Neropsychology interns participating in the geropsychology training program at the Department of Veterans Affairs (VA) Black Hills Health Care System in Fort Meade, S.D., don't just provide services to Native American elders and other older people in South Dakota and Montana. During one of their rotations, they actually reside in an assisted living center near the Northern Cheyenne Indian Reservation.
"It's a frontier area-beyond rural," explains coordinator Tami De Coteau, PhD, a program analyst for the Black Hills VA. "They provide the only behavioral health services available."
However, those services may not be available much longer: The Black Hills VA internship program and six other geropsychology training efforts around the country have lost the funding they receive through the federal Graduate Psychology Education (GPE) Program.
Established by the Bureau of Health Professions in 2002, the GPE program provides funds to train psychologists to specialize in providing integrated services to underserved populations in rural and urban areas. In 2003, the program added dedicated funding for geropsychology training.
But now Congress has slashed GPE's budget, explains Nina Levitt, EdD, APA's associate executive director for education policy. The GPE program's fiscal year 2006 budget was reduced from $4.5 million to $2 million, and the $1.5 million dedicated to the geropsychology program was eliminated altogether. (For more on the 2006 and 2007 federal budgets, "Funding forecast".)
"Since the Gero-GPE grants are finishing their three-year cycle, it was decided not to hold a new competition," says Levitt, noting that funding for the seven Gero-GPE grantees ends in September. The loss isn't just a monetary one, she adds, noting that federal recognition can help shape a field's direction and acknowledge its importance.
An urgent need
Of course, it's older people themselves who will suffer from the shortage of properly trained psychologists, says Deborah DiGilio, director of APA's Office on Aging.
"Although most older adults have good mental health, about 20 percent of them do have psychological disorders such as anxiety, depression and cognitive impairment," says DiGilio. Psychologists are also needed to help older people cope with behavioral health issues such as incontinence, medication compliance and bereavement.
But while there's evidence that psychological interventions are just as effective with this growing older population as with younger adults, says DiGilio, older people are less likely than younger adults to seek out mental health services from mental health professionals. Instead, they present in primary care.
"However, the physicians that they see, either because they have not been trained to recognize mental distress in older adults, or because there's ageism or a lack of time, often aren't very successful in identifying and treating older adults with mental disorders," she explains.
Plus, DiGilio adds, there's a shortage of psychologists specializing in geropsychology. "We estimate that we have between 700 and 1,000 geropsychologists," she says. "Estimates have been done saying we need 5,000 or more to meet the need."
This shortage of geropsychologists-and older people's reluctance to seek out their services-is one reason the Gero-GPE program is so useful, says DiGilio: It puts psychologists and psychologists-in-training where older people already are.
Dividends for seniors
For example, Gero-GPE funding allowed the Black Hills VA to create a geropsychology program that trains three interns a year to provide services to underserved rural and Native American elders.
Over the course of the year, the interns spend four months at each of three rotation sites: a geriatric nursing home unit for all elderly veterans at the VA, a tribal facility that includes a senior citizens center in Eagle Butte on the Cheyenne River Reservation and the Heritage Assisted Living Center for the Elderly on Montana's Northern Cheyenne Indian Reservation. Interns return to "home base" in Fort Meade once a week for seminars, classes and supervision. During the week, the program uses videoconferencing to provide clinical supervision to interns at the Eagle Butte site and hopes to bring a similar system to those at the Montana site.
"In our rural communities, the population that tends to be the most underserved is the elderly," explains De Coteau. "The GPE funding has provided monies for us to be able to provide behavioral health services at two communities that would otherwise have little to none."
Although the VA has agreed to pick up costs for the internship program next year, adds De Coteau, the program will have to undergo significant changes. VA rules will force the program to move the Eagle Butte program from the tribal facility to an Indian Health Service hospital and shut down the Montana site altogether.
The funding gap will cause the Gero-GPE program at the University of South Florida (USF) and Tampa VA Medical Center to close altogether. And that closing poses a significant loss to comprehensive health services to older adults, given the program's integrated health focus, says the program's preceptor, Victor Molinari, PhD, a professor in the Department of Aging and Mental Health at USF's Florida Mental Health Institute.
"The mission of the joint USF/Tampa VA fellowship is to bridge the training gap by teaching students to understand the biopsychosocial needs of older adults by working with other health professionals to provide optimal interdisciplinary care in primary-care and geriatric settings where they feel comfortable being treated," explains Molinari, also a member of APA's Committee on Aging.
The postdoctoral program trains three geropsychologists per year to provide services to underprivileged elders at VA sites, including a nursing home, memory disorders clinic, traumatic brain injury clinic and spinal cord injury unit. Other rotations include a rural health clinic and an assisted living facility. The postdocs also receive training in interdisciplinary teamwork and public policy issues.
One former participant has taken a job serving rural veterans, while another is headed to New Orleans to work with the city's remaining nursing homes.
Now Molinari is working with APA staff and others to help restore the geropsychology funding for fiscal year 2007. They also aim to raise GPE funding as a whole back up to at least $4.5 million. One key strategy will be to ask geropsychologists who are constituents of key members of the congressional Appropriations Committee to explain the program's importance to their senators and representatives.
"We need to inform our legislators that this program is a drop in the bucket in terms of the amount of money it costs, but yields a tremendous dividend," says Molinari.
Rebecca A. Clay is a writer in Washington, D.C.
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