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Telepsychiatry investment results in millions in cost savings Baccalaureate-prepared nurses lead to improved patient outcomes

National model for dental education creates more dentists with less debt

The East Carolina University Division of Health Sciences is known for the highly skilled and compassionate graduates it produces across the spectrum of health professions. It is equally renowned for its leadership in serving and improving the health of the citizens of eastern North Carolina.

Our programs proudly reflect East Carolina’s steadfast commitments to student success, regional transformation and public service. From producing the largest number of expert nurses, training community-minded dentists and conducting trailblazing research for diabetes and obesity to tackling mental health issues through a statewide network and providing innovative outreach to military veterans, we break ground every day in areas that impact the lives of people across our state and beyond.

We transform students into frontline health care providers. Our work will continue, because at East Carolina University, we are in the business of teaching, training, and caring.

RAISING THE GAME INSTITUTE EMPLOYS COLLABORATION TO PUSH BOUNDARIES IN THE SCIENCE OF METABOLISM

BY A M Y A DA M S E L L I S

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On the first three floors of the East Carolina Heart Institute at East Carolina University, medical specialists are immersed in providing world-renowned care to patients living with cardiovascular diseases. But on the fourth floor, scientists are hard at work seeking new strategies to prevent and treat those same diseases.

With every finding, the multidisciplinary group of researchers who comprise the East Carolina Diabetes and Obesity Institute (ECDOI) strengthen ECU’s global reputation as a leading authority in the niche of human metabolism – a major health concern worldwide, but especially in North Carolina.

“We don’t aim to be the biggest research center, but we do strive to be an extremely productive center, and to be recognized internationally for our excellence and expertise in research related to metabolic diseases,” says Dr. Darrell Neufer, the institute’s director since 2009.

Dr. Darrell Neufer with fourth-year PhD student Maria Torres

Currently drawing $4 million annually in research funding, primarily from the National Institutes of Health, ECDOI is a hub for research on ECU’s health sciences campus.

Projects underway in ECDOI labs range in scope from cellular function to whole-body function. They delve into topics like energy balance, exercise, heart and vascular disease, cancer, immunology, nutrition, neuroscience and human development. Their principal investigators represent a variety of disciplines and departments including physiology, biochemistry, anatomy and kinesiology.

Neufer says multifaceted problems like diabetes and obesity require multidisciplinary solutions – an idea that’s reflected in governmental research funding streams.

“What draws the larger grants is research that pushes boundaries,” he says. “They’re awarded based on whether the science of a study stands to

significantly advance the field, whether it’s likely to make a paradigm-shifting impact on health and disease research as a whole. But knowledge multiplies so quickly, it’s very difficult for any one individual to have the expertise needed to push those boundaries.”

Neufer says that’s why funding agencies like NIH value teams of scientists with diverse skill sets who can address a problem from different, yet complementary, angles. That’s also why ECDOI’s laboratory and office spaces were designed without walls.

Responding to an epidemic

The Metabolic Institute, as ECDOI was initially called, was established in 2004 by the UNC Board of Governors in response to the growing epidemic of diabetes and obesity in eastern North Carolina. But Neufer says a grant from the Golden LEAF Foundation in 2007 – and the move into their current physical space

at ECHI a couple of years later – accelerated the institute’s growth and enabled researchers to truly begin pooling their resources, equipment and competencies.

The open, informal atmosphere that resulted feeds a culture of collaboration, generating a steady stream of good relationships and new ideas among the 80 or so faculty members, lab technicians, and undergraduate, graduate and postgraduate students who traverse the space daily.

Since 2009 researchers from the institute have drawn more than $16 million in funding to study topics like how targeting metabolism might more effectively treat certain types of cancers, or new drug approaches to help the heart muscle recover after a heart attack.

Private industry has also taken notice.

So much so that physiologist Dr. David Brown, an expert in mitochondria – or the “engines of the cell,” as he refers to them – has started a contract research organization within ECDOI to help pharmaceutical companies test their drugs for effectiveness prior to animal or human testing.

“Industry has been very impressed with our culture here,” he says.

“We’ve earned a reputation not only for turning out data quickly, but for helping them interpret the data and advising them accordingly.”

The institute has also drawn top scientific talent in recent years from Harvard, Duke and Washington University in St. Louis. Biochemist and molecular biologist Dr. S. Raza Shaikh left Johns Hopkins University in 2008 to join the cutting-edge collaboration he was observing at East Carolina.

Shaikh relies heavily on social media to market ECDOI’s knowledge base and capabilities, and to establish

Dr. David Brown and Dr. Raza Shaikh

contacts with fellow research institutions and private businesses across the state and nationwide.

A specialist in understanding the function of membranes and lipids, he currently oversees a clinical trial to test the effectiveness of a specific fatty acid supplement in obesity and infection.

He finds great value in daily exposure to a variety of disciplines. “It broadens your skill set and pushes you out of your comfort zone, which makes you more competitive,” Shaikh says. “You learn from different ways of thinking. You start anticipating the questions other researchers will ask.”

Although he admits to being energized by the plethora of ideas birthed at ECDOI, Shaikh is quick to point out that not all are worth investing in.

“A big part of our mentality up here is business, not science,” he says. “We consider everything according to the potential NIH R01 [Research Project Grant]. We’re not just up here doing experiments for the fun of it, for the science rush.

“Due to the continued support of the state,” he adds, “we’ve been able to get big returns on our investments.”

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Building on a legacy

East Carolina has a rich history of diabetes and obesity research dating back to the early eighties, when the founding chair of the Department of Surgery, Dr. Walter Pories, pioneered a type of weight-loss surgery called the “Greenville Gastric Bypass,” known not only for producing lasting weight loss, but also for reversing type 2 diabetes.

But ECDOI researchers have no intention of resting on their predecessors’ achievements. Next on their wish list: collaborating with other institutions in North Carolina and beyond in a clinical trial that could help determine, at the molecular level, exactly how physical activity benefits human health.

“We want to partner more with industry,” Neufer says. “We want to develop better translational research and community intervention research – research that informs care not only for our patient population, but for patients everywhere.”

“We still have plenty of room to grow,” he adds.

That’s what happens when you keep pushing the boundaries.

PRIMED TO

PRACTICE ECU SCHOOL OF DENTAL MEDICINE’S FOCUS ON SERVICE AND RURAL HEALTH

Grace Harrell, left, and Dr. Alexis Brown treat a patient at the Ahoskie service learning center.

B Y K AT H R Y N K E N N E DY

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By the time it graduated its first class of 50 dentists in 2015, the East Carolina University School of Dental Medicine was already improving oral health for North Carolinians. The school has created jobs, improved access to dental care in rural and underserved areas, and continues to pioneer a new model for teaching dental medicine.

Its reach extends beyond Greenville into Ahoskie and Elizabeth City, Lillington, and Lumberton. Davidson County, Brunswick County, and the towns of Sylva and Spruce Pine exhibit purple and gold in the form of community service learning centers. There, fourth-year students and residents gain real-world experience working alongside faculty and dental staff.

These newest Pirate graduates are qualified to practice anywhere. But the school hopes most will work in underserved North Carolina communities.

“We only admit North Carolina residents, but we look beyond residency status to roots,” says Dr. Maggie Wilson, associate dean for student affairs at the dental school.

“We want somebody committed to putting others’ needs first; somebody who values service above self.”

A statewide challenge

Students’ desire to work in “home” regions exemplifies the mission of the dental school: to address North Carolina’s oral health challenges, which ECU Dean Dr. Greg Chadwick describes as “a perfect storm.”

Diana Luckhardt, Lara Holland, Kyle Duncan, Alex Crisp and Kyle Given pose in a patient-care area in Ross Hall, home to the dental school.

A decade ago, North Carolina’s population growth was shifting from rural areas to urban centers – creating pockets with limited access to dental care. The state ranked 47th nationally in the number of dentists per capita.

The national average was six dentists for every 10,000 people. In the rural areas of North Carolina, half that many existed. At the time, four northeastern counties had no dentists.

“Eighty of the 100 counties in North Carolina are rural,” says Dr. Alec Parker, executive director of the North Carolina Dental Society. “People living there deserve access to oral health care provided by a licensed dentist.”

Another concern was the number of dentists approaching retirement. A third of North Carolina dentists are age 55 or older.

“Everyone agreed more dentists were needed,” Chadwick says. “What wasn’t clear was how best to meet that need.”

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The model East Carolina administrators proposed – and the tenacity of community members and the local legislative delegation – won over the Board of Governors and, eventually, the Legislature.

“We would educate the next generation of dentists,” Chadwick says. “But we would also deliver care in underserved communities. We’re changing the model of dental education.”

An innovative teaching method

For the 200+ students enrolled at the School of Dental Medicine, education consists of two novel approaches: an innovative curriculum using technology and online instruction, and a network of dental centers peppering the state – yet connected to Greenville via teledentistry – where they hone their skills as fourth-year students and residents. Graduates must be ready to tackle multiple and chronic conditions and be proficient in clinical medicine.

They master complex procedures and exercise critical thinking by serving eight-week rotations at three different community service learning centers in rural and underserved areas across the state. It’s an innovative model for educating students that also improves access to dental care statewide.

Each center is approximately 7,700 square feet and features modern treatment rooms, X-ray equipment, educational space. Each center has 1.5 dental faculty positions, a business manager, dental assistants, dental hygienists, and general dentistry residents. Chadwick estimates the local economic impact to be more than $1 million per center, while ensuring a consistent educational experience for students. Any member of the community – including Medicaid patients – may receive dental care at the centers.

“The Sylva facility is going to lower the burden on our emergency rooms,” says Paula Carden, director of the Jackson County Health Department.

Monecia Thomas, director of the Department of Public Health in Davidson County, says access and cost are often barriers to oral health care, and ECU’s community service learning centers are game changers.

The dental school has served more than 31,500 patients since June 2011.

The school receives nearly 400 applications annually for its 50 student slots. East Carolina is a destination for dental training, she says, and the mission appeals to prospective students.

Graduate Kyle Duncan is one example.

The Bakersville native said at the opening of the dental center in Spruce Pine, “It’s a special place for me. Many people drive to Asheville or Johnson City, Tennessee just to get a dentist appointment, and that certainly cuts down on the frequency of care. People will only go when something hurts, and that’s not good.”

East Carolina keeps tuition relatively low for dental students. According to university figures, the 2015 graduates left the school owing, on average, $123,899 compared to a national average of more than $230,000 for public dental school. Less debt decreases the likelihood graduates will pursue lucrative urban or specialty practices.

Private giving can also encourage students to choose rural practices.

Duncan received a full scholarship from the Samuel L. Phillips Family Foundation with the understanding he would return to western North Carolina to practice for five years.

The dental school’s formula parallels the ECU Brody School of Medicine’s “grow your own” approach to

Student recruitment is key

Many of the carefully selected dental students may be getting their first exposure to small-town life during their fourth-year rotations.

educating providers who will practice primary care in underserved areas.

“It’s becoming harder to get students to practice in rural areas,” N.C. Senator Ralph Hise has said. “But one institution in North Carolina does it, and that’s East Carolina.”

Aligning with ECU’s mission

ECU’s School of Dental Medicine is committed to serving the state’s residents while educating the next generation of dentists to do the same.

“Our mission is to provide public service, to be a national model for regional transformation,” says Chancellor Steve Ballard. “We have no better example than these service learning clinics.”

Dental leaders continue to make sure their model develops effectively. This includes ensuring patients utilize Ross Hall and the service learning centers for treatment. Chadwick sees numerous opportunities for research related to community health and primary care.

“Nobody realized what a big job this was going to be when we started it,” Chadwick says. “But this was a project that the people of eastern North Carolina needed – that the whole state needed.”

Doug Boyd and Amy Ellis contributed to this article.

$1 million in estimated economic impact per dental service learning center

“We want students who are academically capable and who also have excellent non-cognitive skills, the ability to develop relationships, to show compassion,” says Wilson, the associate dean.

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HEALTHY OUTCOMES ECU EDUCATES NC’S FUTURE HEALTH CARE WORKFORCE

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North Carolina’s need for more nurses is clear. Our elderly population is expected to double by 2020, and one in five nurses is nearing retirement age.

But with those factors stressing our health care system, we don’t just need more nurses – we need more nurses educated at higher levels.

“Research relates improved patient outcomes with nurses who have the four-year baccalaureate degree or higher,” explains East Carolina University College of Nursing Dean Sylvia Brown.

About 50 percent of the state’s current nursing workforce is prepared at the baccalaureate or graduate degree level – far short of the North Carolina Future of Nursing Action Coalition’s goal of 80 percent. The remainder have a two-year associate degree in nursing. ECU produces more new nurses with baccalaureate degrees than any other program in the state, and is further answering the call to elevate the education of the state’s nurses with two innovative nursing programs.

ECU’s RIBN, or Regionally Increasing Baccalaureate Nurses, program is a shining example of what can happen with an emphasis on accessibility and affordability for nursing students.

Coordinated statewide by the nonprofit Foundation for Nursing Excellence, RIBN is a partnership with six eastern North Carolina community colleges that enables students to first earn an associate degree in nursing at a participating

BY JULES NORWOOD

community college and transition to complete their bachelor of science in nursing, or BSN, online at ECU. This May, the program’s first class of five graduates will earn their BSN at ECU. Another 15 students will earn

ECU is the

#1 producer of new nurses with baccalaureate degrees in North Carolina

an associate degree from partnering community colleges and are on track to earn their BSN degrees next spring.

The RIBN program allowed Morgan Dawson of Winterville, who will graduate in May, to follow in the footsteps of her mother, who is also a nurse. She says the program gave her

the valuable hands-on experience she needed to pursue her career of choice.

“This program allows us to work to address the nursing shortage currently going on and to begin our full-time careers a full year earlier than a strictly BSN nursing program,” says Dawson, who has worked in the cardiac intensive care unit at Vidant Medical Center since graduating with an associate degree from Pitt Community College in June 2015.

The dual-enrollment model makes a BSN more affordable and accessible by lowering costs for both tuition and housing. The transition from the community college into ECU’s BSN program is seamless, as students are automatically accepted into both the nursing program at the community college and at ECU when they enroll in RIBN. Participants also get the support of a student success advocate, whose role is to help RIBN students navigate any academic challenges they may face.

Graduating nursing student Morgan Dawson

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Going back to get my BSN was my way of regaining my confidence and placing myself at a little more of an advantage to get a job.”

— Tracie Zeagler BSN ’14

Another initiative that helps with the push for more baccalaureate-prepared nurses is ECU’s RN to BSN option, which was created with the working registered nurse in mind. It features online courses and a curriculum designed to prepare nurses to practice as BSNs. Nurses make up the largest sector of the health care workforce, says Becky Whitley, director of the RN/BSN program.

“They need to be prepared to meet the demands of an ever-changing health care system through leadership roles, participation in interprofessional collaboration, conducting research

and education, and navigating a population-based focus in health care delivery,” she says. “A BSN prepares nurses to meet these demands while promoting continued safe, quality, affordable care on both individual and population perspectives.”

Deep Run, N.C., resident Tracie Zeagler, BSN ’14, became a nurse because she wanted to help people feel better. She says the online program enabled her to earn a fouryear degree and rebuild her confidence in her nursing skills despite a hectic schedule at home. She says she also learned new communication and management skills that are invaluable in the workplace.

“As a mother of five boys, I did not have time to go to a classroom in Greenville. I needed something I could work around my home life, and this program really did that,” she says.

“Going back to get my BSN was my way of regaining my confidence and placing myself at a little more of an advantage to get a job.”

Despite living outside Pitt County, Zeagler was active in the College of Nursing and represented the RN/BSN program on the college’s Undergraduate Curriculum Committee, Whitley says. Today, Zeagler is using her new skills to help low-income and disadvantaged patients at Kinston Community Health Center.

By contributing nurses like Zeagler and Dawson to the workforce, ECU is a leader for the state, says Polly Johnson, Chief Executive Officer of the Foundation for Nursing Excellence.

“ECU is helping to lead the way in addressing critical health care challenges facing North Carolina,” she says, “and is doing so by graduating nurses who are prepared to be critical thinkers and leaders for our communities.”

Faculty member Alison Swift and nursing student Staci Allgood work with a patient.

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Elizabeth Willy contributed to this article.

SERVING THOSE WHO SERVE THE COLLEGE OF ALLIED HEALTH SCIENCES BRINGS PEOPLE AND RESOURCES TOGETHER TO IMPROVE LIFE FOR ARMED FORCES SERVICE MEMBERS AND VETERANS.

Allied Health graduate student Foster Hunt

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The accolades have been numerous – East Carolina is recognized nationally as a university dedicated to those who have served in the Armed Forces.

And for the College of Allied Health Sciences, that dedication comes from every facet.

The college’s faculty, staff and students include former military service members and current members of the Reserves. Beyond the personal narratives of service woven into the mission of the college itself, the academic programs and assistancefocused resources it offers reach out into the region to improve the quality of life for veterans.

“We are located in one of the most dense military crescents within the entire U.S., stretching from Washington, D.C. through North Florida,” says ECU Provost Ron Mitchelson. “It makes great sense for the military to be an important part of our vision because we have very strong academic and research programs that are attractive to our active military and our veterans. In addition, our distance education offerings provide the kind of flexibility and accessibility that our service men and women need.”

Paul Toriello, chair of the Department of Addictions and Rehabilitation Studies, says the college has a desire to reach out to the veteran population – along with others in need – to help connect them with services they often don’t know are there for them.

“People want to help those who have served,” Toriello says. “It is a passion of the college as a whole.”

B Y S PA I N E S T E P H E N S

From classroom to community

For some faculty in Addictions and Rehabilitation Studies, that enthusiasm encompasses both educating students and providing specific resources to those in need – including veterans.

The Navigate Counseling Clinic, directed by Celeste Crawford and staffed by faculty and graduate students, provides hands-on training for future professionals while bridging gaps between people and support services including employment, addiction counseling and veteransspecific counseling.

Going a step further, a mobile clinic for homeless veterans – run through Operation Reentry, an initiative is centered on research and projects that help veterans return to civilian life after service – puts these services on the road, finding veterans where they are and providing as much assistance as they want, with issues from biomedical or vocational to relationships.

“Our interaction with them is brief but impactful,” Toriello said.

Jim Menke, military research liaison and project manager for Operation Reentry North Carolina, says his program and the College of Allied Health have a unique relationship that lends itself to finding solutions to the difficult challenges facing veterans today.

“This work is providing needed vocational and behavioral health counseling assistance to veterans where they are,” Menke says.

The benefit is not only to the veterans who receive counseling or other types 16

of assistance. The students earn practice and get a glimpse of the challenges other people face.

“Our students have a lot of pride in what they do,” Crawford says.

“They feel like they are really doing something, not just training. To feel humbled is an invaluable way to start your career.”

Many of the college’s services are made possible through grants from agencies including the Department of Defense, and Substance Abuse and Mental Health Services Administration (SAMHSA).

Toriello secured an additional grant from SAMHSA to help veterans make connections and improve their lives through technology. In its third year, more than 300 participants are using texting, email, message boards, and other technology to rebuild relationships, learn about and apply for jobs, and reconnect with society.

To Toriello, educating students and using professional expertise is only a part of the faculty’s duty; serving those who have served the country through programs and grants is the natural next step.

“It’s the least we can do,” he says.

Entrenched in service

Mark Stebnicki is another Allied Health faculty member who wanted to find a way to do more.

The professor and coordinator of the military and trauma counseling graduate certificate wanted to train students to understand all aspects

Jim Menke and Dr. Paul Toriello pose in front of the Operation Reentry mobile clinic.

of military culture that can present challenges for veterans – psychosocial, vocational and mental health.

and languages, but also to do what she could to ensure that people were better off.

“It seemed natural that our students would likely see a veteran client with some of these,” Stebnicki says.

“Being in the military has changed my life,” she says. “It’s taught me to be a stronger person inside and out.”

Those trained to treat veterans need to understand the medical, physical, psychological and career needs of service members, Stebnicki says. The certificate provides graduates the skills needed to aid military personnel and veterans with their transition back to civilian life after service is complete.

Foster Hunt, an Allied Health graduate student studying to become a physician assistant, learned similar lessons during his time in the military. He saw active duty in the U.S. Marines and still lives a mission of service.

Pat Frede’s day-to-day duties as director of development for Allied Health keep her challenged as well, but ECU and her college are supportive when Frede is deployed as part of the U.S. Navy Reserve.

She has deployed in past years to Afghanistan and Djibouti.

“I got to come back to the same job, and the same desk,” Frede says. “Not everyone is that lucky.”

Serving her country allowed Frede to witness other cultures, people

“It has always been an integral part of my plan to work with veterans, and

Being in the military has changed my life.

It’s taught me to be a stronger person inside and out.”

— Pat Frede Director of Development, ECU Allied Health

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I’m learning to expand my view of the many ways and places I can serve veterans,” Hunt says. “[The College of Allied Health Sciences] has made it possible for me to advance and further myself and my education.”

Hunt captures the feeling of many faculty, staff, and students in CAHS who either have ties to the military or want to use their expertise to improve the lives of those who have served.

“Just like having strong, successful Marines by my side,” he says, “I think it’s important to contribute to living in a healthy community. My community is a direct reflection of me.”

RESTORING LIVES, REDUCING

COSTS

ECU TELEPSYCHIATRY REACHES PATIENTS ACROSS NORTH CAROLINA

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BY DEE DOBSON HARPER

In any industry, the quality of service or whether one receives services at all hinges on one critical element: access. For those needing mental health services, the North Carolina Statewide Telepsychiatry Program, or NC-STeP, offers unprecedented access through an innovative delivery system connecting qualified doctors to mental health and substance abuse patients who sorely need their help. It is altering the landscape of psychiatric treatment and availability in the state.

statewide. Those hospital emergency departments use telemedicine technologies – secure, real-time interactive audio and video technology at the bedside – to treat patients in rural and underserved areas. NCSTeP’s level of reach has enabled over 21,000 patient encounters. As a result, emergency departments have seen shorter lengths of stay, fewer involuntary commitments, less recidivism, and most importantly, a measurable cost savings.

NC-STeP provides expert psychiatric assessments and consultations through a network of 80-plus hospitals

Established through state legislation in 2013 with $2 million in funding annually, NC-STeP is administered by

NC-STeP director Dr. Sy Saeed interfaces with a psychiatric expert at a partner hospital.

the East Carolina University Center for Telepsychiatry and E-Behavioral Health, and is overseen by the Department of Health and Human Services’ Office of Rural Health and Community Care.

“This two million dollar investment from the state has generated five to seven million in cost savings when you consider that 40 percent of patients have been sent home and connected to a community provider. It prevents unnecessary hospitalization,” says Dr. Sy Saeed, the director of both NC-STeP and ECU’s telepsychiatry program.

How does the system work? A nurse at the remote referring site rolls a portable cart outfitted with a monitor, camera and microphone into the patient’s bay or room, establishes a secure link to the psychiatric provider site, and introduces the patient to a psychologist or social worker who has reviewed the patient’s information. Once that individual explores the patient’s situation and gathers any pertinent information from family members, a psychiatrist interviews the patient and makes recommendations to the referring hospital physician, who is ultimately responsible for care decisions.

Saeed points out that today’s emergency departments are jammed, especially in North Carolina due to mental health reform and the dismantling of community-based systems. But the emergency department arrivals are not, as often thought, using the facilities in place of a standard doctor’s visit.

“Contrary to the myth that people go to the emergency department for convenience, we have found that this is a sick and severely decompensated population. Their illnesses run the gamut from acute depression with suicidal thoughts to severe psychotic exacerbations of schizophrenia to manic episodes.

Some cases are substance induced.

Others suffer severe anxiety or panic,” explains Saeed.

Thanks to NC-STeP, about onequarter of the patients to arrive at a participating emergency department with involuntary commitment orders get those orders overturned. According to Saeed, times have never been better for mental health patients because more effective, evidence-based care is available. People are recovering and

able to enjoy family relationships and employment. The drawback remains accessibility to good care among rural populations, but Saeed and his team are working to broaden the reach. He says, “Telepsychiatry fills gaps with what science has promised them. They now have emergency intervention and access to professional medical care.

We’ve opened a door.”

This two million dollar investment from the state has generated five to seven million in cost savings when you consider that 40 percent of patients have been sent home and connected to a community provider.”

— Dr. Sy Saeed, M.D. Director, NC-STeP and ECU telepsychiatry program

Saeed initially had planned for 59 out of 108 hospitals in North Carolina to participate in NC-STeP, based on the number of facilities that had no psychiatric services available, making them ideal candidates. But the demand was greater.

“Within three months,” he recalls, “we realized that 70 hospitals were interested. Word had gotten out by word-of-mouth, press articles and the usual channels. The legislature funded 59. We approached The Duke Endowment to fund over and beyond the legislature (support), and we were able to grow the program to over 80 hospitals.”

Finding providers is an ongoing challenge due to a nationwide shortage of psychiatrists, with rural 21

regions being the hardest hit. One doctor in 10,000 is the generally agreed upon number for psychiatrists.

North Carolina statistics are worse based on county-by-county level breakdowns. Twenty-nine of 100 counties have no practicing psychiatrist, Saeed says. Fifty-eight counties are regarded as “Health Professional Shortage Areas” due to the dearth of providers.

One-third of the patients served by NC-STeP have no health insurance. Saeed and his team offer payment competitive with community mental health centers.

Nevertheless, going up against the financial allure of private practice in metropolitan markets is difficult.

Asked where he would like to see the program go, Saeed answers that the big part of the journey remains. Ideally, he would like to see the program benefit from the cost savings it generates in order to address the shortage of mental health providers. He would like to build community-based locations in areas lacking access without competing with existing programs. Saeed contends that if appropriate health care can be delivered in the community setting, patients are less likely to end up in emergency departments.

Telepsychiatry is technology based and driven, yet it lengthens and strengthens the reach of the health care providers to patients they might not otherwise have an opportunity to engage. Says Saeed, “It helps retain the personal touch. It’s still a human connection. It’s still about building relationships, bridging distances and making health care convenient for people.”

C.S. 16-1733 Printed on recycled paper with nonstate funds.

Photography by Jay Clark and Cliff Hollis. Additional photography by Forrest Croce, Patrick Fay, and Mike Litwin. Contributory photo provided by Pat Frede.

East Carolina University prohibits unlawful discrimination based on the following protected classes: race/ethnicity, color, genetic information, national origin, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation, gender identity, age, disability, political affiliation, and veteran status.