Community Health Center State Initiative — May 2007

For over a decade there has been an Education GRO advocacy initiative seeking opportunities for psychology education and training with the federal National Health Service Corps (NHSC) and the Federally Qualified Health Centers (FQHC) Programs. Through the Congressional authorizing and appropriations processes, gains were made including statutory authority for including psychologists and other mental and behavioral health providers in the NHSC Loan Repayment and Scholarship Programs. Unfortunately the NHSC chose to focus on the Loan Repayment Program and did not allow health professionals other than those already participating to receive scholarships. Through legislative language during the reauthorization of the FQHCs, mental health services was sought by Education GRO and authorized for the community health centers. In addition, through the appropriations process, funding was secured by Education GRO providing for Mental Health Summits throughout the nation that focused on overcoming barriers to integrated service delivery in underserved communities that included mental and behavioral health.

Most of the progress made in advancing psychology and mental and behavioral health have been through direct and continuous contact with the Bureau of Primary Health Care that administered both the FQHC and CHC Programs. The Bush administration moved the CHC Program to the Bureau of Health Professions that also administers the Graduate Psychology Education (GPE) Program. As a result of these ongoing efforts with these federal agencies, the number of psychologists participating in the NSHC Loan Repayment Program jumped from zero to over 350 and the emphasis on primary care medical was expanded to include mental and behavioral health and the focus became integrated service delivery. The FQHC program created "collaboratives" of community health centers for addressing depression and chronic illnesses with a depression component. The CHCs became more vigilant about the mental health needs of their patients but primarily referred them out partially due to the obstacles for getting reimbursement for medical and mental health services through the same facility. When hiring mental health professionals, the CHCs have tended to hire psychiatrists because they get federal aid to hire physicians and social workers who tend to be less costly.

The directors of the NHSC and FQHC programs who are dedicated to integrated services advised Education GRO to focus on individual states since the CHCs are organized by state through the federally funded Primary Care Associations (PCA). In collaboration with the Practice Rural Health Committee, Education GRO decided to start with CA and NM. CA was chosen because it has the largest number of CHCs but they have the fewer number of psychologists so if successful in CA, that would serve as a model for other states. NM has proven to be interested in addressing the mental health needs of its residents. Prescription drug privileges were grants to its psychologists and as a state with many poor rural communities, it is likely to be motivated to increase the number of psychologists at its CHCs.

In February 2007, Nina Levitt, EdD, Education GRO Director and Gil Newman, PhD of the CA Psychological Association and representing an urban perspective and Marv Megibow, PhD, the CA Psychological Association Rural Representative met with CA PCA officials in Sacramento. They were very receptive to working with us to promote the hiring of psychologists and the utilization of psychology interns at the CA CHCs. In fact, they were working to amend a state law that prohibited the reimbursement of mental health and medical services the same day. The CA Psychological Association provided letters of support for their legislative initiative and Gil Newman, PhD, will follow-up with them on informing CHCs about the value of hiring psychologists and using psychology interns.

Later this year Nina Levitt, EdD and Elaine LeVine, PhD of the NM Psychological Association will meet with the NM PCA with hopefully similar results.