Journal of Rural Community Psychology, Vol. 2, No. 1, 1981 
 
A Rural Program for Enhancing Prevention
and Intervention Skills
 
Lennis G. Echterling
Mental Health Continuing Education
Program Harrisonburg, Virginia
 
 
Introduction
 
There recently has been a greater awareness of the mental health worker's need for continuing education (Bloom & Parad, 1977; Jones, 1975). Some attention also has been given to the special challenges of providing continuing education to human service workers in rural settings (Horejsi & Deaton, 1978; Kohn, 1978). This paper presents an overview of a mental health continuing education program in the central Shenandoah Valley area of western Virginia. About 200,000 people live in the five counties making up the central Shenandoah Valley, which covers an area of 3,500 square miles. Farmlands blanket the undulating hills, dotted by occasional small communities, and lined by meandering rivers. Bordered by the Blue Ridge and Appalachian Mountains, the area is not only predominately rural, it is also somewhat geographically isolated.
Program Development

A needs assessment of the area mental health and human service agencies was done in 1977. It revealed a significant number of professionals, paraprofessionals, and volunteers expressing a need for further training, particularly in innovative treatment techniques, community intervention approaches, and prevention strategies. There were, however, few opportunities for continued training in the Valley. Individuals had to travel to urban areas or large university settings to participate in seminars, workshops, and courses. Consequently, a great amount of the limited funds budgeted by agencies for training was spent on travel, food, and lodging expenses.

In response to this need, the Mental Health Continuing Education Program (MHCEP) was formed in October, 1978. It presently is funded by a grant from the National Institute of Mental Health, and also receives local support in the form of fees paid by training participants, use of training facilities, office equipment, and office space. The program is staffed by one director and one assistant.

During the first several months of the program, the director and assistant primarily were involved in establishing a firm foundation for the program. They developed efficient office procedures, set up working relationships with the institutions and agencies participating in the project, organized several planning and evaluation committees in the area, and began preparations for specific training events.

 

Planning and Evaluation Committees

The planning and evaluation committees play an important part in the program. The purpose of the committees is to communicate what training needs and interests people and agencies have, to give feedback about the training offered, and to assist in developing and presenting training events. Each committee, made up of 8 to 10 members, represents all of the services of a particular county in the central Shenandoah Valley. The committee members include administrators, psychologists, social workers, counselors, health professionals, ministers, and volunteers. The members represent different levels of the administrative hierarchy in mental health and mental retardation services; alcohol and drug abuse services; youth, aging and family services; mental health associations; health services; and  school systems.
 
The committees meet separately every other month. Members of the committees survey the workers and volunteers of their agencies and organizations to assess their training needs, and present this information at the meetings. In addition to identifying training topics, the committees also specify particular groups as target populations for training. For example, one committee recognized the need for training in a newly-formed spouse abuse volunteer program in its county. Consequently, the MHCEP developed a training package with this group. Finally, the committees identify possible training resources, such as facilities for training events and consultants with expertise in certain areas. The committees thus provide an effective communication link by identifying training needs, populations, and resources.

In addition to attending committee meetings, individual members often help in the planning and implementation of specific training programs. Most members are actual participants in training events as well. The result of the work by these committees is that the MHCEP is in constant contact and communication with persons who provide mental health and related services, and who are involved in the specific concerns that confront this largely rural area.
 

Training Events

The program's training events began in February 1979. Since then, a total of 89 workshops have been completed, involving more than 1,600 participants in 996 hours of training. The topics of these workshops have included, for example, teaching relaxation skills, leading counseling groups, organizing community education programs, promoting mental health in schools, working with the dying client, supervising counselors, rational emotive therapy, communication skills, time management, community support systems, crisis intervention, incest, and gestalt therapy.

The participants in these workshops have included not only mental health professionals but also paraprofessionals, volunteers, teachers, law enforcement officers, social workers, nurses, clerical workers, and hair dressers.

In addition to involving a variety of topics and trainees, the training programs have taken place in numerous locations throughout the central Shenandoah Valley. The sites of workshops are selected so that they are easily accessible to the participants and appropriate for the training design.

Each training event undergoes a similar process of development. The topic originates in the needs assessment surveys or in the planning and evaluation committee meetings. The first stage of development, the planning stage, varies from 2 to 6 months in length. The director discusses the training possibility with the committees and with particular groups that may comprise the target population. If the need and interest is significant, the director explores the resources available to present the training. Whenever the topic is outside the director's area of expertise, possible trainers are identified and contacted.

Fortunately, there are many excellent resource persons in or near the central Shenandoah Valley area. Local consultants from the participating programs offer their time and expertise as in-kind contributions to the MHCEP. While outside consultants are compensated at their usual rates, they generally are very willing to cooperate in efforts to keep expenses low. For example, they inform the MHCEP when they will be in the area so that travel expenses can be minimized.
The director and consultant discuss and decide on the learning objectives, format, size, length of the program, dates, and location. Using this information, the assistant designs and sends out a brochure at bulk rate to the individuals and agencies on the mailing list. During this phase of planning, the educational materials are reproduced and assembled, the registration forms are processed, and audio-visual aids are reserved.

Most of the workshops involve a fee, which is set to cover the expected expenses of the particular training event. Individual fees are not charged, however, in a number of orientation training programs for volunteer associations and in a number of workshops scheduled as inservice programs for hospitals and school systems. In these cases, the association or institution covers the entire training expense.

The second stage is actually conducting the program. When a consultant leads the workshop, the director serves as coordinator. At the beginning, he takes attendance, takes care of any financial matters, orients the participants to the training, and introduces the workshop leader. During the workshop, the director is available to serve as a trouble-shooter and to take care of organizational matters. The amount of time involved in conducting a workshop varies from 1 to 6 full days, with the typical program lasting 2 days. The format varies from a single, intensive training experience to a series of meetings. Since participatory learning is emphasized, training includes not only lectures and demonstrations, but also exercises, role-plays, and discussions. In about a third of the workshops, the director, in addition to coordinating the workshop, is also the trainer or cotrainer.

The focus in these workshops is on helping participants gain new knowledge, explore and clarify their attitudes, and develop or refine their skills. Consequently, most workshops are designed to have a low leader participant ratio, personalized goals, and practical learning experiences. Also, the emphasis is on the application of new knowledge, attitudes, and  skills to the participants' work settings. Therefore, setting goals, carrying out projects, and discussing possible applications are encouraged in on going workshop sessions and follow-up sessions.

The final stage is evaluation of the training. At the conclusion of the workshop, the director guides the participants through the evaluation process, involving both a discussion and the completion of evaluation forms. The evaluations are done using a form with items having a scale from 1 (low) to 7 (high) on different aspects of the training program, such as activities, workshop leader, materials, and overall quality. The mean participant evaluation of the overall quality of each training experience has ranged from 4.8 to 6.9, with 81% of the workshops receiving a mean overall evaluation of 6.0 or above. Written comments are also requested, received, and reviewed.

 Continuing Education units documenting a person's participation in the training event are given at the conclusion of training, and are included in a permanent transcript at both the local and national levels. At this time participants also receive a certificate of their participation in the training.

Follow-up evaluation is accomplished by questionnaire 2 months after the end of each workshop. The questionnaire includes scaled items concerning the achievement of the workshop objectives and open-ended questions concerning the participants' application in the job setting of the knowledge and skills gained during the workshop. The percentage of participants applying their new knowledge and skills to their work settings at follow-up has ranged from 50% to 100%, with 88% of the workshops having at least 75 % of their participants actually using the knowledge and skills 2 months later.

The assistant compiles the evaluation data, which are shared with the trainers and the planning and evaluation committees. The data are used to consider the success of the training program in achieving its goals, to refine those programs that are repeated, and to plan any more extensive training that may be needed. Input, feedback, and planning are, consequently, a continuous process.

 

Conclusions

The experience of planning, coordinating and evaluating a continuing education program in mental health has led the author to several conclusions.

First, such a program, particularly in a relatively isolated rural area, can be very cost effective. The majority of an agency's training funds can go for the actual training of its staff, instead of travel, lodging, and meals. Even bringing in an outside consultant to offer a workshop is less expensive than sending several staff members to the out-of-state training program.
 
Second, local workshops provide tremendous opportunities for greater contact and interaction between staff members of different agencies. Training at a local level addresses not only the rural workers' need for continuing education experiences (Jeffrey & Reeve, 1978) but also their sense of professional isolation (Berry & Davis, 1978). They not only have a chance to share their common problems, but they also are able to take with them the feelings of cohesiveness and closeness that often emerge during a training experience. These feelings go a long way in facilitating coordinated efforts among agencies.

Third, locally-offered training presents greater potential for extended programs and follow-up sessions. Participants are not required to take "crash courses" or extended leaves of absence to receive significant, intensive training. Regularly scheduled, brief sessions enable participants to acquire new knowledge and skills at a more appropriate pace. And follow up sessions give participants a chance to reconvene to discuss both the difficulties they encountered and the successes they experienced in applying new knowledge and skills to their particular work situations.

Fourth, the program provides the opportunity to "custom-design" training events to fit the specific needs of local participants dealing with local problems and local clientele. Moreover, our frequent use of area consultants to offer training enables us to repeat easily those workshops in which registration exceeded the limit. Particularly successful programs often are repeated because the word of mouth by original participants generates a greater demand for the training.

Finally, because their agencies usually are small and their communities have few formal resources, mental health workers in rural areas require a wide variety of skills and a general knowledge of a variety of problems (Clayton, 1977). Consequently, MHCEP offers a broad range of training topics and avoids specialization. Similarly it is rarely possible to design a workshop for only one select, professional group. Typically, the participants have varied backgrounds in education and experience. Designing a meaningful, relevant educational experience for all the participants often presents challenging problems.

Acceptance of the program is strong and the MHCEP now has a reputation for offering high quality, relevant training. This acceptance has generated an even greater demand for the service. Training participants frequently make request for advanced training in particular areas. Agencies and institutions outside of the Shenandoah Valley now seek out the MHCEP to offer staff inservice training, or to plan and implement cosponsored training events.

MHCEP has demonstrated that a rural continuing education program can be a very efficient use of limited training funds when it is easily accessible and conveniently available, responsive to local needs, flexible in its design, and effective in its training methodology.
 

References

Berry, B., & Davis, A.E. Community mental health idealogy: A problematic model for rural areas. American Journal of Orthopsychiatry, 1978, 48, 673-679.

Bloom, B.L. & Parad, H.J. Professional activities and training needs of community mental health center staff . In I. Iscoe, B. L. Bloom, & C. D. Spielberger (Eds.) Community psychology in transition. Washington, D.C.: Hemisphere Publishing, 1977.

Clayton, T. Conference report: Issues in the delivery of rural mental health services. Hospital and Community Psychiatry, 1977, 28, 673-676.

Horejsi, C. R., & Deaton, R. L. The cracker-barrel classroom: Programming for continuing education in the rural context. ln R. K. Green and S.A.Webster(Eds.)Social work in rural areas: Preparation and practice. Knoxville: University of Tennessee School of Social Work, 1978.

Jeffrey, M.J., & Reeve, R.E. Community mental health services in rural areas: Some practical issues. Community Mental Health Journal, 1978,14, 54-62.

Jones, N.F. Continuing education: A new challenge for psychology. American Psychologist, 1975, 30, 842-847.

Kohn, E. Developing a continuing education program in rural settings. Human Services in the Rural Environment, 1978, 3, 33-31.
 

This paper presents an overview of the planning, implementation, and evaluation of a mental health continuing education program in the central Shenandoah Valley area of western Virginia. Since its inception, the program has offered 89 workshops, involving more than 1,600 participants in 996 hours of training. The training topics have included innovative treatment approaches, community intervention programs, and prevention strategies. Participant reactions, follow-up information, and other data are discussed in evaluating the program. Finally, conclusions concerning the impact of the program, its problems, and potential are discussed.

(Original journal pages 32-38)