At The Journal of Appalachian Health, and Angela Scarpa and colleagues have an article titled "Access to Autism Spectrum Disorder Services for Rural Appalachian Citizens. Not surprisingly, they find problems of availability and affordability. Another problem, however, has gotten less attention: cultural sensitivity to rural people.
When considering increasing the workforce of mental health providers in rural Appalachian regions, policy makers and educators may need to consider the addition of multicultural training that is specific and sensitive to the history and needs of Appalachian residents. It has been suggested, for example, that providers need to spend more time building rapport with clients by engaging in chit-chat and pleasantries (i.e., “front porch talk”), and getting to know specific terms that are used in the region (e.g., “having nerves” to mean experiencing anxiety).Similarly, providers in our sample suggested the need to establish trust and to respect client autonomy by becoming part of the community, avoiding jargon, and treating clients without condescension. Diversity training that includes such information about cultural attitudes may help overcome some initial mistrust of professionals and facilitate better therapeutic relationships. Interestingly, the caregivers themselves did not report these cultural barriers, noting only childcare as the primary barrier to participating in treatment. It is not clear if the lack of caregiver report was due to the small sample size, or if there is a real discrepancy in how families versus providers view barriers to seeking treatment.