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    Mc faul Mc faul Presentation Transcript

    • 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 DirectorALASKA ARIZONA CALIFORNIA COLORADO WICHE Mental Health ProgramHAWAII IDAHO MONTANA NEVADA NEWMEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
    • What do many Americans think of whenthey picture persons with mental healthissues? 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 WorkforceIssues 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 ofPrimary 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 IntegratedHealth 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 ruralbehavioral 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 healthprograms…  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: ApproachingHeavyweight 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 Exchangehrsa.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 ProgramMimi McFaul, Psy.D.mmcfaul@wiche.edu ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING