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The University of Iowa College of Education's Telepsychology Training Clinic (TPTC) serves mental healthcare needs of rural Iowans. Hear from DorisAnn McGinnis, a doctoral student in counseling psychology, working with clients managing opioid and substance use disorder, and Martin Kivlighan, co-director of the TPTC.

Transcript:

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Dean Dan Clay:
Hello and welcome to the University of Iowa College of Education's Office Hours, a spotlight on our faculty and our students. I'm Dan Clay, dean of the College of Education.

Mei-Ling Shaw:

And I'm your host, Mei-Ling Shaw.

Clay:
Today, we will hear from DorisAnn McGinnis, a doctoral student working in the Telepsychology Training Clinic, as well as clinic co-director and counseling psychology professor Martin Kivlighan.

Shaw:

I met with DorisAnn last spring to talk with her about her experiences in the counseling psychology doctoral program.

DorisAnn McGinnis:
I currently work as a practicum trainee for the Tele-Psychology Training Clinic. The clinic is aimed at providing resources to individuals in the rural community. We get referrals from various third parties and so a couple of those referral sources come from the University of Iowa Hospital. So specifically, we get referrals from the clinic, the clinic. It stands for a medication assisted treatment.

Primarily, that clinic is for individuals who are recovering from substance or opioid use disorders, and they're using medication in their recovery process. The majority of my clients primarily come from the MAT clinic.

Shaw:

Have you enjoyed getting to work specifically helping people in rural areas?

McGinnis:

I actually grew up in a rural, rural community myself. I grew up on a crop and livestock farm, and so having those experiences in a rural setting has definitely helped me appreciate what a lot of my clients go through just in terms of like their daily lives. These people are going to have trouble accessing, you know, mental health care, whether there's a pandemic or not.

Shaw:
How did you find your way to counseling psychology?

McGinnis:In my undergraduate career, I did some volunteer work for a local place called Four Oaks Emergency Youth Shelter. This is an organization that provides emergency housing services to children and adolescents who may have been removed from their home or foster home in some way. I got a lot of really eye opening experience his with young children and adolescents who had started using substances, other drugs or alcohol in their very early stages of life and one young girl in particular who I had gotten to know and she had was telling me about how she had all of these, like, career things that she went on to do in her life and how she would probably never have the opportunity to do any of those things because of the way that she was brought up and struggling with her recovery and not having any resources to do that. I found myself wondering, okay, like in what way could I be useful here? How can I develop the kind of empathy and care for individuals who might be struggling with substance use or opioid use?

I often have never gone through what a lot of my clients have gone through. And also that's often not a barrier, which is something that's interesting that I've learned, is that it is truly about having the empathy. It's what in psychology we call this unconditional positive regard. Essentially just caring about people that exist in the world.

Shaw:
In your experiences, are you seeing any kind of trends as far as how people are first exposed to it.

McGinnis:

First exposed to substance use? Yeah. Drug use. Yeah. I just want to preface this by saying that this is not everyone's experience. I think every individual has a very specific kind of lived experience. So if I were to generalize it in a way, I would say that substance use is often the result of trauma, especially in early life.

Not always. I have seen clients where substance use began for them in their thirties, you know, mid adult life. However, the majority of my experiences with clients is them describing to me how substance use, drug use was a way for them to cope with traumatic environmental experiences that were ultimately out of their control. That's often what I talk about a lot of my clients, that is the severe trauma that they experienced where, you know, drug use was drug or alcohol use was the only way for which they could cope with it.

Shaw:
It goes back to Four Oaks Kids that perhaps don't have the resources or supports at the time or do not have health insurance. You know, there's all sorts of barriers.

McGinnis:
Yes. And I take a deep breath because I can just feel like the frustration of that a bit like when I when I think about how we tend to treat people who are criminalized for drug and alcohol use, and because often it does start at an early age and then instead of giving those adolescents, teenagers resources to kind of like course, correct in a way, we punish them for it.

And it just feels so counterintuitive to me. And so when I was working with this 17 year old girl who had been using meth since she was 13, and, you know, her describing that, that the first time that she tried it was because her mother gave it to her. How could she possibly know any different or know any better?

And then instead of her getting the help that she needs, she's put through the foster system and she's constantly trying to battle just being able to have resources to survive and then be penalized that oftentimes this carries over into adult life where that cycle just continues of just needing to survive and drugs ultimately becoming a part of that cycle.

And I think that what's often also forgotten is that substance use disorder, opioid use disorder is mental illness. It is a thing to seek help for and should never be stigmatized, at least in my clinical opinion. Like if you think about a person who has depression or anxiety, I think by and large those kinds of struggles are much more accepted and I see substance and opioid use as very similar. I see these things as essentially equal in terms of being a mental health concerns, mental health issues.

Shaw:
McGinnis is just one of several doctoral students working in the clinic currently. Martin Kivlighan, co-director of the Telepsychology Training Clinic, secured a grant along with co-director Saba Rasheed Ali, from the Health Resources and Services Administration. The grant supports training, counseling psychologists from underrepresented backgrounds to address the need for mental health care services in rural Iowa.

Martin Kivlighan:

Iowa's lack of psychologists is pretty critical. Not only are we just seen across the board low numbers of licensed psychologists and even broader mental health care workforce. You know, then if we look at psychologists that are trained specifically in substance use, opioid use, prevention and treatment. Those numbers get cut in half. And then, you know, another focus that we're really trying to integrate into the clinic is being able to serve young adults, adolescents.

And so those being psychologists in Iowa that are trained to work with substance use concerns with adolescents gets cut in half again, you know, and so then you're seeing such a drop off in accessibility to well-trained, competent mental health care providers.

Shaw:
And this is a life or death kind of situation.

Kivlighan:

Unfortunately, it is for a lot of people. Yeah.

Shaw:
So what is happening in Iowa as far as opioid use?

Kivlighan:

Yeah. Yes. So we're seeing a couple of different things. Unfortunately, Iowa ranks 47th among all U.S. states in the rate of overall illicit drug use. That's critically high. Deaths in Iowa due to prescription opioids have leveled off over the recent years, but deaths due to heroin and synthetic opioids have increased, unfortunately.

Shaw:
So the demographics of those overdoses have shifted.

Kivlighan:

Well the way in which people are using drugs, you know, and one of the ways in which we have tried to crack down on the opioid epidemic is by limiting access to opioids. And so when people don't have access to prescription opioids, then they, you know, seek out other drugs.

Shaw:
And they can be dirty.

Kivlighan:

Exactly. It can be a lot a lot more dangerous.

Shaw:
I was reading about, you know, some of these kids that think they're getting a Xanax from somebody and end up overdosing because it's laced with fentanyl.

Kivlighan:

Yeah. So some of our partners over at UIHC, particularly in addiction medicine, you know, what's what's so great about working with them is they take a harm reduction approach and they recognize this. Right. It's not like just reducing people's people's ability to obtain, you know, a certain substance is going to magically make this problem go away. But if people are going to use, how can we make sure that they're using safely.

Shaw:
Like needle exchange programs?

Kivlighan:

Exactly. I think it's hard for people to wrap their heads around it and not think that you're approving or celebrating the use of these substances. You know, a lot of our work and a lot of the work, I should say, that our students are doing in the clinic, are working with clients who have opioid use disorder or substance use disorder.

But the work is around grief. The work is around depression, the work is around isolation, you know, and that that's the piece that is so critically important, you know, not just similarly defining individuals by, you know, their substance use.

There's towns and communities throughout Iowa who might not have access to any mental health providers. And so that that's when we really can try to provide something from here in Johnson County. You know, the University of Iowa to the larger state. You're 3 hours away. Great. Here's a Zoom link. I'll see you on Tuesday. I mean, one of the unique things of the services that we provide is that they're largely provided by student trainees.

And so we're not billing for these services. So the first way in which that we can increase access or some of the populations that we've been able to reach are those that are uninsured or underinsured. And we know that is a huge number of people nationally. But then also here in Iowa as well.

Shaw:
And across Iowa, are you seeing changing demographics in rural Iowa?

Kivlighan:

It's much more diverse than I think people first imagine when they think rural Iowa. Right. So we're seeing diversity in gender identity, sexual orientation, age, religion, ethnicity, I mean, across all different cultural groups, cultural identities. We're seeing a lot of different diversity emerge.

Shaw:
Let's expand on that. Just yeah, because what you're doing in your program is trying to prepare future counselors, psychologists to be able to serve a diverse population.

Kivlighan:

Yes.

Shaw:
And that diversity can be any number of things that are discordant with their own identity.

Kivlighan:

Yes. And often things that we might not think about in regards to diversity that can include political affiliation, geographical location, religion and those are pieces that can be difficult when the value systems of the therapist and client differ. We still need to be able to provide high quality, culturally affirming care so that we can serve all Iowans, not the ones that just look like us or think like us, or talk like us, or value the same things that we do.

Shaw:
What do you see your role as someone who's training this workforce? How do you see your self playing into helping solve the problem?

Kivlighan:

Obviously it's multifaceted and we can all point to funding and the need for more funding, right? And that would be hugely helpful. But there's other training factors too, that I think a lot of people outside of our kind of specific discipline are not aware of. So for instance, there are only four or pre doctoral internship sites that are accredited by the American Psychological Association in the state of Iowa and completing an APA accredited internship is a requirement to receive your doctorate in psychology and then ultimately become a licensed psychologist.

So even if we have students that, you know are from Iowa or want to stay in Iowa and serve Iowa communities, they may not have the opportunity to complete their training here and may have to go to various parts of the country to complete that internship. And at that point in time, you know, they're then establishing themselves as professionals there. They may receive a postdoc there. And before you know it, you know, they're not coming back to Iowa. And so that's a piece that is not as often talked about outside of maybe our small, you know, counseling psychology, clinical psychology, school psychology realm.

Shaw:
But it's key.

Kivlighan:

But it's key. And of those four, nine are child focused. So all child focused psychologists that we train here in the state of Iowa, we have to send out of state to complete the pre doctoral internship. Wow. So that's something to that I know my colleagues are working on. And you know, in this next iteration of the grant, we're hoping to really kind of dove into and figure out, okay, if we're creating this pipeline here of psychologists that are trained and excited to serve Iowa communities, how can we then make sure that the pipeline extends, if you will, to pre doctoral internship training and then also post-doctoral training and ultimately that the jobs are there as well.

Dean Dan Clay:
Thank you for listening to the College of Education's Office Hours. For more information, please visit education.uiowa.edu.

Shaw:
Today's podcast was produced and edited by Mei-Ling Shaw with editorial assistance from Sara Nelson and Brian Vogelgesang.
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