Munroe-Meyer Institute Responds to Pediatric Mental
Health Needs in Rural Nebraska
If two adolescents in Nebraska are having mental health-related problems
— for example, behavior disorders, anxiety disorders, adolescent depression,
attention deficit disorders — and one youth is from Omaha, while the other
from Greater Nebraska, which youth has the greater access to the professional
resources necessary to handle such issues? Up to now, the answer
would overwhelmingly favor “Omaha.”
But thanks to an innovative new program administered by the UNMC Munroe-Meyer
Institute, a growing number of rural youths now have access to behavioral
health expertise right in their own pediatrician=s office. Even more
promising, some of these same MMI doctoral students serving these adolescents
are opting to return to those communities for further professional development
and practice.
“The family practice physician and pediatrician are still the primary
mental health resource for adolescents in rural communities, and their
need for behavioral health support services is now extraordinary, said
Joe Evans, Ph.D., Project Director and Chief of the Pediatric Psychology
Department at Munroe-Meyer. ASeventy-five percent of all mental health
practitioners live in the Omaha/Lincoln area, leaving shortages in 87 of
Nebraska’s 93 counties.”
In October 1999, MMI initiated the first year of the three-year, $463,000
Quentin N. Burdick Rural Interdisciplinary Training grant funded by the
federal Health Resources and Services Administration, to train pediatric
behavioral health specialists to work in rural communities. In the
program, doctoral and masters level students work with MMI Psychology and
Social Work faculty in providing treatment for patients in Columbus, Hastings,
Fremont, and Plattsmouth.
MMI specialists are providing the equivalent of 40 hours of patient
care per week in Hastings, 24 hours in Columbus, 16 hours in Fremont, and
8 hours in Plattsmouth. There is currently a waiting list of more
than 50 patients in Hastings, 30 families in Columbus and more calls arrive
weekly from other rural Nebraska towns surrounding these Greater Nebraska
communities.
“In all these sites, the patients are referred by their pediatrician,
family physician, school, or parents,” Dr. Evans said. “Our clinic visits
to Hastings draw patients from a 100-mile radius. We even have people driving
up from Kansas to see a pediatric behavioral specialist.”
“The reality is that child adolescent behavior problems are everywhere.
Some studies indicate that as high as forty percent of pediatric patients’
issues are for school-related problems, Attention Deficit-Hyperactivity
Disorder, problems at home, or other mental health disorders.
Munroe-Meyer students not only get exposure to working in rural areas,
but they receive invaluable experience working in a primary care practice,
Dr. Evans said. They pick up many tools that will enable them to
function well after they graduate.
“And from the patient’s perspective, our presence in the pediatrician’s
office is much more acceptable,” Dr. Evans said. “There is still a significant
stigma attached to seeking mental health services in small communities.
Local parents are more comfortable bringing their children to see a behavior
specialist in their primary physician’s office as opposed to visiting an
identified mental health clinic where other community members might see
them and begin to speculate.”
Students in the program have come from UNMC, UNO, Doane College, Mississippi
State, UN-L, UN-K, and the University of Southern Mississippi. Their
training is in areas including psychology, social work, counseling and
marriage and family therapy. During the first year of the program, MMI
mental health specialists provided more than 2,000 patient visits to families
from 47 Nebraska communities.
“There is no mystery as to what is likely to befall rural adolescents
with mental health needs that are not treated, Dr. Evans said. “Just as
in the largest urban environments, we see outcomes of school failure, delinquency,
involvements with substance abuse, depression and anxiety.”
“The Burdick grant is a direct response to the legislature’s challenge
to UNMC to find ways to get more health care practitioners to train, and
ultimately practice, in Nebraska’s rural communities. With the changing
economics of many of our farming communities and the fact that “big city”
problems are now showing up in rural towns, the child and adolescent mental
health patient base is only going to grow and Munroe-Meyer is trying to
meet these needs.
“We have four Ph.D. students who will receive their doctorates in July
and 4 of the 8 have requested additional post-doctoral training and supervision
rotations in rural Nebraska. We anticipate seeing more students opt for
rural behavioral health training as the grant progresses.”