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.
It was while
rambling around central Alabama during my grad school years that I fell in love
with rural work. That sent me to
Nebraska, where the "rambling” turned career; I started providing behavioral
health services in a rural pediatric primary care clinic in 1998 making a
160-mile one-way trip each week.
Rambling indeed! More recently, I’ve
been rambling over the mountains and into the deep "hollers” of the Appalachian
region training students in our doctoral program in Clinical Psychology at East Tennessee State University (ETSU).
willingness to ramble is a central requirement for those interested in rural
work: distances for team meetings, consultations, and school visits are
greater, or more difficult to traverse.
But work in rural areas requires a hardiness and commitment on many
fronts and it’s been tough to find professionals willing to step up to this
kind of work. In Appalachia, Hendryx
(2008) found that near 70% of nonmetropolitan counties are considered to be
mental health professional shortage areas.
Nationally, rural regions are nearly 5 times as likely to be designated
as a mental health professional shortage area than urban regions (Merwin,
Hinton, Dembling & Stern, 2003).
Jameson and Blank (2007) point to integrated
care as having promise for the future of behavioral health practice in rural
areas. In fact, integrated care may have
particular advantages in rural areas.
For example, integrated care might reduce stigma, which is thought to be
stronger among rural residents and impacts their decision to seek services (Hoyt,
Conger, Valde, & Weihs). Moreover, in
a small community one’s car parked outside a specialty mental health clinic is
more readily noticed than in an urban area; a privacy concern readily addressed
by using an integrated model of service delivery. Another advantage may be increased job
satisfaction for rural health care providers.
Certainly this would be a benefit in any setting, however, in rural
areas this is a particular perk for providers who are often burdened with
providing specialty services (such as mental health) which are not otherwise
available in the community.
To create a conversation about rural integrated care, I am hosting a series of topical posts on the CFHA Blog. I'm especially pleased with authors we have recruited. I have invited academics and clinicians working in various rural
communities to discuss their experiences confronting the challenges of rural
work and their thoughts about the utility of integrated care. A few authors are student providers who can
provide insights about "coming into” this work.
Others have been involved in program development and clinical services
in rural areas for many years. I hope
you will ramble along with us!
by Joe Evans and Rachel Valleley
by Natasha Gouge and Alysia Hoover-Thompson
by James L. Werth
by Jamie Tedder and Jeff Ellison