Building a Stronger Workforce in Rural America: Mental Health Stakeholders in Rural Missouri Develop Education and Training Opportunities to Attract and Retain Staff

Article excerpt

Providing behavioral healthcare services in today's ever-changing environment can be challenging for any organization, especially those located in rural areas. The recruitment and retention of qualified professional staff in rural areas are daunting due to lower compensation levels and the scarcity of qualified professionals compared with urban areas.

Midwest Behavioral Healthcare Management, Inc. (MBHM), headquartered in Clinton, Missouri, manages two behavioral healthcare organizations: Pathways Community Behavioral Healthcare, Inc., and Royal Oaks Hospital. Together they provide a full continuum of behavioral healthcare services to individuals across Missouri. MBHM realized the ominous position that rural healthcare providers face, and took a proactive approach by establishing clinical training and educational opportunities in rural Missouri through an innovative effort called Project Training Enhancement of Rural Mental Health (TERMH).

MBHM designed Project TERMH in coordination with the Workforce Development Board of Western Missouri, Inc. (WDB) and the Forest Institute of Professional Psychology. Project TERMH became fully funded in the fall of 2003 with an $8.2 million grant from the U.S. Department of Labor. The grant originally was for three years, and a one-year extension was granted. The Project TERMH Management Committee is comprised of staff from the WDB and MBHM.

Four Initiatives

Project TERMH is comprised of four initiatives. Initiative One is the expansion of a psychiatry residency and fellowship training program at Royal Oaks Hospital, a training program approved by the Accreditation Council for Graduate Medical Education for general psychiatry residents, child/adolescent psychiatry fellows, and geriatric psychiatry fellows from the University of Missouri--Columbia (UMC) School of Medicine's Department of Psychiatry. UMC has limited clinical operations where training can occur. The university relies on outside organizations, such as Royal Oaks Hospital, to provide clinical training for residents and fellows. Project TERMH provided funds to establish a geriatric psychiatry program and to support an existing child/adolescent fellows program at Royal Oaks Hospital.

Empirical data have shown that many psychiatrists stay in the area where they complete their training. Therefore, by increasing the number of psychiatry fellowships in rural Missouri, Project TERMH aims to have more psychiatrists stay in the area, reducing the need for psychiatrists with H-1B visas, who can stay in the country for only a limited time.

Initiative Two is a psychiatric/mental health advanced practice nurse training program directed by Robin Vogt, PhD, RN, FNP-C, director of medical services at Royal Oaks Hospital. The objective is to train 15 people with a bachelor's degree in nursing to become psychiatric/mental health APNs, who can diagnose and prescribe medications for mental health needs while working in collaboration with psychiatrists.

UMC's Sinclair School of Nursing provides online training for nurses with a BSN to become a psychiatric APN. Participants receive 45 online semester credit hours, as well as 500 hours of supervised clinical practicum. The curriculum provides training specifically geared to give students a strong base in psychopharmacology, treatment, and diagnosis of mental health disorders. An additional program, Enhancement of Psychiatric Skills, began in February and targets 30 RNs and LPNs to address psychiatric issues encountered by frontline workers.

"Initiative Two has embraced nurses making the transition from a nursing model to that of a medical treatment model," says Dr. Vogt. "This Initiative truly allows for the expansion of available [mental] healthcare professionals to the workforce. …