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Frontier
Education Center Issue Paper Access to Mental Health and
Substance Abuse Services in Frontier Areas Time for a New
Generation of Providers
ISSUES
WHERE TO GO FROM HERE
Cross-Training
Primary Care Providers
The
Frontier Mental Health Services Network (FMHSN) studied the quantity and
quality of mental health and substance abuse services provided by primary care
providers in small rural and frontier communities. There are several ways to improve the quality of these
services. Circuit-riding
professionals: To provide CQI, case reviews, on-site consultation with
patients, oversight of pharmacological management. Mini-residencies: Either on-site, weekend programs or
distance learning. School Counselors and
School Nurses
In many
frontier communities, these are the default mental health and substance abuse
providers to the school age population and often to their families. There needs to be both a recognition of
this reality and a plan for providing the skills necessary to manage crisis
intervention, triage, and appropriate referral. Work with the National School Boards Association, the
American Association of School Administrators, and the National Association of
School Nurses and other relevant groups to address this issue. Identify
resources, which can be easily and economically provided to school
personnel. For example:
Disseminate information about the American Psychological Association (APA)
nationwide campaign called "Resilience for Kids and Teens," a program
to help children and teens cope with stress and trauma. APA has produced both a
magazine, Time for Kids, a website designed for young people with help from MTV, and also an
online brochure for teachers and parents. [NOTE: Other
default providers are law enforcement, EMS, religious leaders.] New Providers
Alaska Behavioral Health
Aide Program
The
Community Health Aide (CHA) Program is a well-established system of training
residents of remote native villages to be health workers. CHA's now provide up to 80% of the
primary care needs of their villages.
A career ladder has been established for these unique professionals,
with many of them advancing to become Physician Assistants. Now
Alaska is looking to address the many mental health needs of remote villages by
training villagers as behavioral health aides. These new providers will treat, triage, and refer mental
health and substance abuse problems in their villages. Evaluation of this effort will provide
useful information about the applicability of this approach to communities
outside of Alaska. Promotoras
The University
of New Mexico was just awarded a grant by the Robert Wood Johnson Foundation to
look at the use of promotoras (community health workers) as mental health
practitioners. The title of the project is "Promotoras as Mental Health
Practitioners in Primary Care: Reducing Economic, Cultural and Linguistic
Barriers to the Treatment of Depression in Community Health Centers." This
grant will provide important information about the use of community health
workers in the multi-cultural environment of New Mexico. Hub and Spoke Model
The
Frontier Education Center is working with a small, tri-cultural frontier
community in northern New Mexico to develop a system for coordinating a very
fragmented non-system for mental Health and substance abuse services. The hub of the system is a social
worker/case manager with professional support provided by the Rural Outreach
Program of the Psychiatry Program at the University of New Mexico Health
Sciences Center. In this community,
family members currently receive services from 3 or 4 different part-time or
adjacent community providers with nobody looking at the big picture. Some of the spokes are in nearby
communities, an hour away, but others are a 5-6 hour roundtrip to specialized
services, like child psychiatry, the VA hospital, etc. It will take a very special person to
fill this role, because they will essentially be creating a new type of
frontier provider. Culturally Appropriate
Care
Many
frontier communities need very specialized care. This is especially the case where
there are Native American, Hispanic and /or other immigrant or refugee
populations. Increased awareness
of the effects of Historical Trauma has demonstrated that many current training
programs are not educating professionals able to treat the special problems in
these communities. With very
limited resources available, it is critically important that they are as
effective as possible. This is yet
another area where mini-residencies and other specialized training need to be
made available. Culturally
appropriate care, especially for mental health, is much deeper than language
ability alone. --2004 Frontier
Education Center HCR 65
Box 126 Ojo Sarco
NM 87521 505-820-6732 frontierus@frontierus.org www.frontierus.org |