Public Policy Update

Throughout the past decade, APA's Education Public Policy Office has been successfully advocating for training opportunities for psychologists in a variety of federal health programs, many of which are designed to address the health-care needs of rural America. Rural America, in particular, needs psychologists, according to the President's New Freedom Commission, which found that, of the 1,669 federally designated mental health professional shortage areas, more than 85 percent are rural and that many rural primary-care providers are unprepared to diagnose or treat mental illnesses.

In response, APA's Education Directorate has worked to expand the reach and understanding of psychology in rural America and increased training opportunities for psychologists-developments that have changed the health and well-being of many Americans for the better in some of our nation's most underserved areas. However, with member participation, psychology can do a great deal more.

Past successes

In 1994 the Education Directorate successfully launched an initiative to include psychologists and promote as a priority mental and behavioral health services in the National Health Service Corps (NHSC) Loan Repayment Program. In 2002, APA's Education Directorate again successfully advocated for psychology in the Health Safety Net legislation. Statutory language allowing psychologists to participate in NHSC financial aid programs and to encourage the inclusion of mental and behavioral health services in the $2 billion federal Community Health Center Program was included. Prior to that legislative initiative, in 2000, the Education Public Policy Office sought and secured $1 million from Congress for three regional Mental Health Summits convened by the Health Resources and Services Administration in collaboration with the Substance Abuse and Mental Health Services Administration. As a result of this appropriation, 26 states participated in three Mental Health Summits and addressed the need for an integrated approach to health care, including mental and behavioral health services. The summits were so successful that the remaining states requested and received similar opportunities.

From creating a baseline understanding of the mental and behavioral health needs in all 50 states to ensuring the inclusion of psychologists in a number of federally funded grant and loan repayment programs, APA members have worked with Education Advocacy to create real opportunities for psychologists to work with underserved persons in all corners of our nation. The need for mental and behavioral health services in rural regions of America is real, and fortunately so are the opportunities for psychologists to make a difference.

Rural opportunities

Integrated health care that includes mental and behavioral health services has been a cornerstone for advancing the role of psychologists. This approach results in improvements in both the training of health professionals as well as patient care. The placement of psychologists on multidisciplinary teams allows them to provide a range of services-from assessment to intervention, to counseling-and the team to focus on physical problems as well as mental and behavioral disorders. The strength of the integration model lies in its emphasis on treatment of the "whole person," in turn leading to a more complete health-care package.

In rural settings, the vast majority of mental and behavioral health care is administered in primary-care settings as a consequence of access difficulties and stigma concerns. Moreover, federal funds targeted to designated Community Health Centers account for most of the primary and preventative health-care services that are provided in rural communities. For more information on opportunities for psychologists at Community Health Centers, visit http://bphc.hrsa.gov.

In addition to the centers, there are several programs around the United States that successfully apply an integrated approach to health care. Cherokee Health Systems (CHS) has served as a leading example of a multidisciplinary system, integrating behavioral and primary care for more than 25 years. CHS clearly identifies integration as its core objective-a commitment that resonates strongly among the system's staff, including physicians, nurses, dentists, psychologists and other health professionals. Furthermore, CHS offers 12-month, 2,000 hour internships with the goal of providing "an intensive and diverse clinical training experience within a community health setting."

Also, in collaboration with the University of Tennessee, training and practicum experience is provided to advanced doctoral students in both clinical and counseling psychology. For more information, visit www.cherokeehealth.com/Professional%20Training.

Another successful program is the Rural Hawaii Behavior Program. Established in 2000 as a collaborative effort with Tripler Army Medical Center, the program was designed to address the unique needs of one of the country's most diverse states. The Rural Hawaii Behavior Program creates an environment in which the incorporation of psychologists in primary-care settings allows, for example, for a more informed use of motivational techniques to increase the likelihood of positive change as well as treatment compliance for those suffering from chronic illness. In such an integrated environment, mental disorders are treated with respect to the whole person. Training opportunities are available for both predoctoral residents and postdoctoral fellows at the Psychology Training Program at Tripler Army Medical Center. For more information, visit www.tamc.amedd.army.mil/offices/Psychology/Psychology.html.

Another federal program that provides opportunities for psychologists is the National Health Service Corps Loan Repayment Program, in which an eligible health professional works in a designated underserved region in exchange for loan repayment. Participants in the program commit to two years of service at a maximum loan repayment of $25,000 each year with the possibility of extension of service and loan repayment at $35,000 a year. Participants in the program are often placed in federal Community Health Centers and provide critically needed services to low-income and medically-underserved populations. Recently, the need for psychologists has exceeded the number of applicants. At the end of 2005, there were 178 open vacancies for health-service psychologists. For more information, including details on the application process, visit http://nhsc.bhpr.hrsa.gov/join_us/lrp.asp.

The Quentin N. Burdick Rural Program for Interdisciplinary Training is another program for which APA has advocated for continued federal funding and in which psychologists have participated for a long time. Established in 1990 within the Bureau of Health Professions, the $6 million program supports "innovative training that prepares health-care providers for practice in rural communities." For more information on the Burdick Rural Program, visit http://bhpr.hrsa.gov/interdisciplinary/rural.html.

Psychologists are needed to address the specific health-care needs of the underserved rural populations-especially in integrated settings that allow for more comprehensive and seamless service. The aforementioned federal programs are designed to meet the mental and behavioral health-care needs of our nation's underserved. Now, more than ever, psychologists are in demand. If you are interested in working in rural communities, now is the time to take advantage of these opportunities.

Matthew R. Whiting is interning in APA's Education Public Policy Office.