History of Education GRO Initiatives on Federal Community Health Centers & National Health Service Corps

Federally funded Community Health Centers (CHCs) were created because of the millions of Americans, living in inner-city neighborhoods and rural areas throughout the country that suffered from deep poverty and a desperate need for health care. CHCs, which are in underserved areas, also have HPSA designations. Both of these federal programs hold promising employment prospects for psychologists willing to work in our nation's underserved communities in rural and urban areas.

The National Health Service Corps (NHSC) provides financial assistance to psychologists (and other health professionals) in exchange for providing health care services in designated underserved areas known has Health Professional Shortage Areas (HPSAs). In order to gauge the relative need for health care clinicians in communities, the health professional shortage area (HPSA) designation process was established in 1978. Under this process a community must demonstrate a quantifiable critical shortage of health professionals through designation as HPSA in order to qualify for NHSC placement assistance. There are three categories of health professional shortage areas: medical, dental and mental health. Psychologists are listed in the mental health category.

The National Health Service Corps (NHSC) was created due to the health care crises that emerged in the U.S. in the 1950's and 1960's. Rural areas and inner-city neighborhoods competed unsuccessfully with affluent medical practices that offered higher compensation, more interaction with other professionals, and job opportunities for spouses. Rural communities lacked resources to provide the technologically sophisticated facilities that many physicians desired. The National Health Service Corps (NHSC), founded by the Emergency Health Personnel Act of 1970 by public law 91-623, was created to “improve the delivery of health services to persons living in communities and areas of the United States where health personnel and services are inadequate.” In 1974, the NHSC was expanded to include clinical psychologists, social workers, and marriage and family counselors but psychologists did not participate until 1995.

1994

• Meeting of Education GRO staff & NHSC officials in the Office of Senator Daniel Inouye (D-HI) to discuss reviving the dormant Mental Health professions category & including psychologists for the 1st time.

• Education GRO staff successfully gained the inclusion of Report Language in the FY 1995 Labor-Health & Human Services-Education Appropriations bill to promote the inclusion of Psychologists in the NHSC Loan Repayment Program.

 
1995

• Start of on-going discussions with the NHSC on focus on integrated care that included psychologists and other mental health professionals

• First seven slots were awarded to psychologists in NHSC Loan Repayment Program

 1996

• Education GRO staff began talks with the Office of Shortage Designation to get the Mental Health Professional Shortage Areas (MHPSA) designation revised

• Again there was report language in the appropriations bill to support/boost NHSC attention to mental health professions

1997

• Education GRO staff succeeded in getting behavioral added to the Mental Health category

• A NHSC official was assigned to mental & behavioral health issues

• Technical Assistance materials on mental and behavioral health services were developed

• Again there was appropriations report language on mental & behavioral health professionals

1998

• NHSC dedicates $60,000 to jump start a Mental and Behavioral Health Pilot Project in six states

• APA participates in 25th NHSC Conference

• Again there is appropriations report language on mental & behavioral health professionals

1999

• Education GRO staff secure $1 million for NHSC through the House Appropriations Labor-Health & Human Services Appropriations bill for regional mental & behavioral health initiatives

• Education GRO staff began discussions with the National Association of Community Health Centers (NACHC) to gain their support in placing psychologists in CHCs

2000

• Three NHSC-SAMHSA Behavioral & Mental Health Summits were implemented involving 29 states

• APA helped write new NHSC-Mental Health brochure

• Education GRO staff were actively involved in the reauthorization of the NHSC and lead the NHSC Coalition on the reauthorization

• The reauthorization process granted psychology Primary Care status and clarified the eligibility of psychology in the NHSC Loan Repayment Program.

2001

• In the Congressional effort to reauthorize the CHC and NHSC programs, Education GRO staff were successful in the following: The NHSC portion of the bill defined mental health care providers as primary care providers and made psychologists eligible for both the Loan Repayment and Scholarships Programs; The CHC added mental health services for the first time, but only under optional services; The CAP program reinforced mental and behavioral health care as a part of primary health care. An amendment was also successfully proposed to change “clinical psychologist” to “health service psychologist.”

2002

• In 2002, President Bush signed the Safety Net Bill, reauthorizing the NHSC along with APA recommendations on Mental and Behavioral Health for the CHC and CAP programs. The bill also provided $146 million to fund financial incentives for psychologists and other health professionals to work in underserved populations.

2003

• Appropriations Report Language on increasing the number of psychologists was included in the Senate bill

• HRSA began the process of revising the procedure used to determine Mental Health Profession Shortage Areas after many requests by APA

2004

• Psychologists were actively involved in the NHSC Loan Repayment Program and the Ambassadors Programs.

2005

• In fact, there were over 200 unfilled requests for psychologists by community health centers and other eligible health facilities.

2006

• Education GRO staff were involved in the revision of the MHPSAs designation conducted by the University of North Carolina's Shep Center.

2007

• A final draft of the revision of the MHPSAs designation was completed that significantly increased the number of those shortage areas nation wide

• Education GRO staff undertook a state effort to increase the number of psychologists and interns working in CHCs in collaboration with the CA Psych Association and the Practice Rural Health Committee and the California Primary Care Association

• Efforts began to gain the inclusion of doctoral level school psychologists in the NHSC Loan Repayment Program