A Husker psychologist is adding a new dimension to the University of Nebraska–Lincoln’s Clinical Psychology Training Program that will enhance students’ ability to deliver high-quality mental health treatment to vulnerable populations, while simultaneously helping to alleviate Nebraska’s mental health care provider shortage.
Arthur “Trey” Andrews has launched a program focused on increasing the number of students trained to deliver mental health services in community-based primary care settings, such as family doctor, pediatrician and OB-GYN offices. The project is funded with a three-year, nearly $700,000 grant from the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services. The grant enables four trainees per year to provide care in these integrated care settings, while also providing students and faculty enhanced training in substance abuse treatment, trauma-informed care and health care equity issues.
A central goal is to shift students’ focus beyond treatment plans, placing a larger emphasis on the systems involved in mental health care delivery. Considering the larger systems at play will pave the way for helping persistently underserved communities: immigrants and refugees, low-income individuals and those without insurance, and minority racial and ethnic groups.
“Very often, clinical training focuses on what we do in the room. And when we sit down with a client or patient, we do need to know what we’re talking about and how to talk about it,” said Andrews, associate professor of psychology and ethnic studies and co-director of the university’s Minority Health Disparities Initiative.
“But there’s another component, and that’s how the services are structured and how you get access to them: Where are you located, how much time per week is required, and cost and insurance issues. These pieces are really critical to thinking about whether a person can even get in to see you, how feasible it is for them to continue seeing you, and our ability to reach folks who don’t otherwise have access to care.”
With this initiative, Nebraska’s Clinical Psychology Training Program — the state’s oldest and largest mental health training program — joins a small group of other programs nationally that allow students to practice in an integrated primary care setting in the early years of their training. This early exposure is critical because primary care professionals provide mental health services more often than any other service sector, a trend that is amplified among Latinx and immigrant populations.
The integrated care model is increasingly prevalent because it circumvents many barriers to care. Patients can go to a familiar building to receive treatment. They don’t have to disclose to employers that they’re receiving mental health care – an appointment card would simply list the primary care provider. And on-site specialists can dispel myths and introduce non-pharmacological treatments, which physicians may not have the expertise or bandwidth for.
“They’re often limited in what they can provide and with the training they have, and they’re focused on so many other things,” Andrews said. “That’s where we come in. We offer that expertise in the same way that a dietician or audiologist would add expertise.”
Under the grant, trainees will work about 20 hours per week at OneWorld Health Centers in Omaha and Bluestem Health in Lincoln. Both are high-need federally qualified health centers that serve some of the state’s most vulnerable populations. By placing four half-time clinicians at these locations, the training program allays the escalating shortage of mental health care providers in Omaha and Lincoln.
Students at these sites serve as behavioral health consultants who meet with patients after a “warm handoff” — a process where a primary care provider directly introduces the patient to the consultant. The student then provides on-the-spot services, including symptom assessment, referrals and brief interventions like counseling or guided relaxation. They treat a wide range of conditions, ranging from sleeping problems, chronic pain and burnout to eating disorders, depression, attention deficit/hyperactivity disorder and more.
Anneliis Sartin-Tarm, a fourth-year student in the Clinical Psychology Training Program, is a member of the training program’s first cohort. Sartin-Tarm, who specializes in psychophysiological changes after trauma experiences, worked at OneWorld last year and is now at Bluestem. Initially, she was pursuing a career focused predominantly on research. But her clinical experiences have changed that trajectory.
“I started to realize how limited in scope a lot of advanced techniques being studied in psychology actually have,” she said. “I wanted my work to reach more people.”
Through her clinical training, Sartin-Tarm said she could clearly see the dissonance between psychology in the classroom and on-the-ground reality. Nearly all of the interventions she learned about in the classroom needed significant modifications in order to be effective with high-needs populations. That realization prompted her to pursue a career focused on clinical work, with an emphasis on improving access to mental health services.
“In order to best meet our patients where they’re at — who need our services the most — we need to work within the reality of the current health care system,” she said. “Instead of wondering why people aren’t coming to see therapists, or why people aren’t responding to our treatments, we as providers should ask, ‘What can we do to help meet our populations’ needs?’”
Andrews said the opportunity to help students focus on questions like these motivated him to develop the program, which he’s been laying the groundwork for over the past four years. His training experiences through a similar program at the University of Arkansas were key to helping him design the program, which he hopes will pave the way for clinicians interested in broadening access to health care.
Saira Sarwar, another member of the first cohort and a third-year student in the Clinical Psychology Training Program, is pursuing a clinical and research career focused on health outcomes and disparities in pediatric populations. She credits her OneWorld experience with enabling her to treat a much broader range of patients than she did in her previous training role, which served patients from the campus community.
“The experience has given me a lot of exposure to many types of mental health conditions I hadn’t previously been exposed to,” said Sarwar. “At OneWorld, the patients span the spectrum in terms of needs levels and the types of concerns they have, making it an interesting and important training opportunity.”
The training program includes a partnership with the university’s Rural Drug Addiction Research Center, which will enable students and faculty to participate in monthly workshops focused on substance abuse treatment and prevention. Andrews and colleagues are also developing new course offerings focused on integrating trauma-informed and culturally sensitive approaches into primary care.
The team also includes Husker psychologists David Hansen, Anna Jaffe, Tierney Lorenz and Dennis McChargue.