The first three panels (on violence, substance mis-use, and developmental periods) were developed as themes, so the presentations will relate to the overall topic. All speakers will use powerpoint or some other similar technology to display information while speaking to the audience. Questions and answers will be held until the end to ensure the speakers can cover their material. In addition a complex case presentation will be interwoven into each of the panels and the audience will use the speakers as expert consultants as they develop a plan of action. The final four presentations (on special topics / issues) are independent so there will not be a case component. Handouts will be available as necessary and the powerpoint presentations will be available on a website so audience members can download and/or print those they want.

Clinical and Ethical Considerations when Responding to Violence in Rural Areas


Duty to Protect / Harm to Others – James L. Werth, Jr.


This presentation will highlight the key aspects of mental health professionals’ duty to protect, with special focus on potential harm to others. Ethical, regulatory, legal, and clinical considerations will be covered and recommendations for practice will be offered.

Learning outcome: Participants will be able to provide at least 2 examples of situations involving the duty to protect applicable to their work setting.


Interpersonal Violence – Kimberly M. Krause

This presentation will focus on issues related to interpersonal violence in rural America and how they might affect mental health.  Topics will include the different definitions of interpersonal violence and the ethical issues that might arise for one compared to another; safety planning and stigma in regard to survivors seeking help; and the potential responses of professionals, law enforcement, and family/friends.

Learning outcome: Participants will express greater confidence in their ability to address issues of interpersonal violence in their work.


Suicide – Jameson Hirsch

This presentation will examine suicide in rural regions. Suicide risk is greater in rural, than urban, areas, and this risk may be exacerbated by lack of access to appropriate services, lack of knowledge and comfort of healthcare providers to assess suicide risk, and sociocultural values and stigma that prevent help-seeking. Current theory, research, and policy will be reviewed, and indicate that assessment and treatment of suicidal behavior in rural areas is feasible, and is both acceptable to, and deemed to be helpful by, rural residents.

Learning outcome: Participants will have increased knowledge of rural suicide, including at least 2 risk and 2 protective effects conferred by rurality, and of current ethical and clinical considerations for assessing and treating suicide in rural areas.

Public Health and Mental Health Aspects of Substance Mis-Use: Focus on Opioids and Pain Management


Public Health Considerations – Kathy Hosig


This presentation will integrate perspectives from community-based stakeholders in the opioid crisis, including family members, public schools, law enforcement, public health departments, hospitals, community services boards, and service providers.  Lessons learned from community conversations and current projects related to prevention and treatment of opioid misuse will be shared.

Learning outcome: Participants will be able to identify at least one unique challenge for at least two community-based stakeholders in addressing the opioid crisis in Virginia.


Collaborative Care – Marcy Rosenbaum


This presentation will focus on the importance of collaborative treatment when providing medication assisted treatment services. Medication alone has many benefits to the recovery process. However, the addition of behavioral health services in a collaborative care model can improve the opportunity for recovery, reduce medication misuse, and garner community support. 

Learning outcome: Participants will be able to identify at least 2 benefits of collaborative care for opioid use disorder.


Pain Management – Phillip Keck


This presentation will focus on pain management. The cost of chronic pain is measurable in both lives and productivity. Behavioral health providers can help change that narrative with innovative and evidence-based treatment for pain and opioid addiction. The speaker will highlight how the job of the behavioral pain provider is executed in the outpatient health psychology setting.

Learning outcome: Participants will be able to define the role of the behavioral health provider in multidisciplinary pain management.



Rural / Small Community Cultural Competency for MH Professionals – Theresa Burriss


The keynote address will focus on social and cultural issues mental health professionals should consider to be effective in their practice within small/rural communities. With rural Appalachia serving as the case study, the speaker will discuss both strengths and challenges in these communities, as well as suggestions on how to best serve rural residents.

Learning outcome: Participants will acquire social and cultural information focused on small/rural communities that will aid them in their ability to more effectively address mental health issues among these residents.

Intergenerational Considerations


Children – Kurt Michael

This presentation will be focused on some of the particular challenges in working with youth who experience crises. For example, for suicidal youth, talking to parents and developing safety plans are a result part of the intervention strategies. However, navigating these tasks can be difficult in cases where there is a previous family history of suicidality and/or ready access to lethal means.

Learning outcome: Participants will be able to generate at least 1 feasible and effective intervention when faced with a youth who is in crisis.


Older adults – Lisa G. Bradford


This presentation will focus on older adults living in rural areas. Because the majority of older adults desire to age in place, the challenge in rural areas is helping them do so safely. The infrastructure and services available in rural settings are not as plentiful as in a large city so providers must be planful and creative when developing resources for care.

Learning outcome: Participants will be able to identify at least two barriers to aging in place for rural older adults and at least two avenues of support other than family systems.


Family – Marianna Linz


This presentation will discuss the structure and function of extended families in rural areas such as Appalachia.  The speaker will focus specifically on how they are adaptive in isolated, high-need areas and how they have evolved to support healthy development and functioning from birth to old age.  She also will discuss how such structures can malfunction during times of stress and contribute to poor outcomes that become intergenerationally transmissible.

Learning outcome: Participants will understand the nature of extended family structures in Appalachia and other rural areas as well as how such structures can be supportive and how they can become dysfunctional.


Special Topics and Populations


Technology-based services – Michael McClellan


This presentation will provide an overview of the literature regarding the use of technology in rural areas. As an example, the major findings of a recent telehealth study that examined the telehealth usage patterns and attitudes of rural, community mental health center clinical staff will be highlighted.  The findings provide insight and suggestions for advancing telehealth utilization in rural community mental health.

Learning outcome: Participants will be able to identify key factors that improve telehealth usage in rural community mental health.


Veterans – Valerie Leake


This presentation will focus on responding to the needs of veterans who are living in rural areas. Rural residents are over-represented in the military. Research has indicated that rural veterans struggle with similar issues to other veterans and to other people living in rural areas but the combination of factors can complicate service delivery. The speaker will offer suggestions for mental health providers not working in a Veteran-focused setting.

Learning outcome: Participants will be able to identify at least 2 special needs of rural veterans.


Trauma / Disasters – Emily Selby-Nelson

This presentation will explain how the hardship faced by rural underserved communities associated with fewer resources and reduced access to care may exacerbate the impact of trauma. The various contexts for trauma, including the family, community, or broader environment will be reviewed. The various domains of trauma typically observed and treated in rural areas will be used to highlight the roles that mental health professionals can serve during community trauma, including natural and man-made disasters.  

Learning outcome: Participants will be able to discuss at least 2 types of trauma experienced in rural areas and be able to identify at last 2 ways for mental health professionals to contribute to community recovery.


Self-care – Lisa Curtin & David S. Hargrove

This presentation will focus on professional self-care. Complex professional and personal relationships are common in rural behavioral health care practice. The realities of rural practice will be discussed in relation to signs of personal distress and burnout. Self-care will be discussed as an ethical imperative and practical guidelines for developing a sustainable self-care plan will be offered to maximize professional and personal well-being.

Learning outcome: Participants will be able to describe at least two self-care practices that they can implement.