March 12, 2021
Mental Health Services for Rural Communities
The Western Regional Children’s Advocacy Center (WRCAC) supports children’s advocacy centers (CACs), multidisciplinary teams (MDTs) and state chapters that serve a decidedly rural and frontier population. The thirteen states that make up the western region represent nearly half of U.S. land, but less than one-quarter of U.S. residents. The result is a population density that is half the national average – 42.4 persons per square mile in the west versus 89.5 nationally. While the western region features urban centers such as Los Angeles, Honolulu and Seattle with population densities of over 5,000 residents per square mile, most of the states in the west fall well below the national average and comprise vast, sparsely populated areas.

Families residing in remote areas may face daunting challenges accessing services, particularly evidence-based, mental health treatment. In 2018, WRCAC launched a Rural Mental Health Project to increase access to specialized trauma treatment for children and families served by CACs in rural communities. Guided by a review of the professional literature and experts in the field, WRCAC identified several strategies to enhance mental health delivery through CACs in rural and frontier communities: (1) support effective communications to increase awareness of the issue and engage more partners; (2) expand and disseminate the knowledge base demonstrating the effectiveness of telemental health (TMH); (3) pilot creative models to link rural families with trauma treatment; and (4) continue to grow and sustain a talented professional workforce. 

WRCAC launched a comprehensive online Telemental Health Resource Center (THMRC) in 2019 featuring a range of resources from guides for setting up TMH programs to legal and regulatory information. The TMHRC also highlights a growing body of research and practice, including clinical applications, technology basics and funding options to build or update a TMH program. A section was added last spring that focuses on TMH information that is specifically related to the COVID-19 pandemic. To facilitate a transition to TMH service delivery during the pandemic, WRCAC also released an Issue Brief in April 2020, “Moving to Telemental Health in a Children’s Advocacy Center Environment.” The brief details strategies to prepare for service delivery, make clinical adjustments to therapy, and integrate technology and equipment that promote success.

Due to the pandemic, many mental health clinicians transitioned to TMH service delivery quickly with little ability to prepare. As a result, they lost access to informal, peer consultation that they rely upon for support. In response, WRCAC is partnering with the National Children’s Alliance (NCA) to host monthly, virtual Mental Health Peer Consultation Forums for clinicians providing trauma treatment to children served by CACs (in particular, for clinicians serving rural and frontier communities). The Forums provide a safe space to share resources, connect with other clinicians doing similar work, and seek guidance on issues of importance. Experts from the Chadwick Center for Children and Families at Rady Children’s Hospital – San Diego are also available to answer practice-related questions. This ongoing series is held the first Tuesday of each month from 11:00am-12:30pm PT (12:00-1:30pm MT, 1:00-2:30pm CT and 2:00-3:30pm ET). To register for the next Mental Health Peer Consultation Forum, click here

In 2020, WRCAC launched a TMH Pilot Project to establish statewide, TMH networks of trained mental health providers who will provide evidence-based, trauma-focused treatment to children and families served at CACs in rural and frontier communities. WRCAC selected Washington and Montana as pilot states and is working in collaboration with Children’s Advocacy Centers of Washington (CACWA) and Children’s Alliance of Montana (CAM) (the NCA-accredited chapters) to implement the project. The goal is to ensure that all CAC clients have access to high-quality, accessible and appropriate mental health treatment regardless of where they live, build state capacity to meet identified needs of rural CAC clients, and expand access to necessary support systems for children to heal from trauma. The pilot states recently completed an Exploration and Assessment Phase that determined their readiness to create a functioning TMH network that can effectively link clinicians in one part of the state with children in families living elsewhere. In the next phase, pilot states will receive training and technical assistance to plan, develop and sustain their TMH networks. Montana and Washington are ideal for the TMH Pilot Project as they have identified a number of rural, frontier and tribal communities with limited access to resources and services, and both states offer strong commitments to innovate and think strategically to enhance mental health service delivery through TMH. 

WRCAC recognizes that the sudden rise in CACs implementing TMH is not a passing trend that simply meets the needs of the moment, but is a catalyst for lasting change in mental health service delivery. The research of the past decade clearly shows that TMH is as successful as in-person evidence-based treatments in facilitating positive outcomes. TMH continues to be an important tool for communities, (particularly those that are more geographically isolated), to access timely, quality, mental health services. Recent literature in the field validates the premise that returning to traditional in-person care once the pandemic wanes is unlikely. Hybrid models of care that include both in-person and TMH are becoming more accepted and practiced to serve children and families in need of mental health services. Bridging the gap between rural and urban mental health services involves addressing many complex barriers, such as availability, accessibility and acceptability, while developing creative solutions to complex challenges that are often unique to rural areas. TMH is a part of the solution to improving access in rural areas, increasing the likelihood that individuals living in rural locations will engage in care.  

We encourage you to utilize these resources in your efforts to provide quality TMH services to the children and families you serve. If you would like additional information about our Rural Mental Health Project, or have suggestions for new initiatives, please reach out to us at All ideas are welcome!  
Were you forwarded this email?
Opt-in for our mailing list to get the WRCAC Roundup delivered straight to your inbox.
WRCAC is funded through the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention, Grant #2019-CI-FX-K002

View archived issues of the WRCAC Roundup here.