This study examined how a rural setting impacts screening and treatment of metabolic syndrome (i.e., diabetes, cardiovascular disease, obesity) in adults with schizophrenia. Seven consumers with schizophrenia and metabolic syndrome, as well as 7 primary care and 7 psychiatric providers (21 total participants) from 2 rural communities, participated in semistructured qualitative interviews. Many barriers and facilitators to effective care were similar to those reported in urban environments. Issues unique to rural communities included fewer primary care providers willing to treat people with schizophrenia, fewer medical specialists, a lack of public transportation, geographic barriers, fewer financial resources, and high rates of unemployment and poverty. Strengths unique to rural communities included familiarity (between medical and mental health providers, and providers and patients), providers who were willing to “go the extra mile” for patients, many informal social supports, and the relaxed atmosphere of rural communities. Aside from financial and practical limitations, participants indicated that strategies to improve screening and treatment such as onsite phlebotomy and integrated primary care were feasible in rural communities. Addressing barriers that are common to urban and rural settings, as well as those that are unique to rural communities, is necessary to improve metabolic syndrome screening and treatment for this high risk population. Additionally, treatment models that build on the unique strengths of rural communities are most likely to be effective.

Background Emerging evidence supports the effectiveness of contingency management (CM) for addictions treatment among individuals with co-occurring serious mental illness (SMI). Addiction treatment for people with SMI generally occurs within community mental health centers (CMHCs) and it is not known whether CM is acceptable within this context. Client views regarding CM are also unknown. Objectives This study is the first to describe CM acceptability among CMHC clinicians, and the first to explore client views. Clinician-level predictors of CM acceptability are also examined. Methods This study examined views about CM among 80 clinicians and 29 clients within a CMHC within the context of a concurrent CM study. Results Three-quarters of clinicians reported they would use CM if funding were available. Clinicians and clients affirmed that incentives enhance abstinence motivation. Clinician CM acceptability was related to greater years of experience, and identifying as an addictions or co-occurring disorders counselor, more than a mental health clinician. Conclusions The findings provide preliminary evidence that CMHC clinicians, serving clients with addictions and complicating SMI, and client participants in CM, view CM as motivating and a positive tool to facilitate recovery. Scientific Significance As an evidence-based intervention, CM warrants further efforts toward funding and dissemination in CMHCs.