As behavioral health issues arise, UND's Center for Rural Health helps rural areas tackle problems.
Not long ago, the Center for Rural Health (CRH) at the University of North Dakota School (UND) of Medicine & Health Sciences wasn’t very involved with behavioral health issues. But times have changed. Several tracking organizations have noted recently the increasing incidence of depression and anxiety among Americans—youth in particular—over the past decade. As needs have grown around this issue, the number of projects the CRH is involved with has grown as well.
“Behavioral health—mental health and substance use disorder—has come to the forefront as a significant health issue in the past few years,” said Brad Gibbens, deputy director of the CRH. “Over the years we have done some work in this area and certainly assisted rural providers if they were developing a grant to address behavioral health. However, about five years ago through some assessment work we started hearing more and more from a range of rural providers, [about] how behavioral health was becoming an emerging issue, a common problem. As is often the case, they did not have resources. They had needs but limited options to address the problem.”
Not only do many communities have limited resources for prevention, treatment, and recovery, some of the social determinants of health are working against rural communities and contributing to behavioral health problems, including higher rates of poverty, lower educational attainment, high risk behaviors, isolation, higher unemployment, and an aging population, Gibbens said.
But the CRH is trying to help.
“The CRH stepped up and started talking with other groups, including the North Dakota Department of Human Services (NDDHS), our state office in charge of behavioral health,” Gibbens said. “Basically, using some federal and some state resources, we developed a number of programs or services. With some we take the lead. With others we are a partner organization. Some are multiple year efforts, while others are much shorter. Some are stand-alone projects, and others are behavioral health sections of a larger project.”
Right now, the CRH is involved in 14 behavioral health projects that tackle everything from behavioral health workforce issues to treating opioid use disorder.
“It is not simply an urban issue, as it impacts many rural areas,” Gibbens said of behavioral health issues. “Data shows that issues such as opioid abuse and heroin use are prevalent in rural regions. Rural adults have higher rates of alcohol abuse, tobacco use, and methamphetamine use.”
The CRH exists to connect resources and to increase knowledge to strengthen the health of people in rural and tribal communities.
As evidenced by the breadth of these projects, CRH staff possess a wide range of skills to help with behavioral health issues in the state, including assessment and research, evaluation, planning, information dissemination, technology, and program development.
“All of these are capacities we apply through our behavioral health efforts,” Gibbens said. “We don’t believe we have all the answers, but we do believe we have the skills and ability to work with others, particularly people in rural areas, to develop viable solutions. After 39 years of working directly in the rural arena, we understand rural communities and providers. Rural is a different environment than urban, and our history and experience relies on building rural community capacity and transmitting skills.”
And everything comes back to caring about rural communities.
“The reason for this growth [in behavioral health programs] is there is simply a lot of need,” Gibbens said. “We are interested in helping.”
Among the projects the CRH is involved with are:
- Project ECHO: Management of Opioid Use Disorder. With funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), the program is administered through the NDDHS. Through Project ECHO, the CRH is developing a broad, flexible continuum of care delivery specifically to treat opioid use disorders, offering both medication assisted and psychosocial treatments.
- Behavioral Health Workforce Education and Training. With funding from the Health Resources & Services Administration, this program develops and expands the behavioral health workforce through improved training and by providing stipends to graduate students in UND behavioral health programs.
- Behavioral Health Workforce Development. With funding from the NDDHS, this project is developing a multi-focused behavioral health workforce strategic implementation plan for North Dakota that includes provider workforce inventory, review of telebehavioral health policy, and development of behavioral health education roadmaps.
- Evaluation of the North Dakota State Targeted Response to the Opioid Crisis. With funding from SAMHSA administered through the NDDHS, the CRH is evaluating the North Dakota State Targeted Response to the Opioid Crisis (Opioid STR). The Opioid STR’s goal is to reduce opioid-related deaths through increasing access to treatment and recovery services, awareness, and prevention, and reducing stigma surrounding opioid use disorder.
- The National Institute of Mental Health (NIMH) Outreach Partnership, funded by the National Institutes of Health. The CRH is the NIMH Outreach Partner for North Dakota. Through this partnership, CRH provides free publications on various mental health topics. The Outreach Partnership also provides access to information on participating in clinical trials through NIMH.
- The Rural Community Opioid Response Program Planning Grant, funded by the Federal Office of Rural Health Policy. The CRH is working with consortium members in North Dakota to develop and strengthen multi-sector collaborations that will lead to targeted interventions addressing specific opioid use disorder prevention, treatment, or recovery needs in high-risk rural North Dakota communities.
- The State Epidemiological Outcomes Workgroup (SEOW). Founded in 2006 by the NDDHS Behavioral Health Division, SEOW’s purpose is to identify, analyze, and communicate key substance abuse and related behavioral health data to guide programs, policies, and practices. The CRH develops the State Epidemiological Profile and provides ongoing consultation and support for the SEOW, which is funded by the NDDHS.
- The North Dakota Primary Care Office (PCO), funded by the North Dakota Department of Health. The PCO’s mission is to improve primary care service delivery and workforce availability.
- The North Dakota Brain Injury Network (NDBIN), funded by the NDDHS. NDBIN provides information and support to people with brain injury and their family members.
- The Mental Health Technology Transfer Center, funded by SAMHSA. The Mountain Plains – Mental Health Technology Transfer Center provides resources, training, and technical assistance to mental health providers and other practitioners in Region 8.
- Wac’in Yeya: The Hope Project, funded by Sanford Research - Collaborative Research Center for American Indian Health. Wac’in Yeya is a pilot research grant in partnership with Oglala Sioux Lakota Housing to conduct focus groups with Lakota youth and develop creative projects about what gives them hope. The data from this project will be used to develop suicide prevention programs, provide hope to Lakota youth, and determine culturally specific causes of hopefulness.
- The Mood Disorder Assessment Validation Study, funded by the National Institute on Drug Abuse through the Northern Plains Tribal Epidemiology Center Native American Research Center for Health. This study addresses validation of clinical and research assessments of depression, anxiety, substance abuse, quality of life, and rumination to determine if and how they should be used with Northern Plains American Indians.