|Natasha and Alysia's |
blog is the first post
in a month-long series
on integrated care in
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The following highlights
insights from two pre-doctoral interns working in rural, integrated primary
care clinics. Their doctoral programs
differ in foci of training, but do overlap in their focus on providing care to
rural, underserved populations. They are
both currently on internship thru a novel "grow your own” model at Stone
Mountain Health Services (SMHS).
Natasha Gouge, MA
|Cummings, O’Donohue, and
Cummings (2009) put it best: "integrated behavioral/primary care is like a
pomegranate: overwhelmingly people say they like it, but few buy it” (pg.
6). I read this statement a few years
ago while reviewing literature for a term paper, and these words have been
engrained in my mind ever since. The
statement, although originally associated to the economic hurdles associated
within integrated care, is not limited to health care costs or
Within my own graduate
training program, which is tailored to train clinicians to work within
integrated care settings and/or among rural populations, several individuals
"don’t buy it”. Despite the program’s
mission offering an appealing training specialty at the onset, as students get
exposure to integrated care and working within rural areas their commitment to
the model and region often seems to wane.
So I might add a similar statement like, "integrated care and working
within rural areas are like vegetables:
overwhelmingly people recognize they are needed, but few enjoy eating
them every day”.
The ideals of integrated
care and of offering services to underserved areas are generally supported in
theory. However, supporting those ideals
and working in the service of those ideals are two very different tasks. And the result? Turnover.
Students, interns, post docs, residents—the list goes on, embark on
clinical experiences in line with these ideals, only to seek other career
opportunities after their initial obligation is over. So after the 9-week rotation, or semester
practicum, or yearly internship comes to a close, some individuals decide they
no longer have a taste for their vegetables.
(Or worse, in the case of rural underserved regions, this realization
occurs after an individual has received their loan reimbursement installments!)
About Stone Mountain
Alysia Hoover-Thompson, MS
My path to liking vegetables
was a long one, as I suspect is the case with many other clinicians in
integrated care. I had an undergraduate
double-major in physics and anthropology (seriously…what was I going to do with
that combination?) and worked in IT staffing and boarding school admissions
prior to applying to Master’s programs in Counselor Education. I loved my Master’s program, but felt that
pursuing a doctoral program that offered more intensive clinical training, as
well as the opportunity to conduct research, really appealed to me.
My doctoral training
program, which has a focus on rural mental health and additional emphases on
cultural diversity, social justice, and evidence-based practice in psychology,
is designed to train generalists in rural mental health. During my final year as a practicum student,
I had the opportunity to work at a Free Clinic doing integrated care. Beyond coursework and readings, I had limited
exposure to the world of integrated care, prior to this opportunity. I vividly remember my first day at this new
site - I could work in a fast-paced environment, seeing patients alongside
medical providers, doing more than just traditional mental health and someone
would eventually pay me for this? Sign
me up for a vegetarian diet!
While integrated primary
healthcare is right for me, it is certainly not the right fit for
everyone. Along the way, I have often
been asked- "How can you see someone in 15 minutes?” "Don’t you miss really
getting to know your clients?” "How do
you work without an office?” Yes,
these are very good questions but are easy to answer for someone who fits in
this model of care. Do I miss having a
cushy couch to nap on over my hour-long lunch break? Yes.
Do I wish that I could go home every day and not have blisters on my
feet from running around the office in impractical heels? Yes.
Would I trade this vegetarian diet for something less PETA friendly? Definitely not.
The farm that produces our
vegetables is SMHS, a Federally Qualified Health Center that consists of 11
primary care clinics in rural, Southwest Virginia. The mission of SMHS is to promote and
provide quality primary health care that is accessible, affordable, and
community-based for the people of Southwest Virginia. Following from this
mission, the organization’s vision is to be the recognized leader in the
provision of accessible health care in our communities, through integrity,
excellence and diversity of services. Services offered by clinics include:
family health care, black lung, assistance in obtaining medication, x-ray and
laboratory, dental and behavioral health counseling. In 2011, SMHS, in conjunction with East
Tennessee State University and Radford University, created the pre-doctoral
internship to address the needs of this patient population.
We both desire to remain
working in rural primary care after the completion of our internship. Are we the norm among doctoral trainees? Probably not.
Most interns uproot themselves and their families for a 1 year training
experience and then move on. To provide
consistent, doctoral-level providers, SMHS created a "grow our own” model. Two
interns began in August of 2011 and they are now both psychologists within the
organization. We began in August of 2012
and hope to also be offered positions to stay on board. To date, we have seen over 300 patient
contacts (in addition to all of our hours of supervision and didactic
Organizations that wish to
train or employ psychologists who enjoy a daily dose of those rural integrated
care veggies, have quite the challenge!
SMHS recognizes that psychologists who desire working in integrated care
can move to a rural region and lose interest in maintaining their position due
to a lack of resources professionally (e.g., referral options for their
patients) and personally (e.g., academic or extracurricular opportunities for
their children); likewise, psychologists who desire serving the underserved, do
not necessarily want to work within primary care settings. With internship opportunities, employment,
and funding ever in flux, how can a better match between an organization and
applicants be found? Well, SMHS has
taken a novel approach: seek out the
vegetable-friendly professionals already residing in the region and grow them
into vegetable connoisseurs.
Alysia Hoover-Thompson is a doctoral candidate at Radford University in the Counseling Psychology PsyD program. She received her MS in Community Counseling from Radford University in 2009. Her research interests include: women’s issues, body image and rural practice.
Natasha Gouge is a doctoral candidate at East Tennessee State University in the Clinical Psychology PhD program. She received her MA in Clinical Psychology from ETSU in 2011. Her professional interests include dissemination and implementation science; program development, innovation, and evaluation; primary care, rural practice, and pediatrics.
Cummings, N.A., O’Donohue,
T.O., & Cummings, J.L. (2009). The
financial dimension of integrated behavioral/primary care. Journal of Clinical
Psychology in Medical Settings, 1-9. DOI 10.1007/s10880-008-9139-2