Building the Missouri Therapy Network: A PBRN of Psychotherapists Serving Low Income Clients

Background and Purpose: Many mental health services are provided by clinicians at small agencies and in private practices and are funded through Medicaid. These clinicians would not typically participate in research and may not be reached by public-sector and university-based efforts to disseminate evidence-supported treatments (ESTs). For these reasons, social work and psychologist researchers from two universities decided to develop a statewide Practice-Based Research Network (PBRN) that focused on mental health clinicians serving Medicaid-funded clients. Guiding questions were: (1) Would mental health clinicians serving low income clients agree to participate in a PBRN? (2) Would they agree to volunteer for leadership roles? (3) What were their research interests? (4) Would the PBRN be able to attract additional funding to allow its continued existence?

Methods: A public database of over 3000 mental health clinicians certified to bill Medicaid was used to recruit PBRN members via the mail. Mailings informed clinicians of the desire to develop a PBRN and provided a survey about their current mental health practices. A returned survey enrolled clinicians in the PBRN. The mailed information was followed by two reminder post cards, a second full mailing, and an additional reminder. In addition, a website for the PBRN was created and clinicians could join by taking the survey on-line. Responses were purposefully used to recruit a Clinician Advisory Board representative of the PBRN members and to inform future research studies.

Results: To date, 1348  Medicaid mental health clinicians (52% of those thought to be eligible) from 85 different Missouri counties have enrolled in the PBRN. Survey results indicated that the clients of these clinicians tended to be low income (72%), paid via Medicaid (52%), and were often referred from a public social service (31%) or school (11%). Clinician members were mostly master level (70%), and experienced (mean of 14.32 years in practice, +/- 9.53 years) and included social workers (36%), counselors (51%), marriage and family therapists (15%), and psychologists (27%). Some identified with more than one profession. Respondents were evenly split between rural/urban  and agency/private practitioners and were 71% female and 91% Caucasian. Thirty-four percent reported willingness to serve in a PBRN leadership capacity.  Of those who answered an open ended question about what they wanted to learn through the Network, 60% had ESTs among their answer.

A Clinician’s Advisory Board was formed from survey volunteers and has vetted several studies. The Advisory Board has yet, however, to generate a new study idea that has been implemented. The PBRN has received funding as a research platform through one foundation, one university and one NIH grant mechanism.  Struggles have included funding for ongoing maintenance of the PBRN, communication to the members, and publishing from PBRN findings.

 

Conclusions and Implications: Clinicians can be recruited for PBRNs through inexpensive means raising the possibility that other social work relevant PBRNs could be established. However, attracting continued funding for PBRN infrastructure may be difficult. Clinicians show interest in learning ESTs and this may be one way to interest clinicians in practice-focused research.