Distance technology and community mobilization are transforming the mental health landscape of rural Nebraska, where the success of CYFS affiliates’ research may soon benefit communities worldwide.
Richard Bischoff, chair of child, youth and family studies, and Paul Springer, associate professor, are partnering with international colleagues to address an issue that they say transcends geography and culture—access to mental health services. Their model, which was developed six years ago in rural Nebraska communities, integrates distance technology and begins by drawing community members around the proverbial table.
“Many developing countries mirror rural Nebraska with issues surrounding mental health access and the stigma related to it,” Springer said. “Our model is dedicated to overcoming mental health barriers by using technology, mobilizing communities and bringing the right people to the table. We want to bridge the gap.”
Bischoff and Springer’s mental health model has two distinct components: community-based participatory research (CBPR) and tele-mental health, which includes any mental health service—such as counseling—delivered via distance technology. If tele-mental health provides one piece of the mental-health puzzle, then CBPR paints the overall picture. CBPR assesses the resources of a single community and relies on solutions from many vested stakeholders, including police officers, teachers, lawyers and healthcare providers.
If a community opts to implement tele-mental health, UNL graduate students then provide this service to rural patients using video conferencing software. Tele-mental health is embedded within local medical clinics, which protects patient anonymity and eases the stigma surrounding mental health care. Graduate students provide distance services to their patients three times per month; for the fourth appointment, students travel to the community and meet with their patients in person.
The innovative use of technology is exciting, because I’ve seen the positive impact that this work has on rural communities and schools.
Richard Bischoff, chair of child, youth and family studies
Springer encourages his students to maintain a visible presence in the communities they visit, which includes eating at local restaurants and attending sporting events. There are waiting lists for his team’s tele-mental health services, he said, because they have been successful in building strong relationships. For communities facing a shortage of mental health care providers, as many do, tele-mental health offers a collaborative care solution.
“The innovative use of technology is exciting, because I’ve seen the positive impact that this work has on rural communities and schools,” Bischoff said. “People who previously did not have access to mental health care now have access to culturally sensitive, state-of-the-art treatment. At the same time, students receive a rich, experiential learning opportunity that increases their appreciation of the care culture in rural communities and trains them in the use of videoconferencing technologies.”
While tele-mental health provides a new resource for rural providers, CBPR takes a holistic approach to identify existing resources and build community capacity—the ultimate goal is ownership and empowerment. Each community chooses its own approach; they may develop themes, such as bullying, and then host school presentations. Some implement tele-mental health services or bring in guest speakers to address mental health issues.
Perhaps the best example of successful CBPR in Nebraska came two years ago, when a rural town experienced two back-to-back suicides. The town’s community group, created through CBPR, came together and immediately mobilized resources to address the situation. The group brought in community experts to do a QPR training (Question, Persuade and Refer), which helps people ask the right questions and refer individuals at risk for possible suicide.
This example, Springer said, illustrates that communities are developing competence and confidence in addressing their own mental health needs.
Brazil and Beyond
Bischoff and Springer are partnering with CYFS affiliate Cody Hollist, associate professor of child, youth and family studies, to bring their model to Brazil. The opportunity is twofold: a Brazilian medical provider wants to implement tele-mental health for rural patients and Brazilian researchers want to utilize CBPR to assess mental health disparities in an impoverished community. The lessons learned in small-town Nebraska now play a key role in cross-cultural translation.
“We’ve learned that, even throughout rural Nebraska, each community is very diverse,” Springer said. “This sensitivity helps us to tailor the ways in which we provide our interventions, because our model is all about honoring communities.”
As Brazilian colleagues begin CBPR data collection this spring, Hollist and Springer are providing training and support. The CBPR intervention in Brazil is part of a 15-year longitudinal study that has followed children from birth to 15 years old and evaluates family functioning.
… Our model is all about honoring communities.
Paul Springer, associate professor
Bischoff and Springer are also discussing the application of their mental health model with interested researchers in Portugal and India. They know, from their work in rural Nebraska, that this model bridges the gap in accessibility, provides resources and reduces mental health’s stigma. They continue to build local and global relationships, because they also know this—mental health solutions begin by bringing everyone to the table.