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Stone Mountain Health Services Behavioral Health Internship

Summary 
  • Need: Increase behavioral health services and providers in rural Appalachian communities of Southwest Virginia.
  • Intervention: Implementing a behavioral health internship that is a partnership of 2 universities and a community health center, with infrastructure to also support a social work internship.
  • Results: Behavioral health services now available in the 7-county area served by the health center, with designated behavioral health staff to supervise psychology and social work interns.

Description

Areas of Appalachia have increased behavioral health needs because of chronic disease rates, substance abuse rates, and stress related to the rural region's depressed economics and geographic isolation.

Compounding the situation is a shortage of behavioral health providers in the region, making access difficult from the aspects of travel time and cost, resulting in long waits for appointments.

These issues are even further exacerbated by the lack of behavioral health education programs with training internship sites in this part of the state.

In order to address these issues, several organizations teamed together to form the Stone Mountain Health Services (SMHS) Behavioral Health Internship to impact behavioral health workforce needs in rural Appalachian communities of southwest Virginia.

SMHS, a federally qualified health center (FQHC), Radford University, and East Tennessee State University (ETSU) created the original internship.

Now the program serves students in both psychology and social work, with SMHS providing internship training sites and the dedicated staff to supervise both professions' interns. This increase in workforce has allowed service expansion into seven counties (Lee, Wise, Buchanan, Dickenson, Russell, Washington, and Smyth).

The psychology internship was accredited by the American Psychological Association as of March 2016 for 7 years, the maximum accreditation interval possible.

The program did receive a Rural Health Workforce Development grant from the Federal Office of Rural Health Policy, funded for 3 years from September 2010 through August 2013.

Services offered

The internship uses an integrated behavioral health model with the behavioral health intern serving as a member of the primary care team.

In addition to addressing traditional behavioral health issues (e.g., anxiety, depression, substance use), obesity, tobacco use, hypertension, pain, and other physical health concerns are addressed because behavioral changes can improve the quality of life for patients with those conditions.

Prior to receiving their master's degree, social work interns complete final clinical rotation requirements by spending a minimum of 20 hours per week in a clinical setting seeing patients, supervised by a Licensed Clinical Social Worker (LCSW).

Psychology interns are full-time employees of Stone Mountain Health Services and work for 40 hours a week. They complete a 1-year internship under the supervision of Licensed Clinical Psychologists (LCPs) as the final requirement prior to receiving a doctoral degree in psychology.

In addition to working in the integrated care setting, psychology interns at Stone Mountain Health Services receive training in psychological assessment for a wide variety of issues including:

  • Mental health disorders
  • Intellectual functioning
  • Children's behavioral health disorders
  • Dementia
  • Adult and child ADHD
  • Learning disabilities

Results

As of September 2018, the internship is in its 7th year, its 5th sustainable year without grant funding.

Stone Mountain Health Services has:

  • 5 licensed clinical psychologists, including an assessment clinical psychologist
  • 2 clinical psychology interns
  • 3 licensed clinical social workers
  • 2 adult psychiatric nurse practitioners

The internship has impacted the region's behavioral health workforce by:

  • Recruiting interns to fill the open internship slots
  • Retaining interns to meet SMHS workforce needs (these graduates serve as supervisors for future interns)
  • Providing qualified staff for other integrated care sites throughout the Appalachian region and elsewhere
  • Implementing an integrated model within the existing primary care system

Although SMHS has not retained all interns, having reached organizational staffing capacity, nearly all the program's graduates have returned to rural areas and/or are working in an integrated behavioral health setting.

The internship has improved behavioral healthcare access in the region:

  • Nearly 10,000 patient encounters provided by the behavioral health staff for each of the last three fiscal years.
  • Behavioral services are now available in all 7 counties of the SMHS service area with minimal wait times for appointments
  • Behavioral health testing (psychological assessment) is now offered, a service which had not been readily available in the past
  • All services are available on a sliding fee scale for the uninsured or underinsured residents of the area

Barriers

The challenges experienced by the program related to intern recruitment include the following:

  • In the first year, the program was 1 psychology intern short. To meet the gap, faculty from Radford University helped recruit a student from Georgia Southern University.
  • Radford University moved their social work program back to the main campus in Radford, Virginia, but East Tennessee State University has continued to fill 1 social work internship slot when students are available.
  • East Tennessee State University's Clinical Psychology program withdrew as an official partner in the internship, but they have continued to send qualified applicants to the internship program.

Replication

This program could be replicated in other rural areas experiencing similar difficulties with inadequate numbers of rural internships, behavioral care access problems, and shortages of rural behavioral health care providers. Communities interested in replicating this program would need to:

  • Identify universities in close enough proximity to the training site to entice students to apply for internships
  • Locate partners willing to commit to the faculty time requirements
  • Find a primary care site willing to participate and foster the intern as a part of the medical team

Contact Information

James L. Werth, Jr., PhD, ABPP
Stone Mountain Health Services
276.546.5310
jwerth@stonemtn.org

Topics
Appalachia
Behavioral health
Behavioral health workforce
Federally Qualified Health Centers
Health workforce education and training
Mental health

States served
Virginia

Date added
October 27, 2014

Date updated or reviewed
September 7, 2018


Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.