Purpose-Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers' knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains.Methods-Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, "What are the 3 things you wish someone would have told you about delivering health care in rural areas?" were thematically coded.Findings-Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner.Conclusion-Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities.

Public health initiatives regarding FASD have been effective in increasing knowledge among a broad range of professionals. However, between-group differences indicate the need for targeted, discipline-specific interventions. These differences highlight the need for all professional groups to provide a consistent public health message regarding maternal alcohol consumption.

Community-based participatory research (CBPR) focuses on specific community needs, and produces results that directly address those needs. Although conducting ethical CBPR is critical to its success, few academic programs include this training in their curricula. This paper describes the development and evaluation of an online training course designed to increase the use of CBPR in mental health disciplines. Developed using a participatory approach involving a community of experts, this course challenges traditional research by introducing a collaborative process meant to encourage increased participation by special populations, and narrow the parity gap in effective mental health treatment and services delivery. KeywordsCommunity-based research; research ethics; research training Despite years of federal and state efforts devoted to improving the health of all Americans, large demographic groups across the nation remain "underserved," and do not receive the medical or mental health care they need. As an example of persisting disparities in mental health care, higher rates of mental disorders and consequent disabilities among racial and ethnic minorities are not due to greater prevalence or severity of illnesses in these populations per se, but rather to the lack of care or inadequate care. Members of these populations remain underserved in their mental health services needs primarily because of various barriers to care such as poverty, language, homelessness, geographical and social isolation, and suffering from stigmatizing disorders (President's New Freedom Commission on Mental Health, 2002; United States Public Health Service Office of the Surgeon General, 2001).Address correspondence concerning this manuscript to: Catherine Bruss, Co-Principal Investigator, Terra Nova Learning Systems, 10437 W. Innovation Drive #400, Wauwatosa, WI 53226, voice: (414) 475-9973, fax: (414) 475-9974, cathy@terranovalearning.com. NIH Public Access Author ManuscriptEthics Behav. Author manuscript; available in PMC 2010 November 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptBarriers to mental health services delivery are also barriers to participation in research. Underrepresentation of special populations in research delays the advancement of effective treatment for these groups, and in forming national health policy that is largely based on data collected from research. For example, the U.S. Surgeon General's 2001 Report, Mental Health: Culture, Race, and Ethnicity, describes in detail the limited or lacking information on certain racial and ethnic groups in randomized clinical trials evaluating the efficacy of treatments for bipolar disorder, major depression, schizophrenia, and attention-deficit/hyperactivity disorder. Such under-representation in mental health research is harmful to special populations, as without sufficient research data to inform national health policy, disparity in services delivery will remain unchanged.The President's 2002 New Freedom Commission on Mental Healt...

Purpose-Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers' knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains. Methods-Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, "What are the 3 things you wish someone would have told you about delivering health care in rural areas?" were thematically coded. Findings-Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner. Conclusion-Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities.