SECTION ONE – INTRODUCTION AND SPECIAL CONSIDERATIONS

1. The Current State of Rural Mental Health (K. Bryant Smalley, Ph.D., Psy.D. & Jacob C. Warren, Ph.D.)

a. Introduction

b. What is Rural?

c. Mental Health in Rural Areas

d. Addressing Core Problems in Rural Mental Health

e. Conclusion

f. References

2. Advancing Federal Policies in Rural Mental Health (Patrick H. DeLeon, Ph.D., J.D., M.P.H., Mary Beth Kenkel, Ph.D. & Diana V. Shaw, Ph.D., M.P.H., M.B.A., F.A.C.M.P.E.)

a. Introduction

b. Three Historical Views of Rural Mental Health that Shaped Policy Directions

c. The Importance of Personal Involvement in Advocacy and Long Term Vision for Mental Health Providers in Rural Areas

i. Opportunities for Involvement in Rural Mental Health Advocacy

d. Recruiting and Retaining Rural Mental Health Workers

e. The Patient Protection and Affordable Care Act (PPACA)

f. Technology Effectively Addressing the Impact of Historical Isolation

g. The Advent of Telepsychology and Licensure Mobility

h. Conclusion

i. References

3. Rurality as a Diversity Issue (K. Bryant Smalley, Ph.D., Psy.D. & Jacob C. Warren, Ph.D.)

a. Introduction: The Importance of Culture in Mental Health

b. What about Rural?

c. The Culture of Rural Living

i. Remoteness and Isolation

ii. Agriculture

iii. Poverty

iv. Religion

v. Behavioral Norms

vi. Stigma

d. Implications for Training Programs

e. Implications for Practicing Therapists

f. Conclusion

g. References

4. The Impact of Mental Health Stigma on Clients from Rural Settings (Jonathon E. Larson, Ed.D., M.S., L.C.P.C., C.R.C., Patrick W Corrigan, Psy.D. & Thomas P. Cothran)

a. Introduction

b. Public Stigma

c. Self-Stigma

d. Stigma in Rural Settings

e. Treatment of Self-Stigma in Rural Settings

i. Case Illustration

1. Presenting Problem and Client Description

2. Case Formulation

3. Course of Treatment

f. Conclusion

g. References

5. Loneliness and Isolation in Rural Areas (Jackson P. Rainer, Ph.D., A.B.P.P. & Johnathan C. Martin, Ed.S.)

a. Introduction

b. Loneliness as a Psychotherapy Issue

c. When Loneliness Becomes a Problem

d. Isolation and the Pain of Yearning

e. The Treatment of Loneliness and Isolation

f. Conclusion

g. References

6. Religion and Rural Mental Health (Jamie Aten, Ph.D., Patrick Hall, M.Div., Isaac Weaver, Michael Mangis, Ph.D., & Clark Campbell, Ph.D., A.B.P.P.)

a. Introduction

b. Religion

c. Impact of Religion on Well-Being

d. Role and Influence of Religion in Rural Communities

e. The Role of the Church in the Rural Community

f. Rural Religious Worldviews

i. Amish Religious Worldview

ii. Appalachian and Serpent-Handling Religious Worldviews

g. Mental Health Care in the Rural Context

h. Mental Health Care with Rural Religious Clients

i. Conclusion

j. References

7. Ethical and Professional Challenges of Mental Healthcare Delivery in Rural Communities (James L. Werth, Jr., Ph.D., A.B.P.P.)

a. Introduction

b. A Day in the Life of a Small Town Psychotherapist

c. Major Ethical Issues and Professional Challenges in Rural Areas

i. Incidental Encounters

ii. Visibility of the Therapist

iii. Multiple Relationships

1. Current Clients

2. Former Clients

3. Among Current/Former Clients

4. Among the Therapist’s Significant Others and Current/Former Clients or Significant Others of Current/Former Clients

5. Among Staff/Consultants and Clients/Former Clients

6. The Special Case of Barter

iv. Confidentiality

v. Competence

1. Clinical Competence

2. Assessment Competence

3. Expansion of Responsibilities because of Lack of Available Referral Options

d. Recommendations for Practice in Rural Areas

e. References

8. Rural Mental Health Practitioners: Their Own Mental Health Needs (David S. Hargrove, Ph.D., A.B.P.P. & Lisa Curtin, Ph.D.)

a. Introduction

b. Provider Distress, Impairment, and Burnout

c. Prevention, Detection, and Intervention: Importance of Self-Care

d. Bowen Family Systems Theory

e. Case Study

i. Background

ii. Interpretation of Case Study

f. Conclusion

g. References

SECTION TWO – MODELS OF SERVICE DELIVERY

9. Integrated Care in Rural Areas (David Lambert, Ph.D. & John Gale, M.S.)

a. Introduction

b. Background

i. Definition of Integration

ii. Models of Integration

iii. Barriers to Integration

iv. Evidence for Integration

c. Integrated Care in Rural Areas

d. Current and Best Practices in Rural Integration

e. Case Studies of Integrated Care in Rural Communities

f. Rural Integration in a Changing Policy Environment: The Road Ahead

i. State Fiscal Pressures

ii. The Road Ahead

g. Practical Steps to Getting Started

h. References

10. Technological Innovations in Rural Mental Health Service Delivery (Sarah Velasquez, M.A.B., M.S., Angela Bannitt Duncan, M.A. & Eve-Lynn Nelson, Ph.D.)

a. Introduction

b. Telephone

c. Televideo Interventions

d. Mobile Interventions

e. Computer-Based Technologies

i. Computer-Based Assessment

ii. Computer-Based Therapy

f. Social Media Tools

g. Technology Implementation with Mental Health Interventions

h. Conclusion

i. References

11. School and Home-Based Interventions in Rural Communities (Angela M. Waguespack, Ph.D., Carmen Broussard, Ph.D. & Kristin Guilfou)

a. Introduction

b. The School as the Hub of Service Delivery

c. Use of Problem-Solving and a Multitiered System of Service Delivery

i. Tier 1: Universal

ii. Tier 2: Selected or Targeted Support

iii. Tier 3: Targeted, Intensive

d. Incorporating an Ecological Perspective

i. Family School Partnerships

ii. Interagency Collaboration

e. Case Example

i. History and Background

ii. Universal Interventions (Tier 1)

1. Partnering with Families

2. School-Wide Positive Behavioral Interventions and Supports (PBiS)

3. Monitoring of Behavioral and Academic Progress

4. Tier 1 Results

iii. Strategic Interventions (Tier 2)

1. Problem-Solving Committee (PSC)

2. Tier 2 Results

iv. Intensive Interventions (Tier 3)

1. Problem-Solving Committee (PSC)

2. Tier 3 Results

v. Case Summary and Suggested Improvements

1. Tier 1

2. Tier 2

3. Tier 3

f. Conclusion

g. References

SECTION THREE – WORKING WITH SPECIFIC POPULATIONS AND ISSUES

12. Substance Use and Abuse in Rural America (Jennifer D. Lenardson, M.H.S., David Hartley, Ph.D., M.H.A., John A Gale, M.S. & Karen B. Pearson, M.L.I.S., M.A.)

a. Introduction

b. Prevalence of Rural Substance Use and Abuse

i. Patterns of Substance Use

ii. Patterns of Substance Abuse by Demographic and Socioeconomic Characteristics

iii. Specific Substance Use Issues in Rural Communities

c. Prevention

i. Review of Prevention Theory and Practice

ii. Applying Theory and Practice to Rural Populations

d. Substance Abuse Treatment

i. Distribution and Characteristics of Rural Providers

ii. Lack of Intensive Services and Special Programs

iii. Challenges to Treatment Accessibility

iv. Treatment Models with Relevance for Rural Providers

1. Role of Primary Care in Identifying and Treating Substance Abuse

2. Telehealth

3. Residential Service Options

e. Continuing Care and Long Term Support

f. Conclusion

g. References

13. Suicide in Rural Areas: Risk Factors and Prevention (Courtney Cantrell, M.S., Sarah Valley-Gray, Psy.D. & Ralph E. Cash, Ph.D., N.C.S.P.)

a. Introduction

b. Risk Factors for Suicide in Rural Areas

i. Access to Lethal Means

ii. Geographic and Social Isolation

iii. Culture of the Community

iv. Stigma

c. Suicide in Rural Areas: Prevention, Intervention, and Systems of Care

i. Prevention

ii. Intervention

iii. Systems of Care

d. References

14. Providing Mental Health Services for Racial, Ethnic, and Sexual Orientation Minority Groups in Rural Areas (Ishan Williams, Ph.D., Derick Williams, Ph.D., Amanda Pellegrino, Psy.S. & Jacob C. Warren, Ph.D.)

a. Introduction

b. Racial and Ethnic Disparities in Rural Areas

i. Barriers to Provision of Mental Health Services for Rural Minorities

c. The Impact of Sexual Orientation on Mental Health in Rural Areas

i. Heterosexism

ii. Invisibility and “Don’t Ask, Don’t Tell”

iii. Victimization and Discrimination

iv. Isolation

v. Lack of Support

vi. Mental Health Providers and Services

d. A Holistic Approach to Mental Health for Rural Minorities

i. The Indivisible Self Wellness Model

e. Implications for Best Practices and Recommendations for the Future

i. Racial and Ethnic Minorities

ii. Sexual Orientation

f. Conclusion

g. References

15. Providing Mental Health Services for Women in Rural Areas (Frieda Farfour Brown, Ph.D., Shannon P. Warden, Ph.D., L.P.C., N.C.C. & Amanda Brown Kotis, M.A., D.M.D.)

a. Introduction

b. The Biopsychosocial Model

c. Collaboration between Primary Care Providers and Psychologists

d. Collaboration between Religious Organizations and Mental Health Professionals

e. Collaboration with Community-Based Programs: Case Examples

f. Collaboration with University Training Programs

g. Conclusion

h. References

16. Providing Mental Health Services for Men in Rural Areas (Don Gorman, R.N., Dip.N.Ed., B.Ed., M.Ed., Ed.D., F.R.C.N.A., F.A.C.M.H.N., Robert Eley, Ph.D. & Delwar Hossain, Ph.D.)

a. Introduction

b. Characteristics of Rural Men

c. Health-Related Behavior

d. Stigma of Mental Illness

e. Suicides in Rural and Remote Communities

f. Provision of Health Services to Rural Men

g. What Works: Steps That Can Be Taken to Address the Needs of Rural Men

h. Community Capacity Building

i. Conclusion

j. References

17. Providing Mental Health Services for Children, Adolescents, and Families in Rural Areas (Heidi Liss Radunovich, Ph.D. & Brenda A. Wiens, Ph.D.)

a. Introduction

b. Need for Mental Health Care Among Rural Children, Adolescents, and Families

c. Challenging Issues and Barriers to Care for Rural Children, Adolescents, and Families

i. Lack of Providers

ii. Distance

iii. Financial Issues

iv. Confidentiality and Ethical Practice Concerns

v. Stigma and Perceptions of Therapy

d. Potential Solutions for Increasing Service Provision

i. Use of Technology for Service Provision

ii. School-Based Care and Coordinated Community Response

1. Case Example: Project CATCh

2. Community-Based Participatory Collaboration

iii. Prevention-Based Focus

e. Conclusion

f. References

18. Providing Mental Health Services for Older Adults and Caregivers in Rural Areas (Martha R. Crowther, Ph.D., M.P.H., Forrest Scogin, Ph.D., Ernest Wayde, M.A. & Audrey Austin, M.P.H., M.A.)

a. Introduction

b. Older, Rural Adults

c. Mental Health and Rural Elders

d. Family Caregiving and Rural Elders

e. Adapting CBT for Treating the Rural Elderly

f. Using CBT for Treating Depression in the Rural Elderly

g. Case Illustration

i. Presenting Problem and Client Description

ii. Case Formulation

iii. Course of Treatment

h. Clinical Practices and Conclusion

i. References

19. Providing Mental Health Services for Rural Veterans (John Paul Jameson, Ph.D. & Lisa Curtin, Ph.D.)

a. Introduction

b. Characteristics of Rural Veterans

c. Barriers to Care for Rural Veterans

d. Working with Rural Veterans: Practice Issues

e. Future Directions for Research and Practice

f. References

20. Working in Frontier Communities (Jaedon P. Avey, M.S., Mimi McFaul, Psy.D., Tamara L. DeHay, Ph.D. & Dennis Mohatt, M.A.)

a. Introduction

b. Challenges and Adaptations

i. Developing Relationships

ii. Community Self-Determination and Co-Participation

iii. Boundaries and Ethics

c. Rural Lifestyle and Self-Care

d. Workforce Recruitment and Retention

e. Rewards of Working in a Frontier Setting

f. Experiential Lessons Learned

i. Logistics

ii. Presence

iii. Awareness of Self

iv. Awareness of Community

v. Self-Presentation

vi. Professional Relationships and Collaboration

vii. Self-Care and Safety

g. Conclusion

h. References

SECTION FOUR – LOOKING TO THE FUTURE

21. Rural Mental Health: Future Directions and Recommendations (K. Bryant Smalley, Ph.D., Psy.D. & Jacob C. Warren, Ph.D.)

a. Introduction

b. Improving Availability of Services

c. Increasing Accessibility of Care

d. Improving Acceptability of Mental Health Services

e. Evidence-Base for Rural Practice

f. The Importance of Advocacy

g. Conclusion

h. References