Building a stronger workforce in rural America: mental health stakeholders in rural Missouri develop education and training opportunities to attract and retain staff.

Providing behavioral healthcare services in today's ever-changing environment can be challenging for any organization, especially those located in rural areas. The recruitment and retention of qualified professional staff in rural areas are daunting due to lower compensation levels and the scarcity of qualified professionals compared with urban areas.

Midwest Behavioral Healthcare Management, Inc. (MBHM), headquartered in Clinton, Missouri, manages two behavioral healthcare organizations: Pathways Community Behavioral Healthcare, Inc., and Royal Oaks Hospital. Together they provide a full continuum of behavioral healthcare services to individuals across Missouri. MBHM realized the ominous position that rural healthcare providers face, and took a proactive approach by establishing clinical training and educational opportunities in rural Missouri through an innovative effort called Project Training Enhancement of Rural Mental Health (TERMH).

MBHM designed Project TERMH in coordination with the Workforce Development Board of Western Missouri, Inc. (WDB) and the Forest Institute of Professional Psychology. Project TERMH became fully funded in the fall of 2003 with an $8.2 million grant from the U.S. Department of Labor. The grant originally was for three years, and a one-year extension was granted. The Project TERMH Management Committee is comprised of staff from the WDB and MBHM.

Four Initiatives

Project TERMH is comprised of four initiatives. Initiative One is the expansion of a psychiatry residency and fellowship training program at Royal Oaks Hospital, a training program approved by the Accreditation Council for Graduate Medical Education for general psychiatry residents, child/adolescent psychiatry fellows, and geriatric psychiatry fellows from the University of Missouri--Columbia (UMC) School of Medicine's Department of Psychiatry. UMC has limited clinical operations where training can occur. The university relies on outside organizations, such as Royal Oaks Hospital, to provide clinical training for residents and fellows. Project TERMH provided funds to establish a geriatric psychiatry program and to support an existing child/adolescent fellows program at Royal Oaks Hospital.

Empirical data have shown that many psychiatrists stay in the area where they complete their training. Therefore, by increasing the number of psychiatry fellowships in rural Missouri, Project TERMH aims to have more psychiatrists stay in the area, reducing the need for psychiatrists with H-1B visas, who can stay in the country for only a limited time.

Initiative Two is a psychiatric/mental health advanced practice nurse training program directed by Robin Vogt, PhD, RN, FNP-C, director of medical services at Royal Oaks Hospital. The objective is to train 15 people with a bachelor's degree in nursing to become psychiatric/mental health APNs, who can diagnose and prescribe medications for mental health needs while working in collaboration with psychiatrists.

UMC's Sinclair School of Nursing provides online training for nurses with a BSN to become a psychiatric APN. Participants receive 45 online semester credit hours, as well as 500 hours of supervised clinical practicum. The curriculum provides training specifically geared to give students a strong base in psychopharmacology, treatment, and diagnosis of mental health disorders. An additional program, Enhancement of Psychiatric Skills, began in February and targets 30 RNs and LPNs to address psychiatric issues encountered by frontline workers.

"Initiative Two has embraced nurses making the transition from a nursing model to that of a medical treatment model," says Dr. Vogt. "This Initiative truly allows for the expansion of available [mental] healthcare professionals to the workforce."

Initiative Three aims to increase the number of clinical psychology internships and residencies by targeting 51 pre/postdoctoral candidates, thus creating more mental health professionals to triage, manage, and provide care to patients with mental health needs in rural Missouri. Through Initiative Three, the Heart of America Psychology Training Consortium was created to initiate and maintain a training program for doctoral psychology interns and residents. The training consists of 2,000 hours for both pre/post-doctoral participants. After completing the training and passing the examination, participants are eligible for licensure as a psychologist.

"Our training program has not only increased the number of mental health practitioners in rural Missouri, but has also provided over 20,000 hours of patient care that otherwise would not have occurred," says C.J. Davis, PsyD, director of professional services at Royal Oaks Hospital and director of Initiative Three.

Initiative Four is psychiatric training for primary care physicians, modeled from the UMC International Center for Psychosocial Trauma's "Teachers as Therapists" program. Initiative Four's objective is to provide specialized psychiatric training for licensed medical professionals to increase the availability of mental health services in rural Missouri. Training consists of five sessions with a total of 84 hours of classroom and clinical components. "Project TERMH, particularly Initiative Four, represents an innovative answer to the shortage of psychiatric services in rural areas," says Syed Arshad Husain, MD, executive vice-president of medical services for MBHM, chief of child/adolescent psychiatry at UMC, and director of Initiative Four.

Results

"In rural Missouri the need for mental health services far exceeds the availability due to the severe shortage of qualified professionals," explains Al Greimann, president/CEO of Royal Oaks Hospital. "Project TERMH has helped narrow that gap, as several participants from each of the initiatives have remained in the rural areas to practice their specialty."

To date, 139 mental health professionals have been trained through Project TERMH, with 128 remaining in rural Missouri to practice. This has dramatically helped to increase the availability of mental health services in rural areas. Additionally, 100 participants are enrolled for this training year.

Although our grant expires this year, many of the initiatives will remain operative. Initiative One will continue, as this program was in place before Project TERMH. Initiative Three will continue on a smaller scale with fewer clinical sites until further funding is attained to sustain the Consortium. Initiative Four also will continue. Project TERMH's Coordinating Committee is reviewing each initiative's budget and operation to determine what resources are needed to successfully continue each initiative.

By creating unique and innovative programs through unprecedented partnerships, Project TERMH has provided additional outlets to serve those in need of mental health services, as well as provided educational training opportunities in rural areas.

For more information, write to Brian Martin at Midwest Behavioral Healthcare Management, Inc., 1800 Community Dr., Clinton, MO 64735.

BY BRIAN MARTIN, MBA

ABOUT THE AUTHOR

Brian Martin, MBA, is Director of Business Development at Midwest Behavioral Healthcare Management, Inc., in Clinton, Missouri. He is also the Financial Manager for Project TERMH.

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