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Breaking Down Silos in Rural Healthcare
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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.

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).

A 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!

Click on the links below to read the rural series posts:

Necessary Components of Integrated Behavioral Health in Rural Primary Care
by Joe Evans and Rachel Valleley
by Natasha Gouge and Alysia Hoover-Thompson
by James L. Werth
by Jamie Tedder and Jeff Ellison


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CFHA is a member-based, 501(c)(3) non-profit organization dedicated to making integrated behavioral and physical health the standard of care nationally. CFHA achieves this by organizing the integrated care community, providing expert technical assistance and producing educational content.