mc faul
DESCRIPTION
TRANSCRIPT
ALASKA ARIZONA CALIFORNIA COLORADO
HAWAII IDAHO MONTANA NEVADA NEW
MEXICO NORTH DAKOTA OREGON SOUTH
DAKOTA UTAH WASHINGTON WYOMING
Rural Behavioral Health: A Glimpse into What is Working and What is to Come Virginia Rural Health Plan Access Council Summit December 7, 2011
Mimi McFaul, Psy.D. Associate Director WICHE Mental Health Program
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
What do many Americans think of when they picture persons with mental health issues?
A homeless person on a city street
An out-of-control teenager in a large metropolitan school
A person on a locked hospital ward
Persons making poor choices
Someone else
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Few Americans Picture
A farmer or rancher with serious depression
The stress associated with changing rural economies
Someone driving 150+ miles to a clinic
A traveling psychiatrist
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
The Cold, Hard Facts
More than 60% of rural Americans live in mental health professional shortage areas
More than 90% of all psychologists and psychiatrists, and 80% of MSWs, work exclusively in metropolitan areas
More than 65% of rural Americans get their mental health care from their primary care provider
The mental health crisis responder for most rural Americans is a law enforcement officer
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
So What’s Different about Rural?
Not prevalence – rural/urban rates of mental disorders are pretty much the same.
Accessibility (getting there and paying)
Availability(someone there when you are)
Acceptability(choice, quality, knowledge)
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Some Common Rural BH Workforce Issues
Lack of sustained effort to prepare and deploy professionals for rural practice
Lack of systematic recruitment and retention of behavioral health workforce
Lack of communication between educational institutions and providers
Those who spend the most time with patients receive the least training
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
How did it get this way?
Stigma/Discrimination
Lack of a rural plan
Lack of sustained effort to prepare and deploy professionals for rural practice
One size fits all planning and funding
Mental Health Care is “optional”
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
What can we do?
Advocacy/Public Education
National Health Service Corps (NHSC) – Rural sites should become eligible sites – recruitment tool
Improve Primary Care/Mental Health Integration
Take rural into account – get a plan
Increase rural training placements
Grow Your Own
Train Natural Helpers (Mental Health First Aid)
Acknowledge rural innovation
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
The Trend Toward Integration of Primary Care and Behavioral Health
It’s happening in an agency near you
How does this impact who we hire? How we train?
Many people seek care for mental health issues in primary care.
Primary care even more central in rural communities where BH workforce is limited.
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
SAMHSA/HRSA Center for Integrated Health Solutions (CIHS)
http://www.integration.samhsa.gov/
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
What are we doing to work on rural behavioral health access?
Suicide Prevention Toolkit for Rural Primary Care Providers
Rural Psychology Internship Consortia (Alaska, Hawaii…)
Integrated Care Projects
State-specific Consultation
Synthetic Estimation of Prevalence and Unmet Need
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
How do we know what is working for rural
communities?
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Urban Testing Ground for EBPs
What is the rural applicabilty?
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Challenges and Opportunities
Challenges of implementing EBPs in rural due to smaller economies of scale
What is a realistic goal for rural?
Evidence-based practice vs. Practice-based evidence
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Many rural behavioral health programs…
Have always relied on creativity and working within their current resources
Have not been researched sufficiently to be considered EBPs for rural
Do not have evaluators (except if attached to a specific grant) to conduct ongoing research
Are fearful of what to do with data and how to use it in a meaningful way – we don’t need to measure everything!
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
It always comes back to…FIDELITY
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Starting with the Community
What’s working in rural communities?
Promising Practice: Treatment programs or interventions designed for a particular population that have at least some data supporting their effectiveness in terms of client outcomes
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Why do this?
Recognition for model rural programs
Share best practices
Connect programs to researchers
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Inside the Boxing Ring: Approaching Heavyweight
Round One: 6 Programs
Round Two: 30 Programs
Round Three: 62 Programs
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Learning from Experience
Need clearly criteria for what defines a rural promising practice but…
Criteria also need specificity for particular program/population served
Need categories to “cluster programs”
The “will” is there but…
Programs need a road map for using evidence to demonstrate success and support program activities
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Rural Promising Practices Project
Nomination Process
Web-based Surveys
Phone Interviews to “drill down”
Categorization Scheme
Pruning Process
Top Tier Nominees
Site Visits
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Selected Questions
Type of “practice nominated”
Rationale/theory for practice
Indicators of success (decreasing symptoms, increasing staff retention)
% Rural
Staff Training/”Fidelity”
Manualized?
Evaluation Staff to collect data?
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
32 of 50 States Represented!
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Categories
Adapting EBPs for Rural
Community education and outreach programs
Integrated care programs
Court teams
Crisis services programs
Hotline programs
Peer support programs
Programs serving special populations
Telemental health programs
Training programs
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Themes
Relevance to Rural
Impact on Rural
Sustainability and Expansion Capability
Capacity
Documentation of Program Information
Effectiveness
Community Engagement
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Highlighted Programs
One highlighted program for each theme
A few examples…
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Goal of Document
Highlight rural promising practices cohort across categories
Resource guide
Information Exchange
hrsa.gov/ruralhealth/pdf/ruralbehavioralmanual05312011.pdf
Future Directions…Dreaming
Rural “Oscars”
Website with interactive functionality
Connecting rural researchers to these programs
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Adapting and Adopting EBPs
Core clinical components
Hybrid models
Climbing up the evidence ladder
Rural-specific criteria
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
ACA and Rural Behavioral Health??
More eligible for services (Medicaid) – heightens workforce issues
How do we incentivize people to be Medicaid providers?
State plans vary for Medicaid benefits for MH
How will our pre-service education, continuing education, and other training programs need to be adjusted to meet new workforce needs driven by integrating care?
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA
NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Questions?
Contact Information:
WICHE Mental Health Program
Mimi McFaul, Psy.D.