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Faculty Member Promotes Public Health Research and Workforce Development in Rural Texas Counties

Last Updated on February 16, 2022 at 12:00 AM

Originally published February 16, 2022

By Laura L. Acosta

UTEP Marketing and Communications

With only three part-time licensed professional counselors to provide mental health and behavioral health services in Alpine, Marfa and Presidio in West Texas, residents in the state’s Big Bend region have little choice but to wait weeks to receive mental and behavioral health care or go without treatment, according to Adrian Billings, M.D., Ph.D., chief medical officer of Preventative Care Health Services (PCHS) in Presidio.

In 2021, Thenral Mangadu, center front, secured more than $3 million in federal grants to develop multidisciplinary, community-based public health initiatives under UTEP’s Minority AIDS Research Center. Photo: J.R. Hernandez / UTEP Marketing and Communications
In 2021, Thenral Mangadu, center front, secured more than $3 million in federal grants to develop multidisciplinary, community-based public health initiatives under UTEP’s Minority AIDS Research Center. Photo: J.R. Hernandez / UTEP Marketing and Communications

The shortage of mental health care providers is especially evident in three rural counties in the Big Bend region – Brewster, Presidio and Jeff Davis. The area, which is one of the most remote places in the United States, has been federally designated a Health Professional Shortage Area, or HPSA, not only for its critical shortage of mental health professionals, but also for its lack of primary care providers and dental health workers.

“Some (patients with behavioral health problems) may end up in the emergency room in a suicidal crisis or in a manic episode if they’re bipolar, or they may attempt to access a telehealth option if they have insurance and if it offers telecounseling,” said Billings, who is a rural health core member of The University of Texas at El Paso’s Minority AIDS Research Center. “Many of them have to drive to the urban areas of Midland, Odessa and El Paso in order to access care. But in reality, the majority of them do not access care so their behavioral health disorders can worsen.”

With clinics in Alpine, Marfa and Presidio, Billings said PCHS serves about 5,000 patients in Brewster and Presidio counties, half of whom require mental health care and behavioral health care services.

But thanks to a new partnership between PCHS, UTEP and Sul Ross State University, help is on the horizon.

A $1.9 million grant awarded to UTEP’s Minority AIDS Research Center (MARC) from the U.S. Department of Health and Human Services will launch the Behavioral Health Workforce Education and Training program in 2022. Throughout the next five years, the program will leverage the talent of UTEP and Sul Ross students to create a workforce of  behavioral health specialists that could improve access to mental health and behavioral health care services in the Big Bend’s tri-county region and Culberson and Hudspeth counties.

Established in 2019, MARC aims to advance research and treatment for minority populations relative to HIV/AIDS, with complementary work in substance abuse and behavioral health.

“These five counties in Texas Public Health Region 9/10 have some of the highest mental health professional shortage area (MHPFA) scores in the United States,” said Thenral Mangadu, M.D., Ph.D., UTEP associate professor of public health sciences in the College of Health Sciences. “We are tackling this issue through multiple contexts. It is not only about providing prevention and outreach services, but it is also about increasing sustainable access and utilization through workforce capacity building.”

Providing Access to Services in Rural Counties

The Behavioral Health Workforce Education and Training (BHWET) program is one of eight programs led by Mangadu, MARC’s executive director, that focus on the challenges of getting health care to Texas’ rural counties of Hudspeth, Culberson, Presidio, Brewster and Jeff Davis.

In 2021 alone, Mangadu secured more than $3 million in federal grants to develop multidisciplinary, community-based public health initiatives under MARC that would help people in these low-resource areas navigate their way to services for primary care, mental health care, substance use disorder, suicide prevention and mental health awareness training.

“These health disparities and the factors driving them are interrelated,” said Mangadu, who was appointed UTEP Associate Vice President for Interdisciplinary Research in October 2021. “What is key is for academics and community partners to work together to address different components of behavioral health simultaneously in the same region in order to provide much more sustainable services.”

Starting in the spring 2022 semester, 29 students from UTEP’s Master of Rehabilitation Counseling program and Sul Ross’ Master of Education in Counseling program will be selected each year for the BHWET program. Students will gain hands-on practical experience in local primary care clinics, rehabilitation facilities and other health care organizations in Presidio and surrounding counties.

In total, the program will train 116 students who can be recruited to practice professionally in the region after graduation.

 “We don't have all of the resources or all of the knowledge that our patients and communities need and deserve,” Billings said. “It's only through collaborations with academic centers like MARC at UTEP that we can really try and bring those academic center resources out to these under-resourced areas.”

Maximizing Impact in the Region

The success of MARC’s community-engaged programs stems from a consortium of regional interdisciplinary partners that also includes Aliviane Inc., a nonprofit behavioral health and substance use disorder treatment center in El Paso.

The new rural health programs are an expansion of MARC’s previous initiatives and established framework of community engagement for addressing minority health disparities.

By leveraging each partners’ resources, the consortium is able to maximize its impact in the region by providing sustainable and holistic solutions to the region’s most pressing public health challenges such as opioid abuse.

Since 2020, MARC and Aliviane have been working to implement an opioid response program in the five counties. In 2021, they received $381,106 from the Substance Abuse and Mental Health Services Administration (SAMHSA) to expand substance use disorder treatment and recovery services to 12-to-18-year-old adolescents and 18-to-21-year-old transitional age youth, as well as their families and caregivers.

Carolina Gonzalez, Aliviane's Outpatient Services Administrator, said starting in 2022 the new grant would provide access to treatment for substance use and co-occurring mental health disorders via telehealth to families in rural communities unable to obtain these services in person.

Mangadu’s efforts to address substance use disorder in Texas’ rural region have not gone unnoticed. In 2021, she was one of four recipients honored with the Lone Star Award from the Texas Association of Substance Abuse Programs. The award recognized Mangadu for her leadership and contributions to substance use disorder prevention, treatment and recovery in Texas.

Rebecca Gallegos is the program coordinator for MARC’s Por Mi Familia program. Since 2018, Por Mi Familia has collaborated with Aliviane to provide substance use-related services and health education to 117 women and their children and other family members in the five Texas rural counties.

Gallegos has been assisting Mangadu with her public health initiatives since she was one of Mangadu’s students in UTEP’s Master of Public Health Program. Gallegos said it was wonderful to be part of Por Mi Familia, which contributes to the center’s mission to reduce HIV-related health disparities by addressing risk factors such as substance use disorder.

“We’ve been lucky to involve a lot of women in this program thanks to the provision of substance use-related services, including linkage to care, recovery services, and follow-up,” Gallegos said. “Whether it’s our program or a program related to mental health or workforce training, it’s wonderful to be part of MARC, especially when so many people need these services.”

Raising Mental Health Awareness 

At UTEP, MARC is collaborating with University and community partners to provide behavioral health services on campus. MARC was awarded $306,000 from SAMHSA in 2021 to develop a campus response for suicide prevention with the UTEP Division of Student Affairs, UTEP Police Department and the College of Health Sciences.

With support from another SAMHSA grant worth $625,000, MARC and Aliviane are expanding the Mental Health Awareness Training for Healthy U.S.-Mexico Border Minority Communities project they launched in El Paso in 2018 to Hudspeth, Culberson, Presidio, Brewster and Jeff Davis counties.

The new mental health awareness training program, or MHAT, will provide evidence-based education and training to first responders, law enforcement and caregivers of individuals with mental disorders, including serious mental illness and serious emotional disturbance disorders in the five counties.

Vivian Daher coordinates mental health workforce capacity building activities across 6 counties for the MHAT program. Several of MARC’s current and former program coordinators, including Daher, are Mangadu’s former students. In addition, more than 100 students have participated in paid community-based research opportunities through MARC’s healthcare workforce development initiative.

For Daher, the research opportunities Mangadu provides allow students to directly engage in the community and develop the skills they need to address complex public health problems.

“It’s important to have this mental health program because there’s this big stigma around mental health,” Daher said. “The important thing is to remind people there’s hope. You can get better, and recovery is possible.”