West Virginia Rural Health Education Partnerships/Area Health Education CentersWest Virginia Rural Health Education Partnerships/Area Health Education Centers

WV RHEP Program History

Guiding Principles

In pursuit of our vision, the West Virginia State Legislature has appropriated state funding and, with these resources, we have built a community based health sciences education infrastructure upon the following values:

The mission of the West Virginia Rural Health Education Partnerships is to achieve greater retention of West Virginia trained health science graduates in underserved rural West Virginia communities by creating partnerships of community, higher education, health care providers, and governmental bodies.

This mission is not rhetoric, rather one that has been carved from a set of guiding principles formulated by the partners who govern this organization and have thirteen years experience at building this partnership. Our organization is characterized by value-based leadership from all elements that constitute the partnership: the community and rural providers, higher education, and state government.

Through our mission of training health sciences students in rural community based settings, we are guided by the following principles:

The Early Years: from Kellogg to RHI

The West Virginia Rural Health Education Partnerships (WVRHEP) grew from the integration of two programs, the Kellogg Community Partnerships Initiative and the West Virginia Rural Health Initiative (RHI) (see: Kellogg/RHI Integration Guidelines, 5/22/95). The partnership between the state of West Virginia and the W.K. Kellogg Foundation is cultivating an environment supportive of long range, creative strategies to address the problem of critically limited primary health care in rural and medically underserved areas of the state.

In the spring of 1991, West Virginia initiated dialogue with the W.K. Kellogg Foundation about needed changes in health profession education. In the early fall of 1991, the university system received a four year Kellogg Community Partnership grant to develop a community based academic program. The sustainability of the Community Partnerships program was addressed by the governor through assurances to the W.K. Kellogg Foundation that he would seek financial support from the legislature.

The governor would ask the legislature to fund the building of a state infrastructure of community based training sites and to make changes within the academic institutions. These changes placed emphasis on rural primary care and interdisciplinary clinical training at the community level. With this assurance was the expectation that the Community Partnership sites would become part of the state funded program.

Also in 1991, debate began in the legislature concerning the funding of three medical schools in the state. This debate led to a joint proposal by the schools and the governor to develop rural community based training programs and a reallocation of funding for this purpose. The governor called a special legislative session in the fall of 1991 and on October 18 passed H.B. 213, the Rural Health Initiative Act.

Based upon the Community Partnerships model, rural community sites were selected and the first students begin rural placements at the Kellogg sites in the fall of 1992 and at RHI sites in the spring of 1993.

The Bureau for Public Health took a significant lead role in initiating the program and selecting the sites that would eventually become the WVRHEP lead agencies. Working with the Vice Chancellor of the University System, the Office of Community and Rural Health Services laid the foundation for the collaboration and ignited the partnership spirit between these two state agencies.

The partnership role modeling of these agencies fostered the growth of a tremendous statewide infrastructure by articulating the need for change in health professions' education, and by encouraging and eliciting cooperation from local communities in partnership building.

The birth of RHEP

By April 1994, the RHI and Kellogg Community Partnerships had developed strong ties and the community and program leaders began the process of integrating both programs into one statewide program. The first steps of this process were to establish a set of guiding principles, develop an integration plan and timetable, and select the leadership needed to guide this process.

The integration and restructuring committee provided the oversight for an 18 month process of focus groups, committee meetings, drafting of legislation development, review of input from all elements of both programs, and the development of a set of restructuring guidelines for all training sites of both programs to follow.

At every juncture of this process, the outcomes have reflected the guiding principles and values jointly established by the leadership of both programs. In the fall of 1994, the University System of WV Vice Chancellor mandated that all system supported health science students, except Dentistry, must complete a minimum of three months of clinical rotations in rural areas of the state.

On March 9, 1995, the West Virginia State Legislature passed S. B. 161 amending the RHI Act and providing for the official and legal integration of the Rural Health Initiative and the Kellogg Community Partnerships program. These two programs are now a statewide program consisting of 13 training consortia or networks of community based health, social, and education agencies, covering 47 of West Virginia's most underserved counties.

This enabling legislation called for the appointment of an integrated state Advisory Panel, which reports to the Vice Chancellor for Health Sciences of the University System in the development and implementation of the restructured program. The Vice Chancellor served as the project director of the Kellogg Community Partnerships and the Rural Health Initiative and now heads the integrated program.

The 1995 legislation renamed the program "The West Virginia Rural Health Education Partnerships" and prescribed the membership and duties of the State Advisory Panel appointed by the governor, that reports to the Vice Chancellor for Health Sciences.

RHEP oversight: State Rural Health Advisory Panel,
its structure and responsibility

Based upon the experiences in the Rural Health Initiative and the Kellogg programs, the Advisory Panel has articulated the vision, values, mission, and goals of the restructured and integrated program. The State Advisory Panel approves all policies for the organization. The functions and duties of the state panel are to establish and maintain the vision and mission of the program. The panel oversees development and implementation of policy in governance and administration including personnel policies, operations and management, and finance.

The membership of this body is recommended by the Vice Chancellor, and elects its own chair. This membership is as follows: one community member from each of the designated consortia, the Dean or designee from each of the participating University System of West Virginia health sciences schools (ex officio), one representative from the private colleges, one representative from the state college system, and one site coordinator elected from the site coordinators group.

Also on the body, by legislation, are five rural health provider representatives, two of whom are rural physicians, two of whom are representatives of rural health facilities and one of whom is a nurse practitioner in the delivery of rural health care; the Commissioner of the Bureau of Public Health (ex officio); and the Director of the Office of Community and Rural Health Services (ex officio).

Term limitations are three years for the community members and terms will be staggered to achieve a 1/3 annual turnover of the body. The private and state colleges, and the site coordinators are to select their representatives and set the term limits to be not greater than three years.

In addition to the above duties and functions, this body reviews, through its various committees, the following standard reports at appropriate times: committee reports, network level and centralized budgets, matters of state level policy, site coordinator reports, annual review of affiliation agreements, and annual reports.

RHEP Funding: past and present

Over the eight years of its growth, WVRHEP has come to reflect a true collaborative partnership of state government and higher education, local communities and providers, and private funding sources. Six million dollars came from the Kellogg Foundation from 1991 to 1996.

Approximately 37% of these funds went to the educational institutions to support faculty time, project management and administration, curriculum development, campus and field faculty development, and technical assistance for services and program development at the community level. The remaining 63% of these funds went to the community sites and was used to hire field professors and site coordinators, provide clerical support and office materials, build and furnish Learning Resource Centers, provide student housing, and reimburse field faculty travel.

The Rural Health Initiative state appropriated dollars were used for the same functions as the Kellogg Initiative and, in some cases, for the renovation of clinical space for additional patient exam rooms, offices, and conference rooms needed due to increased student and patient education activities.

Annually, 66% of the funds are distributed to the educational institutions and 33% to the community sites. In 1996, the Legislature approved an additional $1.5 million in the higher education/RHI line item. These funds were used to accommodate the integration of the four original Kellogg Community Partnership sites, Kellogg support activities at the schools, and a new consortium in the western part of the state.

Educational pipelines: preparing our future health professionals

In building the WVRHEP program it became evident that efforts were needed to develop a full educational pipeline to include health workforce development strategies from grade school education to graduate health professions education and even into the practice arena. Efforts were needed in communities at the public school level to identify and encourage students who may have an interest in the health sciences.

WVRHEP recognizes that training, recruiting, and retaining appropriately trained health professionals in rural areas of the state is a very complex and multifaceted issue. Strategies to meet this challenge have to include interventions at many levels and partnerships of local leaders, government, and the educational system. To this end, the Health Sciences and Technology Academy (HSTA) was developed and funded by the W.K. Kellogg Foundation in January 1995.

The HSTA program identifies eighth to twelfth grade students from underserved areas and, through a summer program, fosters and encourages their interests in the health sciences. HSTA's goal is to increase the number of economically disadvantaged and African American high school students from West Virginia who pursue post-secondary education in the areas of health science.

Students in this program progress through four years of summer training with their local schoolteachers and campus based faculty. The students are enrolled in HSTA Science Clubs and are led by trained middle and high school teachers in group and individual projects. They develop networking skills, communication skills, and the ability to pull together resources and a feeling of ownership in providing solutions to community problems.

In 1997, the state legislature gave state-supported schools the authority to grant full tuition and fee waivers to successful HSTA students. For more information, visit the HSTA website.

Recruitment and retention

In 1994, the University System received a two-year grant from the Claude Worthington Benedum Foundation to establish the West Virginia Recruitment & Retention Project and an advisory group appointed by the vice chancellor.

The goal of this project was to provide statewide coordination of financial strategies to alleviate shortages of primary care providers in rural West Virginia. The project began coordinating efforts of the University System, the state's health science schools, rural communities, and the Bureau for Public Health to recruit and retain primary care physicians and other primary care providers.

The project focuses on policies, financial incentives, and placement activities to develop an integrated state strategy on recruitment and retention. During the 1995 legislative session, the Health Sciences Scholarship Program (HSSP) was enacted and given a separate appropriation from that of the WVRHEP and the general higher education budget. The Office of the Vice Chancellor administers the HSSP.

In 1996 the advisory group became the R&R Committee of WVRHEP. This committee is recognized in WV Code as the group responsible for coordination of R&R activities and strategies in the state. This committee includes representatives of the sponsoring agencies, the schools, the hospital association, and the primary care association and makes policy and strategy recommendations to state agencies and the WVRHEP program.

The committee awards HSSP scholarships to medical students, physician assistant students and nurse practitioner students. Through integration and coordination of the Recruitment and Retention Committee within WVRHEP, a workgroup has begun to evaluate the state's financial incentive programs and create a database to track recipients. The committee is also giving consideration to broadening the scope and availability of these financial incentive programs to include more graduate trainees from a wider array of disciplines.

Outcomes and Accomplishments to Date

To truly understand the significance of legislative support for this program, one must become aware of the environment in West Virginia. Given the pressure on the Legislature to allocate resources for chronic economic, health, and social problems, the dedication of these dollars annually to invest in non-traditional strategies to increase primary care services in underserved areas is certainly insightful if not courageous. Health professions education plays a critical role within any strategy designed to address issues of health care access. However, given the challenges to improving and maintaining positive health and quality of life in rural areas, it is critical that any mission in this area also embrace community and economic development efforts to complete the full complement of needed strategies.

 

If we can help you with more information, please contact us. Thank you for your interest in rural health education in West Virginia.


Robert C. Byrd Health Sciences Center at West Virginia University, Office of Rural Health
P.0. Box 9003
Morgantown, WV 26506-9003
(304) 293-4996