title: Nebraska's rural behavioral healthcare workforce distribution and relationship between supply and county characteristics.
abstract: BACKGROUND
  Specific attention is needed to improve mental health outcomes in rural communities. Rural communities continue to have higher unmet mental health needs than their urban counterparts. Quantifying workforce supply and shortages can aid in identifying areas in need of the recruitment, training, licensure, and retention of behavioral health professionals. However, workforce analyses have presented a challenge as comprehensive workforce data are limited. This study examines the geographic distribution of behavioral healthcare professionals and the relationship between supply and county characteristics in Nebraska in 2012.
  
  
  METHODS
  Practice location data for behavioral healthcare professionals were obtained from the 2012 University of Nebraska Medical Center's Health Profession Tracking Service Survey. Behavioral healthcare professionals included were psychiatric prescribers, independent behavioral professionals, mental health practitioners, and addiction counselors. The rural and urban distribution of professionals was examined using descriptive statistics. The relationships between county-level provider-to-population ratios and county characteristics were examined using multivariate Poisson regression analyses.
  
  
  RESULTS
  In 2012, there were 2468 behavioral health professionals actively practicing in Nebraska. The majority (71.2%) of all behavioral professionals in Nebraska were actively practicing in metropolitan areas as compared to 27.3% in rural and 1.5% in frontier areas. For all categories of professions, excluding physician assistants, Nebraska's urban areas had the highest ratios of provider to 100 000 population as compared to rural and frontier areas in Nebraska. The total supply of behavioral health professionals was positively associated with metropolitan areas and the percentage of populations in poverty. The total supply of behavioral health professionals was negatively associated with the percentage of children under 18 years of age and the percentage of elderly aged 65 years or older.
  
  
  CONCLUSIONS
  Rural counties and areas with high proportions of children and aging populations in Nebraska face significant challenges in recruiting and retaining behavioral healthcare professionals. The findings from this study have implications for quantifying the need and demand for behavioral healthcare professionals in workforce planning and policy analysis.
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. atnnguyen2@gmail.com.
authors.forename: Anh T
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. kate.trout@unmc.edu.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Trout
authors.affiliation: Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. liwuchen@unmc.edu.
authors.forename: Li-Wu
authors.initials: LW
authors.lastname: Chen
authors.affiliation: Departments of Psychiatry and Pediatrics, School of Medicine, Creighton University;Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA. drmadison@cox.net.
authors.forename: Lynda
authors.initials: L
authors.lastname: Madison
authors.affiliation: Communicable Disease Program, El Paso County Public Health, Colorado Springs, Colorado, USA. k8watuns@gmail.com.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Watkins
authors.affiliation: Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. swatanabe@unmc.edu.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Watanabe-Galloway
mesh_terms: D003376:Counseling; D006297:Health Services Accessibility; D006280:Health Workforce; D006801:Humans; D008605:Mental Health Services; D009329:Nebraska; D020380:Needs Assessment; D011570:Psychiatry; D019035:Rural Health Services; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Health Service reform; Management/Administration; Mental Health; North America; Primary Health Care; Public Health; Workforce