David Lambert, PhD

Contact information for this researcher is no longer available, but you can still access their previous work.


Completed Projects - (4)

Locally Managed Behavioral Health Organizations: How Do They Affect The Capacity of Medicaid Managed Behavioral Health Programs to Serve Rural Populations?
Research center: Maine Rural Health Research Center
Topics: Medicaid and S-CHIP, Mental health, Networking and collaboration
Role of Inpatient Psychiatric Units in Small Rural Hospitals and Rural Mental Health Systems
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.
Research center: Maine Rural Health Research Center
Topics: Health services, Hospitals and clinics, Mental health
Rural E-Mental Health: Models That Enhance Access, Service Delivery, and Integration of Care
E-mental health programs have been developed in rural areas as a promising approach to address the chronic challenges of low availability of mental health clinicians, long travel distances, and stigma surrounding mental health care. The literature has established the technical feasibility of these programs and interest remains strong in developing and implementing them more broadly. However, we lack a clear understanding of the viability of current rural e-mental health programs - both the business case for starting and sustaining them and the clinical case for what services and functions may be provided _ and what impact they have had. The current rural health environment is changing significantly and it is important to understand where and how e-mental health programs have been established and sustained, what impact they have had, and what value they may add to other initiatives. To address this gap we will conduct interviews with between 24-30 current rural e-mental health programs.
Research center: Maine Rural Health Research Center
Topics: Mental health, Telehealth
Rural-Urban Differences in Access to Children's Mental Health Services
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.
Research center: Maine Rural Health Research Center
Topics: Children, Health services, Mental health

Publications - (19)

  • Access to Mental Health Services and Family Impact of Rural Children with Mental Health Problems
    Maine Rural Health Research Center
    Date: 10/2010
    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.
  • Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Policy Brief)
    Maine Rural Health Research Center
    Date: 03/2012
    After controlling for a broad range of key risk and protective factors, it is clear that an unexplained rural effect persists with rural adolescents still exhibiting higher alcohol use than their urban counterparts
  • Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Working Paper)
    Maine Rural Health Research Center
    Date: 03/2012
    Rural adolescent alcohol use is a complex social problem. Using data from the 2008-2009 National Survey of Drug Use and Health, this study by the Maine Rural Health Research Center examines alcohol use among rural and urban adolescents between the ages of 12 and 17. After controlling for a broad range of key risk and protective factors, it is clear that an unexplained rural effect persists with rural adolescents still exhibiting higher alcohol use than their urban counterparts. Our findings suggest that rural 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, we found urban-rural differences in specific protective factors, which may be the most promising for evidence-based, rural-specific prevention strategies targeting parents, schools, and churches.
  • Integrating Primary Care and Mental Health: Current Practices in Rural Community Health Centers
    Maine Rural Health Research Center
    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
    Maine Rural Health Research Center
    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)
    Maine Rural Health Research Center
    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
    Maine Rural Health Research Center
    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
    Maine Rural Health Research Center
    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.
  • Mental Health Problems Have Considerable Impact on Rural Children and their Families (Policy Brief)
    Maine Rural Health Research Center
    Date: 10/2010
    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 policy brief provides 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.
  • Mental Health Services in Rural Jails (Policy Brief)
    Maine Rural Health Research Center
    Date: 09/2009
    The prevalence of mental illness among prison and jail inmates has attracted increasing attention in both mental health and criminal justice circles.
  • Mental Health Services in Rural Jails (Working Paper)
    Maine Rural Health Research Center
    Date: 08/2010
    Using a qualitative approach, this study explored the role of rural jails in the mental health systems in rural communities, investigating how rural jails manage mental health and substance abuse problems among inmates, determining barriers to providing mental health services faced by rural jails, and identifying promising practices for service delivery. Rural jail administrators and mental health providers understood the need for mental health services for jail inmates but were constrained by inadequate community mental health resources, lack of coordination with community mental health providers, and infrastructure challenges including facilities, transportation, training, and legal processes. Promising practices include short-term hold policies, separation of inmates with mental health concerns, and regular communication among stakeholders.
  • The Role of Community Mental Health Centers as Rural Safety Net Providers
    Maine Rural Health Research Center
    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
    Maine Rural Health Research Center
    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 healthcare delivery. Also discusses the roles that telehealth and that the State Offices of Rural Health should play in service delivery.
  • Rural Children Don't Receive the Mental Health Care They Need (Policy Brief)
    Maine Rural Health Research Center
    Date: 01/2009
    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.
  • Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
    Maine Rural Health Research Center
    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
    Maine Rural Health Research Center
    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.
  • Telemental Health in Today's Rural Health System
    Maine Rural Health Research Center
    Date: 12/2013
    Describes the organizational setting, services provided, and staff used in 53 telemental rural health programs. Also outlines the opportunities and challenges for telemental health in the rural health system.
  • Understanding the Business Case for Telemental Health in Rural Communities
    Maine Rural Health Research Center
    Date: 07/2016
    This article describes the current landscape and characteristics of rural telemental health programs and then examines their business case.
  • Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
    Maine Rural Health Research Center
    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.