Treating the Whole Person Focus of $1 Million Grant

TUSCALOOSA, Ala.  — Two University of Alabama researchers are hoping to improve both the mental and physical health of the people in Walker County, thanks to an almost $1 million grant.

Drs. Monika Wedgeworth and Joshua Eyer, both assistant professors at UA’s Capstone College of Nursing, were recently awarded a $976,918 nursing education program grant from the Health Resources and Services Administration for their project “Gateway Capstone: Interprofessional Behavioral Health for Walker County.”

The project will integrate behavioral health into the services provided by the Capstone Rural Health Center, which is a nurse-managed federally qualified health center — one of only a handful in the nation that is funded as a nurse-managed center. The health center serves as the main primary care provider for the financially disadvantaged residents of Walker County.

“In addition to being in a rural, under-served area, these people also lack financial resources and transportation, so just the fact that we’re getting them to the clinic is very important,” Wedgeworth said. “When we get them there, we want to make sure we’re addressing any need they might have.”

About 80 percent of the health center’s patients live below the poverty line, said Dr. F. David Jones, the center’s executive director, nurse practitioner and co-investigator for the project. Of the patients seen, 42 percent have no insurance, 30 percent have Medicaid, 12 percent have Medicare and 16 percent have various commercial insurances.

“Most of our patients are simply ‘stressed out’ trying to make ends meet, often coming from several generations of poverty and low education and literacy rates,” Jones said. “Mix in a significant amount of substance abuse, and it’s a recipe for disaster. We see substance abusers seeking narcotics multiple times a day.”

The center treats patients suffering from depression with medication as needed, but many of the patients need counseling to improve their thinking and decision-making skills, he added. While the center does have a licensed clinical social worker two days a week, Jones said it is hard to meet the demand for counseling because counselors/social workers can only see a small number of patients per day.

The Gateway Capstone project will provide funding for a full-time behavioral health care provider and consulting part-time psychiatric provider; implement universal screenings of all patients for core behavioral health concerns, such as depression, anxiety and substance abuse issues; develop a clinical practicum site for nursing students providing training in interprofessional, integrated care; build technological and billing infrastructure and clinical care systems to establish a sustainable integrated-care delivery model at the Capstone Rural Health Center; and evaluate project success.

Integrated behavioral health moves past the false notion that physical and mental health should be treated separately and focuses on providers working together to ensure the patient is being treated as a whole, Eyer said.

“Someone who has a chronic long-term physical ailment may feel depressed in part because of that ailment,” he said. “Other people might have depression, and it’s causing physical problems because they never get out, never exercise. It’s all interconnected. The more you can help with one problem, the more it benefits the other.”