. What type of research is this?
2. What is the central argument presented in the paper?
3. Is there a hypothesis?
4. Summarize the conclusion (don't copy and paste the summary. Use your words)
5. What did you learn from reading this paper?
6. What questions emerged from the paper you feel are still unanswered?
COMMENTARY Technology in Rural Behavioral Health Care Practice: Policy Concerns and Solution Suggestions Paul Force-Emery Mackie Minnesota State University, Mankato There is a history of expectations attached to the use of technology to better facilitate rural behavioral health care service delivery. Clinicians, scholars, and government officials alike have touted the benefits of technology to provide better, more accessible behavioral health care, and often consider it a way to bridge the “geographic divide.” The use of technology is viewed as a response to problems associated with improving consumer contact. Although the use of technology has effectively addressed many service delivery concerns, it continues to fall short of being the overarching remedy to what ails rural behavioral health care needs. Often, challenges associated with the full implementation and utilization of technology into rural behavioral health care is in conflict with state and federal policies and laws. Identifying and responding to these barriers is important to move opportunities for growth forward, but requires more than hope and limited support. There is a need for committed political will matched with focus and desire along with the allocation of adequate resources. Suggestions for policy changes and responses are offered to encourage continued dialogue on this topic. Keywords: behavioral health, policy, rural, technology Providing and receiving behavioral health services in rural areas have long been identified as challenges for consumers and practitioners alike. For example, Stone (2011) shared how a grant request for money to support purchasing a desktop computer for a rural social service agency was viewed as “unusual” in 1986. The author stated that, at that time, not many social service agencies had such equipment and many staff had never seen or used a computer. Stone noted that not long after his observations sur- rounding his request for that initial computer, Macarov (1991) predicted the growth of technol- ogy in rural behavioral health and social service delivery would essentially replace commonly ac- cepted treatment and information processing mo- dalities. In 2003, Farrell and McKinnon discussed the importance of the then fast-emerging Internet as a tool to bridge the geographic divide. Spe- cifically, they said, “as an alternative to tradi- tional face-to-face contact for those in rural . . . areas, the Internet potentially can bridge the disparities in health care access for rural mental health services” (p. 20). Indeed. Today, a grant request to support the purchase of a computer would not only be considered normal, it is ex- pected. Additionally, the use of the Internet is now commonplace and often is no longer de- pendent on access to a desktop computer as phones and tablets are now powerful enough to conduct the same operations. However, this does not imply that rural stakeholders, be they consumers or practitioners, are able to enjoy all of the benefits the use of technology has to offer. Editor’s Note. Dr. Paul Force-Emery Mackie is the Pres- ident-Elect of the National Association for Rural Mental Health (NARMH). His two-year Presidential term begins July 30, 2015. The Journal of Rural Mental Health is a publication of NARMH and is sent to all members of the organization. Given these facts, Dr. Mackie was invited to submit an article identifying one or more significant issues that he planned on addressing during his Presidency. The article was not reviewed in the typical manner because it is an expression of Dr. Mackie’s reflections and views of the issues discussed herein. Correspondence concerning this article should be ad- dressed to Paul Force-Emery Mackie, Department of So- cial Work, 358 Trafton Hall North, Mankato, MN 56001. E-mail:
[email protected] T hi s do cu m en t is co py ri gh te d by th e A m er ic an Ps yc ho lo gi ca l A ss oc ia tio n or on e of its al lie d pu bl is he rs . T hi s ar tic le is in te nd ed so le ly fo r th e pe rs on al us e of th e in di vi du al us er an d is no t to be di ss em in at ed br oa dl y. Journal of Rural Mental Health © 2015 American Psychological Association 2015, Vol. 39, No. 1, 5–12 1935-942X/15/$12.00 http://dx.doi.org/10.1037/rmh0000027 5 mailto:
[email protected] http://dx.doi.org/10.1037/rmh0000027 In our modern technological world, there are considerable benefits associated with the use of technology in health and behavioral health care service delivery, such as facilitating communi- cations between consumers and providers, pro- viders and providers, and even consumers and consumers. We have learned that reducing dis- parities between rural and urban communities are now real possibilities in the areas of sub- stance abuse and mental health services (Bena- vides-Vaello, Strode, & Sheeran, 2013). We also now understand that social media applica- tions have increased the acceptability and ac- cessibility of telemental health services in geo- graphically remote locations (Reed, Messler, Coombs, & Quevillon, 2014). Although much good can, does, and will con- tinue to come from the aforementioned ad- vances, claiming that technology is a cornuco- pia where only good digital fruit spills forward also is an overstatement. Challenges associated with the use of technology continue to be very real, and are in an array of fields such as licens- ing limitations, workforce preparedness, con- sumer literacy and acceptability, insurance, fee- for-service reimbursement, privacy concerns, and a variety of related regulatory consider- ations (Kramer, Kinn, & Mishkind, 2014). To address these and other issues, state and federal policies must be implemented, enhanced, or strengthened to meet the modern needs. This can be a challenge given that, too often, the technological developments occur faster than legislation. Regardless of the speed of occur- rence associated with these processes, two things are quite certain: (a) Opportunities to expand access to behavioral health care services will grow as technological advances occur, and (b) systems that regulate these acts need to be relevant, supportive, and timely. Therefore, fo- cused, willful policy work must be accom- plished if mental health professionals are to realize the full potential of what technology can do to enhance services. The inclusion of technology into behavioral health care practice can provide positive out- comes for rural consumers, a point well sup- ported in the literature (Benavides-Vaello, Strode, & Sheeran, 2013; Reed et al., 2014). In theory, technology can be used to address many problems associated with delivering a variety of health and behavioral health services in rural places and be the bridge across broad land- scapes by meeting consumers “where they are” rather than “where we are.” In practice, how- ever, just because technology can be used to improve the lives of rural residents through new and innovative ways doesn’t necessarily mean it will be used this way. There are still many barriers to achieving the goal of connecting rural areas with high quality behavioral health care: workforce shortages, fiber optics and in- frastructure availability, consumer and practi- tioner technology literacy, and licensing juris- dictions. Perhaps the most stark barrier of all is the lack of effective state and federal policies developed to encourage and enhance inclusion, respond to health care rights, and finding ways to fully integrate all citizens into our delivery system. Brief Historical Policy Review Although it is difficult to identify a specific date when rural behavioral health services emerged as State and Federal concerns, one can identify key historical moments where address- ing these important concerns emerged and were addressed through legislation. The Morrill Act of 1862 (12 Stat. 503, U.S.C. 301) and the Morrill Act of 1890 (26 Stat. 417, U.S.C. 322) were focused on the development of institutions of higher education, built on land that was granted to states for that purpose. These facili- ties were mandated to provide agricultural and mechanical educational opportunities, and they were home to departments and programs di- rected to provide education aimed at advancing rural home, family, and community life. Specif- ically, the Morrill Acts and land grant institu- tions that grew from these laws included edu- cation in home economics, which was designed to prepare students to address health and wel- fare needs in rural regions. This type of educa- tion evolved into educational responses to a variety of rural social service needs. Over time, the further development and growth of the Fed- eral Extension Service through the Smith-Lever Act of 1914 (38 Stat. 7, U.S.C. 341) advanced land-grant university connections with rural so- cial health and welfare responses. Today, what was the Federal Extension Service is now the Cooperative Extension System, which is charged with a wide variety of rural-based health, welfare, nutrition, and social responsi- bilities aimed at enhancing the lives of rural 6 MACKIE T hi s do cu m en t is co py ri gh te d by th e A m er ic an Ps yc ho lo gi ca l A ss oc ia tio n or on e of its al lie d pu bl is he rs . T hi s ar tic le is in te nd ed so le ly fo r th e pe rs on al us e of th e in di vi du al us er an d is no t to be di ss em in at ed br oa dl y. residents (United States Cooperative Extension System, 2014). No discussion about rural behavioral health policy can be complete and fully inclusive with- out a discussion about the impact of the Mental Health Centers Act of 1963 (PL 88–164). This law was created to provide behavioral health services to residents of underserved areas, which included rural locations. Although there is fair and considerable criticism associated with this law (Mermelstein & Sundet, 1988), it was clearly a genuine attempt on the part of the federal government to increase support and funding to underrepresented populations as well as recognize the need to address behavioral health needs across the country, especially among some of the most impoverished and iso- lated communities in the United States. Later, other influential policy works such as President Carter’s Commission on Mental Health in 1978 (Grob, 2005) and President G.W. Bush’s New Freedom Commission on Mental Health (2003) further focused political resources and energy toward more comprehensive responses to be- havioral health needs. The Mental Health Sys- tems Act of 1980 (PL 96–398) came as a result of the Carter Commission, but according to Grob (2005), “the commission’s work led to the formulation of the influential National Plan for the Chronically Mentally Ill . . . [however,] a system of care and treatment for persons with serious mental illnesses was never created” (p. 425). The New Freedom Commission on Men- tal Health report received criticisms as well (Satel & Zdanowicz, 2003), though this report specifically included rural language and in-