gardens everywhere are kicking out crops at last. Just yesterday I
pulled six cucumbers from a vine and set three more tomatoes on the
kitchen windowsill. Hmmm… with balsamic and oil? Mozzarella and basil?
Psychology Department at East Tennessee State University (ETSU) is at a
similar point. About ten years ago, a grant from HRSA provided seed
funds to develop an idea: a doctoral program in Clinical Psychology with
a special emphasis on rural, integrated care. About five years ago,
the program accepted its first cohort. This fall, the program will have
a full complement of students including three attending internship.
It’s been a long growing season and we are excited to see the fruits of
is nestled in the foothills of the Appalachians. We’re a gorgeous
one-hour drive through the mountains to Asheville, NC or to dozens of
other communities nowhere near as populous, gentrified, or well-served.
The University has established a niche in serving rural communities
across multiple disciplines with, for example, an award-winning program
in Rural Family Medicine. That our new doctoral program would serve
rural communities was a given.
care boasts particular advantages in rural communities where travel and
stigma are top barriers to behavioral health care. So, it made sense
to our program’s forward-thinking founders*, that the integrated model
should be a strong component and we developed a program with graduated
didactic and experiential rural and integrated
training elements. This includes interdisciplinary courses with other
health professionals, courses in our department exclusively focused on
integrated practice, and out-in-the-field experiences in integrated care
at the observer, externship, and, if chosen, internship levels. This
year, two of our three students will complete internships in integrated
said, the shortage of behavioral health providers is perhaps the most
significant barrier to care in rural areas and simply training our
students to provide integrated care is not enough to address it. In
developing a program with a rural focus, we have had to grapple with how
to use the integrated model in innovative ways to get services to
remote places and
to recruit students to locate to rural communities, particularly in our
underserved region. This is where working in the garden gets really
fun. To extend the metaphor, it is a little bit like moving beyond
simple plant-and-pick gardening to learning how to preserve seeds, use
cuttings to start new plants, or can crops.
example includes the development of the Southern Appalachian Children’s
Telebehavioral Health Clinic. Funded by HRSA (Office for the
Advancement of Telehealth**), this Clinic is staffed full-time to
provide behavioral health consultation to patients in five pediatric
clinics in rural Tennessee and one school-based health network in rural
North Carolina. Equipment is located in primary care clinics and "open
access hours” allow physicians on-the-spot consultation and the capacity
for warm hand-offs which, sometimes occur at a rate of 5 to 8 in a day!
We are experimenting with all kinds of interesting seeds and it is
thrilling to see some of them sprout and grow.
example is the initiation of the East Tennessee/Southwest Virginia
Predoctoral Psychology Internship. Few local internship opportunities
for our students meant that some of them would have to move away from
the region for a year and the possibility that they might not return to
grow the local workforce. Recently, Dr. Kay Matlock of Stone Mountain
(an FQHC based in rural Southwest Virginia about one hour northwest of
ETSU) was awarded HRSA, Office for Workforce Development funding to
develop behavioral health professions training at their site, using a
truly integrated model. Co-directed by Dr. Jodi Polaha (ETSU) and Dr.
Jim Werth (Radford University), this predoctoral internship will see its
first trainees begin on August 15th.
This reminds me of our strawberry plants, whose runners leap from
garden boundaries about this time of year. We cut them and plant in
another bed, providing a whole new crop in the Spring!
has been a pleasure to write this blog entry, to take the time to
appreciate all we’ve grown, and to anticipate our "fall garden” which
will be very full indeed! Now, out to the garden with all you readers!
You can never put enough water down in August, and, for a readership of
forerunners in integrated care, I’m guessing you’ve got a few baskets
of your own veggies to harvest!*Dr.
Peggy Cantrell, Director of Clinical Training; Dr. Wallace Dixon, Jr.,
Department Chair; Dr. Bruce Beringer, Office of Rural Health **
The project described was supported by grant number H2AIT16623 from the
Office for the Advancement of Telehealth, Health Resources and Services
|Jodi Polaha, Ph.D.
is an Associate Professor in the Department of Psychology at East
Tennessee State University where her primary professional interest is
research, training, and workforce development in rural integrated
practice. In addition to her work, she spends lots of time with her
husband and two young boys swimming, biking, and hiking in the