For Your Health

News from the University of North Dakota School of Medicine & Health Sciences

From plains to peaks

UND’s satellite occupational therapy program in Casper, Wyo., celebrates 30 years of rural health delivery.

As a product of the program in which she now teaches, Nicole Harris understands the challenge: how to provide occupational therapy to an overwhelmingly rural population.

“People worry about a level of saturation – that there’ll be no jobs – but they’re hiring for OT in every single town in Wyoming,” says the assistant professor from her office at the UND Department of Occupational Therapy (OT) satellite campus at Casper College in Casper, Wyo. “So, we need more students. We don’t have enough OTs, and we need to fill those positions.”

This desperate need for health providers in a state even more sparsely populated than North Dakota – which is to say, even more rural in scope – is at the heart of what led Tom Clifford, Jr., the son of the former University of North Dakota President, Tom Clifford, Sr., and the late LeRoy Strausner, who served as Casper College’s President from 1991 to 2004, to push for an OT program in Wyoming back in the early-1990s.

To Breann Lamborn, it was this vision that has been vital to the provision of healthcare in Wyoming for three decades.

“We were the first OT program in the country that crossed state lines,” says Lamborn, a Casper-based associate professor of occupational therapy for UND. “And for many years we were the model for the proprietary programs that opened after us. Nobody had done it before.”

The new Chair of UND’s Department of Occupational Therapy, Dr. Sarah Nielsen, agrees, noting how UND has been identified by the Accreditation Council for Occupational Therapy Education (ACOTE) for its integrated model.

“Until recently, I did not understand the significant impact UND has had on additional location models,” Nielsen says. “When I started on the ACOTE, I was placed on the policies and procedures committee specifically because of UND’s role in setting the gold standard for additional locations. We are viewed as doing it right: one program with one curriculum where we collaborate every day.”

Mirror site

The UND Department of Occupational Therapy satellite program in Casper turns 30 this year.

Putting such a milestone in context, Lamborn, who has been with the program almost from day-one, recalls how there was no guarantee that the gamble Casper made on a distance degree would last more than a few years.

According to a document provided by the Department, Strausner was first interested in starting an occupational therapy assistant (OTA) program in Wyoming, which had no OT or OTA training options at the time. He took the idea to Clifford, Jr., then-Chair of the Life Sciences Division at Casper College, who, given his contacts up at UND, connected with then-Chair of the Department of Occupational Therapy, Sue McIntyre. Asking McIntyre if she would consult

Casper on opening an OTA program, Clifford was surprised at McIntyre’s modified “yes” response.

“Tom had been advising and guiding his students to North Dakota, which of course was his alma mater,” explains Lamborn. “And Sue, being highly innovative, said ‘Well, what would you think if we were just to deliver the bachelor’s degree in OT to you, from UND?’ That’s how the ball got rolling for an OT program in Wyoming.”

Founded in 1954 and continuously accredited since 1956, UND’s OT program established its “mirror” site officially in 1993, offering a Bachelor of Occupational Therapy degree in Wyoming. Today, the bachelor’s degree has been upgraded to an occupational therapy doctorate (OTD), which is the profession’s entry-level degree, and can be earned in both Casper and Grand Forks.

Despite the distance, though, the two student cohorts remain part of a single program with a single faculty.

“When the program started, the faculty in Grand Forks literally shipped teaching material to Casper and the instructors down there taught it,” adds Nielsen. “Then came video connection on large televisions that were rolled into rooms and we started some teaching to Casper at a distance. Fast forward to now: we have four full-time Casper faculty who have different expertise and teach students up here while Grand Forks faculty teach in Wyoming in an integrated way.”

And, Lamborn is quick to note, none of the above would have been possible without generous support from the UND administration, particularly that of SMHS Dean Joshua Wynne, who has helped oversee the partnership for almost half of its life.

“The administration’s commitment to the program here has been unwavering,” continues Lamborn. “That’s important to note and we can’t thank UND enough for what the support has meant for rural health across the region.”

Rural health needs

As Lamborn suggests, since 1993, the Casper program, which is housed in the least populous state in the U.S., has focused on producing therapists for rural practice.

“From the beginning, we intended the Wyoming program to fill a critical need in healthcare providers for rural practice – because there was no OT school even close to us at that time,” she says, citing research data suggesting that rural areas have an especially difficult time recruiting and retaining health providers. “We’ve always maintained that emphasis on offering this program with the hope, as in North Dakota, that students would come here and then they would choose to stay here and practice. Up to this point, we’ve been very successful with that. The majority of OTs in Wyoming are grads from our program.”

Harris serves as a case-in-point.

“I got my bachelor’s degree at the University of Wyoming, but, afterwards, I really wasn’t sure what I was going to do,” says Harris. “Then I found out about this program. I was a single mom and it was wonderful starting at the Casper OT program. Being able to still be close to family was helpful. After graduating with my OT degree, I practiced for a couple of years in home health and then saw the position advertised to work at Casper, so I applied.”

And here she is, teaching the students who will be Harris’s future colleagues.

Such potential colleagues include Casper-based OTD students Makenzie Kroupa and Josie Sylte.

A Rock Springs, Wyo., native, Kroupa said that having experienced the need to “travel several hours to receive any kind of medical care,” she felt compelled to become a health provider who would someday be able to offer better care closer to home for her clients.

“I chose occupational therapy because I liked how really versatile it is,” Kroupa smiles. “You can work with pediatrics, adults, and all these different diagnoses. You can work on everyday activities – leisure or after school activities – and I liked how I was going to have a wide range of possibilities of where I could work and grow.”

Nodding in agreement, Sylte, the Ipswitch, S.D., native who earned her undergraduate degree from UND before matriculating into the OTD program in Casper, adds that having a parent who is a rural occupational therapist allowed her to see, every day, the value-add that health providers bring to rural communities.

“I grew up sitting outside of my mom’s office when she was working at the schools, tagging along on some of her jobs,” Sylte states. “That helped me realize there’s a need for rural OT. I was lucky enough to live half an hour from the biggest hospital in the area, but a lot of individuals that I know are two or three hours from the nearest big hospital. So, it’s hard for them to get services and I really liked the idea of being able to give something back to a rural community.”

This sentiment, says Nielsen, is part of what makes the program so valuable to both states.

“The beauty of this collaboration is that we have found similar issues in health delivery in both states, and we have also found that the ways each state addresses challenges varies,” she notes. “One of the most fascinating things we’ve learned is that Wyoming has incredibly innovative frontier service delivery strategies for education and healthcare. We then bring that knowledge back to our own state as we impact delivery in North Dakota.”

‘OT can really go anywhere’

Not content to stand on its laurels, then, UND’s satellite OTD program is looking to the future.

For the next 30 years, says Lamborn, the Casper College OTD program hopes to continue to grow, increasing the number of grads hired for OT positions across Wyoming. Echoing Harris’s quip that “we definitely still need more students” (the class size is currently 18 students admitted each year), Lamborn suggests that she also hopes to bring more off-campus fieldwork training sites into the system for her students.

“When our doctoral students complete their experiential placements, they’re designing some incredible programs for their capstone projects in areas where OT isn’t yet in place, but needs to be,” she says. “I have a student who created a mental health awareness and suicide prevention program for the Natrona County suicide task force targeted to adolescents.”

Because OT is a “perfect fit” for such work, says Lamborn, “possible locations for program implementation include social service agencies and youth community programs. What we really try to encourage agencies and our students to understand is that while there are traditional placements for OT fieldwork experiences, OT can really go anywhere.”

Establishing and growing such partnerships with communities is particularly important for rural health providers insofar as such partnerships both help expand and stabilize not only state educational programs, but the same rural health programs that even now are short on staff.

All of which, says Lamborn, is a way of restating that relationships with alumni – who often end up working in those community agencies – matter.

“We have benefitted so much from alumni support, especially in Wyoming, because a significant number of our supervisors at clinical sites are graduates of our program, either here or in Grand Forks,” she concludes. “Our alumni continue to give back to us through their willingness to be clinical supervisors for students. They see it as their responsibility to train the next generation of grads – and we can’t thank them enough for that.”

By Brian James Schill