TEXAS JOURNAL OF RURAL HEALTH

PREVIOUS

ISSUE 19(4), 2001

TABLE OF CONTENTS
 
Editor’s Comments
James E. Rohrer, Ph.D.
FULL TEXT

Interview

Interview with Karen Madden
Lee Ann Paradise
Texas Journal of Rural Health 2001; 19(4): 3-8
ABSTRACT

Notes From the Field

Community Perinatal Needs Assessment for the Northwest Region of Texas
James E. Rohrer, Ph.D., Phillip Flamm, M.B.A.
Texas Journal of Rural Health 2001; 19(4): 9-21
ABSTRACT
 
Environmental Pollution in the Colonias of the Texas-Mexico Border: Its Potential Effect on Health
Darryl M. Williams, M.D., M.P.H.
Texas Journal of Rural Health 2001; 19(4): 22-32
ABSTRACT

Policy and Law

Tides of Rural Health Care Shifting: A Promise for a Bright Future
Richard Hoeth, F.A.C.H.E., C.A.E.
Texas Journal of Rural Health 2001; 19(4): 33-41
ABSTRACT
The Texas Children's Health Insurance Program (CHIP) One Year Later-Where Do We Go From Here?
Paul L. Thomas, M.H.A., F.A.C.H.E., Lynne Hudson, R.N., M.P.H.
Texas Journal of Rural Health 2001; 19(4): 42-50
ABSTRACT

Research

A Review of Primary Care Physicians' Detection, Diagnosis, and Treatment of Depression
Tyrone F. Borders, Ph.D.
Texas Journal of Rural Health 2001; 19(4): 51-59
ABSTRACT

Review

A Unique Medically Under-served Rural Population: The Kickapoo Traditional Indian Tribe of Texas
George Burke, Dr.PH, F.A.C.H.E., Jennifer Murray, Jim Summers, Ph.D., C.H.E.
Texas Journal of Rural Health 2001; 19(4): 60-68
ABSTRACT

ABSTRACTS

Interview with Karen Madden
Lee Ann Paradise
Texas Journal of Rural Health 2001; 19(4): 3-8
ABSTRACT
Karen A. Madden is the Director of the New York State (NYS) Office of Rural Health. Ms. Madden has been with the Office for seven years. Prior to being named Director, she held increasingly responsible positions within the Office, most recently serving as Project Director of the NYS Rural Hospital Flexibility Program. Ms. Madden has expertise in health policy analysis, network development, and hospital conversion.
The Office of Rural Health is located in the NYS Department of Health and is responsible for developing, implementing, and monitoring policies designed to improve access to quality health care services for the residents of NYS's rural communities. The Office is staff to the NYS Rural Health Council and works collaboratively with stakeholders and experts in rural health care, particularly the NYS Legislative Commission on Rural Resources and the Healthcare Association of NYS.
Ms. Madden serves on the Board of Directors of the National Organization of State Offices of Rural Health, is the Vice-Chair of the National Rural Health Association's State Office Council, and on the Advisory Council of the NYS Area Health Education Center. She is also a member of the National Rural Health Resource Center, Advisory Committee for the Technical Assistance and Services Center of the Rural Hospital Flexibility Program.
Ms. Madden holds a Master of Arts in Public Policy from the University at Albany's Rockefeller College of Public Affairs and a Bachelor of Arts in Political Science from the State University of New York College at Oswego.

LP: What are the difficulties in maintaining your rural health networks, and how successful has their participation been?

KM: The single largest difficulty is helping them to become self-sustainable or at least not so dependant on the funding that comes from our program. The difficulty in relying solely or mostly on our funding is that when the funding is delayed, many of them have no other means to support their programs or operations. So not only do they have the problem of being able to pay their staffs, they also have the problem of not being able to do what they're meant to do and provide the services that they provide. That's troubling to us because they have successful programs that are sometimes interrupted.

On a network specific level each network has its own difficulties, and we expect that, because it's pretty much due to the nature of what they're trying to do, which is to get healthcare providers to collaborate in an environment that is becoming increasingly competitive with fewer available resources. And here we are asking them to all get together to collaborate to provide services for their communities and yet when they walk away from their network meetings they all become competitive again. So, it's very difficult for them. I hope and I think that they've been fairly successful. We try when we fund the programs to help them choose programs that enhance access to services in their communities and will benefit their members. In terms of completing the work plans that they have, they've been mostly successful across the board.

Author Affiliations

  • Lee Ann Paradise, Managing Editor, Texas Journal of Rural Health, Texas Tech University Health Sciences Center, Lubbock, Texas

Community Perinatal Needs Assessment for the Northwest Region of Texas
James E. Rohrer, Ph.D., Phillip Flamm, M.B.A.
Texas Journal of Rural Health 2001; 19(4): 9-21

Abstract

In the spring of 2000, the Department of Health Services Research and Management in the Texas Tech School of Medicine conducted a perinatal needs assessment to guide resource allocation and educational efforts. The purposes of the needs assessment were to:

1. Describe the geographic area in terms of economy, demography, and the population of women giving birth;

2. Describe and analyze key indicators of perinatal health for the region;

3. Describe the availability of perinatal health services; and

4. Develop policy recommendations.

Key words: birth outcomes, prenatal care, rural health care. (Texas Journal of Rural Health 2001; 19(4): 9-21)

Author Affiliations

  • James E. Rohrer, Ph.D., Professor and Chair, Department of Health Services Research and Management, Texas Tech University Health Sciences Center, Lubbock, Texas
  • Phillip Flamm, M.B.A., Research Assistant, Department of Health Services Research and Management, Texas Tech University Health Sciences Center, Lubbock, Texas

Environmental Pollution in the Colonias of the Texas-Mexico Border: Its Potential Effect on Health
Darryl M. Williams, M.D., M.P.H.
Texas Journal of Rural Health 2001; 19(4): 22-32

Abstract

The colonias are substandard housing developments located on the outskirts of cities along the Texas/Mexico border. There are several environmental factors that result in increased health risks among the individuals who live in these communities. Shortages of potable water and appropriate sewerage capabilities have been long associated with a number of infectious diseases among colonias residents. Recent efforts to bring water and sewerage to the colonias promise to reduce these risks, but potential exposure to toxic chemicals in surface water and in polluted air also poses potential health risks. Use of contaminated home products and building materials as well as occupational exposures have also been documented, confirming the need for identification and remediation of these health hazards.

Key words: border health, colonias, pollution, Texas/Mexico border. (Texas Journal of Rural Health 2001; 19(4): 22-32)

Author Affiliations

  • Darryl M. Williams, M.D., M.P.H., Director, The Office of Border Health, Texas Tech University Health Sciences Center, El Paso, Texas

Tides of Rural Health Care Shifting: A Promise for a Bright Future
Richard Hoeth, F.A.C.H.E., C.A.E.
Texas Journal of Rural Health 2001; 19(4): 33-41

Abstract

When Congress passed the Balanced Budget Act of 1997 (BBA), Medicare reimbursement for Texas rural/small hospitals was cut severely, so much so that the act spawned two other bills, the Balanced Budget Refinement Act of 1999 (BBRA) and the Benefits Improvement and Protection Act of 2001 (BIPA). The two sequela pieces of legislation were largely due to intensive grass roots lobbying efforts on the part of hospital and other health care providers, health-related associations, and other advocacy organizations as well as the formation of effective rural coalitions of elected officials on both the state and federal level.

However, the work has only just begun if we are to ensure preservation of the fragile safety net, which comprises our current rural health care delivery system. Workforce issues and reimbursement continue to be the major concerns for rural as well as other hospitals in Texas (Texas Hospital Association, 2001). Therefore, it is incumbent upon every one concerned about rural health care to continue to advocate strongly for continued legislative and regulatory reforms to address those vitally important issues.

Key words: Balanced Budget Act (BBA), BBRA, critical access hospitals, rural health legislation, rural hospitals. (Texas Journal of Rural Health 2001; 19(4): 33-41)

Author Affiliations

  • Richard Hoeth, F.A.C.H.E., C.A.E., Vice President, Rural Health and Membership, Texas Hospital Association, Austin, Texas

The Texas Children's Health Insurance Program (CHIP) One Year Later-Where Do We Go From Here?
Paul L. Thomas, M.H.A., F.A.C.H.E., Lynne Hudson, R.N., M.P.H.
Texas Journal of Rural Health 2001; 19(4): 42-50

Abstract

The United States Congress passed the State Children's Health Insurance Program (CHIP) as part of the Balanced Budget Act in 1997. In April 2000, the state of Texas introduced its single eligibility determination process called "TexCare Partnership." The TexCare Partnership (TCP) was created to bring the private coverage sponsored by the Texas Healthy Kids Corporation, the children's Medicaid program, and CHIP under a single umbrella organization. In May 2001, the Texas Healthy Kids Corporation was phased out. This was in part due to the outcome of a successful first year of CHIP enrollment.

With 16 months of implementation and utilization experience, participating health plans, providers, and state officials are now addressing first year growing pains of the CHIP program. While enrollment of eligible children is generally considered a wonderful success, enrollment of additional children and more importantly, financial reimbursement issues are taking center stage. Statewide, 13 of 14 health plans have lost millions in the first year of operations. The impact this unfavorable financial situation will have on the overall program is unclear.

Key words: BBA, CHIP, enrollment eligibility, Medicaid, TexCare partnership, Texas Healthy Kids. (Texas Journal of Rural Health 2001; 19(4): 42-50)

Author Affiliations

  • Paul L. Thomas, M.H.A., F.A.C.H.E., HMO Administrator, Texas Tech Physician Associates, Texas Tech University Health Sciences Center, Lubbock, Texas
  • Lynne Hudson, R.N., M.P.H., Director, Managed Health Care Operations, Texas Tech Physician Associates, Texas Tech University Health Sciences Center, Lubbock, Texas

A Review of Primary Care Physicians' Detection, Diagnosis, and Treatment of Depression
Tyrone F. Borders, Ph.D.
Texas Journal of Rural Health 2001; 19(4): 51-59

Abstract

Depression is one of the more common diseases in urban as well as rural areas of the United States, with approximately 17% of all Americans experiencing depression over their lifetimes. An even greater percentage of the population may experience minor to moderate depression or have depressive symptoms not meeting the formal criteria for the diagnosis of a disorder. The initial point of contact for the treatment of depression is frequently a primary care physician rather than a mental health care professional. Yet, questions remain about the ability of primary care providers to successfully detect, diagnose, and treat depression. This article reviews the literature about the treatment of depression in primary care settings and suggests priorities for future research.

Key words: major depressive disorder, unipolar depression, primary care. (Texas Journal of Rural Health 2001; 19(4): 51-59)

Author Affiliations

  • Tyrone F. Borders, Ph.D., Assistant Professor, Department of Health Services Research and Management, Texas Tech University Health Sciences Center, Lubbock, Texas

A Unique Medically Under-served Rural Population: The Kickapoo Traditional Indian Tribe of Texas
George Burke, Dr.PH, F.A.C.H.E., Jennifer Murray, Jim Summers, Ph.D., C.H.E.
Texas Journal of Rural Health 2001; 19(4): 60-68

Abstract

The Kickapoo Traditional Indian Tribe of Texas presents special challenges to health care workers. The Kickapoo's conceptions of health and disease are not part of modern medicine. The Kickapoo have a centuries-long history of resisting domination and acculturation from the Anglo culture. The Kickapoo, given their strong diversity, provide a model for the approach health care workers from outside the culture must use to have any success in treating health problems. Prescriptions include understanding the culture's conceptions of health and disease. As one of many cultures dominated by a stronger culture, their resistance to the efforts of health care workers must also be understood within the context of a larger political struggle. Building trust by understanding and patience may be the most important tools for health care workers trying to help this or members of similarly diverse cultures.

Key words: Kickapoo, rural health, tribal culture. (Texas Journal of Rural Health 2001; 19(4): 60-68)

Author Affiliations

  • George Burke, Dr.PH, F.A.C.H.E., Professor, Department of Health Administration, Southwest Texas State University, San Marcos, Texas
  • Jennifer Murray, Graduate Assistant, Department of Health Administration, Southwest Texas State University, San Marcos, Texas
  • Jim Summers, Ph.D., C.H.E., Associate Professor, Department of Health Administration, Southwest Texas State University, San Marcos, Texas
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