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 outstate, which kid has the greater access
to the professional resources necessary to handle such issues? Up
to now, the answer would be Omaha — period.
But thanks to an innovative new program administered by the UNMC Munroe-Meyer
Institute, a growing number of rural youths now have access to MMI mental
health expertise right in their own pediatricians office. Even more
promising, some of these same MMI doctoral students serving these adolescents
are opting to return to those communities for professional practice.
The family pediatrician is still the primary mental health resource
for adolescents in rural communities, and the need for our services is
now extraordinary, said Joe Evans, Ph.D., director of the psychology department
at Munroe-Meyer. Eighty percent of all mental health practitioners live
in the Omaha/Lincoln area, leaving shortages in 83 of Nebraskas 93 counties.
In October 1999, MMI began the first year of the three-year, $463,000
Quentin N. Burdick Rural Interdisciplinary Training grant, in conjunction
with the Nebraska Health Resources and Services Administration, to train
pediatric behavioral health specialists to work in rural communities.
In the program, doctoral students work with veteran MMI faculty members
and professionals in providing treatment for patients in Columbus, Hastings,
Fremont and Plattsmouth.
MMI specialists are providing the equivalent of 40 hours of consultations
per week in Hastings, 24 hours in Columbus, 16 hours in Fremont and eight
in Plattsmouth. There currently is a waiting list of more than 50
patients in Hastings, at least a dozen in Columbus and more calls arrive
weekly from other rural Nebraska towns.
In all these sites, the patients were referred by their pediatrician
or family physician, Dr. Evans said. Our clinic visits to Hastings
draw patients from a 100-miles radius. We even have people driving
up from Kansas.
The reality now is that child adolescent behavior problems are everywhere.
Forty percent of our patients issues are for school-related problems,
Attention Deficit-Hyperactivity Disorder and problems at home.
Munroe-Meyer students not only get exposure to working in rural areas,
but they receive invaluable experience working as part of the patients
primary care package, Dr. Evans said. They pick up many tools that
will enable them to function well after they graduate.
And from the patients perspective, our presence in the pediatricians
office is much more acceptable, Dr. Evans said. There is still too much
stigma attached to mental health services in small communities. Local
parents are more comfortable bringing their children to see us in the primary
physicians office, as opposed to visiting an identified mental health
clinic where neighbors might see them and begin to speculate.
Students in the program have come from UNMC, UNO, Doane College, Mississippi
State and the University of Southern Mississippi. Their training
is in areas such as psychology, nursing, social work, counseling
and marriage and family therapy. During the first year of the program,
MMI specialists served more than 2,300 patient visits.
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 Senator Chuck Hagels challenge
to UNMC to find ways to get more students to train, and ultimately
practice, in Nebraskas 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 adolescent mental health patient
base is only going to grow and Munroe-Meyer is trying to meet these needs.
We have four graduate students who will receive their doctorates in
July and all four have requested rotations in rural Nebraska. We
anticipate seeing more students opt for rural training as the grant progresses.