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Finally, the Fruits of Our Labor! Bringing Integrated Care to Rural Communities in Southern Appalachia

Posted By Jodi Polaha, Ph.D., Thursday, August 11, 2011
Summer 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? Decisions, decisions!

The 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 our labor!

ETSU 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.

Integrated 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 care settings.

That 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.

One 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.

Another 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!

It 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 Administration, DHHS.”

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 surrounding mountains.

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