Summarizes survey of American Psychological Association accredited clinical internships to determine extent of involvement with rural clients and opportunities for rural clinical/community work. Tables include list and brief description of 19 clinical internship programs with rural placements and 28 names and addresses for clinical internships with rural components

Heyman, Steven

Singer, Jefferson A.

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Journal of Rural Community Psychology, Vol. 7, No. 1, 1986Finding Clinical Internshipsin Rural Settings:A Survey and ReportJefferson A. Singer This article provides a service forYale Uniuersity graduate students interested in a clini-Steven Heyman cal-community internship in a rural set-umvenity of Wyoming ting. At the 1984 meeting of the RuralIssues Task Force, sponsored by Divi-sion 27, the membership agreed thatgraduate students need more informa-tion about APA accredited clinical in-ternships that contain a rural placementor access to a rural population. The ba-sic reference source for informationabout clinical internships, the Associa-tion of Psychology Internship Centers' (APIC) directory, indicates that aspecific program may serve rural patients, but it fails to say in whatmanner or with what frequency. Without access to information aboutwhat types of opportunities may be available to them in rural internships,clinical-community graduate students will continue to direct their interestand applications toward established programs in urban areas. This is par-ticularly worrisome in light of 1980 census data showing that though farmpopulation has decreased, nonfarm population in rural areas has in-creased rapidly.This is a summary of a paper presented at the annual convention of the American PsychologicalAssociation. Los Angeles, CA, August, 1985.Requests for reprints should be sent to Steve Heyman, Department of Psychology. Box ,H415. UniversityStation, The University of Wyoming, Laramie, Wyoming 82071.6162 Singer. HermanIn an effort to inform graduate students about existing rural intern-ships, we conducted a survey of all APA accredited clinical-communityinternships with rural addresses, as listed by trie Washington D.C. office ofthe American Psychological Association. We defined "rural address" asany program located in a rural area or any suburban or urban programlocated in a predominately rural state. We mailed a two-page question-naire to 93 programs, inquiring about the percentage of their catchmentpopulation that lives in rural areas, the percentage of their actual clientpool that qualifies as rural, the types of rural placement opportunities forclinical and community work, and the amount of time an intern mayspend working with rural residents. We also asked about any relatedservices, seminars, or research concerned with rural issues, as well asabout the willingness of programs in rural areas to create new servicesand/or placements involving rural interests. A second follow-up surveyasking for more specific information was mailed to 41 programs that hadindicated regular involvement with rural patients.Results and DiscussionFifty-nine programs have responded to the questionnaire (63% re-sponse rate). Of the 34 nonresponding programs, 12 of them were medi-cal center programs set in urban universities of largely rural states. It maybe their nonresponse was a comment on the relevance of the question-naire to the populations they serve. Of the 59 programs responding, 41offered an opportunity to work with rural individuals ranging from a day aweek to full time. This means that 70% of the programs respondingoffered at least a day a week of work with rural residents.As Table 1 indicates, V.A. medical centers provided the most oppor-tunity for access to rural populations; only 2 of the 21 responding failedto serve rural populations. There was a wide geographic distribution oftheir programs, most likely attributable to a federally mandated healthcare system. V.A.s were followed by university medical centers and statehospitals, respectively. State hospitals, while not serving the largest ruralpatient population, clearly offered the most time for an intern to workwith rural residents. This finding is explained by their reliance on specialprograms and external placements (5 out of the 7 state hospitals offeredthese types of opportunities).In all, 19 of the 41 programs actually possessed a specific trainingcommitment to rural issues in the form of a rural placement rotation orclinical-community service targeted at a rural population. An example ofthe former would be a placement offered by Hutchings Psychiatric Cen-ter, Syracuse, New York, in which an intern could do a rotation with theTable 1Summary of Internship Programs with a Rural ComponentTypeV.A.Medical Centers(20)UniversityMedical Centers(9)State Hospitals(7)Other -Consortium. Private.Military(5)Totals(n = 41)LocationN.E.S.E.M.W.WestN.E.SE.M.W.WestN.ES.E.M.W.WestN.E.S.E.M.W.N . E .S.E.M.WWest% Ruralpatients(Mean)5 - 40%7261 57%5121 26%1231 24%22s :*7'f,15711% Time spentwith ruralpatients(Mean)41%56%80%28%M'-Y.Internshipswith ruralrotation orprogram835311oaoQu>ff64 Singer, HeymanMental Health Department of Madison county, a neighboring rural area.An example of the latter would be at the Dartmouth Medical Schoolwhere interns might join an N.I.H. funded program for the treatment ofthe chronically mentally ill in a rural community setting.An interesting geographical difference emerged in both the percent-age of the client pool that is described as rural and in the amount of timeone could work with rural residents. Rural programs in the eastern part ofthe United States (for this sample, Arkansas and East) served on averagea 46% rural client population, while rural programs in the Midwest andWest combined served on average only a 32% rural client population.Additionally, rurally oriented Eastern interns spend on average 54% oftheir time working with rural residents, while interns choosing a Westernrural program on average spend only 32% of their time working withrural clients.To examine whether these geographic differences in client popula-tion and time spent with rural patients were statistically significant, weperformed a MANOVA with Location (East vs. West) as our betweenfactor. Since the MANOVA was significant, Wilks's Lambda = .84, F(2,37) = 3.62, p < .05, we examined the univariate analyses for the twodependent variables; rural percentage of client population, and timespent working with rural residents. These analyses showed a highly signif-icant difference for time working with rural residents, F(l, 39) = 7.38, p< .001, and a marginal effect for rural percentage of client population,F(l, 39) = 3.33, p < .08. Of the programs that chose to respond to oursurvey, the Eastern programs offered on average more opportunity for anintern with a rural focus. Of course, since an intern ends up attendingonly one internship, it should be noted that individual institutions withoutstanding rural programs were distributed across the country.Table 2 presents a breakdown of the 19 internships that include ruralrotations or program components geared toward rural patients (see Table3 for contact names and addresses for internships). Surprisingly, twoprograms not listed in Table 2 have recently dropped their rural rotationsfrom an intern's list of options. One director indicated the termination ofthe program was due to lack of interest shown by interns. This is unfortu-nate when one considers the severe hardship (mental and physical) largeincreases in farm foreclosures has brought to rural inhabitants in the lastfew years.The results of this survey will be written-up in booklet form for poten-tial distribution by the APA and Division 27 to graduate programs inclinical psychology. It is hoped that this booklet might help to increase theinterest of graduate students in valuable internship opportunities servingrural populations.3«aTable 2 QListing of Clinical Internships with Rural Placement or Program Component §j. , , . . _ _— oo_(See Table 3 for contact persons and addresses of programs) ^Program What It Offers 3CO1. Atascadero State Hospital 1 day per week in rural CMHC. .=•Atascadero. California to2. Student Counseling Center Rural outreach with community agencies in outlying rural counties.Iowa State University.Ames. Iowa3- DCS Moines Child Guidance Center, l/2 day in rural clinic: consultation and evaluation for community agencies in rural counties.Des Moines. Iowa4. VAMC 300 hours at rural county mental health center; special focus on treatment of elderly. ;Knoxviile, Iowa5. Topeka State Hospital Staff placements in rural CMHC; Consultation for rural patients on reintegration into home communities.Topeka. Kansas6 VAMC 2 Vietnam Vet Outreach Center rotations; Sensitivity to problems presented by almost exclusively rural patientTogus. Maine population.7. Springfield Hospital Center 1 day a week placement in rural county outpatient setting. Inpatient wards where 80% of patients are ruralSykesville. Maryland residents.8. Dartmouth Medical School Program in the treatment of the chronically mental ill in a rural community setting (funded by N.I.H.). SeminarsHanover. New Hampshire and training in rural community issues.9 School of Medicine Placement through Indian Health Service to consult with Indian pueblos 'reservations in New Mexico and ArizonaUniversity of New Mexico around problems of handicapped childrenAlbuquerque. New Mexico10. Hutchings Psychiatric Center \-'z time rotation in rural county with emphasis on development of community resources in coping with mentalSyracuse, New York health problems.0\i0\e 2 (Continued)Listing of Clinical Internships with Rural Placement or Program ComponentProgram11. VAMCSyracuse. New York12. VAMCDurham. North Carolina13. Wright State UniversityKettering. Ohio14. VAMCMemphis. Tennessee15. Vanderbilt UniversityNashville. Tennessee16. Austin State HospitalAustin, Texas17. VAMCSan Antonio. Texas18. VAMCSalt Lake City. Utah19. VAMCSalem. Virginia(See Table 3 for contact persons and addresses of programs)What It OffersPossibility of 300 hour externship at rural CMHC.Participation in a home-based health care project. Supervision includes sensitivity to rural issues.Between 2 and 3 day per week rotation at rural clinic.Vocational training with Vietnam veterans from rural backgrounds. Supervision includes sensitivity to rural problems.2 days per week with rural patients. Case conferences, seminars, and presentations.1 day per week at outreach center in rural counties.4-month rotation at outpatient facility in large rural catchment area.Large scale study underway of rural medical service delivery. In process of negotiating for psychology service in ruraloutreach clinics.Training director has background in rural mental health. Possibility of externships in satellite rural clinicsCOCQ3QTable 3List of Names and Addresses for Clinical Internships with a Rural ComponentexCQ1.2.3.(This list also includes programsSam Clements PhDChild Study Center -Mail Slot 589University of Arkansas for Medical SciencesLittle Rock. AR 72205Robert Haynes. PhDAtascadero State HospitalAtascadero. CA 93423Alan Glares PhDDepartment of Clinical PsychologyBox j-165. JHMHCUniversity of FloridaGainesville. FL 32610whose patient population is composed6. John F. Tedesco PhDDes Moines Child Guidance Center1206 Pleasant St.Des Moines. IA 503097. Robert Hall PhDVA Medical CenterKnoxville. 1A 501388. Mary P. Quinn PhDTopeka State Hospital2700 W. 6th St.Topeka. KS 666069. George L. Henderson PhDoj at least 25 % rural residents)11.12.13.14.David Haltiwanger PhDSpringfield Hospital CenterSykesville. MD 21784Chester D. Gaston Jr. PhDPsychology Service (116b-l)VA Medical CenterGuilport. MS 39501Ron Drabman PhDUniversity of Miss. — Jackson VA Consortium2500 N. Stat. St.Jackson, MS 391 10Daniel K. Sturgis PhD8_:TST-i3f/y3-•6'50Abraham A. Spevack PhDPsychology Service 116B.Gainesville VA Medical Center.Gainesville. FL 32602Roy F. WarrmanStudent Counseling ServiceIowa State UniversityAmes. IA50011Central Louisiana State HospitalU 24. P.O. Box 31Pineville. LA 7136010. Philip S. Pierce PhDVA Medical and Regional Office CenterTbgus. MF 04330Norfolk Regional CenterBox 1209Norfolk, NE 68701R. R. Blurton PhDReno VA Medical Center1000 locustReno. NV »952UTable 3 (Continued)List of Names and Addresses for Clinical Internships with a Rural Component16.17.18.19.(This list also includes programs whose patient population is composed of at least 25% rural residents)Stanley D. Rosenberg PhD 20.Dartmouth Medical SchoolHanover, NH 03756Joseph P. CardilloDivision of Child and Adolescent PsychiatryDept. of Psychiatry. School of Medicine 21.University of New Mexico2600 Marble, N.E.Albuquerque. NM 87106Mark A. Ginsberg PhDHutchings Psychiatric Center 22.Box 27 University StationSyracuse. NY 13210Robert P. Sprafkin PhDVA Medical Center 23.800 Irving AvenueSyracuse, NY 13210Jack Edinger PhDVAMC (116B)508 Fulton StreetDurham. NC 27705P.O. Box 3895Russell J. Bent PhDWright State UniversitySchool of Professional Psychology2901 Galewood StreetKertering, OH 45429Joel Chapman PhDPsychological Service: VAMC1030 Jefferson Ave.Memphis, TN 38104Kenneth N. AnchorDirector, Vanderbilt Internship ProgramVanderbill UniversityBox 319 Peabody CollegeNashville, TN 3720324. David Cansler PhDAustin State Hospital4110 Guadalupe St.Austin. TX 7875125. Rodney R. BakerPsychology Service (116B)VA Medical CenterSan Antonio, TX 7828426. Linda J. Gummow PhDVA Medical Center500 Foothill DriveSalt Lake City. UT 8414827. Leo A. Kormann PhDVA Medical CenterSalem. VA 2415328. Richard Seime PhDDept. of Behavioral Medicine and PsychiatryWest Virginia University Medical CenterMorgantown. WV 26506CQre-3D3

Finding Clinical Internships in Rural Settings: A Survey and Report

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Finding Clinical Internships in Rural Settings: A Survey and Report

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