Muskie School of Public Service

1. Use of Mental Health Services by Rural Children David Lambert, PhD Muskie School of Public Service Maine Rural Health Research Center Georgetown University National Technical Assistance Center for Children's Mental Health Webinar: Healthy Children and Families: Reducing Behavioral Health Disparities in Rural and Frontier Areas March 18, 2010

2. Muskie School of Public Service Maine Rural Health Research Center BACKGROUND • Most children with emotional or mental health problems go untreated • Gap between need and service use is assumed to be wider in rural than in urban areas • Assumed that rural children have lower access to mental health services & are less likely to have needs met • National level research is limited, particularly regarding access across levels of rurality

3. Muskie School of Public Service Maine Rural Health Research Center Maine Rural Health Research Center Studies to Address This Gap • Use of Mental Health Services by Rural Children, 2008. • Data: National Survey of America’s Families (NSAF); pooled data 1997, 1999, 2002 • Access to Mental Health Services and Family Impact of Rural Children with Mental Health Needs, Forthcoming. • Data: National Survey of Children with Special Health Care Needs • (NS-CSHCN) 2005-2006 and Area Resource File,2006 • Both studies are large enough to look at different size rural areas • Both studies rely on family self report of mental health issues and care received

4. Muskie School of Public Service Maine Rural Health Research Center Research Questions Addressed in the Studies • What is the prevalence of mental health needs across rural and urban residence? • Do children in rural and urban areas vary in their level of mental health needs? • Do children in need of mental health services receive it? Does this vary by rural and urban residence? • What impact does family income and type of insurance have on the use of mental health services by children across rural and urban residence? • What impact (financial and emotional) do children’s mental health needs have on their family (rural vs. urban)?

5. Muskie School of Public Service Maine Rural Health Research Center Findings • Rural and urban children have similar rates of mental health problems (rural very slightly higher). • A greater percentage of rural children with mental health needs have a behavioral difficulty than urban children (59.1 vs. 53.7 %). • Rural and urban children have similar rates of any mental health care (initial access). • Rural children receive less follow-up care / are less likely to have their mental health needs met than urban children.

6. Muskie School of Public Service Maine Rural Health Research Center Findings, continued • Public insurance (Medicaid and S-CHIP) helps all children, but particularly rural children who receive mental health care. • Rural families with children with mental health needs are more likely to spend 6 hours or more a week coordinating their child’s care than urban families (12.1 vs. 8.5 %).

7. Muskie School of Public Service Maine Rural Health Research Center Policy Recommendations • Support and enhance private and public (Medicaid, S-CHIP) health insurance for children. • Build and fund a range of rural service systems (e.g., schools, child welfare, primary care) that support children’s mental health. • Support modalities that can enhance ongoing access to mental health for rural children (e.g. telemental health). • Support rural families.

8. Muskie School of Public Service Maine Rural Health Research Center For Further Information David Lambert, PhD davidl@usm.maine.edu (207) 780-4502 Jennifer Lenardson, MHS jlenardson@usm.maine.edu (207) 228-8399