By Bridget Murray
Monitor staff

Thanks to a government program, psychologist Liliana Hoyos Kite, PsyD, a 1996 graduate of the University of Denver School of Professional Psychology, is enjoying her first job and the salary it brings.

In return for her work with underserved Hispanic youth and families, the federal government is paying off Kite?s graduate school loan.

The funding comes from the National Health Service Corps (NHSC), a federal Bureau of Primary Health Care loan-repayment program that places health professionals in underserved areas. Health professionals who work in an underserved area for two years get up to $50,000 in loan repayment, and a three- or four-year commitment pays them up to an extra $35,000. Kite has opted for the three-year plan. The only stipulation is that she spend all her work time seeing patients, regardless of their ability to pay.

Such hands-on work is Kite?s forte. The Hispanic clients she serves in her job at Charter Oak Terrace Rice Heights Health Center Inc. in Hartford, Conn., are mostly monolingual Spanish-speakers who need help conquering learning disorders and substance abuse or dealing with AIDS. Kites says her fluency in Spanish and English is a real asset in her work, enabling her to effectively do psychotherapy with her clients as well as coordinate their housing, medical treatment, special schooling and other services.

Before 1990, Kite would probably not have reaped NHSC?s benefits. Back then legislators proposed scrapping the program, and physicians and dentists were its primary beneficiaries. But, in 1990, when Congress decided to continue the program instead of cutting it, the NHSC began encouraging underserved communities to fill a growing need for mental and behavioral health professionals. Soon afterwards, with the work of APA?s Education Directorate and NHSC?s leader, physician Donald L. Weaver, MD, and support from APA?s Practice Directorate, the Corps started admitting psychologists.

APA set the process in motion, and with Weaver?s help, 13 repayment positions were slated for psychologists by 1995. Since then, the number has grown slowly but steadily to a total of 20.

Officials in APA?s Education Directorate hope to open even more slots to psychologists through continued work with Weaver. The outlook is promising, says Nina Levitt, EdD, APA?s director for education policy, because the NHSC recently committed itself to boosting the number of mental and behavioral health participants it funds. The program has stepped-up its attention to the mental and behavioral health care professions ?to better meet the needs of the poorest, least healthy, most isolated members of our society,? says Weaver.

Defining the need
Just as it does with dentists and physicians, the NHSC targets areas of the country that lack adequate mental and behavioral health services. Almost three quarters of the shortage areas are rural, the rest are mostly urban. The program supplies health professionals where they are sparse and scattered ?separated from patients by vast midwestern plains, the sheer cliffs of the Rockies or miles of scorching Southwestern desert.

It also sends health providers into inner cities, where gunfire, poverty and rampant substance abuse make providers scarce?and the need for them all the greater.

To be designated a shortage area, a region must have a low health provider-to-population ratio; have high rates of poverty, alcoholism and substance abuse; and have substantial populations of elderly or young people.

Shortage areas can be as large as several counties or as small as a town. Providers serve their populations in a variety of ambulatory settings, from community health, migrant or mental health centers to prisons and schools. NHSC data on shortage areas indicate high need for mental and behavioral health providers. State and local officials have identified more than 500 communities as mental health shortage areas, and there are likely many more, according to APA?s Levitt. Plenty of psychologists and other mental and behavioral health professionals are willing to fill that need, she says.

Why the high need? It?s likely because urban and rural areas suffer higher poverty rates and have less money for health care, says Louise Doss-Martin, a public health analyst at the NHSC. Country dwellers must often drive for hours to seek treatment, and inner-city residents have far fewer health care services than their suburban neighbors.

Getting placed
Each year, the NHSC?s designated shortage areas change as their population-to-provider ratios fluctuate. Psychologists interested in participating must be sure they apply for positions in a current shortage area.

The NHSC favors providers with special skills geared for underserved populations. Kite?s bilingualism and training in treating trauma and addictions gave her a boost because it qualifies her for work with Hartford?s large monolingual, Spanish-speaking population. Language differences are an enormous barrier to health services, she says.

Luck can also play a role in gaining loan repayment. After graduating with his PhD, psychologist Robert Blinn moved from California to Nebraska in 1996 and took a job at Blue Valley Mental Health Center in Wahoo. Shortly afterwards he found out by chance that his job fell into a shortage area. Now approved for loan repayment, Blinn says the endless corn fields and cattle farms seem more appealing.

He also feels he?s making a difference tackling the area?s high rates of depression and alienation, brought on, he says, by the boredom and isolation that?s sometimes a part of rural life.

Meeting the health-care needs of underserved people requires teamwork between mental and behavioral health professionals and other members of the primary health-care team, Weaver posits. (Four other mental and behavioral health providers in addition to clinical psychologists are eligible for NHSC loan repayment: clinical social workers, marriage and family therapists, psychiatric nurse clinicians and psychiatrists.)

One-stop health-care service, where patients can receive physical, mental, behavioral and oral health care, is particularly convenient for people with limited health-care access, he notes. For example, the center where Kite works, provides patients with everything from dental care to housing services.

NHSC also encourages providers to build strong referral networks, which Blinn has done in his rural Nebraska community. In Wahoo and David City, the two small towns where he works, Blinn knows most of the attorneys, probation officials and social services staff. ?I can just walk over and talk to them,? he says.

Meeting the need
To spur the creation of more NHSC slots for mental and behavioral health professionals, APA?s education officials plan to help NHSC band with other groups to inform communities about mental health?s role in curbing?and preventing?alcoholism, drug abuse and other problems. The association also seeks to help convene meetings with NHSC staff, representatives of community health and mental health centers, rural health clinics and other health-care groups. And for its part, the NHSC plans to publish pamphlets that tout the contributions of mental and behavioral health care.

The program is also considering other tacks to grow more slots. But these plans are germinal. For now, APA is pleased to see the NHSC voicing and publicizing its commitment to mental and behavioral health, say APA officials.

?These efforts underscore the important role psychologists have in successful primary health-care and community health-care settings,? says Jill Reich, PhD, APA?s executive director for education. ?We have worked many years to reach this point and look forward to continuing this progress.?