Stephanie Loux, MS


Publications - (16)

  • Are Advanced Practice Nurses A Solution To Rural Mental Health Workforce Shortages?
    Maine Rural Health Research Center
    Date: 04/2004
    Summarizes the clinical skills and prescriptive authority of Advanced Practice Psychiatric Nurses (APPNs), and investigates current trends in their geographic distribution to determine what their future role may be in addressing rural mental health needs. Includes information on prescription authority and collaboration requirements for each state, as well as state distribution of APPNs.
  • Comparing Patient Safety in Rural Hospitals by Bed Count
    Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 2005
    Reports results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals. The authors found that small rural hospitals had rates of potential patient safety events that were significantly lower than those of large rural hospitals for three of the 19 patient safety indicators (PSIs). The types of services offered by rural hospitals varied significantly according to bed numbers, and the likelihood of an offered service increased as bed counts increased. The types of patients treated by rural hospitals, however, did not vary significantly by bed count. The results suggest that rural hospitals differ substantially by offered services and differ somewhat in PSI rates, relative to bed counts. But given the limited information on patient severity using administrative data, future research should look to develop more effective ways to account for patient severity when measuring patient safety rates among hospitals with varying bed counts.
  • Creating Program Logic Models: A Toolkit for State Flex Programs
    Maine Rural Health Research Center
    Date: 04/2006
    Provide states with a tool for planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments; assistance in identifying and defining measurable outcomes; information linking state-level Flex Program strategies to specific and measurable outcomes; and a consistent program-reporting framework to convey results to both internal and external stakeholders. The Program Logic Model (PLM) Toolkit is organized according to the steps in the PLM development process and guides the user through each section. Included in the Toolkit is an overview of PLMs, their component parts, and the application of the PLM framework to the planning, implementation, and evaluation of the Flex Program. The bulk of the Toolkit provides a step-by-step approach to developing a Program Logic Model. The final section of the Toolkit lists resources for additional information on PLMs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2006
    Describes the EMS related activities that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-2005. Since the first full year of funding, the number and range of EMS improvement activities proposed has increased substantially states' proposals contained 239 documented EMS improvement activities. Of these, 40% focused on the Integration of Health Services attribute, 13% on Human Resource challenges, and 13% on Education Systems. Continued support of activities begun prior to 2004 was common. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Encouraging Rural Health Clinics to Provide Mental Health Services
    Maine Rural Health Research Center
    Date: 05/2010
    This study examined changes in the delivery of mental health services by Rural Health Clinics (RHCs), their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Key Findings:
    • Approximately 6% of independent and 2% of provider-based RHCs offer mental health services.
    • 38% of study RHCs reported their mental health services were not profitable but continued to provide them in response to community and patient needs.
    • An important factor in the development of RHC mental health services is the presence of a local champion who spearheads the development effort.
  • 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.
  • Prioritizing Patient Safety Interventions in Small Rural Hospitals
    Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 12/2006
    Determines if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
  • The Provision of Mental Health Services by Rural Health Clinics
    Maine Rural Health Research Center
    Date: 05/2010
    The number of Rural Health Clinics (RHCs) providing specialty mental health services remains limited. This study examined changes in the delivery of mental health services by RHCs, their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Approximately 6% of independent and 2% of provider-based RHCs offer mental health services by doctoral-level psychologists and/or clinical social workers. Models used to provide mental health services include contracted and/or employed clinicians housed in the same facility as primary care providers. A key element in the development of mental health services is the presence of an internal champion (typically clinicians or senior administrators) who identify the need for and undertake implementation of services, help overcome internal barriers, and direct resources to the development of services.
  • A Review of State Flex Program Plans, 2004-2005
    Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Date: 03/2006
    Examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. Highlights recent trends in State Flex Program planning, development, and implementation. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Rural Hospitals and Long-Term Care: the Challenges of Diversification and Integration Strategies
    Maine Rural Health Research Center
    Date: 2006
    There are many contemporary challenges experienced by older rural residents and their communities in accessing and providing services. However, the issue is not in comparing rural older adults to their urban counterparts; rather, it is that rural people have unique characteristics that must be considered when planning and providing services.
  • 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.
  • Rural-Urban Differences in Work Patterns Among Adults With Depressive Symptoms
    Maine Rural Health Research Center
    Date: 03/2008
    This study addresses the issue of poor mental health among young to middle-career rural residents and how their employment may be affected. Using the National Longitudinal Survey of Youth (NLSY), a nationally representative survey of adults, the authors investigate how depressive symptoms affect employment patterns, and the extent to which such effects differ by rural and urban residence. Analysis of the data identified the rural sample as more likely to be married, have less education, are less likely to be black or Hispanic, and less likely to have health insurance than the urban sample. For both rural and urban subjects, individuals with depressive symptoms work less than those not depressed. Although the findings indicate no significant difference between depressed rural and urban residents in maintaining employment, questions remain about rural access to mental health services, such as employee assistance, productivity on the job, and the survival or coping strategies of rural workers with depressive symptoms.
  • Scope of Services Offered by Critical Access Hospitals: Results of the 2004 National CAH Survey
    Maine Rural Health Research Center
    Date: 03/2005
    Three years of national survey data (2000, 2002, and 2004) were used to examine the scope of services offered by Critical Access Hospitals (CAHs). The authors investigated how the services offered by CAHs have changed, the role of network affiliations in these changes, and the reasons administrators gave for reported service expansions. Additionally, the authors looked at how services in CAHs have changed over time. Consistent with findings in previous surveys conducted by the Flex Team, conversion to CAH status has not led to downsizing of services. Most CAHs offer a core set of services including radiology, laboratory services, emergency rooms, swing beds, pharmacy, outpatient rehabilitation, outpatient surgery, and specialty clinics. While this core has not changed significantly over the period of three surveys, many CAHs have added or expanded services not dependent on inpatient capacity Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Smallest Rural Hospitals Treat Mental Health Emergencies
    Maine Rural Health Research Center
    Date: 2006
    Discusses the extent to which rural emergency rooms encounter and treat mental health patients.
  • 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.
  • 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.