New ‘Short Talks’: Expanding Access to Mental Health Service in Rural Arkansas

Editor’s note: This interview occurred before November 2020, when some of the services began. Johanna Thomas is now an associate professor of social work. 

Sarah Brown: Hello, welcome to Short Talks From the Hill, a podcast of the University of Arkansas. My name is Sarah Brown. I’m a communications assistant here at the university. Today I’m talking with Johanna Thomas, an assistant professor of social work in the Fulbright College of Arts and Sciences.

In a joint effort with the Western Arkansas Counseling and Guidance Center, the School of Social Work has been awarded two grants which will significantly help rural Arkansans gain access to mental health services. Both grants are supported by the Substance Abuse and Mental Health Services Administration. Joanna is here to fill us in on the details.

Johanna Thomas: Thanks for having me.

SB: The first grant that you and your colleagues received was worth $4 million. Can you tell us more about that?

JT: So that grant is actually an expansion of the Western Arkansas Counseling and Guidance Center services. It was for them to become a certified community behavioral health clinic, as opposed to just a mental health clinic, so it integrates mental and behavioral health care into one service that’s provided. We are using that to expand to 2,000 Arkansans that don’t currently have access to those services across a six county catchment area over in western Arkansas.

SB: And about how many people do you expect to serve in that area?

JT: The new grant will actually allow us to add about 2,000 additional people to their roles, and so we are expecting about 900 in the first year and around 1,100 in the second year.

SB: How has the coronavirus outbreak affected the people eligible for these services?

JT: So really, we’re seeing an uptick in the number of people who need primary care services, and so being able to offer primary care services to people who are uninsured or underinsured has been huge for the area. Currently the clinic is being built… um, WACGC did not have the facilities, and so they spent about $75,000 from the grant to upgrade their facilities, to hire two nurse practitioners, a physician, several nurses, so that we could offer care to the people in those communities who’ve been affected. As we all know Northwest Arkansas, in particular the River Valley, has seen a very large caseload of coronavirus, and so this will allow people in that area to be tested but to also receive other medical services that they wouldn’t have otherwise. We’re also seeing people being dropped off insurance and insurance going away so these services are critical in this area.

SB: What sort of improvements will be implemented by this grant in those rural communities?

JT: Right, so Fort Smith will be the campus, obviously, that has the health providers, however, as part of the grant, we’ve also purchased an RV for a mobile mental health unit, and so we will be… in the end of the first year and during this second year, we’ll actually be able to send out a therapist, and other therapists, out into rural communities. We have about a 27 percent rate of people who don’t show for their appointments, and this is because they don’t have access to transportation, they’re unable to make it to their appointments for whatever reason, and so the purchase of the RV allows us to be able to make it to them. And so we made sure that the RV was handicapped accessible, we made sure it had two office spaces, and so we’re going to be able to come to them and bring those services to them and we’re really excited about this. WACGC already had telehealth services and so that is an option. That’s how they sometimes get out to that six-county catchment, since we’re talking about extremely rural western Arkansas, so they offer telehealth services, and they will also offer telemed services, so our doctors will also see people through those services. But again, it’s a little bit harder because you have to have access to internet, and we know in Arkansas that continues to be an issue.

SB: So what is being done to help those in need of care who are uninsured or underinsured in this area?

JT: So, we’re actually partnering… There is a new mental health treatment court that will begin in January. So we’ve partnered with them to ensure that individuals there have access to mental and physical health care. We’ve partnered with the Juvenile Detention Center, so about… A little more than 800 children come through there, and once they’re detained, they lose access to their Medicaid. And so they’re not getting treatment while they’re being detained. And so we’ve partnered with JDC to bring that. We’ve partnered with the schools to ensure that children who are suspended or expelled for smoking or vaping are also getting services. So we have created a smoking cessation, vaping cessation program for them. We’re also working with uninsured or non-VA-eligible veterans. And so that is another population that we see a lot of in western Arkansas. And so that is also somebody that we’ve partnered with to ensure that veterans have the services that they also need.

SB: Yeah, that’s a great segue into the second grant you received, the 1.9 million to serve the veterans treatment court. Tell us a little bit about that.

JT: So, currently the veterans treatment court serves about 30 veterans a year through their court program. And these are usually veterans that come in with some kind of charge, obviously through the courts, and so all of them are… To be able to go through the court currently you have to be VA-eligible, and so you have to be able to get your services through the Veterans Administration. Not every veteran is VA-eligible. I learned about this just recently, because I had no idea, I just assumed if you were a veteran that you were eligible for those services. But if you were not active duty, if you were a reservist, if you were less than honorably discharged, you may not be eligible for those services. And so our veterans deserve better than that, and so part of what we’re doing with that grant is ensuring that uninsured or privately insured or… they don’t have quite enough insurance to meet the needs, we’re making sure that they also get the services that they need, and they’re able to enter the court and get those charges discharged at the end, so that they can go on to lead productive civilian lives.

SB: And will this serve about the same area as the other grant?

JT: So, this is actually Sebastian and Crawford counties only because those are the two jails that we work with but we expect that program to more than double. That’s actually a five-year grant, and so over that time we’re expecting that to increase substantially. Judge Tabor is a huge proponent of veterans. He’s super excited about this grant, and this has been a dream of his to be able to open his court and his services to veterans who, for whatever reason or not, have not been eligible. The Western Arkansas Counseling and Guidance center is a partner in this, as well as Harbor House, to make sure that we’re able to offer substance abuse treatment, and that we’re able to offer mental health services. And then, of course, they would also be allowed to use our physical health services through the other grant. So it’s kind of like we’re doing a full-spectrum, holistic kind of approach for our veterans.

SB: Yeah, that’s great. Are there any other community partners that have come on board with you on this project?

JT: On this one, no, it is obviously Sebastian County and Judge Hudson and then Judge Tabor. Western Arkansas Counseling and Guidance Center and Harbor House and the VA is helping us with some things like training, making sure that they have training, that our services are similar to services that they would offer through the VA and that we ensure that the services that WACGC offers become veteran-centric. So it’s really important that veterans are together and that those services look similar because they’re a very, you know, this population has special needs, and so we have asked the Veterans Administration to help us to ensure that that also happens.

SB: Now, do you see like a certain age demographic when it comes to people who need these services?

JT: No, I mean it is truly across the life course. We’re treating people from zero, literally birth, until the end. The court obviously sees a little bit different demographic, but it’s pretty spread out, you know, people get in trouble at all stages of life, so our goal is to make sure that we can serve people across the lifespan.

SB: How are university students involved in these grants? Are they conducting any research in this area of social work?

JT: So because these are so new, they’re not up and running, so we will not be seeing our first clients at WACGC. We just went and saw some at JDC, and veterans won’t be treated until November, and so we are still up and running. However this will become an opportunity for internship, for our students. This will also become an opportunity for, obviously, secondary data collection and analysis for their capstones or theses or whatever they might choose. We do currently have a student who is going to work with us in the Veterans Treatment Court, and he is going to help us collect data and enter that data and really get to know the court process. And so his internship is actually with the Department of Corrections, but he has a special interest in veterans and asked if he could be part of this. So we are including students as we go along, and I expect to see a lot more students as we work through this.

SB: Like the news stories have indicated, there are other faculty members involved in these projects. How are they participating in these efforts?

JT: For the first grant, I have a partner in sociology/criminology, and he is actually a statistical specialist, and so doing a lot of work helping with data collection, data analysis, writing reports. He is a PI, that’s Dr. Shaun Thomas over in Sociology. And then we also have partners at American University. And so those partners also have help with or have experience in doing large-scale implementation and evaluation. With a $4 million dollar grant it takes a lot of people, and that’s what we’re finding. And so a team is the best way to approach this. Otherwise it might be unmanageable. And so our partners at American University are also helping with data instrumentation, collection, report writing, because serving 2,000 people is going to take… it’s going to take a lot of effort. My faculty also in social work is offering free training for all of the counseling and social workers in the agency on topics that are needed for this particular grant. So for the veterans grant, Dr. John Gallagher is actually the PI on that one. I’m a co-PI, so same… We’re partners in this together, for this grant. And so we do, again, most of the evaluation, but we’re also working on implementation. Judge Hudson and Judge Tabor have never had a grant this large before, and so we’re helping them kind of learn the ropes and what SAMHSA requires and how to get all of this done, and it’s a big project, and so it requires that. And then we’ve partnered with a group called the Baldwin Group that is also helping us create instruments and do the evaluation, because, again, it’s… you know, I’ve learned that research is a team sport.

SB: Truly, truly is. Another question I have for you comes from the university news article published a couple months ago about this first grant that you received. They say that you’re going to be using evidence-based practices in your approach, and I was wondering how do you think that makes a difference?

JT: That is a great question. So I think when you’re offering something that’s evidence-based, you know, that it has… that it’s been used in the population that you’re serving and that it has outcomes that have been tested, And so not every intervention has that. And so a lot of times in social work we depend on things like provider knowledge or provider history or what they think has worked in the past, and that isn’t always the case. We may be using an intervention with a population that hasn’t been tested, and so we could possibly harm a client instead of helping them. And so it really is important that we make sure that we understand who this intervention has helped, how it’s helped them, the outcomes we should be looking for, and constantly assessing those to ensure that it’s doing what it should be doing and that we’re getting the outcomes that we want. So evidence-based intervention is the gold standard, really, for social work, and and most clinical interventions. So it’s really, really important. WACGC is already using these. We’re just adding in some more. We don’t… we have zero intentions of harming clients, and so we want to make sure that that the interventions that we use don’t do that.

SB: Well it looks like that’s all the time we have for today. Thanks for joining us on Short Talks, Johanna.

JT: No problem. Thanks for having me.

Matt McGowan: Music for Short Talks From the Hill was written and performed by local musician Ben Harris. For more information and additional podcasts, visit Arkansas Research. That’s arkansasresearch.uark.edu, the home of science and research news at the University of Arkansas.

A version of this story also appeared in the University of Arkansas’ Arkansas Research publication.