Donna C. Bird, MS


Publications - (5)

  • Addressing Mental Health Workforce Needs in Underserved Rural Areas: Accomplishments and Challenges
    Maine Rural Health Research Center
    Date: 10/2001
    Reviews efforts to address mental health workforce needs in underserved rural areas and addresses three questions: 1) How is health and mental health workforce adequacy currently measured? 2) How do unique characteristics of rural communities and the mental health service delivery system challenge current methods for determining workforce adequacy? 3) What role has the federal government played in addressing health and mental health workforce needs in underserved rural areas? Finds that current workforce adequacy measurements all focus on physicians and are limited by the lack of a commonly accepted way to obtain needed data and by widely varying estimates of adequate population-to-provider ratios. In addition, the pluralistic and minimally coordinated nature of the mental health services system makes it difficult to translate methods for estimating workforce adequacy from health to mental health. Finally, there are several federal efforts to address workforce needs that foster training, provide scholarships, fund demonstration programs, and allow foreign medical graduates to serve in underserved areas. Makes several recommendations pertaining to the collection of data, field-testing of estimation models, and increasing the supply of mental health service providers.
  • 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.
  • 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.
  • 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.