207.780.4417
E-mail: davidl@usm.maine.edu

Maine Rural Health Research Center
University of Southern Maine
PO Box 9300
Portland, ME 04104-9300

Current Projects

Rural-Urban Differences in Access to Children’s Mental Health Services
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Health services, Mental health
This study uses data from the Urban Institute’s National Survey of America’s Families to examine and compare the use of mental health services by rural and urban children, age 6 to 17, relative to their need for mental health care, family income, and insurance status.

Completed Projects

Locally Managed Behavioral Health Organizations: How Do They Affect The Capacity of Medicaid Managed Behavioral Health Programs to Serve Rural Populations?, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicaid and S-CHIP, Mental health, Networking and collaboration

Maine Mental Health Evidence-Based Practice Planning Initiative, Lead researcher
Research center: Maine Rural Health Research Center
Funder: National Institute of Mental Health (NIMH)
Topic: Mental health
This project will develop and conduct a survey of regional and area officials and community providers in Maine to assess the state's need, capacity and readiness for implementing evidence-based practices at the community mental health level.

Role of Inpatient Psychiatric Units in Small Rural Hospitals and Rural Mental Health Systems
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Hospitals and clinics, Mental health
This is a descriptive, exploratory study which will investigate the role of the small rural hospital IPU from the perspectives of both the rural hospital, in terms of scope of services and revenue enhancement, and the regional mental health system, meeting the needs of outpatient mental health and primary care providers, law enforcement, and human services.

Publications

• Integrating Primary Care and Mental Health: Current Practices in Rural Community Health Centers
  Author(s): David Lambert, John Gale
  Research center: Maine Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Mental health
  Citation: Kansas City, MO: National Rural Health Association
  Date: 10 / 2006
  Provides information on models for integrating mental health services in rural community health centers, viability of linkages between primary care and mental health providers, resources available, reimbursement, treatment philosophy, diversification, referral and enhancement. Available for purchase.
• Medicaid Managed Behavioral Health in Rural Areas
  Author(s): David Lambert, John Gale, Donna Bird, David Hartley
  Research center: Maine Rural Health Research Center
  Topics: Medicaid and S-CHIP, Mental health
  Report Number: Working Paper No. 24
  Date: 01 / 2001
  Study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas. Describes these programs in terms of Medicaid populations served, program design, and implementation model. Describe the experience of programs regarding access to and coordination of services.
• Medicaid Managed Behavioral Health Programs in Rural Areas (Research and Policy Brief)
  Author(s): David Lambert, John Gale, Donna Bird, David Hartley
  Research center: Maine Rural Health Research Center
  Topics: Medicaid and S-CHIP, Mental health
  Date: 08 / 2001
  Study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas. Describes these programs in terms of Medicaid populations served, program design, and implementation model. Describe the experience of programs regarding access to and coordination of services.
• Mental Health Care in Rural Communities: the Once and Future Role of Primary Care
  Author(s): John A.Gale, David Lambert,
  Research center: Maine Rural Health Research Center
  Topics: Health services, Mental health
  Citation: North Carolina Medical Journal, 67(1), 66-70
  Date: 2006
  Discusses issues related to the delivery of mental health services in the United States. Addresses how these issues complicate the delivery of services in rural areas. Offers an argument for integrating primary care and mental health in rural areas.
• Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
  Author(s): David Hartley, Erika Ziller, Stephenie Loux, John Gale, David Lambert, Anush Yousefian
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
  Report Number: Working Paper No. 32
  Date: 09 / 2005
  Investigates the extent and types of cases that present with mental health problems in Critical Access Hospitals (CAHs) emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to such patients. Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate = 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. On average, CAHs had 99 emergency room visits per week. Of these visits, 9.4% were mental health related. CAH ERs play a significant role in providing mental health services to rural residents. Although nearly 20% of mental health encounters result in transfers to other facilities, over 40% of mental health problems are addressed on-site through treatment or referrals. Nearly half (43%) of CAH ER managers reported having no access to local mental health providers of any kind.
• Role of Community Mental Health Centers as Rural Safety Net Providers
  Author(s): David Hartley, Donna C. Bird, David Lambert, John Coffin
  Research center: Maine Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Mental health
  Report Number: Working Paper No. 30
  Date: 05 / 2002
  Investigates the extent to which those organizations formerly designated as community mental health centers (CMHCs) currently act as a rural mental health safety net, e.g., provide mental health services for free or at reduced charges to rural populations not covered by public or private insurance or grants. Findings: Based on three comparative case studies, CMHCs continue to believe that it is within their mission to act as a mental health safety net, but all three also acknowledged that their priority population is now SPMI (serious and persistent mental illness) adults and SED (seriously emotionally disturbed) children. Their ability to serve indigent clients who do not fall into these categories depends on their ability to cross-subsidize such services with funds designated for their priority populations. These providers were also able to fund some safety net services with grant funds made available through federal and regional programs, often targeted to outreach and prevention. In Minnesota and Oregon, county government and county funded social services also supplemented the safety net in meaningful ways. Lacking such county involvement, the Maine CMHC was forced to use waiting lists to manage the demand for free care. We conclude that county funding and grant writing are two ways that CMHCs have been able to plug the otherwise widening hole in the rural mental health safety net. Based on the findings, the report recommends an explicit discussion of the mental health safety net, both urban and rural, using the Institute of Medicine's report on America's Health Care Safety Net as a model. Also recommended are outreach programs to facilitate access to services for rural residents experiencing stress, depression and anxiety, and a shift from diagnosis-specific funding to the use of a family systems approach for those thus referred.
• Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices
  Author(s): Donald Sawyer, John Gale, David Lambert
  Research center: Maine Rural Health Research Center
  Topics: Frontier health, Mental health, Substance abuse, Telehealth
  Citation: Waite Park, MN: National Association of Rural Mental Health
  Date: 2006
  Discusses barriers to mental and behavioral health service delivery in rural America. Includes model programs and model policy strategies for rural mental and behavioral health care delivery. Also discusses the roles that telehealth and that the State Offices of Rural Health should play in service delivery.
• Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
  Author(s): Stephenie Loux, David Hartley, David Lambert
  Research center: Maine Rural Health Research Center
  Topics: Health services, Hospitals and clinics, Mental health
  Date: 08 / 2007
  Inpatient Psychiatric Units (IPUs) may not only be an important source of care for rural residents, but may also assist in the development of community-based services and the recruitment of mental health professionals. This study investigates the typical characteristics and admission processes of IPUs in rural hospitals with less than 50 beds, as well as the community-based services available to them when discharging patients. Reasons for developing these IPUs as well as the barriers to opening and operating a rural IPU and factors that have led some to close are also explored.
• State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
  Author(s): David Hartley, Erika C. Ziller, David Lambert, Stephenie L. Loux, Donna C. Bird
  Research center: Maine Rural Health Research Center
  Topics: Legislation and regulation, Mental health, Workforce
  Report Number: Working Paper No. 29
  Date: 05 / 2002
  Investigates whether and the extent to which licensure laws that determine the permissible scope of practice for each of these professions may affect the availability of mental health services, particularly in rural communities. Findings: Licensure laws authorize non-physician mental health providers to practice assessment, treatment planning, and individual and group counseling independently in most of the 40 states studied. Many states do not explicitly grant the authority to all of these professions for diagnosis or psychotherapy, but none explicitly deny it. Despite this finding, Medicare and some other payers do not directly reimburse Marriage and Family Therapists or Licensed Professional Counselors. Laws that require clinical supervision of newly trained practitioners to be performed exclusively by a member of the profession in a face-to face setting may make it difficult for a new graduate seeking rural practice to log the number of required hours within the specified time limit to qualify for independent practice. Some states' laws allow supervision that is not face-to-face, a rural-friendly policy. Also discussed are the nature and effects of guild behavior in the mental health professions. Based on the findings, report recommends that states simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency; that Medicare reconsider its position on reimbursing Marriage and Family Therapists or Licensed Professional Counselors; that professional competition over the right to practice and be reimbursed be addressed; and that supervision requirements be modified to allow new mental health professional graduates to address rural needs soon after graduation.
• Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
  Author(s): David Hartley, Erika C. Ziller, Stephenie L. Loux, John A. Gale, David Lambert, Anush E. Yousefian
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
  Citation: Journal of Rural Health, 23(2), 108-115
  Date: 2007
  Describes the results of a study investigating the use of critical access hospital (CAH) emergency rooms by patients with mental health problems to understand the role these facilities play in rural mental health needs and the challenges they face.