Community Health Center (CHC) Psychology Training Pilot Project, Bureau of Primary Health Care, Health Resources & Services Administration

Background: Nearly every community health center (CHC), in both rural and urban areas, provides mental health and substance abuse services onsite or through formal referral arrangements. Mental health and substance abuse-related conditions together are the primary reason for a visit to a community health center. Visits for either mental illness or substance abuse grew faster than other major chronic conditions. (National Association of Community Health Centers –NACHC-Issue Brief 2004 Summary Sheet)

Purpose: The CHC Psychology Training Pilot Project would demonstrate how advanced psychology trainees could the use of low cost graduate psychology interns would increase the quality and quantity of much needed mental and behavioral health services to underserved persons though local community health centers.

Currently there are very few psychologists co-located in community health centers. However, psychologists have extensive training in both mental (e.g., depression) and behavioral health (i.e., those associated with chronic illnesses) and provide an array of services including assessment, diagnosis, treatment, rehabilitation and consultation that are required in an integrated health care setting. Placing (supervised) psychology trainees in selected community health centers would allow for the delivery of integrated mental and behavioral health care services in a setting designed to facilitate "one stop shopping" for underserved consumers in addition to enriching the training experience of future psychologists. The use of psychology trainees would also foster a pipeline of highly qualified professionals from the training setting into the workforce serving communities most in need. It is necessary to determine how to replicate the two exemplary models (i.e., the Cherokee Health Systems and the rural Hawaii Behavior Program of integrated health care in underserved communities.)

Request: $2 million in the FY 2008 Labor, HHS, and Education Appropriations bill for the Bureau of Primary Health Care (Health Resources and Services Administration) for a pilot project to provide supervised psychology trainees in select Community Health Centers to provide mental and behavioral health care to underserved persons.


Addressing the Mental and Behavioral Health Care Needs of Underserved Persons

  • Behavioral health concerns are one of the primary reasons for a medical visit to the CHC. Some community health centers report that between 50-70% of their patients have a behavioral health disorder, with presenting problems spanning the life cycle from childhood to adulthood.(NACHC Issue Brief  2004)

  • Integrating behavioral health with primary care provides the best care for CHC patients. Interdisciplinary care leads to improvements in the process of care, quality of life, health outcomes, and is cost-effective. (NACHC Issue Brief 2004 Summary Sheet)

  • Depression and chronic illnesses are among leading CHC health concerns. Working through collaboratives, community health centers are targeting the mental disorder of depression and two chronic illnesses, diabetes and hypertension, which also have behavioral health components, and will soon be adding cardiovascular, diabetes, asthma, and cancer. (Don Weaver , Deputy Assistant Administrator, for Primary Health Care Health Resources and Services Administration, APA Convention, 2005)

Need for Psychologists in Rural America

  • In rural settings, the vast majority of mental and behavioral health care is provided 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. (Rural America in Need, APA Monitor, 2005)

  • Rural populations have greater need for psychological services. Rural communities have a higher proportion of people who are at risk for mental and behavioral health problems, especially the elderly and the chronically ill.  (National Advisory Committee on Rural Health and Human Services Report, 2004)

Need for Psychologists in Urban Inner Cities

  • Urban settings create increased need for mental and behavioral health services.  Studies show that there is an enormous range of disorders associated with urbanization, including psychoses, depression, sociopathy, substance abuse, alcoholism, crime, delinquency, vandalism, family disintegration, and alienation. (Marsella , A.J., 1998, p. 624).

  • High rates of depression and anxiety are found in poor urban neighborhoods. Research studies have demonstrated that fear of crime in poor urban neighborhoods is associated with higher levels of anxiety and elevated levels of depression. (Taylor, Perkins, Shumaker, & Meeks, 1991)

  • Lower income populations are at higher risk for mental disorders. Studies have consistently shown that people in the lowest strata of income, education, and occupation are two to three times more likely to have a mental disorder than those in the highest strata. (Urban Mental Health, Report of the Task Force on Urban Psychology, APA, 2001)

Exemplary Models of Integrated Health Care for Underserved Persons

  • The Cherokee Health System (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." (Rural America in Need, APA Monitor, 2005)

  • The Rural Hawaii Behavior Program (RHBP) is another successful program. Established in 2000 as a collaborative effort with Tripler Army Medical Center, the program is designed to address the unique needs of one of the country's most diverse states. The RHBP has incorporated psychologists in all its primary-care settings, thereby providing a greater range of treatment options (e.g., treatment compliance for those suffering from chronic illness). In this integrated, interdisciplinary environment, mental and behavioral disorders are assessed and treated in a comprehensive manner with respect to the whole person.

Contributions of Psychologists

  • Psychologists possess the training and skills for treating mental health problems and alcohol and substance abuse problems in adolescents and adults. Psychologists have also developed highly effective programs to treat other behaviorally based health problems, such as smoking, eating disorders, poor diet and stress. (Journal of Consulting and Clinical Psychology, June 2002)

  • Psychologists are highly qualified to promote healthy behavioral choices that can prevent or ameliorate many chronic illnesses (e.g. heart disease, diabetes, and cancer). This is especially significant given that chronic diseases are responsible for 7 out of 10 deaths in the US and affect the quality of life of 90 million people. (CDC, 2005)

  • Psychological services that offer early treatment for mental problems could save the U.S. billions. According to the National Mental Health Association, untreated and mistreated mental illness cost the United States $150 billion in lost productivity and another $8 billion in crime and welfare expenditures each year. (2001)