This publication
was supported through contract #:03H11630801D
United States Department of Health and Human Services
Health Resources and Services Administration
Office of Rural Health Policy
Introduction
- The President's New Freedom
Commission on Mental Health Final Report:
Rural Mental Health Workforce Shortages
The National Context: Mental Health Care in America
The Rural Context: Mental Health Care in Rural and
Frontier America
Workforce Shortages
The Regional Picture: How Does the Workforce Shortage
Issue Play Out at Home
- WICHE: Higher Education in
the West, The Perfect Storm
- WICHE Student Exchange
Program/NEON: Higher Education Options
The
Professional Student Exchange Program (PSEP)
The Western Undergraduate Exchange (WUE)
The Western Region Graduate Program (WRGP)
The NEON Project
More Higher Education Options
- Legislative Consultant Comments
- Workforce Development
Planning
Components
of a Transformed Rural & Frontier
Mental Health Shortage Initiative
Strengths of the Region
Regional Barriers and Challenges
Potential Mental Health Disciplines, Academic
Assets, and Resources
- Federal Partnership Opportunities
- Review and Identification
of Next Steps
- Recommendations
- Closing Remarks
APPENDICES
Appendix A: Designated Mental Health Professional
Shortages Areas by State
Appendix B: Tables 4 - 9
Appendix C: Consultant List
Appendix D: Mental Health Oversight Committee
Members FY 2003-04
Introduction
The Western Interstate Commission for Higher Education
(WICHE) comprises America's western most rural States, and the professional
shortages faced in the frontier areas of the West create a critical
barrier to effectively meeting the mental health care needs of the
region. To share and gain perspectives on workforce shortages in
the West, the WICHE Mental Health Program consulted with leaders
in the mental health field and higher education, as well as legislators
from WICHE member States. The product of these consultations and
shared knowledge is a broader understanding of the national, regional,
and State contexts regarding rural/frontier mental health workforce
shortage issues and potential avenues for addressing them. Several
of these important issues are:
- Identification of regional strategies and mechanisms
to address critical mental health professional shortages in frontier
areas of the WICHE West;
- Action planning for cross-sector, inter-institutional,
and interstate collaborative action to expand access to professional
training to improve the supply of critical mental health professionals
in frontier areas; and
- Exploring opportunities for regional integration
and coordination of funding strategies to support mental health
professional training and promote frontier practice.
One potential path for accomplishing these tasks
is through partnerships with and programs in higher education, such
as those currently offered by WICHE.
WICHE is a Federally chartered Interstate
Compact for higher education and serves a simple, straightforward
mission: to provide the citizens of the member States with expanded
access to high-quality postsecondary education, and to do so by
promoting innovation, cooperation, resource sharing and sound public
policy among our States and institutions. WICHE does so not for
the sake of western higher education, but for the sake of the region's
social, economic, and civic life, which will thrive only if we provide
broad access to excellent higher education. Specific WICHE programs
that may be of value to member States will be discussed in subsequent
sections of this report. However, in addition to the educational
side of WICHE is the Mental Health Program, which is a technical
assistance (TA) and evaluation center, with nearly a half-century
of expertise in responding to behavioral health issues, collaborating
with experts in the field to identify and disseminate best practices
in mental health and supporting public behavioral health systems
in program evaluation, clinical performance measurement and data
driven decision support.
Mental Health Workforce Development - Throughout
the past 50 years the WICHE Mental Health Program has been actively
engaged in mental health workforce development activities for the
West. The program was funded for over a decade to serve as the Human
Resource Development Program for the Western States by the National
Institute for Mental Health. Upon the creation of Substance Abuse
and Mental Health Services Administration (SAMHSA) in the early
1990's, Federal support for the Human Resources Development programs
was discontinued. However, the Mental Health Program has extensive
expertise in regional planning, consensus-building, recovery-driven
services, cultural competence, telemedicine/Web-based health and
knowledge synthesis and dissemination. Additionally, WICHE facilitated
a multi-year activity to identify core-competencies in behavioral
health practice that have been adopted as national standards by
SAMHSA. Most recently the program was selected to serve in a consultation
role to the rural issues subcommittee of the President's New Freedom
Commission on Mental Health, and provided the professional support
for the preparation of the subcommittee report and recommendations.
Frontier Mental Health - WICHE is a recognized
leader in the areas of rural and frontier mental health, workforce
development, and the Frontier Mental Health Resources Network for
researching and reporting on practices, problems and solutions in
service delivery. WICHE served as the technical assistance center
for frontier mental health under contract with SAMHSA from 1995-1998,
when program funding was eliminated. WICHE has maintained a capacity
to provide technical assistance focused upon frontier mental health
services, and a portion of its Web site is devoted to this area
of focus.
Thus, between WICHE's higher education and
mental health programs, an infrastructure of interstate and regional
collaboration has already been established. Helping member States
address rural and frontier mental health workforce shortages is
a logical role for WICHE. The remainder of this report will describe
the multilevel contexts in which workforce shortages exist, the
implications of these shortages and a description of the possible
solutions generated by consultants.
The National Context: Mental Health Care in
America
For the first time since the Carter Administration,
there is a Federal initiative to evaluate and reform America's mental
health system. President Bush's New Freedom Commission on Mental Health
recently released its final report, which identified significant barriers
to mental health care in the country, including fragmentation and
gaps in care for children and adults with serious mental illness,
a lack of care for older adults with mental illness, a failure to
make mental health and suicide prevention national priorities, as
well as socioeconomic factors, such as high unemployment and costly
disability. The report concluded that incremental reform of the mental
health system is no longer a viable option; a fundamental transformation
is needed.
The Commission identified national goals and potential
action steps to transform mental health care, including (see http://www.mentalhealthcommission.gov/):
- Americans understand that mental health
is essential to overall health.
- Advance and implement a national campaign
to reduce the stigma of seeking care and a national strategy
for suicide prevention
- Address mental health with the same urgency
as physical health
- Mental health care is consumer and
family driven.
- An individualized plan of care for adults
and children
- Use the skills of consumers and families
- Federal program realignment
- A real, comprehensive State plan
- Disparities in mental health services are
eliminated.
- Improve access to quality care that is culturally
competent
- Improve access to quality care in rural and
geographically remote areas
- Early mental health screening, assessment,
and referral to services are common practice.
- Early childhood mental health
- Mental health in schools
- Screen and treat/refer in primary care
- Screen and treat/refer for co-occurring
disorders
- Excellent mental health care is delivered,
research is accelerated.
- Accelerate research: recovery, resiliency,
cure
- Put science to action: promote evidence-based
practice
- Focus science on understudied areas (disparities,
trauma)
- Improve and expand the workforce
- Technology is used to access mental
health care and information.
- Protect privacy
- Use telehealth to expand rural access to
care and consultation
"Our country must make a commitment. Americans
with a mental illness deserve our respect
and they deserve
excellent care."
- President George W. Bush
|
We envision a future where recovery and resilience are
the expected outcomes and when mental illnesses can be prevented
or cured.
- New Freedom Commission on Mental Health 2003
|
The Rural Context: Mental Health Care in Rural
and Frontier America
The New Freedom Commission on Mental Health final
report included a subcommittee report on unique problems Americans
living in rural or frontier regions face in accessing mental health
care. The committee identified several key issues with respect to
mental health in rural America:
- The Federal government lacks a consistently
applied definition of rural America.
- There are critical gaps in accessibility to
services.
- There are critical shortages in the availability
of providers and programs.
- Acceptability of care is often impaired due
to urban-based models and strategies.
- A clearly defined plan to address long standing
rural mental health disparities does not exist.
- Mental health policy is routinely established
without consideration of its rural impact.
Where and what is rural America?
Different government agencies use different definitions,
typically based on population density and/or socioeconomic factors.
Rural America is often viewed and defined by what it lacks, which
is important and telling when considering mental health services.
For instance, more than 60 percent of rural Americans live in "mental
health professional shortage areas" (MHPSAs). Over 90 percent
of all psychologists and psychiatrists, and 80 percent of MSWs,
work exclusively in metropolitan areas. More than 65 percent of
rural Americans get their mental health care from their primary
care provider.
Due to these facts, accessing mental health services
is difficult in rural America. Additionally, rural Americans have
to travel further to provide or receive services, are less likely
to have insurance benefits for mental health care, and are less
likely to recognize mental illnesses and understand their care options.
As a result, rural Americans enter care later in the course of their
disorders, with more advanced symptoms, and require more intensive
and expensive interventions. Compounding the problem is that there
are few programs training professionals to work competently in rural
places. Stigma is associated with having mental illness, and there
is some professional misunderstanding about rural America, as indicated
by the prevalent assumption that urban models of treatment and practice
will work in rural areas.
In summary, rural America needs, but does
not have, an appropriate supply of technically competent and skilled
professionals who have demonstrated knowledge and experience in
rural/remote practice.
Workforce Shortages
As of September 30th, 2003, 881 (74 percent)
of federally designated mental health professional shortage areas
are non-metro.1 Multiple reports dating
from the Eisenhower era Presidential Commission on Mental Health
indicate that the problem is persistent with little improvement
(Bird et al., 1999; Flax et al., 1979; Larson et al., 1994; Murray
& Keller, 1991). As indicated earlier, few psychiatrists, psychologists,
or clinical social workers practice in rural counties. The ratio
of these providers to the population worsens as rurality increases
(Holzer et al., 2000). Additionally, due to declining nursing school
graduates, an aging workforce and general population, decline in
wages and alternative job opportunities, nursing shortages are expected
to reach 20 percent by 2020 (Buerhaus et al., 2000).
Although the data in this area are not as consistently
Designated Mental Health Professional monitored as in other areas
of health care (often due Shortage Areas
to myriad of State and guild driven policies), available data portrays
a critical disparity in the availability of mental health professionals
in rural areas. The National Advisory Committee on Rural Health
(1993) noted that across the 3,075 counties in the United States,
55 percent had no practicing psychiatrists, psychologists or social
workers, and all of these counties were rural.
These workforce shortages are worse for specialty
areas (e.g., children's mental health, older adult mental health),
and are so great it is identified as a "hole in the safety
net" in a recent report to the Secretary of the U.S. Department
of Health and Human Services (National Advisory Committee on Rural
Health, 2002).
The availability of rural mental health professionals
is dependent upon several interrelated factors, including education,
rural training opportunities, recruitment and retention activities
and continuing education and support.
Existing funding streams and training programs
do not mandate a set of skills that lead toward rural competency
(National Advisory Committee on Rural Health, 1994). Most specialty
mental health (psychiatry and psychology) care is available only
in larger regional trade centers or locally only via itinerant providers
(Wagenfeld et al., 1994). Over the past decade, many rural hospitals
have either closed or converted to Critical Access Hospitals (CAH);
thereby limiting the number of available specialty services. Some
modifications to the CAHs convertion program however, has improved
availability of psychiatric units in some areas. Closures and conversions,
have further eroded the basic rural health infrastructure. Furthermore,
for rural persons with emergent mental health needs, law enforcement
is often the emergency responder and transport out of the community
(Larson et al., 1993). This could be prevented with the availability
of competent professionals to direct triage and stabilization.
Many rural primary care sites are effectively staffed by physician
extenders. However, difficulty in recruiting and retaining primary
care physicians in rural communities is further complicated by the
failure of the mental health field to develop a mid-level strategy
for meeting the needs of rural people. Instead, mental health workforce
policy has focused almost exclusively upon doctoral level providers
(i.e., psychiatrists and psychologists). Rural systems of care have
been staffed by a de facto workforce strategy, which includes an
array of non-doctoral level providers. There are no consistent existing
standards or core competencies, and treatment is driven more by
State scope of practice regulations and insurance reimbursement
rules rather than science or competency (Bird et al., 1999; Ivey
et al., 1998, Jerrell & Herring, 1983, Olson, 1983).
The Regional Picture:
How Does the Workforce Shortage Issue Play Out at Home?
Major changes in America's general workforce
are anticipated between now and the year 2025. This change is brought
into sharp focus when comparing the percentage of the population
entering the workforce to the percentage leaving it. Table 1 (below)
presents projections in this regard for each of the WICHE States
(for access to this data, go to http://www.higheredinfo.org/).
On average, WICHE States will see a projected
18 percent increase in the number of people between the ages of
18 to 64 entering the workforce by 2025 (the range is a low of 1.4
percent for North Dakota and a high of 37.8 percent in Hawaii).
However, the projected average percent of persons 65 and older (i.e.,
retirement age) leaving the workforce in WICHE States is a staggering
122 percent (with a low of 72.6 percent in South Dakota and a high
of 159.7 percent in Utah).
On average, it is projected that WICHE States will see
an 18 percent increase in people entering the workforce by 2025...The
projected average percent of persons leaving the workforce by
the same year is 122 percent. |
As this translates into actual numbers of
people, some WICHE States will have more citizens entering than
leaving the workforce, while others will have more leaving than
entering (see Table 1). For instance, California is projected to
have an increase of 2,828,432 in their retirement age population,
but will have an increase of 7,326,046 (i.e., a gain of 4,497,614)
in their workforce age population by 2025. Arizona, on the other
hand, is projected to have an increase of 700,290 in their retirement
age population, but an increase in workforce of only 373,026 (i.e.,
a loss of 327,264). In all, only four WICHE States-Alaska, California,
Hawaii and New Mexico-are projected to have actual numbers of people
entering the workforce in excess of the numbers leaving.
Table 1: Projections of the Working and
Retirement Age Populations from 2000 to 2025.
State |
Actual Pop.
Ages 18-64 (2000)
|
Projected Pop.
Ages 18-64 (2025)
|
% Change 2000 to 2025 |
Actual Pop. Ages 65+ (2000) |
Projected Pop. Ages 65+
(2025) |
% Change 2000 to (2025) |
Entering (+) vs Leaving
(-) workforce by 2025 |
AK |
400,516 |
516,611 |
29.0 |
35,699 |
92,235 |
158.4 |
+59,559 |
AZ |
3,095,846 |
3,468,872 |
12.0 |
667,839 |
1,368,129 |
104.9 |
-327,264 |
CA |
21,026,161 |
28,352,207 |
34.8 |
3,595,658 |
6,424,090 |
78.7 |
+4,497,614 |
CO |
2,784,393 |
2,971,381 |
6.7 |
416,073 |
1,043,918 |
150.9 |
-440,857 |
HI |
755,169 |
1,040,295 |
37.8 |
160,601 |
288,581 |
79.7 |
+157,146 |
ID |
779,007 |
940,187 |
20.7 |
145,916 |
374,410 |
156.6 |
-67,314 |
MT |
551,184 |
599,757 |
8.8 |
120,949 |
274,424 |
126.9 |
-104,902 |
ND |
386,873 |
392,293 |
1.4 |
94,478 |
166,611 |
76.3 |
-66,713 |
NM |
1,098,247 |
1,458,993 |
32.8 |
212,225 |
440,582 |
107.6 |
+132,389 |
NV |
1,267,529 |
13,44,107 |
6.0 |
218,929 |
486,854 |
122.4 |
-191,347 |
OR |
2,136,696 |
2,387,747 |
11.7 |
438,177 |
1,054,368 |
140.6 |
-365,140 |
SD |
444,064 |
469,081 |
5.6 |
108,131 |
186,629 |
72.6 |
-53,481 |
UT |
1,324,249 |
1,559,168 |
17.7 |
190,222 |
494,003 |
159.7 |
-68,862 |
WA |
3,718,130 |
4,477,116 |
20.4 |
662,148 |
1,580,554 |
138.7 |
-159,420 |
WY |
307,216 |
380,192 |
23.8 |
57,693 |
144,843 |
151.1 |
-14,174 |
Source: http://www.higheredinfo.org/
The implications of these projections are grim.
Not only will most WICHE States have fewer people entering the workforce
than leaving, the retirement-aged or elderly population will grow
substantially. Since elderly persons typically require more healthcare
services than younger age groups, it appears that without significant
workforce development, there will be fewer people to offer these
services. As indicated in the New
Freedom Commission on Mental Health report, services to
elderly populations are already insufficient. The significant increase
in persons entering this age group over the next 20 years, combined
with the relatively low numbers entering the workforce, suggests
very serious problems in providing care to those who will need it
most.
Mental health workforce, especially in highly
rural WICHE States, faces many of the problems in their rural mental
health systems identified in previous sections. However, unique
issues can arise for a given area due to State-specific
characteristics, which may include economics and State budgets, reimbursement
systems, natural disasters or other factors. Describing State-specific
problems highlights both the commonalities and differences in the
WICHE West and facilitates discussion of what others have done to
address or prevent similar problems or ways that the region can come
together to find solutions. Consultants from Nevada, Alaska, South
Dakota, Arizona and Washington described the State of the field in
their respective areas.
Nevada: Nevada was described as having
a rural professional staff vacancy rate of 22 percent (9 out of
40 positions). Additionally, the rural turnover rate in the last
4 years has been 23 percent. The problem is so severe that an attempt
was made in the most recent legislature to reclassify social work
positions to mental health counselor positions, thus, allowing both
Licensed Marriage and Family Therapists and Licensed Clinical Social
Workers to fill positions. Furthermore, the turnover rate is thought
to be related to problems of cultural and rural competence. Many
times, young professionals come from schools that do not have an
appropriate curricula regarding rural or cultural competence, yet
these are the areas in which they must work.
We would like to look at higher education to turn out
students who are able to work in the rural frontier area.
- Carlos Brandenburg Nevada Dept of Human Resources |
Nevada would like to look at higher education
to turn out students who are able to work in the rural/frontier
area. At present, psychiatrists do not live and work in rural Nevada.
Therefore, the psychiatrist positions were converted into contract
services. Twelve psychiatrists are under contract at the present
time, and many clients are still waiting over 14 days for services.
Some clients wait as long as 5 months for outpatient and medication
clinic services. As a partial remedy, the State is utilizing the
Federal Loan Repayment program to entice professionals (non-medical)
to work in rural areas. In addition, the State is exploring ways
to reimburse interview and moving expenses. Finally, there is considerable
pressure to make positions revenue - generators to help offset State
general fund dollars.
Alaska: Two main questions being asked
in Alaska are: How do we get young people interested in the field,
and what is the field going to look like 10 or more years from now?
One frustration is getting young people fresh from school who are
unprepared to work in the current clinical environment. It is hoped
that there will be a regional "think-tank" that envisions
what the system should look like 10 or more years from now and finds
ways to prepare young professionals for the coming system.
A major issue is retention of providers:
Most young professionals only work in Community Mental Health Centers
for about 2 years, perhaps slightly longer. A tremendous amount
of time, energy, and money is spent teaching them the basics of
service provision (e.g., through supervision, mentoring); however
after approximately 2 years, they decide to go into private practice
or move out of the area. Precious resources are lost when this occurs.
Therefore greater efforts toward retention are needed.
Rural Alaska has over 250 indigenous cultures
living beyond all road systems and maintaining traditional hunting/gathering
lifestyles in villages of 150 to 800 people. The rates of suicide
among young Alaskan Natives in these areas is among the highest
in the world. Rural University of Alaska campuses have Minority
Serving designations, which serve Native Alaskans. To improve training
and retaining of clinicians, a career track within the community
needs to be created. There is a need to show people a career track
once they get in the school system. (Young professionals function
as free agents, and there is an obligation to work with providers
and the system with this understanding.) Alaska has the vision of
a counselor in every village. They envision residents from the villages
functioning as counselors and doing basic intervention, screening
and assessment and referrals. There is a need to "grow your
own" in the communities and give professionals the resources
and capabilities to stay in those communities.
How do we get young people interested in the field,
and what is the field going to look like 10 or more years from
now?
- Bill Hogan
Director of the Division of Mental Health & Developmental
Disabilities Alaska |
Alaska is in the middle of integrating mental
health and substance abuse services into a Behavioral Health Division.
They are looking at licensing and credentialing issues, as this
is very important, particularly in rural areas. There is a lot of
expectation that practitioners be licensed or that they meet certain
standards to be able to practice. However, there is a concern that
these expectations would severely restrict the number of clinicians
available. Alaska is also looking at collaboration between mental
health and substance abuse providers, as well as primary care providers.
Current funding is not enough to pay for separate administrative
infrastructures for mental health agencies, substance abuse agencies
and community health centers. Ideally, there would be a way to combine
these organizations, thereby saving administrative dollars and providing
direct service. Other important issues include over-regulation,
technology and information sharing, and retention of providers.
South Dakota: South Dakota reported many
of the same kinds of problems as Nevada and Alaska, such as recruitment
and retention, shortages of psychiatrists and clinicians (in the
top three for all States), and inadequate access to care, which
can result in higher costs. In 2002, the State formulated a Task
Force on Children's Mental Health, which involved stakeholders from
many State departments, advocacy groups, families and other members
of the community. They collaborated with the WICHE Mental Health
Program to conduct needs assessments, facilitate the meetings and
conduct core competency studies. The needs assessment indicated
that 58 percent of children with mental health problems are not
receiving services. The Task Force Report had a number of recommendations,
including the development of an action plan to address relinquishment
of custody problems, early identification through screening and
a public education campaign. The State is also looking at using
telemedicine technology to improve access to services.
Arizona:
Arizona identified a number of challenges in their State. An assessment
of the State's mental health workforce indicated an attrition rate
of 34 percent. One of the outcomes of this assessment was an interview
with workers. The number one frustration reported was confusion
about their roles as mental health workers, as well as excessive
paperwork and redundancy. Reasons for leaving one's job included
low salaries, conflicting relationships with supervisors or lack
of supervision. Information was also obtained from administrators
and directors, who reported that people are not applying for these
jobs, particularly support jobs.
Arizona has been reviewing and working on these
issues from several different angles. First, they are looking at
their process of assessment, who is doing the assessments and why
there is so much paperwork/data. After examining all the data being
collected, the conclusion was that the majority of it was unneeded
and had the effect of "paralyzing" clinicians. This led
to an assessment of the essential data needed to make decisions
about the delivery system, which turned out to be basic information
regarding safety issues and reason for seeking services. An effort
is currently underway to take this idea out into the State and "sell"
it, as well as train clinicians on the new assessment process.
Another way Arizona has recently addressed workforce
issues is by completing a Provider Manual, which contains centralized
policies written in laymen's terms to reduce past frustrations/confusion
and increase providers' understanding of the State requirements
and expectations. They have also released an RFP that seeks to help
develop the workforce. Arizona is looking at more ways to use telemedicine
technology to improve access. On the education front, they are looking
at creating a partnership between Behavioral Health and Higher Education,
particularly in terms of influencing curriculums in the higher education
arena.
Washington: Similar to other States, Washington
is having significant difficulty recruiting and retaining all types
of mental health professionals. For instance, it is projected that
there will be a 13 percent increase in the shortage of psychiatric
nurses. However, the problem is not a lack of applicants but a lack
of schools; for every three applicants there is only one school
opening available. Furthermore, teaching salaries for nursing school
faculty are only about $20-30,000, which is less than the salaries
of nurses working in the field.
Recruiting and retaining psychiatrists is difficult.
Many psychiatrists provide itinerant services to rural areas and
are paid more for doing so. However, costly travel expenses and
the higher rate of pay adds to the expense of these services. Additionally,
a factor that keeps some psychiatrists from living in rural areas
is that they have professional spouses who cannot find work in their
particular fields. Other mental health professionals may begin their
careers in rural areas, but often move to urban areas after receiving
required supervision for licensure. Finally, the most challenging
group of professionals to recruit and retain are geriatric mental
health specialists. Given the statistics indicated earlier in this
report regarding the projected increase in the elderly population
over the next 20 years, it is likely that many, if not most, States
will face similar shortages of geriatric specialists.
At present, a Washington Task Force is reviewing
workforce shortage issues and developing some initial recommendations.
These include increases in nursing enrollment slot funding, increases
in nursing faculty funding and the use of scholarship and loan repayment
programs as incentives.
One potential avenue for decreasing the workforce
shortage in mental health is through programs in higher education.
A subsequent section will describe a number of existing higher education
programs that might serve this purpose. This section will provide
an overview of the current status of higher education regarding
supply and demand, those who are or could be served in higher education,
and the financial status of the WICHE West. Understanding the current
and projected higher education environments will help administrators
in mental health more clearly judge their options as they pursue
opportunities.
As a metaphor for the current and projected status
of higher education, The Perfect Storm (David Longanecker,
Director, WICHE) captures the idea that several "waves"
of events and factors are occurring and need to be considered. In
general, there are three primary waves: 1) an increasing demand
and need for higher education by individuals and society in general,
2) a customer base that has been either difficult to serve or not
served effectively, and 3) a limited pool of resources, at least
in the public purses.
Wave One - Rising Demand: The demand for
college education is projected to rise 13 percent nationally (2002-2012)
and the West's higher education enrollments will be the highest
in the Nation. The graph below presents high, middle, and low projections
of total enrollment in all degree-granting institutions over the
next 8 years. Whether enrollment projections are actually at the
low or high ends, it is expected that demand will significantly
exceed supply. More specifically, it is anticipated that there will
be a 25 percent growth in the 18- to 24-year-old population (2000-2015).
The West's high school graduation rate is skyrocketing with expectations
of a 12 percent increase (2002-2012), which is by far the biggest
increase of any region (the South will see an 8 percent boost; the
Northeast, 4 percent; North-central, .2 percent). In some States,
such as California, these increases will likely be too great to
be handled by the public education system. As a result, it is likely
that parents will need to find ways to fund their children's education
in the absence of government funding, which will create more strain
for those families.
Wave Two - Those We Serve will be Harder to
Serve: Not only is the demand for higher education projected
to exceed supply, but the diversity of students is expected to grow
as well. An increasing share of higher education's population is
coming from communities that higher education traditionally has
not served well. For instance, communities of color will supply
54 percent of the West's high school graduates by 2012 (up from
41 percent in '02). Of course, this will differ from State to State
(e.g., Hawaii = 87 percent, Nevada = 62 percent, Utah = just 8 percent).
Another example is that Hispanic high school graduates will be 34
percent of the West's graduates (up from 23 percent in '02). The
success rates for Hispanic students in school have not been high.
For instance, in the United States, Hispanic students are 10.5 percent
less likely to attend higher education. In 2000-01, Hispanics represented
24 percent of the population and 15 percent of full-time first-time
freshmen. However, only 16 percent of those were awarded associate
degrees, and 11 percent of those were awarded bachelor's degrees.
Another group not historically served well in
higher education is low-income students. For example, from 1999-2001
low-income student participation dropped from 27.5 to 23.1 percent.
Additionally, 14 of the 15 WICHE States saw drops ranging from .2
to 8.4 percent. However, Hawaii was unique in the West, in that
they saw an increase of 12.9 percent in low-income student participation
(36.5 percent total).
Some schools will be better equipped than others
to accommodate this vast array of students, but others will struggle
to gain the resources and professional staff that make it possible
to provide a quality educational environment for all students. Nevertheless,
there are some opportunities for mental health. For instance, since
cultural and rural competence are considered important issues in
transforming the mental health workforce, efforts can be made to
attract students from diverse backgrounds into the field.
Wave Three - Constrained Finances: As the
two national maps below indicate, most States in the country are
facing significant financial problems. All but five States faced
or are facing budget shortfalls, 22 are in recession, 22 are near
recession, and only six are expanding. The impact of September 11th
on the Nation's and States' economies is well-documented, but there
are other factors that contribute to State budget shortfalls. At
the Federal level, a number of factors are indicated, including
the general economy, tax cuts, funds being focused on homeland and
international security, as well as the "No Child Left Behind"
mandate. At the State level, many States have antiquated tax structures.
For instance, States typically have sales taxes on goods, rather
than services. Since ours is now a service-based economy, the current
setup is misaligned.
State |
Size of Cuts
($ in Millions)
|
Alaska |
$ 0.0 |
Arizona |
$ 393.6 |
California |
$ 4,468.6 |
Colorado |
$ 621.5 |
Hawaii |
$ 20.7 |
Idaho |
$ 19.5 |
Montana |
- |
Nevada |
$ 57.0 |
New Mexico |
$ 0.0 |
North Dakota |
$ 18.3 |
Oregon |
$ 465.0 |
South Dakota |
$ 0.0 |
Utah |
$ 25.0 |
Washington |
$ 0.0 |
Wyoming |
$ 0.0 |
To combat lost revenue and bring budgets into
balance, States are taking a number of steps. One of the primary
steps being taken is cuts in higher education, decrease in aid
to localities, or across-the-board budget cuts. There have also
been suspensions, such as with employer retirement contributions,
construction projects, tax cut delays, or layoffs, furloughs, hiring
freezes and early retirement. Finally, States have had to tap into
other funds, such as "rainy-day" or tobacco settlement
money, and many have had dramatic tuition increases.
A potential resource in addressing the rural mental
health workforce gap is WICHE's three student exchange programs:
Professional Student Exchange Program (PSEP), Western Undergraduate
Exchange (WUE) and Western Regional Graduate Program (WRGP). Each
of these will be briefly described. (Information is taken from and
can be found at http://www.wiche.edu/SEP/WUE/index.asp.)
The Professional Student Exchange Program (PSEP)
PSEP enables students in 13 western States to
enroll in selected out-of-State professional programs (e.g., dentistry,
medicine, occupational therapy and optometry, to name just a few),
usually because those fields of study are not available at public
institutions in their home States. Exchange students receive preference
in admission. They pay reduced levels of tuition, usually resident
tuition in public institutions or reduced standard tuition at private
schools. The home State pays a support fee to the admitting school
to help cover the cost of students' education. State support and
program participation affecting students are subject to change by
legislative or administrative action. The number of students supported
by each State is determined through State legislative appropriations.
Traditionally, the PSEP program has supported
the training of professionals in out-of-State programs because of
three conditions: 1) the sending State identified the profession
as critical; 2) the sending State's higher education institutions
did not offer programs of study in the identified critical profession;
and 3) receiving higher education institutions had capacity to accept
students to their established programs. The conditions are different
in the area of rural and frontier mental health.
WICHE's student exchange programs - PSEP, WUE, WRGP,
& NEON - may be useful in closing the rural mental health
workforce gaps. |
Currently, no mental health disciplines
are specifically identified as part of the PSEP program. For the
most part, States have not identified mental health disciplines
as critical. Additionally, most States have mental health professional
training programs in nursing, psychology, social work, psychiatry
and allied fields. However, they often do not have programs that
specifically train mental health professionals to serve rural/frontier
populations or other underserved populations (e.g., children, older
adults, ethnic/racial minorities, etc.). As a result, the strategy
employed to address professional development to meet the needs of
underserved populations will need to develop a more refined process
of discipline and training program identification.
Finally, the current State revenue picture requires
careful examination of funding strategies that could be used to
support workforce development in this area. An array of existing
fellowships, scholarships and loan repayment options exist at both
Federal and State levels (e.g., National Health Service Corps Scholarship
and Loan Repayment Program), and it may prove beneficial to create
linkages between any WICHE regional activity and these programs.
Students must meet requirements for certification
and admission to the participating institution. Regarding certification,
each State establishes its own requirements for certification through
an application process and designates a State certifying officer.
Certification is not a guarantee of support; only those students
who are certified and funded through appropriations in each State
can be supported via PSEP. In terms of admission, the student applies
for admission to participating institutions through regular channels.
The institution has full discretion regarding admission. Most States
have some residency requirements, such as one year prior to application
(AK, CO, ID, MT, NV, ND, OR, WA), or up to 5 years prior to application
(AZ, HI, UT). There are also States that have a payback or other
obligation once schooling is complete, such as repayment of all
support fees (plus interest) or practicing in the "sending"
State 1 year for each year of academic support received.
The Western Undergraduate Exchange (WUE)
Through WUE, students in western States may enroll
in many 2 year and 4 year college programs at a reduced tuition
level: 150 percent of the institution's regular resident tuition.
WUE tuition is considerably less than nonresident tuition. Some
receiving States will now accept students from all WICHE States,
including California. Students do not need to demonstrate financial
need to receive the WUE tuition benefit. Students who enroll in
participating Western Undergraduate Exchange programs will qualify
for the WUE tuition rate.
Virtually all undergraduate fields are available
to WUE students at the participating colleges and universities.
Some institutions have opened their entire curriculum on a space-available
or first-come, first-serve basis; others offer only designated programs.
To be eligible for WUE, students must be a resident
of one of the WICHE States. However, residents of California may
only be accepted in some States in some institutions. Please refer
to each State's listing to determine if this applies. Some colleges
and universities also have additional criteria such as American
College Testing (ACT)/Scholastic Aptitude Test (SAT) scores or high
school Grade Point Average (GPA). Consult the WUE Bulletin for details.
At present, more than 17,000 students participate
in the WUE program. Through the WUE program, WICHE States have saved
a combined total of $77.8 million. By State, the savings are:
Alaska
|
$8.5
|
Idaho
|
$4.9
|
Oregon
|
$5.6
|
Arizona
|
$2.5
|
Montana
|
$5.0
|
South Dakota
|
$4.0
|
California
|
$5.0
|
Nevada
|
$2.9
|
Utah
|
$2.5
|
Colorado
|
$7.1
|
New Mexico
|
$4.1
|
Washington
|
$9.1
|
Hawaii
|
$8.4
|
North Dakota
|
$2.2
|
Wyoming
|
$6.2
|
The Western Regional Graduate Program (WRGP)
WRGP makes high-quality, distinctive graduate
programs available to students of the West at a reasonable cost.
As part of the Student Exchange Program of WICHE, WRGP helps place
students in a wide range of graduate programs, all designed around
the educational, social and economic needs of the West. Through
WRGP, residents of Alaska, Arizona, Colorado, Hawaii, Idaho, Montana,
Nevada, New Mexico, North Dakota, Oregon, South Dakota, Utah, Washington
and Wyoming are eligible to enroll in available programs outside
of their home State at resident tuition rates.
Students need not meet financial aid criteria.
To receive WRGP tuition status, students simply apply directly to
the institutions of their choice and identify themselves as WICHE
WRGP applicants. WGRP students must fulfill all the usual requirements
of the institution concerned and meet all admission deadlines.
WRGP is open to all residents of the 14
participating States. Normally, students should be a resident of
one of these States for at least 1 year before applying for admission
as a WRGP student. Determination of residency is usually made by
the institution where the student is enrolling. If necessary, the
WICHE certifying officer of the student's home State can assist
the institution in making a determination of residency.
The Northwest Educational Outreach Network (NEON)
Project
WICHE is partnering with NEON, a group of
32 higher education institutions and State governing and coordinating
boards in 10 States, to develop new strategies to improve student
access to various academic disciplines using technology-mediated
education. Through institutional collaborations, NEON is working
to extend the availability of degree programs in three disciplines
to students via Web-based or electronically-delivered courses. The
initial programs include: a Ph.D. in nursing; a graduate certificate
in logistics and supply chain management; and online courses that
lead to fulfilling the certification requirement for school librarians.
This interstate project is funded by the U.S. Department of Education's
Fund for the Improvement of Postsecondary Education (FIPSE). Over
time, NEON's collaborations may be expanded to include other academic
programs; allowing students to enroll in courses while remaining
in their communities.
More Higher Education Options
In addition to current WICHE programs that may
be useful to States in narrowing their workforce shortages, consultants
from Nevada, Alaska, North Dakota and Idaho described programs in
their respective States that have the same purpose. These are summarized
in the table below.
In terms of rural shortage, two general models
exist, both of which are valuable. One was described as the "Brill
Cream" model, in which some amount of rural focus will do and/or
is better than nothing. On the other hand, the second model indicates
that one must have, within an institution, departments that focus
on rural from "A to Z," that is, a program fundamentally
focused on rural issues and competency. One difficulty is that mental
health programs are primarily in metropolitan universities, and
rural health tends to be overlooked. What is needed is a change
on the mission to include rural issues more prominently. It was
suggested that Land Grant University models may be a mechanism that
could be used or built upon via cooperative extension, as this is
a new perspective is community health.
State |
Program |
Nevada |
Current programs:
- Health Care Access Program - designed to make sure money
is available to students, in certain fields, who go outside
the State to get their degrees and come back to serve in
a rural community for 2 years; they have 5 years to complete
the 2 years; and they utilize the PSEP to do
- WICHE PSEP - require students to come back to the State
and give a year for every year they are in school
- Match program between State of Nevada and National Health
Service Corps; Nevada pays 50 percent of the cost; currently
working with dental students, but will be working with mental
health programs in the near future
Goals:
- Get the private sector to "chip in"
- New funding that will allow Nevada to fund students after
they graduate
- NEON - taking the program to the student
|
North Dakota |
Project CRISTAL (Collaborative Rural Interdisciplinary
Service Training And Learning) - provides interdisciplinary
training for students in clinical laboratory science, occupational
therapy, physical therapy, medicine, nursing, x-ray and radiology
technology, social work and potentially pharmacy to improve
health care services to populations residing in rural/underserved
areas of North Dakota
The goals of Project CRISTAL:
- Increase the number of clinically competent health care
providers practicing in rural areas of North Dakota
- Build primary care systems which support the retention
of practitioners
- Promote interdisciplinary health service learning as a
core component of the education of health professionals
- Develop a curriculum that embraces the interdisciplinary
training model
- Develop collaborative relationships between academic faculty,
the Indian Health Service, Tribal representatives and rural
facilities
- Produce relevant research aimed at improving the health
status of rural and underserved populations
Criteria for trainee recruitment and selection:
- Eligible students must be enrolled in clinical laboratory
science, occupational therapy, physical therapy, medicine,
nursing, x-ray and radiology technology, social work and
potentially pharmacy and be in good standing
Acceptance into the program is based on the following criteria:
- Rurality or community of origin, prior work or educational
experience working in underserved or rural areas
- Knowledge of community-based primary care
- Interest in working as part of an interdisciplinary team
- Familiarity with patient care settings
- Strong interest in primary care and community-based practice
|
Alaska |
Barriers:
- Lack of parity between Health and Mental Health (a colonial
power structure)
- 90 percent of MA level supervisors turned over within
2 years
- All were trained outside of Alaska
- None were trained in a rural program
- None were indigenous to the area
- Need to grow our own
- Multidisciplinary
Structure and role of higher education:
- Three universities with University of Alaska Fairbanks
have a special mission to rural contexts
- Rural campuses that are minority serving institutions
- Significant investment in distance education at certificate
to master's degree level
- Development of sequenced and articulated degrees
Goals:
- Larger numbers of rural residents at the higher degree
levels
- Completion rates increase
- Growing parity with health professions in terms of density
of service providers
- Increasing better qualified and supported mental health
professions at all level
|
Idaho
|
Barriers:
- Boise State is a "metropolitan university"
- Communication/collaboration is a huge problematic issue
- Not only do we have to "grow them ourselves,"
but we have to "grow them up"
- Small program - 30 MSW graduates this academic year
- Do not have young people coming to school, average age
is 35, between the MSW and BSW
- More applications than we can take with a major budget
cut
Goals:
- Get communities to partner with us and to give students
placements in the communities
- Percentage of in-State students has grown over the years,
the challenge is to get them out of the "metropolitan"
area
- Collaborate with Idaho State University
|
Developing a broader and more stable mental health
workforce has to occur within the context of political realities.
As described earlier, States are facing budget shortfalls that require
tighter control over spending. It is unclear when the national and
State-level economies will rebound, which creates generalized uncertainty
and can interrupt planning. However, consulting legislators from
South Dakota and Nevada provided a clearer picture of what States
are facing politically and what can be done to facilitate mental
health workforce development and connections to higher education
within the current context of fiscal tightening.
Each legislator explained aspects of their State,
including current major issues. For instance, South Dakota was described
as a generally low tax State, as it is a very rural and low wage
(37th for per capita income) State. However, it has one of the most
broad-based sales tax programs in the country. The pros and cons
of this system were discussed, especially regarding the effect changes
in the system would have on funding. There is also a very large
Native American population in South Dakota, which, given the history
of difficult relationships between this population and the government,
raises unique issues.
Nevada, on the other hand, was described as being
a largely metropolitan State (70 percent of the population lives
in Las Vegas). However, there are significant rural areas that deal
with many of the issues described at the beginning of this report.
Furthermore, legislators representing rural areas were described
as less active in promoting mental health service programs. Nevada
has recently increased their mental health budget, yet the State
is ranked 50th in getting their share of Federal tax money back.
The State has a growing Latino population, but no Latino legislators.
Mental health organizations or groups must present a
unified message and relevant data to legislators regarding their
needs. |
he legislators emphasized the importance of mental
health organizations or groups presenting a unified message and
relevant data regarding their needs. Too often, different groups
from the same field will not collaborate and, in turn, present conflicting
requests or ideas to legislators. Legislators are generally uncomfortable
having to make a choice of one group over the other in such circumstances.
There was agreement that higher education
can play a significant role in workforce development. Early prevention
with family involvement was seen as critical to addressing mental
health problems generally; however, there was acknowledgement that
the "No Child Left Behind" mandate is frightening to many
teachers and school officials, and may remove focus from youth who
have mental health problems. On the other hand, some see this program
as a way to encourage schools to find ways of more effectively working
with youth and their families, particularly through collaboration
with mental health agencies.
WICHE has been working with expert consultants
to examine more closely the mental health workforce needs of the
WICHE West as a first step in developing a comprehensive mental
health workforce development strategy. A component of these activities
was the identification of specific professional disciplines and
potential training programs to accept students for inclusion in
the PSEP program. Other aspects included identifying the components
of a transformed rural and frontier mental health shortage initiative,
the strengths of the region, the regional barriers/ challenges and
the academic assets (e.g., current training programs) and resources.
Tables 4 - 9 in Appendix B list responses for each of these areas,
but each will be summarized in this narrative.
Components of a Transformed Rural & Frontier
Mental Health Shortage Initiative
Creating the components of a transformed mental
health workforce requires a strategy that looks at both short and
long-term goals. For instance, one near-term goal identified was
focusing on "professionals in transition" and helping
them re-invent their roles. This group usually consists of young
professionals, not many years out of their graduate programs, who
have good clinical experience but are unsure in what direction to
take their careers. Long-term goals include the idea of "grow
your own" professionals, curriculum overhaul, and inter-disciplinary
collaboration.
A major component of transformation is rural-specific
training and research. Regarding training, it was suggested that
there be either rural training programs or rural tracks that lead
a student from paraprofessional through post-graduate study and
work. This will require significant overhaul of current curricula
in many programs, as well as a greater emphasis on rural and cultural
competence. Students should also have opportunities for rotations
and/or practica in rural communities. In accordance with the "grow
your own" concept, consultants suggested targeted efforts to
engage indigenous rural/frontier residents in professional development.
Distance learning and continuing education programs were considered
important for addressing workforce shortages. Additionally, the
importance of engaging research universities to provide support
for developing best practices related to rural mental health cannot
be understated.
Strengths of the Region
The WICHE West is a strong region for many reasons.
A primary and fundamental reason noted by consultants is a shared
philosophy regarding the desire for communities to prosper and be
healthy. In this regard, there is a commonality of need, particularly
in rural areas. In such places, there is what may be called "relationship
capital," meaning that those who live and work together recognize
and value what each member of the community has to offer. This also
extends to collaborative efforts of organizations, such as rural
associations or other agencies (e.g., VAs, IHS, HRSA). People from
diverse backgrounds live in rural areas; there is a wealth of knowledge
and experience into which one can tap. Furthermore, WICHE States
have innovative programs to share, universities sensitive to rural
issues (e.g., Health Sciences Centers) and researchers who can investigate
and help identify best practices for treating Americans in rural
areas with mental health problems. Technology is linking people
together who were formerly separated by geographic or other barriers.
In addition, the WICHE infrastructure and specific programs (e.g.,
Nursing) were identified as strengths of the region. Thus, the region
has strengths that range from common philosophy to organized infrastructures
that will facilitate change.
WICHE States have a shared philosophy that emphasizes
prosperous and healthy communities. |
Regional Barriers and Challenges
Capitalizing on strengths requires an honest assessment
of the barriers and challenges one faces. The WICHE West has numerous
strengths, but also significant barriers, some of which were described
in previous sections focusing on rural mental health. Consultants
identified a number of barriers and challenges western States face,
which can be categorized as: 1) Disciplinary, 2) Academic/Practice,
and 3) Political.
As a discipline, mental health is fragmented.
Squabbles between different groups of clinicians exist, as does
competition to acquire students, communication is poor, and sub-disciplines
have dissimilar training, philosophy and credentialing processes.
In this regard, there is a significant rift between academia and
mental health practice, especially related to rural. Part of the
rift derives from a negative view of rural, considered to be "second
class." Rural research is not considered significant. There
is also a positive myth that rural areas are idyllic places where
few problems exist. However, as described earlier, issues that many
in urban or suburban areas take for granted, such as transportation,
are highly salient issues for those in rural America.
A lack of understanding about rural exists in
Federal and State political arenas as well. The Federal government
tends to use eastern and metropolitan models, assuming they apply
to the rural west. As noted earlier, there are multiple Federal
definitions of rural, which affect funding. States better understand
rural issues, but a "suburbanization" of legislators translates
into poorer representation in political decision making for rural
residents. Similarly, there is limited family and consumer participation
in shaping State systems of care. Furthermore, those systems tend
to be reactionary and range-of-the-moment in their focus. Taken
together, these are significant difficulties to be overcome, as
they cut across multiple areas of the mental health care system.
Potential Mental Health Disciplines, Academic
Assets, and Resources
As the WICHE West moves toward transforming the
mental health workforce, it will need a clear vision of what it
will do and how it will be done. That is, what will the workforce
consist of and how will this vision be achieved programmatically.
Consultants took on the task of answering these questions through
several steps that included identifying: 1) potential mental health
disciplines, 2) academic assets (i.e., existing training programs),
and 3) resources to support their efforts. (Lists of each of these
areas are provided in Tables 7-9 in Appendix B.)
In terms of potential disciplines States might
create, a general idea is that programs can be created that are
geared toward a particular level of training (e.g., paraprofessionals,
Masters, Doctoral), a particular focus (rural, community health,
primary care), or a combination of the two. In any of the cases,
it is important to look not only at those trained specifically in
mental health (e.g., psychologists, social workers), but also those
who work in a mental health capacity (e.g., nurses, school personnel,
primary care) and are from the local area. For example, a program
might be developed that begins with an associate's level certification
combined with paraprofessional practice, then moves a person through
bachelor's and graduate training to either a master's or doctoral
level. Such a program could have a rural or community and cross-cultural
emphasis, and recruitment could focus on people indigenous to the
area in which the program is offered.
A number of programs exist in the WICHE West that
could be used as models for creating new disciplines. For example,
there is the program at the University of Alaska that was described
in an earlier section, a rural psychiatry program at the University
of New Mexico, and multidisciplinary family practice residencies
through the Universities of Wyoming, Utah, Hawaii and Idaho State
University. The University of Alaska also has a distance learning
program for working paraprofessionals called "Learn as You
Earn." There are master's programs in human services at Sinte
Gleska University and in nursing at UNLV. This is not an exhaustive
list of relevant programs, but examples that others might consider
doing in their States.
Programs can be created that are geared toward a particular
level of training (e.g., paraprofessionals, Masters, Doctoral),
a particular focus (rural, community health, primary care),
or a combination of the two. |
In order to realize the
potential programs and disciplines identified, it is necessary to
identify the resources that will support these efforts. Among the
resources identified were State-sponsored loan repayment programs,
the Federal Office of Rural Health Policy's Network and Outreach
grants, or employer-sponsored career ladder programs for graduate
degrees. Other suggestions included looking at Title IV-E possibilities,
HCAP, the National Health Service Corps repayment and scholarships
program or Americorp educational stipends. In addition to these
ideas, two Federal partnership opportunities with the Rural Assistance
Center (RAC) and the National Health Services Corps (NHSC) were
described, which will be discussed in the next section.
The Office of Rural Health Policy has created
the Rural Assistance Center (RAC), which is a new national resource
on rural health and human services information. From their Web site
(www.raconline.org), the RAC was "established in 2002 as a
rural health and human services 'information portal' to help rural
communities and other rural stakeholders access the full range of
available programs, funding, and research that can enable them to
provide quality health and human services to rural residents. To
accomplish this, RAC gathers and streamlines information from myriad
sources and provides easy access to that information. In gathering,
synthesizing, and disseminating that information, RAC works with
the State Offices of Rural Health, the Rural Health Research Centers,
Poverty Research Centers, Area Agencies on Aging, American Public
Human Services Association, the National Association of State Workforce
Agencies, the National Association of Counties and many other public
and private efforts."
To achieve its goals, RAC:
- Identifies and collects sources of rural health
and human services research, support programs, funding and related
information;
- Archives and makes information accessible;
- Disseminates information and promotes the use
of RAC's service by rural communities, researchers, policymakers
and others; and
- Makes the information "actionable" by integrating
information into meaningful, policy-relevant and implementation-specific
frameworks.
The RAC also provides links to funding opportunities
across a range of disciplines.
The National Health Services Corps (NHSC)
also has various programs that might present partnership opportunities
for States seeking to expand their mental health workforce. The
mission of the NHSC is to improve "the health of the Nation's
underserved." Approximately 50 million people live in communities
without access to primary health care, and NHSC helps these communities
recruit and retain primary care clinicians, including dental and
mental and behavioral health professionals. These communities exist
across the country, in rural and urban areas.
NHSC has loan repayment programs for trained health professionals
that are dedicated to working with the underserved and have qualifying
educational loans. Additionally, these clinicians receive a competitive
salary, some tax relief benefits and a chance to have a significant
impact on a community. There is also the Ready Responders program,
which involves providing essential primary care to people in need
and being a member of a mobile team of health professionals trained
to respond quickly and effectively in the event of a large-scale
regional or national medical emergency. Successful applicants receive
all the benefits of serving in the U.S. PHS Commissioned Corps and
join the tradition of service in the National Health Service Corps.
They also may be eligible for the NHSC Loan Repayment Program.
Based on the workforce development planning, WICHE
asked consultants to describe the steps Key stakeholders such as
State mental health divisions, legislators, advocacy organizations
and educators can take to begin developing a more stable and effective
mental health workforce in their respective areas. The identified
steps are:
- Use the President's Commission as a framework
for change.
- Utilize WICHE's resources for training purposes.
- Utilize the WICHE vehicle to assist in evaluation
methods as innovations are put into practice.
- Use WICHE to facilitate dialogue between mental
health and higher education, as well as academics and public mental
health.
- Utilize WICHE to evaluate training/workforce
needs.
- Use WICHE as a repository of implementation
strategies.
- Look for strategies beyond WICHE to impact
educators.
- Look at medication issues, e.g., prescription
privileges.
WICHE agreed to do the following:
- Prepare and circulate a draft report of the
consultations.
- Identify rural mental health disciplines to
be considered for inclusion in WICHE exchange programs.
- Synthesize the discussion and develop a set
of recommendations to be included in a report for Federal, State,
higher education and State agencies.
- Replicate this discussion with appropriate
persons/groups in WICHE States.
- Provide a connection with medical education,
i.e., training initiatives for primary care clinicians being linked
with mental health.
- Develop promising practice models regarding
rural/frontier settings.
- Create an easily accessible resource list.
- Evaluate what tools Governors in the West have
to help articulate State mental health plans.
- Facilitate shorter term exchanges for graduate
programs that do not have an expertise in rural.
- Facilitate evaluation of workforce needs to
present to States and impact licensure, e.g., policy roundtables.
- Help States look at licensure systems as they
bear on rural practice.
- Within the next 12 months, funding should be
made available to support a survey of higher education institutions
to identify those mental health professional training programs
with a rural focus. The survey will determine:
- Program location, discipline, degrees offered
- Capacity
- Rural specific curriculum
- Rural specific applied study/practicum/internship
opportunities
- Linkages to rural public and/or private treatment
systems
- Faculty rural research or practice experience
- Distance learning opportunities for rural
students
- Rural continuing education programs
- Within the next 12 months, funding should be
provided to convene a regional meeting that will include public
mental health policy makers, higher education officials, practitioners
and consumers, to strengthen linkages and mutual accountability
for addressing rural mental health professional shortages.
- Based on recommendations one and two, identify
and support opportunities for regional collaboration to develop
rural specific training and continuing education opportunities.
- In cooperation with the Substance Abuse and
Mental Health Services Administration (SAMHSA), the Health Resources
and Services Administration (HRSA) should establish a funding
opportunity through its Office for the Advancement of Telehealth
(OAT) that solicits demonstration projects focused on distance
learning strategies.
- WICHE, in collaboration with university partners,
should support the development of an articulated career pathway
from paraprofessional through post-graduate training.
- WICHE, in collaboration with State partners,
should explore adding psychiatric nursing to public mental health,
student exchange programs and NEON.
The WICHE West is a vast area rich with people,
knowledge and opportunity. Due to its very rural nature, there are
barriers and challenges facing mental health, particularly in regard
to workforce shortages. However, these consultations demonstrate
that people in leadership positions are willing to meet these challenges
head-on, with optimism and enthusiasm.
Some major themes that emerged from the
consultations were that WICHE States share a common philosophy about
helping people in their communities, face similar problems in their
respective systems, but also have resources within and among the
States. Specifically, there are existing programs that train professionals
to work in rural/frontier areas. However, there is a need to expand
and support these programs innovatively and provide incentives for
clinicians in multiple disciplines to remain in the areas where
their services are most needed. Programs that "grow their own"
clinicians starting at the paraprofessional level and moving to
the advanced graduate level, will be particularly valuable. Additionally,
there is a need to improve training curricula to focus on rural/frontier
issues, provide opportunities to practice in those areas and conduct
research that identifies best practices for treating rural residents.
WICHE has programs in higher education that may be expanded to include
mental health professions. WICHE's Mental Health Program can offer
technical assistance, program evaluation, needs assessment and training
in cultural and rural competence for those States interested.
APPENDIX A
Health Professional Shortage Areas (Mental Health)
Alaska
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation
Type |
N |
ALEUTIANS EAST BOROUGH
|
6
|
Designated Area
|
Single County
|
N |
ALEUTIANS WEST AREA
|
6
|
Designated Area
|
Single County
|
N |
BETHEL AREA
|
19
|
Designated Area
|
Single County
|
N |
BRISTOL
BAY BOROUGH
|
10
|
Designated Area
|
Single County
|
N |
DILLINGHAM AREA
|
9
|
Designated Area
|
Single County
|
N |
FAIRBANKS NORTH STAR BORO
|
14
|
Designated Area
|
Single County
|
N |
HAINES BOROUGH
|
8
|
Designated Area
|
Single County
|
N |
KETCHIKAN GATEWAY BOROUGH
|
7
|
Designated Area
|
Single County
|
N |
LAKE AND PENINSULA
BOROUGH
|
11
|
Designated Area
|
Single County
|
N |
MATANUSKA-SUSITNA BOROUGH
|
14
|
Designated Area
|
Single County
|
N |
NORTH
SLOPE BOROUGH
|
10
|
Designated Area
|
Single County
|
N |
NORTHWEST
ARCTIC BOROUGH
|
10
|
Designated Area
|
Single County
|
N |
PRINCE OF WALES-OUTER KET
|
8
|
Designated Area
|
Single County
|
N |
SOUTHEAST-FAIRBANKS AREA
|
6
|
Designated Area
|
Single County
|
N |
VALDEZ-CORDOVA AREA
|
9
|
Designated Area
|
Single County
|
N |
WADE-HAMPTON AREA
|
11
|
Designated Area
|
Single County
|
N |
WRANGELL-PETERSBURG AREA
|
6
|
Designated Area
|
Single County
|
N |
YUKON-KOYUKUK AREA
|
11
|
Designated Area
|
Single County
|
N |
NOME
|
10
|
Designated Area
|
Geographical Area
|
Arizona
Metro/
Nonmetro |
HPSA
Name |
HPSA
Score |
HPSA
Status |
Designation
Type |
N |
PINAL/GILA
CATCHMENT AREA
|
17
|
Designated
Area
|
Geographical
Area
|
N |
N.
ARIZONA MENTAL HLTH CATCH AREA
|
18
|
Designated
Area
|
Geographical
Area
|
M |
SOUTHWEST
AZ CA
|
18
|
Designated
Area
|
Geographical
Area
|
California
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
N |
CALAVERAS |
19 |
No Data Provided |
Single County |
N |
GLENN |
19 |
Designated Area |
Single County |
N |
IMPERIAL |
18 |
Designated Area |
Single County |
N |
KINGS |
15 |
Designated Area |
Single County |
N |
LAKE |
17 |
Designated Area |
Single County |
F |
LASSEN |
14 |
Designated Area |
Single County |
M |
MADERA |
14 |
Designated Area |
Single County |
M |
MERCED |
18 |
Designated Area |
Single County |
F |
MONO |
7 |
Designated Area |
Single County |
N |
SISKIYOU |
17 |
Designated Area |
Single County |
N |
TEHAMA |
15 |
Designated Area |
Single County |
F |
TRINITY |
18 |
Designated Area |
Single County |
N |
TUOLUMNE |
16 |
No Data Provided |
Single County |
N |
WEST SIDE FRESNO CO (MSSA 25-28) |
15 |
Designated Area |
Geographical Area |
N |
LOW INC - SHASTA CO |
17 |
Designated Area |
Population Group |
N |
VISALIA (MSSA 227, 228, 233A,
233B) |
17 |
Designated Area |
Geographical Area |
N |
EARLIMART (MSSA 230) |
20 |
Designated Area |
Geographical Area |
N |
WOODLAKE (MSSA 229) |
9 |
Designated Area |
Geographical Area |
N |
PORTERVILLE (MSSAS 231 & 232) |
17 |
Designated Area |
Geographical Area |
N |
BARSTOW (MSSA 149) |
17 |
Designated Area |
Geographical Area |
M |
EAST STANISLAUS CO |
15 |
Designated Area |
Geographical Area |
M |
WEST STANISLAUS CO |
16 |
Designated Area |
Geographical Area |
M |
RURAL WESTERN KERN CO |
17 |
Designated Area |
Geographical Area |
M |
GOLDEN HILLS/LOGAN HEIGHTS (MSSA
161C) |
16 |
Designated Area |
Geographical Area |
N |
LANCASTER/PALMDALE (MSSA 77.1A-C) |
15 |
Designated Area |
Geographical Area |
N |
TRACY (MSSA 163) |
14 |
Designated Area |
Geographical Area |
N |
MSFW - YOLO CO (S) |
21 |
Designated Area |
Population Group |
N |
CENTRAL KERN CO (MSSA 61, 66A-66C) |
17 |
Designated Area |
Geographical Area |
N |
RURAL EASTERN KERN CO (MSSA 62-65) |
13 |
Designated Area |
Geographical Area |
M |
INNER MISSION/PORTERS HILL/SOUTH
OF MARKET(S) |
17 |
Designated Area |
Population Group |
N |
DESERT REGION |
17 |
Designated Area |
Geographical Area |
N |
LOW INC - N HUMBOLDT(MSSA 38,39,41-43,45) |
17 |
Designated Area |
Population Group |
N |
GARBERVILLE/REDWAY (MSSA 44) |
13 |
Designated Area |
Geographical Area |
M |
OAKLAND SOUTH (MSSA 2D) |
6 |
Designated Area |
Geographical Area |
Colorado
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
N |
SAN LUIS VALLEY |
17 |
Designated Area |
Geographical Area |
N |
NORTHEAST/EAST CENTRAL MH REG |
14 |
Designated Area |
Geographical Area |
Idaho
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
M |
MENTAL HLTH REGION I |
14 |
Designated Area |
Geographical Area |
N |
MENTAL HLTH REGION II |
15 |
Designated Area |
Geographical Area |
N |
MENTAL HLTH REGION V |
17 |
No Data Provided |
Geographical Area |
N |
MENTAL HLTH REGION VI |
16 |
Designated Area |
Geographical Area |
N |
MH REGION VII |
16 |
Designated Area |
Geographical Area |
M |
LOW INC/MFW - CATCHMENT AREA
III |
|
Designated Area |
Population Group |
Hawaii
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
N |
PUNA |
19 |
Designated Area |
Geographical Area |
N |
KAU CA |
11 |
Designated Area |
Geographical Area |
N |
LOW INC - N HAWAI'I CA |
14 |
Designated Area |
Population Group |
N |
ISLAND OF MOLOKAI |
19 |
Designated Area |
Geographical Area |
M |
KALIHI PALAMA |
14 |
Designated Area |
Geographical Area |
N |
LOW INCOME - HANA-EAST MAUI |
11 |
Designated Area |
Population Group |
N |
WAIMEA SA |
8 |
Designated Area |
Geographical Area |
Montana
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
F |
BEAVERHEAD |
10 |
Designated Area |
Single County |
F |
BIG HORN |
13 |
Designated Area |
Single County |
F |
BROADWATER |
10 |
Designated Area |
Single County |
F |
CARBON |
12 |
Designated Area |
Single County |
F |
GOLDEN VALLEY |
12 |
Designated Area |
Single County |
F |
GRANITE |
11 |
Designated Area |
Single County |
F |
JEFFERSON |
9 |
Designated Area |
Single County |
N |
LAKE |
20 |
Designated Area |
Single County |
F |
LINCOLN |
19 |
Designated Area |
Single County |
F |
MADISON |
11 |
Designated Area |
Single County |
F |
MEAGHER |
11 |
Designated Area |
Single County |
F |
MINERAL |
12 |
Designated Area |
Single County |
F |
MUSSELSHELL |
12 |
Designated Area |
Single County |
F |
PARK |
16 |
Designated Area |
Single County |
F |
POWELL |
8 |
Designated Area |
Single County |
N |
RAVALLI |
19 |
Designated Area |
Single County |
F |
SANDERS |
12 |
Designated Area |
Single County |
F |
STILLWATER |
10 |
Designated Area |
Single County |
F |
SWEET GRASS |
10 |
Designated Area |
Single County |
N |
EASTERN MONTANA |
19 |
Designated Area |
Geographical Area |
N |
LEWISTOWN |
19 |
Designated Area |
Geographical Area |
F |
NORTH-CENTRAL MONTANA |
20 |
Designated Area |
Geographical Area |
N |
SILVER BOW/DEER LODGE |
17 |
Designated Area |
Geographical Area |
Nevada
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
F |
CHURCHILL CO |
17 |
Designated Area |
Single County |
F |
ELKO |
14 |
Designated Area |
Single County |
N |
ESMERALDA |
8 |
Designated Area |
Single County |
N |
EUREKA |
9 |
Designated Area |
Single County |
N |
HUMBOLDT |
17 |
Designated Area |
Single County |
N |
LANDER |
8 |
Designated Area |
Single County |
N |
LINCOLN |
13 |
Designated Area |
Single County |
N |
LYON |
13 |
Designated Area |
Single County |
F |
MINERAL CO |
10 |
Designated Area |
Single County |
N |
NYE |
15 |
Designated Area |
Single County |
N |
PERSHING |
9 |
Designated Area |
Single County |
N |
WHITE PINE |
15 |
Designated Area |
Single County |
M |
WESTERN CLARK COUNTY |
13 |
Designated Area |
Geographical Area |
M |
MESQUITE |
18 |
Designated Area |
Geographical Area |
New Mexico
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
N |
CIBOLA |
17 |
Designated Area |
Single County |
M |
DONA ANA |
17 |
Designated Area |
Single County |
N |
RIO ARRIBA |
19 |
Designated Area |
Single County |
N |
TAOS |
18 |
Designated Area |
Single County |
N |
TORRANCE |
16 |
Designated Area |
Single County |
M |
VALENCIA |
15 |
Designated Area |
Single County |
M |
SOUTHWEST VALLEY |
|
No Data Provided |
Geographical Area |
N |
BORDER MH SERVICE AREA |
20 |
Designated Area |
Geographical Area |
N |
PLAINS MH SERVICE AREA |
18 |
Designated Area |
Geographical Area |
N |
SOUTHEASTERN CA |
16 |
Designated Area |
Geographical Area |
M |
NORTHERN SANDOVAL |
|
Designated Area |
Geographical Area |
N |
CATCHMENT AREA 1 |
19 |
Designated Area |
Geographical Area |
N |
SOUTH CENTRAL CA |
18 |
Designated Area |
Geographical Area |
M |
NORTH VALLEY |
17 |
Designated Area |
Geographical Area |
North Dakota
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
F |
ADAMS |
10 |
Designated Area |
Single County |
F |
BILLINGS |
9 |
Designated Area |
Single County |
F |
BOTTINEAU |
10 |
Designated Area |
Single County |
F |
BOWMAN |
10 |
Designated Area |
Single County |
F |
BURKE |
10 |
Designated Area |
Single County |
F |
DIVIDE |
10 |
Designated Area |
Single County |
F |
DUNN |
11 |
Designated Area |
Single County |
F |
EMMONS |
11 |
Designated Area |
Single County |
F |
GOLDEN VALLEY |
12 |
Designated Area |
Single County |
F |
GRANT |
12 |
Designated Area |
Single County |
F |
HETTINGER |
11 |
Designated Area |
Single County |
F |
KIDDER |
10 |
Designated Area |
Single County |
F |
MCKENZIE |
11 |
Designated Area |
Single County |
F |
MCLEAN |
10 |
Designated Area |
Single County |
N |
MERCER |
9 |
Designated Area |
Single County |
F |
MOUNTRAIL |
10 |
Designated Area |
Single County |
F |
NELSON |
11 |
Designated Area |
Single County |
F |
OLIVER |
10 |
Designated Area |
Single County |
N |
PEMBINA |
10 |
Designated Area |
Single County |
F |
PIERCE |
10 |
Designated Area |
Single County |
N |
RANSOM |
11 |
Designated Area |
Single County |
F |
RENVILLE |
10 |
Designated Area |
Single County |
N |
RICHLAND |
18 |
Designated Area |
Single County |
F |
SARGENT |
11 |
Designated Area |
Single County |
F |
SHERIDAN |
11 |
Designated Area |
Single County |
F |
SIOUX |
12 |
Designated Area |
Single County |
F |
SLOPE |
12 |
Designated Area |
Single County |
F |
STEELE |
10 |
Designated Area |
Single County |
N |
TRAILL |
10 |
Designated Area |
Single County |
N |
WALSH |
10 |
Designated Area |
Single County |
N |
DEVILS LAKE CA |
18 |
Designated Area |
Geographical Area |
N |
JAMESTOWN (CA 38004) |
16 |
Designated Area |
Geographical Area |
Oregon
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
N |
CLATSOP |
17 |
Designated Area |
Single County |
N |
DOUGLAS |
17 |
Designated Area |
Single County |
M |
JACKSON |
16 |
Designated Area |
Single County |
N |
JOSEPHINE |
14 |
Designated Area |
Single County |
N |
LINCOLN |
16 |
Designated Area |
Single County |
N |
TILLAMOOK |
16 |
Designated Area |
Single County |
F |
SOUTHEASTERN OREGON |
18 |
Designated Area |
Geographical Area |
N |
EAST COLUMBIA |
16 |
Designated Area |
Geographical Area |
N |
CATCHMENT AREA 14 |
17 |
Designated Area |
Geographical Area |
N |
NORTHEASTERN OREGON |
18 |
Designated Area |
Geographical Area |
N |
MID COLUMBIA C.A. |
16 |
Designated Area |
Geographical Area |
F |
CENTRAL OREGON |
19 |
Designated Area |
Geographical Area |
M |
LOW INC/MFW/HOMELESS - MARION
AND POLK CO |
15 |
Designated Area |
Population Group |
N |
SOUTHCENTRAL OREGON |
17 |
Designated Area |
Geographical Area |
South Dakota
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
N |
CATCHMENT AREA 1 |
16 |
Designated Area |
Geographical Area |
N |
CATCHMENT AREA 2 |
18 |
Designated Area |
Geographical Area |
N |
CATCHMENT AREA 3 |
17 |
Designated Area |
Geographical Area |
N |
CATCHMENT AREA 4 |
17 |
Designated Area |
Geographical Area |
N |
CATCHMENT AREA 5 |
17 |
Designated Area |
Geographical Area |
N |
CATCHMENT AREA 8 |
22 |
Designated Area |
Geographical Area |
N |
CATCHMENT AREA 10 |
22 |
Designated Area |
Geographical Area |
N |
CATCHMENT AREA 12 |
17 |
Designated Area |
Geographical Area |
Utah
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
N |
SUMMIT |
12 |
Designated Area |
Single County |
F |
TOOELE |
15 |
Designated Area |
Single County |
M |
UTAH |
14 |
Designated Area |
Single County |
N |
WASATCH |
15 |
Designated Area |
Single County |
N |
FIVE COUNTY MHCA (SW DISTRICT) |
17 |
Designated Area |
Geographical Area |
F |
SIX COUNTY MHCA |
19 |
Designated Area |
Geographical Area |
M |
LOW INC - WEBER/MORGAN |
8 |
Designated Area |
Population Group |
N |
LOW INC - FOUR COUNTY MHCA (SE
DISTRICT) |
18 |
Designated Area |
Population Group |
F |
LOW INC - BRIDGERLAND AREA |
15 |
Designated Area |
Population Group |
F |
UINTAH BASIN |
18 |
Designated Area |
Geographical Area |
Washington
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
N |
ADAMS |
20 |
Designated Area |
Single County |
N |
CLALLAM |
16 |
Designated Area |
Single County |
F |
FERRY |
11 |
Designated Area |
Single County |
N |
GRANT |
20 |
Designated Area |
Single County |
N |
GRAYS HARBOR |
17 |
Designated Area |
Single County |
N |
JEFFERSON |
15 |
Designated Area |
Single County |
N |
KITTITAS |
17 |
Designated Area |
Single County |
N |
KLICKITAT |
17 |
Designated Area |
Single County |
F |
LINCOLN |
11 |
Designated Area |
Single County |
F |
OKANOGAN |
20 |
Designated Area |
Single County |
N |
PACIFIC |
14 |
Designated Area |
Single County |
F |
PEND OREILLE |
12 |
Designated Area |
Single County |
N |
STEVENS |
19 |
Designated Area |
Single County |
N |
WAHKIAKUM |
12 |
Designated Area |
Single County |
N |
CHELAN/DOUGLAS |
16 |
Designated Area |
Geographical Area |
M |
MSFW - YAKIMA CTY |
16 |
Designated Area |
Population Group |
M |
TRI-CITIES |
13 |
Designated Area |
Geographical Area |
N |
LOW INC - LEWIS CO |
15 |
Designated Area |
Population Group |
N |
LOW INC - COWLITZ CO |
15 |
Designated Area |
Population Group |
N |
LOW INC/MFW-KAGIT/WHATCOM |
15 |
Designated Area |
Population Group |
N |
GARFIELD/COLUMBIA |
9 |
Designated Area |
Geographical Area |
Wyoming
Metro/ Nonmetro |
HPSA Name |
HPSA Score |
HPSA Status |
Designation Type |
F |
CARBON |
9 |
Designated Area |
Single County |
F |
FREMONT CO |
16 |
Designated Area |
Single County |
F |
LINCOLN |
10 |
Designated Area |
Single County |
F |
SUBLETTE |
9 |
Designated Area |
Single County |
F |
SWEETWATER |
16 |
Designated Area |
Single County |
F |
TETON |
14 |
Designated Area |
Single County |
N |
UINTA |
17 |
Designated Area |
Single County |
N |
NORTHWEST WYOMING MH AREA |
15 |
Designated Area |
Geographical Area |
N |
EASTERN |
7 |
Designated Area |
Geographical Area |
N |
SOUTHEAST |
15 |
Designated Area |
Geographical Area |
F |
NORTHEAST WYOMING MHCA |
14 |
Designated Area |
Geographical Area |
APPENDIX B
Table 4
Components of a Transformed
Rural & Frontier Mental Health Shortage Initiative |
- Strengthened opportunities for rural
training rotations and practica in rural communities
- Rural specific training programs
- An integrated rural mental health training/education
pathway from paraprofessional through post-graduate
- Targeted pipeline efforts to engage indigenous
rural/frontier residents in mental health professional development
(Grow Our Own)
- Strategies to accomplish both immediate
and long-term (e.g., "grow your own") goals
- Distance learning opportunities
- Education in the community and supportive
systems for practice realities
- Revamped curriculum
- Utilization of persons in various professions
connected to mental health
- Professional development
- Tailored programs to meet needs of target
populations, especially related to age
- Maximize National Service Corps
- Collaboration of guilds and higher education
institutions around missions
- Focus on competency-based curriculum
- Understanding the help-seeking behaviors
of the population, especially regarding diverse populations
and cultural competence
- Near-term goal of "re-inventing" current
practitioners (e.g., professionals in transition)
- Public health model that looks at primary
and secondary intervention
- Land grant institutions as model
- Research universities that provide support
for developing best practices related to rural
- Addiction specialists within mental health
field
- Retention efforts re: support and supervision
|
Table 5
Strengths of the Region |
- Commonality of need
- High amounts of relationship capital
- WICHE infrastructure
- Innovative programs in each State to
share
- Budding technology
- Western Interstate Nursing program
- Philosophy of communities wanting to
survive and be healthy
- Researchers currently looking at care
for rural residents that can become best practices
- Health Sciences Centers in a number of
States that are sensitive to these issues
- Current providers as allies in this effort
(e.g., VA, IHS, HRSA)
- Rural associations focused on rural issues
- Diversity and access to growing diverse
populations
- Research centers specifically related
to ethnic minority health issues
|
Table 6
Barriers and Challenges |
- Perception in academia that rural is
second class; rural research is not as significant
- Suburbanization of legislators
- Image of rural as ideal place where there
are no problems
- Feds work on eastern rural model, lack
of understanding of west
- Lack of transportation, lack of access
to technology
- Multiple definitions of rural/frontier
at Federal level
- Limited collaboration and agreement among
particular areas about definition of rural, and based on
factors (qualitative) other than population, etc
- Lack of communication between academia
and practice
- High turnover in State agencies, no system
of regular communication
- Health Sciences Centers regarding public
mental health
- Poorly organized data that is of limited
use
- Lack of investment in rigorous evaluation
models
- Need for multifaceted policy solution
- High expectations of service delivery
to families, but limited delivery
- Limited family/consumer participation
in driving system
- Lack of financial resources
- Lack of long term planning
- Interdisciplinary squabbles
- Institutional racism between multiple
disciplines in the system
- Competition for students among multiple
disciplines
|
Table 7
Potential Mental Health Disciplines |
- Rural behavioral health services program-start
at AA level or certification (exists in Alaska)
- Curriculum for a mental health support
professional or paraprofessional
- Doctoral program in primary care psychology
- Public health focused program
- Collaboration with business school for
education of health care professionals
- WICHE could negotiate development of
new school for master's level providers in psychology
- Rural psychiatric nursing programs
- Rural-specific mental health programs
in nursing
- Expansion of school social work
- Value-added incentives for rural practitioners
- Doctoral program in community clinical
psychology with cross-cultural focus
- Opportunities for rural providers to
exchange with academics, e.g., in-services and providing
services
- PA and nurse practitioners
- Articulated pathway from certificate
to bachelor's
- Disabilities in rural, e.g., deaf and
hard of hearing mental health services
|
Table 8
Academic Assets - Existing
Training Programs |
University of Alaska |
Human Services Certificate – master’s programs
w/rural and cross-cultural emphasis |
University of New Mexico |
Rural Psychiatry program |
University of Wyoming |
Family practice residencies, includes nurse
practitioners and will include social workers and psychology
interns |
Idaho State University |
Similar to U. of WY, rural placements, multidisciplinary |
University of North Dakota |
Quinten-Burdick program |
Sinte Gleska University |
Master’s in human services distance delivery |
UNLV |
Master’s program in nursing with placements
in rural |
University of Oregon Health Sciences Center |
AHEC program and Social work at Portland
State U. |
Billings |
Family practice residency, psychiatrist mentor |
University of Utah |
Interdisciplinary psychology, social work,
psychiatric nursing track |
University of Alaska |
Partnership with family and youth services
for training of child protective services. Also has distance
program for working paraprofessionals “Learn as you Earn” |
Hawaii |
Interdisciplinary primary care program that
includes mental health for 4 disciplines, team experiences in
remote areas |
WWAMI |
|
Alaska |
Rural placements for medical students and
family practice |
Lewis & Clark |
Idaho community technician program |
Wyoming |
Western Wyoming college, human service curriculum
re: disabilities |
Tribal Colleges |
Associate’s degrees in human services programs |
University of Alaska |
Certificate for children’s residential treatment,
use toward associates degree and beyond |
Fort Mead, IHS |
Internship training program |
Idaho |
Ideas group: consortium in multiple States,
curriculum standards related to substance abuse |
|
State mental health partnerships with mental
health programs |
Table 9
Resources |
- State-sponsored repayment programs
- Internal loan repayment, pay for education;
State agency continuing education sponsored
- Federal Office Of Rural Health Policy
Network and Outreach grants
- National Health Core repayment
- Targeted State programs, e.g., Washington
re: critical need
- Employer sponsored career ladder programs
for graduate degrees
- American Psychological Association (APA)
working with HRSA on graduate psych education, geropsychology
programs, and some with SAMHSA
- Health Care Assurance Program (HCAP)
- money to bring collaboration together around health services,
possibly training
- Community Mental Health Council's (CMHC)
mental health as missions; Federal Qualified Health Centers
(FQHC)
- Americorp possible tie-in, educational
stipend
- Title IV-E possibilities? Arizona has
a program
- Virginia system has rural offices
- National Association of Rural Mental
Health (NARMH)
- Tax burden of NHSC loan repayment to
providers - results in loan repayment $ being reserved for
tax help...if tax exempt...up to 40 percent more funds available
to support providers
|
APPENDIX C
Consultant List
By State
Alaska
Blanche Brunk
Director
Health Programs
College of Rural Alaska
University of Alaska - Fairbanks
PO Box 756500
Fairbanks, AK 99775-6500
Phone: (907) 474-6640
Fax: (907) 474-5824
Email: blanche.brunk@uaf.edu
Bill Hogan
Director/Division of Behavior Health
State of Alaska Health & Social Services
PO Box 110620
Juneau, AK 99811
Phone: (907) 465-3370
Fax: (907) 465-2668
Email: director@health.State.ak.us
Gerald Mohatt
Head
Department of Psychology
University of Alaska, Fairbanks
708B Gruening
P.O. Box 756480
Fairbanks, AK 99775
Phone: (907) 474-6415
Email: jerry.mohatt@uaf.edu
Karen Perdue
Associate Vice President
Statewide Health Programs
University of Alaska
PO Box 757040
Fairbanks, AK 99775
Phone: (907) 474-1970
Email: karen.perdue@alaska.edu
Elizabeth Sirles
Director/School of Social Work
College of Health and Social Welfare
University of Alaska Anchorage
3211 Providence Drive
Anchorage, AK 99508
Phone: (907) 786-6907
Fax: (907) 786-7912
Email: afeas1@uaa.alaska.edu
Arizona
Suzanne Rabideau
Policy Advisor
Division of Behavioral Health Services
Arizona Department of Health Services
150 N. 18th Avenue, 2nd Floor
Phoenix, AZ 85007
Phone: (602) 364-4753
Fax: (602) 364-4570
Email: srabide@hs.State.az.us
Idaho
Ray Millar
Program Specialist
Bureau of MH/SA
Idaho Dept of Health & Welfare
450 W. State St., 5th Floor
PO Box 83720
Boise, ID 83720-0036
Phone: (208) 334-6500
Fax: (208) 334-6664
Email: millarr@idhw.State.id.us
Martha Wilson
Director
School of Social Work
Boise State University
1910 University Dr., E-716
Boise, ID 83725-1940
Phone: (208) 426-1789
Email: mwilson@boiseState.edu
Maryland
Blanca Fuertes
Policy Analyst
DHHS/HRSA
Office of Rural Health Policy
5600 Fishers Lane, Rm 9-A-55
Rockville, MD 20857
Phone: (301) 443-0612
Fax: (301) 443-2803
Email: bfuertes@hrsa.gov
Charles VanAnden
Consultant
National Health Services Corp.
12670 Emory Arm Lane
Sykes, MD 21784
Email: vananden@aol.com
Montana
Arthur McDonald
PO Box 326
Lame Deer, MT 59043
Phone: (406) 477-6441
Fax: (406) 477-8157
Nevada
Carlos Brandenburg
Division Administrator
Mental Health & Developmental Services
Nevada Dept of Human Resources
505 E King St, Room 602
Carson City, NV 89701-3790
Phone: (702) 684-5943
Fax: (702) 684-5966
Email: cbrandenburg@dhr.State.nv.us
Larry Buel
Director
Rural Clinics Community Mental Health Centers
503 N. Division St.
Carson City, NV 89703-4104
Phone: (775) 687-3691
Fax: (775) 687-3419
Email: cbuel@dhr.State.nv.us
Roseann Colosimo
Assistant Professor of Nursing
School of Nursing
University of Nevada, Las Vegas
4505 Maryland Pkwy
Box 453018
Las Vegas, NV 89154-3018
Phone: (702) 895-4613
Email: Roseann.Colosimo@ccmail.nevada.edu
Caroline Ford
Director
Nevada State Office of Rural Health
University of Nevada, School of Medicine
Mail Stop 150, SAV 53
1664 North Virginia Street
Reno, NV 89557-0042
Phone: (775) 784-4841
Fax: (775) 784-4544
Email: cford@med.unr.edu
Sheila Leslie
State Assembly Member
Interim Finance Committee
Nevada Legislature
825 Humboldt Street
Reno, NV 89509-2009
Phone: (775) 684-8845
Fax: (775) 333-1059
Email: sleslie@asm.State.nv.us
Pamela Matteoni
Regional Aide
Senator Ensign's Office
400 South Virginia Street, Ste.738
Reno, NV 89501
Phone: (775) 686-5770
Fax: (775) 686-5729
Email: Pam_Matteoni@ensign.senate.gov
Ron Sparks, II
Certifying Officer for Nevada
WICHE Student Exchange Program
The University of Nevada-Reno
Mail Stop 304
Reno, NV 89557-0116
Phone: (775) 784-4900
Fax: (775) 327-5193
Email: sparks_r@scs.unr.edu
New Mexico
Daniel Montoya
Projects Director
Frontier Education Center
The National Clearinghouse for Frontier Communities
HCR 65 Box 126
Ojo Sarco, NM 87521
Phone: (505) 820-6732
Email: daniel@frontierus.org
North Dakota
Mary Amundson
Assistant Professor
North Dakota Primary Care Office
UND - Center for Rural Health
P. O. Box 9037
Grand Forks, ND 58202-9037
Phone: (701) 777-4018
Fax: (701) 777-2389
Email: mamundson@medicine.nodak.edu
Oregon
Paula McNeil
Executive Director
Western Institute of Nursing, SN-ADM
3455 SW Veterans Road
Portland, OR 97239-2941
Phone: (503) 494-0869
Fax: (503) 494-4350
Email: mcneilp@ohsu.edu
Diane Vines
Vice Chancellor for External Relations and Economic Development
Oregon University System
Chancellor's Office
P.O. Box 751
Portland, OR 97207-0751
Phone: (503) 725-5700
Fax: (503) 725-5709
Email: diane_vines@ous.edu
South Dakota
Amy Iversen-Pollreisz
Community-Based Services Manager
Division of Mental Health
South Dakota Dept of Human Services
East Highway 34, Hillsview Plaza
c/o 500 East Capitol
Pierre, SD 57501-5070
Phone: (605) 773-5991
Fax: (605) 773-7076
Email: amy.iversen-pollreisz@State.sd.us
Ed Olson
State Senator
Chair, Education Committee
South Dakota Legislature
41141 252nd. Street
Mitchell, SD 57301
Phone: (605) 995-5773
Fax: (605) 996-2441
Email: deal@santel.net
Wyoming
Pablo Hernandez
Administrator/Mental Health Division
Wyoming Dept of Health
Wyoming State Hospital
P. O. Box 177
Evanston, WY 82931-0177
Phone: (307) 789-3465
Fax: (307) 789-5277
Email: pherna@State.wy.us
James Page
Associate Dean for Clinical Affairs
Medical Education & Public Health
University of Wyoming
Box 3432
University Station
Laramie, WY 82071
Phone: (307) 766-3473
Email: jbpage@uwyo.edu
WICHE Staff
Scott Adams
Post-Doctoral Fellow
Mental Health Program
WICHE
PO Box 9752
Boulder, CO 80301
Phone: (303) 541-0257
Fax: (303) 541-0291
Email: sadams@wiche.edu
Sandy Jackson
Coordinator
Student Exchange Programs
WICHE
PO Box 9752
Boulder, CO 80301
Phone: (303) 541-0214
Fax: (303) 541-0291
Email: sjackson@wiche.edu
David Longanecker
Executive Director
WICHE
PO Box 9752
Boulder, CO 80301-9752
Phone: (303) 541-0201
Fax: (303) 541-0291
Email: dlonganecker@wiche.edu
Jere Mock
Director of Programs and Services
WICHE
P.O. Box 9752
Boulder, CO 80301-9752
Phone: (303) 541-0222
Fax: (303) 541-0291
Email: jmock@wiche.edu
Dennis Mohatt
Program Director
Mental Health Program
WICHE
PO Box 9752
Boulder, CO 80301-9752
Phone: (303) 541-0256
Fax: (303) 541-0291
Email: dmohatt@wiche.edu
Jenny Shaw
Administrative Assistant
Programs & Services/Mental Health
WICHE
PO Box 9752
Boulder, CO 80301-9752
Phone: (303) 541-0311
Fax: (303) 541-0291
Email: jshaw@wiche.edu
APPENDIX D Mental Health Oversight Committee Members FY
2003-04
ALASKA
Walter Majoros
Direcor
Div. Of Mental Health & Dev. Disabilities
Alaskka Dept. of Health & Human Services
ARIZONA
Leslie Schwalbe
Deputy Director
Div. Of Behavioral Health Services
Arizona Dept of Health Services
Div of Behavioral Health Services
CALIFORNIA
Stephen Mayberg
Director
California Dept of Mental Health
COLORADO
Thomas Barrett
Director
Colorado Mental Health Services
HAWAII
Thomas Hester
Chief
Adult Mental Health Division
Hawaii Dept of Health
IDAHO
Roy Sargeant
Bureau Chief
Bureau of Mental Health & SA
Idaho Dept of Health & Welfare
MONTANA
Lou Thompson
Chief
Mental Health Services Bureau
Montana Dept of Public Health & HS
NORTH DAKOTA
Karen Larson
Director
Div of Mental Health & SAS
ND Dept of Human Services
NEW MEXICO
Mary Schumacher
Director
Behavioral Health Services Div
New Mexico Dept of Health
NEVADA
Carlos Brandenburg
Administrator
Div of MH & Developmental Services
Nevada Dept of Human Resources
OREGON
Ann Brand
Administrator
Mental Health & Addiction Services
Oregon Dept of Human Services
Diane Vines
Vice Chancellor for External Relations and Economic Development
Chancellor's Office
Oregon University System
SOUTH DAKOTA
Kim Malsam-Rysdon
Division Director
Div of Mental Health
South Dakota Dept of Human Services
UTAH
Randall Bachman
director
Div of Mental Health
Utah Dept of Human Services
WASHINGTON
Karl Brimner
Director
Mental Health Division
Washington Dept of Social & Health Svcs
WYOMING
Pablo Hernandez
Administrator
Mental Health Division
Wyoming Dept of Health
Wyoming State Hospital
|