NCTSN Center Supports Rural Trauma-Informed Care

Establishing ongoing trauma-informed services is
one of the most difficult challenges facing rural
mental health programs. Schools, community
groups, and natural helpers try to meet needs, but often go unsupported. Health professional
shortages are widespread in rural communities.
There are few facilities where services can be
provided and many caregivers find themselves
trying to be “all things to all people.”

Consequently, health services are typically
available from a “generalist,” who may or may not target specific mental health issues like trauma.
Rural and frontier helpers also may not be able to
find time for continuing education. In general, rural providers work more hours, see more patients, and take fewer days off than do their urban counterparts. Because they live in small towns, or are the only providers available, it may be necessary for them to provide trauma treatment to people they know. Moreover, because rural people are more likely to be uninsured or on Medicaid or Medicare, reimbursements are generally lower than in urban areas, even with identical services. These
challenges, coupled with provider shortages,
severely challenge efforts to deliver high-quality care.

As part of the NCTSN effort to address this issue,
the NCTSN Center for Rural, Frontier, and Tribal
Child Traumatic Stress Interventions developed an intervention called the Health Services Systems Environmental Scan (HSSES) to strengthen, retain, and improve the quality of rural mental health care through mental health clinics, primary care,
schools, and other community groups. Recognizing that rural, frontier, and tribal communities are
unique environments, the intervention takes an ecological approach with a community-based “environmental scan.” This is defined by the Robert Wood Johnson Foundation as a process for “understanding . . . the current environment in a particular [community] by identifying and obtaining information from key informants and other resources. The aim is to identify trends, gaps and issues . . .
for future planning.”

The HSSES is a four-phase, standardized
intervention that reviews organizational and community characteristics, including provider
number, type, training, and mental health; the economic health of the organization and the community; social and geographic characteristics; and many other traits.

The joint HSSES implementation is an effort between the community seeking help and a team knowledgeable across trauma-focused mental health care, health services systems, geography, economics, and community development.

The HSSES process begins with a needs and resources assessment leading to an environmental scan. The scan leads to the plan’s development, implementation, and assessment. The intervention’s assessment includes two focused questions:  1) Is our plan working or do we need to adjust it?, and 2) How well did our plan work? The plan is prioritized based on ease of implementation and need. The goals are as varied as the communities themselves and may include learning Trauma-Focused CBT, or other goals such as increasing the amount of available federal subsidy money. Community organizations may have goals such as gatekeeper training or anti-stigma campaigns.

Entry into the HSSES is through the Idaho NCTSN Center and the Rural Child Traumatic Stress Virtual Program Center. The HSSES program is supported by several national and community partners, including the National Rural Mental Health Association, National Rural Health Association, Sidran Foundation, Western Interstate Commission on Higher Education, Medical Group Management Association, and the National Alliance for the Mentally Ill. The HSSES program works to improve trauma care in systems that serve nearly half a million rural constituents

For more information, visit http://childts.isu.edu or write to childts@isu.edu.

Joshua Arvidson Receives
"Light of Hope Award"

Joshua Arvidson, project director of the Alaska Child Trauma Center at Anchorage Community Mental Health Services (ACMHS), is the winner of the "Light of Hope Award," given for his “outstanding effort on behalf of Alaska's children." This award is given annually to a person from the behavioral health field by the State of Alaska's Office of Children's Services and Office of Public Advocacy. Arvidson was granted the award in recognition of his efforts to improve services for children who have been abused or neglected. He is the second ACMHS employee to win this prestigious award. Dee Foster, director of Children's Services at ACMHS, also won the Light of Hope Award in 2000. Congratulations!