Rural Mental Health
Workforce Development Meeting
March 4 – 5, 2005
Mesa, AZ

Meeting Minutes
Friday March 4th

Welcome
Norma Garcia-Torres, Arizona Dept. of Health Services

Achieving the Promise for Rural Amercians (powerpoint)
Susan Keys, SAMHSA

Rural Mental Health Workforce Development & Higher Education (powerpoint)
David Longanecker, WICHE

Rural Mental Health Challenges and Opportunities Caring for the Country (powerpoint)
Dennis Mohatt, WICHE Mental Health Program

Establishing a National Agenda for Strengthening the Behavioral Health Workforce/Annapolis Coalition (powerpoint)
Michael Hoge/John Morris


Saturday March 5th

Heather Koch, Pat Kerstner
Bridging the two cultures of community behavioral health delivery system and academia
Integrate Arizona clinical practices models into the higher education curricula
Develop and recruit a workforce that is representative of the local communities; grow your own approach

Cultural Competence Workforce Development and African Americans (powerpoint)
Thomas Arthur

Cultural Competence Workforce Development and Latinos (powerpoint)
Pablo Hernandez

Cultural Competence Workforce Development and Native Americans (powerpoint)
Art McDonald

• Resources
  o Commitment of time, space, money & people
  o Interface with government
  o Engage the states that are funding active rural recruitment

• Evaluation and Outcomes
  o Consider participatory evaluation models – include family members & consumers
  o Translate evaluation outcomes into useable language for community stakeholders

• Training
  o Train people as educators at all levels of organization – broaden training models for advocacy, training, education
  o Revamp training to be evidence-based
  o Include rural issues across curriculum, and in preparation of mental health professionals and other provider groups
  o Bring accrediting bodies together
  o Identify model rural training programs
  o Leadership ladders (continuing leadership education)

• Grow Your Own
  o Identify potential pools of students
  o Distance learning across career ladder
  o Develop more programs - entry-level mental health @ community colleges (accessible education)

• Cultural Competence
  o Implement class standards from office of minority health
  o Recognize what you don’t know (missing)
  o Include rural in cultural competence

• Community Collaboration
  o Get cash on table
  o Consult communities about their unique needs
  o Include consumers in decisions

Break-out groups derived from above list
1. Distance learning across career ladder
Goal: Use Distance Education as a strategy to meet the needs that states identify as gaps across rural behavioral health career ladder
Outcome: A seamless distance-delivered education for all rungs of the rural behavioral health career ladder

State MH and Education Dept. Partnership

• Conduct Needs Assessment/Gaps
  • Technology or alternative learning models,
    • What would make this training accessible? (i.e. IT capacity, etc.)
  • Workforce
    • Who needs training across career ladders?
    • # of people needed; what do they need to know; how long is the demand?
  • Catalog what’s out there
    • Current distance learning mechanisms
    • Model rural behavioral health curricula
  • Business plan (e.g. fiscal feasibility, regulatory issues, etc.)
• Fundraising/Grant Writing/ Toil/Delineate Outcomes
• Develop the curricula to fill gaps in career ladder
  • What distance learning/alternative learning method(s) to use
• Train in specific distance learning/alternative learning methods
• Evaluate

• “Usual suspects”
  • Consumers
  • Leaders (identified by community)
  • Broaden the “net”
  • Schools, Churches
• Value of broadening search
  • Helps to bread down barriers that mental health field has created
• Develop plan for how process will work (always a gap between forecast and reality). Need to forecast the changing need and resources in community – demographics.
• In the analysis, understand concept of “stigma” – don’t re-create it
• Part of needs analysis – assess readiness for change
• Workforce
  • Promote retention of students in schools so community can provide foundation for local workforce
  • Import people into workforce to provide linguistic and cultural competency

3. Include rural in cultural competence
Goal: Determine ways to introduce rural and “cultural humility” into cultural competence. I.e. unique aspects of rural; no one rural; values of individual and community; spirituality; linguistics; provide services well

• DSMIV Clinical Formulation Subset – use to promote cultural identity
• Vision of culture – incorporate frontier/rural into cultural competency and diversity (i.e. panels and presentations, definition and training)
• SAMHSA should provide fellowship programs for those seeking advanced training as Rural providers – “how to become a rural provider”
• SAMHSA should provide curriculum for disparities in rural mental health
• Likely impact on consumers and families
  • Quantifying resources available
  • Will facilitate inclusion of frontier/rural into training and under-representation from frontier/rural communities
  • States will recognize disparities and this will reduce feelings of alienation in local planning
  • Include in polity reports; work with Guild Organizations to incorporate rural
  • Can link with cultural community brokers/National center on cultural competencies – model after this “Rural Cultural Brokers”
• Obstacles
  • Lump as one single entity of Rural, don’t see diversity
  • Without appreciation of knowledge base in rural
  • Policies written around urban
  • Schools are in urban areas – have to grow our own in that solution; need from urban US rural placements
  • Power differential urban/rural
  • Isolation problems
• Change:
  • Shifting priorities of universities to better rural training
  • Rural technology
• Likely partners:
  • Guilds
  • National conference of state legislatures
  • Private institutions – to focus on rural issues (i.e. education, industries)
  • Employee assistance programs
  • Training programs (include frontier/rural in all aspects of training; with goal of reducing disparities)
  • Consumer advocacy groups
  • Rural/frontier minority populations
• Materials, resources, successful models already available:
  • Class standards – Office of Minority Health
  • DSMIV Clinical Formulations
  • APA cultural standards document
  • National Center of Cultural Competence (Georgetown University)
  • SAMHSA’s RFPs should have extra points for prioritizing incorporating rural
    • Increase research resources for rural mental health research and prioritize rural in RFPs

• Definition:
  • Urban-based delivery to rural
  • Created in rural
  • Blended treatments delivered in specific locales
• Content of training
  • 5 vision principles focused on rural
    • holistic view of person
    • interdisciplinary
    • promotion/prevention/Tx
    • evaluation system
    • verify model effectiveness
  Delivery Methods
  • Interdisciplinary
• Audience
  • “Adopters”
    • Universities, community colleges, high schools
    • State agencies, community agencies
    • Training associations, professional associations, licensing/accrediting groups
  • Trainees
    • Persons in recovery
    • Staff at all levels
    • Students in professional programs
    • Community leaders/agencies
    • Career changers
    • Rural residents
    • High-schoolers, elderly, military
  Career Ladder
• Concretes
  • Call for nominations of innovative, successful rural programs
    • Must have data
    • Call goes to all professions
  • Factors that lead to success in rural
  • Interdisciplinary exchange and intention
  • Replication – expansion (resources)
  • Dissemination

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