Office of Rural Health and Primary Care - mental and behavioral health models

Successful Model for Rural and Underserved Communities

Minnesota Consortium for Advanced Rural Psychology Training

Project: Reduce the shortage of psychologists practicing in rural communities due to poor retention of mental health professionals in underserved areas and enhance access to quality mental health services in rural communities.

Geographic Area: Northern Minnesota

Description: In 2006, five mental health providers in the Detroit Lakes area accepted a $23,000 Minnesota state grant and began writing a curriculum to provide post-doctorate psychologists with first-hand experiences practicing in a rural setting. Minnesota Consortium for Advanced Rural Psychology Training (MCARPT) has graduated eight students with two currently in the program. All but one of the MCARPT graduates have gone on to provide services in underserved areas of Minnesota, with the one accepting a position in rural North Dakota. It has also enhanced the way existing agencies and providers interact for the betterment of an entire rural region.

Background: One of the major challenges for behavioral health care providers in rural areas is that few are adequately prepared for the realities of practicing there. In a rural community, a mental health provider sees a wide variety of clients at all life stages, often referred from various community agencies.

It is also very difficult for providers to decide when their scope of practice has been exceeded and a referral has to be made. Do I keep a client even when I know that there is a provider several hours away with more knowledge about a specific condition? Since many clients won’t travel that far due to transportation or financial issues, are such clients actually better off with the care I can provide even when it will be more generalized?

There is also the aspect of running a “fishbowl medical practice.” Because clients and providers are thrust into the same day-to-day routines, it is difficult, if not impossible, for a provider to ever really leave the office. In a small town, your client works on your car, serves on a church committee with you, attends the same parties. Those are ethical issues that you don’t learn about in school.

In addition to lower pay through a client-base that is primarily covered by either Medicare or Medicaid, there is also the added burden of the inherent risk factors and cultural differences of working with a rural population that is poor, uninsured and living in isolated areas. Another way to describe the problem is by the “four As”: accessibility, availability, acceptability and affordability. Each impact the rural residents seeking even the most basic health care.

Plans for the Future: Originally we expected to financially compensate supervisors at the partner sites. Instead the sites found that having the post doctoral students at their sites was so valuable they began contributing financially to MCARPT.

Future plans continue to focus on ensuring funding for a minimum of two post doctoral students per year. If funding were not an issue, the program currently has the capacity for four students per year.

In addition, the program hopes to continue its history of increasing the number of rural mental health psychologists—if not in our area, then in another rural area of Minnesota or another state.

Contact :
Cyndi Anderson, executive director
Cyndi@mcarpt.org
Minnesota Consortium for Advanced Rural Psychology Training
P.O. Box 948
Detroit Lakes, MN 56502
218-844-6980

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Updated Thursday, March 03, 2011 at 11:17AM