Outreach Rural Health for Rural Maine

This project was designed to expand home care services for patients with anxiety and depression in the easternmost counties of the United States—Aroostook County, which covers 6,672 square miles and has a population of 73,140 people (14.3 percent of whom live below the poverty level), and Washington County, which spans 2,568 square miles and has a population of 33,573 people (19.0 percent of whom live below the poverty level).

A significant focus of the project was the use of a novel application of inexpensive, interactive video systems to enhance conventional, in-person home visits for clients with depression. The goal of this approach was to improve their health status and reduce the need for institutionalization. In addition to providing direct, inhome mental health services, the project used small, telephone-linebased home telemedicine units and ISDN-based Polycom units for meetings and consults.

Another innovative feature for delivering home-based mental health services was the use of psychiatric occupational therapists for assessments, therapeutic interventions, and participation in monthly case review sessions with the clinical committee. The occupational therapist’s assessments included visual and memory checks and sensory integration.

The project recorded 38 assessments by the occupational therapist, 207 visits by social workers, 2 telemedicine assessments by the psychiatrist, and 526 sessions with a psychiatric nurse. The age of patients ranged from 40 to 95 years, and more than a third of patients were female. Nearly 96 percent of patients served were Caucasian, some of whom lived up to 45 miles from their nearest home care facility.

The project resulted in several important lessons:

• Home-based mental health screening and treatment is an important supplement to home health programs. The high proportion of chronic disease among these patients increases the likelihood that symptoms of depression and anxiety will go undetected and untreated.
• A psychiatric occupational therapist is a critical component of a balanced treatment team.
• Supplementing in-person visits by home mental health care staff with telehealth sessions is readily accepted by most home health patients and yields a high rate of patient satisfaction.
• Videoconferencing technologies are a cost-effective approach for conducting program management meetings involving staff members at different agencies. Videoconferencing also provides an effective means for conducting case reviews and promoting collaboration among program staff and specialists.
• It is critical to develop clinical protocols when a new service is added to a home health agency’s range of services. These protocols help to ensure that all staff members fully understand and comply with clinical procedures.

• Involve staff members who will be performing the service and collecting the data in the project’s planning to avoid gaps between the planning and execution phases of the project.
• Establish clear lines of authority and responsibility for all managers, staff members, and patients.
• Hire qualified staff members, which can be a formidable challenge in rural areas.
• Provide staff members with information-processing resources and sufficient training to use those resources. This step includes providing adequate computer software and hardware to support the collection, processing, and delivery of data.
• Provide a full-time director to ensure effective management of the project.