Meeting behavioral health needs in rural Kentucky

By Natalie Pope

Rural areas in the United States face a shortage of behavioral health practitioners. As CNN recently reported, a new study in the American Journal of Preventive Medicine found that 47-percent of non-metropolitan counties don’t have access to a psychologist. The shortage extends to psychiatrists, nurse practitioners and a cadre of behavioral health resources including shelters, hospitals and community support groups.

Kentucky ranks 40th in the nation for primary care physicians, rural communities represent 42 percent of Kentucky’s population, and yet 17 percent of the state’s primary care physicians work in rural areas. On top of this, Kentucky only has 15 geriatric medicine specialists to serve the entire population.

Kentucky also has a shortage of mental health professionals with only half of adults with mental health conditions receiving the care they need. Limited resources as expected to be strained even more in coming years as the older adult population in rural communities is expected to increase more than in urban areas.

This is troubling because poor access to mental healthcare, according to experts, is a serious issue that overlaps with other public health crises like drug abuse and suicide.


The University of Louisville Trager Institute is working to meet this need in rural Kentucky through its federally funded FlourishCare program.

Beginning in 2018, the UofL Trager Institute places around 38 students each year who specialize in behavioral health into over a dozen rural health care sites across 10 rural and underserved communities. In this program, students provide direct behavioral health interventions at primary care practices as well as in patient homes.

“Older adults are particularly affected by the lack of behavioral health practitioners,” said Anna Faul, PhD, the Trager Institute’s executive director. “Isolation and depression are common issues for older adults, with 20 percent of rural older adults diagnosed with depression. Not having access to behavioral health care can severely worsen conditions and lead to physical decline. Furthermore, mobility limitations can make it difficult for older adults to drive long distances to get the care they need.”

In addition to behavioral health services, older adults participating in the FlourishCare program receive comprehensive care coordination and chronic disease management services.

“In our first year of this program, we provided behavioral health services to over 150 of older adult patients in rural Kentucky. We look forward to continuing this service this coming year with our new cohort of students,” said Faul.

Locations where the students will be placed for fall 2019 include:

  • J. Sampson Family Medicine Center (covering Barren, Hart, and Metcalfe Counties)
  • Exceptional Senior Living (Oldham County)
  • Multi-purpose Community Action Agency (Bullitt and Shelby Counties)
  • Tri-County Community Action Agency (Oldham and Trimble Counties)

Several practices, while in Jefferson County, serve older adults in rural areas:

  • University of Louisville AIM Clinic (Jefferson County)
  • University of Louisville Family & Geriatric Practice (Jefferson County)
  • University of Louisville PNES Clinic (Jefferson County)
  • Presbyterian Homes and Services of Kentucky (Jefferson County)

The UofL Trager Institute is currently looking to expand the number of student placement locations.

In addition to provide much needed behavioral health and care coordination services to older adults, the FlourishCare program also work to increase the geriatrics behavioral health workforce in rural communities. Both undergraduate and graduate students across multiple disciplines are involved in this program. Many of the masters and doctoral-level students are participating in the Institute’s Flourish Behavioral Health Graduate Internship. As part of this internship, students receive professional skills training, job placement services and a Professional Certificate in Integrated Primary Care and Behavioral Health.

Natalie Pope is with the University of Louisville Trager Institute, formerly the Institute for Sustainable Health & Optimal Aging.





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