John Gale - Academia.edu (original) (raw)

Papers by John Gale

Long-standing shortages of mental health services have shifted much of the burden of care for men... more Long-standing shortages of mental health services have shifted much of the burden of care for mental health issues to the primary care sector. 1 Almost 3,800 Rural Health Clinics (RHCs) provide important primary care services in rural communities. 2 An earlier study found that few RHCs offered mental health services by employing doctoral level psychologists (0.12%) or clinical social workers (0.07%). 3 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. Methodology Using 2005-2006 Medicare Hospital and Independent RHC Cost Reports, we identified 62 independent and 28 provider-based RHCs that employed doctoral-level psychologists or clinical social workers. From this group, we conducted semi-structured interviews with staff from 14 randomly selected (six independent and eight provider-based) RHCs to explore the reasons for developing mental health services, barriers to doing so, their operational and clinical characteristics, and challenges to their sustainability. At the time of our interviews, 13 of these clinics provided mental health services and had done so for an average of eight years. The remaining clinic had closed its service upon losing its mental health provider.

Maine Rural Health …, 2010

Due to chronic shortages of mental health services, much of the burden of care for mental health ... more Due to chronic shortages of mental health services, much of the burden of care for mental health issues in rural areas has shifted to the primary care sector (Gale & Lambert, 2006). The National Advisory Committee on Rural Health and Human Services recognized the important role played by the primary care sector in meeting the mental health needs of rural residents in its 2004 report to the Secretary of the Department of Health and Human Services (National Advisory Committee, 2004). With almost 3,800 clinics in operation, Rural Health Clinics (RHCs) are an important rural primary care resource (CMS, 2009). An earlier study of RHCs found that few offered mental health services (0.12% employed a doctoral-level psychologist and 0.07% employed a clinical social worker) (Gale & Coburn, 2003). This study examined changes in the delivery of mental health services by RHCs, operational characteristics of these services, barriers and challenges experienced by RHCs, and policy options to encourage more RHCs to deliver mental health services. Methodology Using 2005-2006 Medicare Hospital and Independent RHC Cost Reports, we identified 62 (out of 1,117) independent RHCs and 28 (out of 1,349) provider-based RHC that employed a doctoral-level psychologist or clinical social worker. From this group, we completed in-depth semi-structured interviews with 14 randomly selected RHCs (six independent and 8 providerbased) to explore the reasons for developing mental health services, barriers and challenges to doing so, the operational and clinical characteristics of their mental health services, and challenges to their ongoing operation and sustainability. Thirteen clinics were currently providing mental health services and had done so for an average of eight years. One providerbased RHC had terminated services when its sole mental health provider left the practice. Findings Approximately 6% of independent and 2% of provider-based RHCs offer mental health services by employing doctoral-level psychologists and/or clinical social workers. The models used to provide mental health services included contracted and/or employed clinicians housed in the same facility as the primary care providers. The most commonly treated conditions were depression, attention deficit hyperactivity/attention deficit disorders, and anxiety. Participants

For those of you who are not familiar with the Rural Health Research Gateway, we are a website an... more For those of you who are not familiar with the Rural Health Research Gateway, we are a website and we provide easy and timely access to research and findings from federally funded rural health research centers dating all the way back to 1997. Really, our primary goal is to help move the new research findings of these rural health research centers to various end users as quickly and efficiently as possible and in different modes—one of which includes the webinar that you are on today.

BACKGROUND Although opioid use rates are comparable in rural and urban counties, rural opioid use... more BACKGROUND Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover.1 Little is known about what states with large rural populations are doing to combat opioid use disorders (OUDs) in rural communities. In addition to the multiple socio-economic vulnerabilites of rural residents, the rural healthcare system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature of the opioid crisis varies across rural communities and requires multifaceted, communitybased strategies to address the problem. Based on interviews with key stakeholders in four states, this qualitative study identifies rural challenges to the provision of OUD prevention, treatment, and rec...

Psychiatric Services, 2010

The Journal of Rural Health, 2003

The Journal of Rural Health, 2008

Addressing substance abuse in rural America requires extending our understanding beyond urban-rur... more Addressing substance abuse in rural America requires extending our understanding beyond urban-rural comparisons to how substance abuse varies across rural communities of different sizes. We address this gap by examining substance abuse prevalence across 4 geographic levels, focusing on youth (age 12-17 years) and young adults (age 18-25 years). Methods: The analysis is based on 3 years (2002-2004) of pooled data from the National Survey on Drug Use and Health. We measure rurality using a four-tier consolidation of the 2003 Rural-Urban Continuum Codes: urban, rural-adjacent, rural-large, and rural-small and medium. Findings: Rural youth have higher alcohol use and methamphetamine use than urban youth and the more rural the area, the higher the use. Rural young adults living in rural-large areas have higher rates of substance abuse than their urban peers; those living in the most rural areas have nearly twice the rate of methamphetamine use as urban young adults. Rural youth are more likely than urban youth to have engaged in the high-risk behavior of driving under the influence of alcohol or other illicit drugs. Conclusions: Higher prevalence rates, coupled with high-risk behavior, place rural youth and young adults at risk of continued substance use and problems associated with this use. Rural community infrastructure should be enhanced to support substance abuse prevention and intervention for these populations. T he increased use and impact of methamphetamine (meth) over the past decade have led county law officials to declare it America's top drug problem. 1 Meth use started in California several decades ago and has spread steadily eastward, reaching high levels in a number of states that are largely rural. As a result, meth is often described as a "rural problem." 2-4 Depicting meth as a rural issue has helped to focus attention on an important problem. This should also renew interest in other substances abused in rural America, including alcohol, marijuana, and cocaine. These substances are more prevalent than meth, have significant clinical and social impact, and are associated with the use of other drugs, particularly among youth and younger adults. 5 Although there is more research today on rural substance abuse than 5 or 10 years ago, there is a major limitation to much of this work: it compares all rural areas to all urban areas or to different size urban areas. Because substance abuse is a public health problem that affects certain high-risk populations more than others, a population health approach, focusing on differences among sub-populations, is appropriate. 6 The literature is clear that youth and young adults are at higher risk of substance abuse than older age groups. 7,8 A more limited literature suggests that rural youth and young adults may be at higher risk of abuse of some substances than urban youth and young adults and that this risk varies by size of rural community. 9 If we are to develop effective substance abuse prevention and intervention programs for rural youth and young

Long-standing shortages of mental health services have shifted much of the burden of care for men... more Long-standing shortages of mental health services have shifted much of the burden of care for mental health issues to the primary care sector. 1 Almost 3,800 Rural Health Clinics (RHCs) provide important primary care services in rural communities. 2 An earlier study found that few RHCs offered mental health services by employing doctoral level psychologists (0.12%) or clinical social workers (0.07%). 3 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. Methodology Using 2005-2006 Medicare Hospital and Independent RHC Cost Reports, we identified 62 independent and 28 provider-based RHCs that employed doctoral-level psychologists or clinical social workers. From this group, we conducted semi-structured interviews with staff from 14 randomly selected (six independent and eight provider-based) RHCs to explore the reasons for developing mental health services, barriers to doing so, their operational and clinical characteristics, and challenges to their sustainability. At the time of our interviews, 13 of these clinics provided mental health services and had done so for an average of eight years. The remaining clinic had closed its service upon losing its mental health provider.

Maine Rural Health …, 2010

Due to chronic shortages of mental health services, much of the burden of care for mental health ... more Due to chronic shortages of mental health services, much of the burden of care for mental health issues in rural areas has shifted to the primary care sector (Gale & Lambert, 2006). The National Advisory Committee on Rural Health and Human Services recognized the important role played by the primary care sector in meeting the mental health needs of rural residents in its 2004 report to the Secretary of the Department of Health and Human Services (National Advisory Committee, 2004). With almost 3,800 clinics in operation, Rural Health Clinics (RHCs) are an important rural primary care resource (CMS, 2009). An earlier study of RHCs found that few offered mental health services (0.12% employed a doctoral-level psychologist and 0.07% employed a clinical social worker) (Gale & Coburn, 2003). This study examined changes in the delivery of mental health services by RHCs, operational characteristics of these services, barriers and challenges experienced by RHCs, and policy options to encourage more RHCs to deliver mental health services. Methodology Using 2005-2006 Medicare Hospital and Independent RHC Cost Reports, we identified 62 (out of 1,117) independent RHCs and 28 (out of 1,349) provider-based RHC that employed a doctoral-level psychologist or clinical social worker. From this group, we completed in-depth semi-structured interviews with 14 randomly selected RHCs (six independent and 8 providerbased) to explore the reasons for developing mental health services, barriers and challenges to doing so, the operational and clinical characteristics of their mental health services, and challenges to their ongoing operation and sustainability. Thirteen clinics were currently providing mental health services and had done so for an average of eight years. One providerbased RHC had terminated services when its sole mental health provider left the practice. Findings Approximately 6% of independent and 2% of provider-based RHCs offer mental health services by employing doctoral-level psychologists and/or clinical social workers. The models used to provide mental health services included contracted and/or employed clinicians housed in the same facility as the primary care providers. The most commonly treated conditions were depression, attention deficit hyperactivity/attention deficit disorders, and anxiety. Participants

For those of you who are not familiar with the Rural Health Research Gateway, we are a website an... more For those of you who are not familiar with the Rural Health Research Gateway, we are a website and we provide easy and timely access to research and findings from federally funded rural health research centers dating all the way back to 1997. Really, our primary goal is to help move the new research findings of these rural health research centers to various end users as quickly and efficiently as possible and in different modes—one of which includes the webinar that you are on today.

BACKGROUND Although opioid use rates are comparable in rural and urban counties, rural opioid use... more BACKGROUND Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover.1 Little is known about what states with large rural populations are doing to combat opioid use disorders (OUDs) in rural communities. In addition to the multiple socio-economic vulnerabilites of rural residents, the rural healthcare system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature of the opioid crisis varies across rural communities and requires multifaceted, communitybased strategies to address the problem. Based on interviews with key stakeholders in four states, this qualitative study identifies rural challenges to the provision of OUD prevention, treatment, and rec...

Psychiatric Services, 2010

The Journal of Rural Health, 2003

The Journal of Rural Health, 2008

Addressing substance abuse in rural America requires extending our understanding beyond urban-rur... more Addressing substance abuse in rural America requires extending our understanding beyond urban-rural comparisons to how substance abuse varies across rural communities of different sizes. We address this gap by examining substance abuse prevalence across 4 geographic levels, focusing on youth (age 12-17 years) and young adults (age 18-25 years). Methods: The analysis is based on 3 years (2002-2004) of pooled data from the National Survey on Drug Use and Health. We measure rurality using a four-tier consolidation of the 2003 Rural-Urban Continuum Codes: urban, rural-adjacent, rural-large, and rural-small and medium. Findings: Rural youth have higher alcohol use and methamphetamine use than urban youth and the more rural the area, the higher the use. Rural young adults living in rural-large areas have higher rates of substance abuse than their urban peers; those living in the most rural areas have nearly twice the rate of methamphetamine use as urban young adults. Rural youth are more likely than urban youth to have engaged in the high-risk behavior of driving under the influence of alcohol or other illicit drugs. Conclusions: Higher prevalence rates, coupled with high-risk behavior, place rural youth and young adults at risk of continued substance use and problems associated with this use. Rural community infrastructure should be enhanced to support substance abuse prevention and intervention for these populations. T he increased use and impact of methamphetamine (meth) over the past decade have led county law officials to declare it America's top drug problem. 1 Meth use started in California several decades ago and has spread steadily eastward, reaching high levels in a number of states that are largely rural. As a result, meth is often described as a "rural problem." 2-4 Depicting meth as a rural issue has helped to focus attention on an important problem. This should also renew interest in other substances abused in rural America, including alcohol, marijuana, and cocaine. These substances are more prevalent than meth, have significant clinical and social impact, and are associated with the use of other drugs, particularly among youth and younger adults. 5 Although there is more research today on rural substance abuse than 5 or 10 years ago, there is a major limitation to much of this work: it compares all rural areas to all urban areas or to different size urban areas. Because substance abuse is a public health problem that affects certain high-risk populations more than others, a population health approach, focusing on differences among sub-populations, is appropriate. 6 The literature is clear that youth and young adults are at higher risk of substance abuse than older age groups. 7,8 A more limited literature suggests that rural youth and young adults may be at higher risk of abuse of some substances than urban youth and young adults and that this risk varies by size of rural community. 9 If we are to develop effective substance abuse prevention and intervention programs for rural youth and young