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Growing Vegetable Connoisseurs

Posted By Jodi Polaha, Thursday, January 3, 2013
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Natasha and Alysia's
blog is the first post
in a month-long series
on integrated care in
rural settings.

Read the entire
series here.

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

Natasha Gouge, MA
East Tennessee
State University
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 sustainability.

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!)

Alysia Hoover-Thompson

Alysia Hoover-Thompson, MS

Radford University

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.

About Stone Mountain Health Services

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 training).

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

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