Hannah Flanery Blog

Hannah Flanery on her time in Redfield

Week One:

As a clinical psychology student, I am interested in learning how mental health care is utilized within a rural setting. I am interested in examining the community’s interest in mental health care. Through REHPS, I can consider my purpose as a professional clinical psychologist practicing within a rural South Dakota town. Kristin and I started our first day of REHPS on Wednesday. We met with Aly Howard, the Pharmacy Director of Redfield Community Memorial Hospital Avera and the REHPS Site Coordinator. Aly is a former REHPS participant who chose to practice in rural healthcare after her REHPS experience. She is a very interesting and humorous person! She gave us the grand tour of the Community Memorial Hospital and the Redfield Clinic. She introduced us to the professionals that keep the hospital and clinic running (so many names and faces, my goal is to have them memorized soon!). This week was a busy one in the clinic and in the hospital, especially with so many ER visits. There were several high-level ER patient visits which, apparently, is something of rarity in Redfield. We were able to observe several of these patients receiving initial assessment and treatment. I was amazed at the level of teamwork the staff provided; Everyone cares about getting the best possible treatment for patients. I do not have any medical training so I focused on observing the relationship between the providers and their patients. I am impressed with the genuine nature of the providers and the provider’s hard work to give their patients the best care. Something interesting is that in rural care, it is likely providers and clients know each other outside of receiving clinic or hospital services. I discussed this with several providers, all of whom described the unique bond between provider and patient in rural areas.

I was able to chat with several patients who experiencing psychological distress and the benefits of therapy. I did not conduct any therapy with them, but I think it is helpful for people to talk to a relative stranger about their life. I was told by several patients they found it easy to talk with me and enjoyed our experience. It was those moments that reinforce why I applied to REHPS. I think it is important to talk with patients and even though I am not providing therapy, I am strengthening my conversational skills … and figuring out how to keep conversations within a certain time set!

Kristin and I toured the South Dakota Developmental Center (SDDC), a residential care facility for people with both developmental and psychological disabilities. The SDDC has a long history. It used to operate with over 1000 patients but now serves a few hundred patients. The grounds were beautiful. The staff have nicknamed the facility as the ‘campus’ due to its expansive land and facilities. SDDC has its own community of healthcare providers and staff that work to reestablish patients into the outside community. There is a strong emphasis of behavior therapy and I was able to look over a few treatment plans.

The SDDC has created a place for patients with developmental delays/disabilities who require psychological services and provide residential living spaces and activities. It was very humbling to learn about the day to day operations and the amount of work both staff and providers put in to better the patients’ experiences. Kristin and I spoke with many of the staff who work hard to keep the SDDC running smoothly. The SDDC runs several group skills trainings for patients, and I am excited to sit in on the weeks to come!

Other great opportunities I experienced: I observed a cardiac therapy session. I was given a crash course in Meditech so I am able to familiarize myself with the care of the patients in both the clinic and the hospital. Kristin and I received a tour of the Eastern Star Home, a nursing home and assisted living services facility. The staff was very lively and caring. I hope Kristin and I can return and shadow some of their operations. We also sat in on a TELEMED session. Programs using online communications to develop treatment plans are a relatively new practice. The use of TELEMED and other online programs is a hot topic in the healthcare field. It was interesting to observe the TELEMED process and the collaboration between rural and rural providers.

I really do love the feel of the clinic and hospital and its connection with the community. Kristin and I are very fortunate to interact with such great staff and providers who allow us to shadow their caseload while teaching us their process and also sharing their experiences of working in healthcare in a rural setting.

In our free time, Kristin and I explored a few of Redfield’s restaurants. We drove to Aberdeen upon recommendation to paint some pottery; We both got really into it and stayed for several hours! I experienced my first drive in movie theater which held Redfield’s strawberry pop (it’s amazing!). This week has consisted of Kristin and me settling into our new home for the next few weeks. We have explored a bit of the Redfield community and surrounding area, but we have a lot of places to check out!

Week Two:

Kristin and I had another busy week in Redfield! For this week we arrived at the hospital by 8AM for hospital rounds with a physician. The patients were receptive and willing to include us students in the discussion of their progress and course of treatment. There was another telemed conference I sat in on and I also observed several cardiac rehab sessions with two different nurses. The hospital nursing staff remain warm and receptive; they always update Kristin and myself on patients’ current progress and events going on in the hospital. We sat in on a medical staff meeting where many providers and administers of the hospital and the clinic met over lunch to discuss patient care and hospital and administration policies.

There was another ER patient that came in and I was able to observe the collaborative process between providers yet again. Aly Howard showed Kristin and I her anticoagulation clinic. We were able to sit in on a few sessions with patients and learn more about Aly’s unique position in Redfield. Kristin and I then went to the medical lab and learned about the hospital’s process of drawing blood and the equipment used for testing the blood.

I shadowed several physical and occupational therapy sessions this week. I was luckily enough to shadow an occupational therapist evaluating patient progress. I observed several fine motor tasks with an adolescent patient and a geriatric patient. I went with the occupational therapist to assess the condition of hospital patients who might need OT services as part of their overall treatment plan. I really enjoyed my time with the physical and occupational therapists. I tried to reflect my own knowledge on neurological and cognitive functioning and the psychological impact of needing PT and/or OT services.

For most of the week I spent my afternoons shadowing providers in the clinic. I followed two physicians and two physician assistants. I spent generally 4 hours a time with each health care provider which allowed me to observe a diverse set of patients and treatment plans. The providers and I talked about the lack of physicians practicing in rural areas and its negative impact on rural communities. We discussed the shortage of mental health professionals and how patients need to travel to larger towns, such as Aberdeen and Sioux Falls, if they wanted to seek out certain mental health services.

While following a physician, I went on rounds to a nearby nursing home with a locked unit for memory impaired residents. When I was shadowing a physician assistant, I was able to witness an ER patient go to radiology for some x-rays. It was interesting to observe the procedure as I myself have never been in a radiology department. A different physician assistant that I shadowed gave me a tour of the hospital’s old operating room that is no longer in use. I had never been in a surgical room before so it was interesting (and a bit creepy) to look at the lighting equipment, the bed, and the large blank walls.

I shadowed another pharmacist and I received a tour of the clinic pharmacy. It was very interesting to see the process of refilling a prescription and the actual act of getting the pills into the bottles. I then went to one of the nearby nursing homes to review charts of the residents with the pharmacist. As I examined the charts, I was able to review the medical history as well as neurological assessments and medication recommendations based on cognitive functioning.

My time here has already shown me that we need to improve mental health care access for people living rural areas. I have talked with providers in the hospital, clinic, nursing homes, and South Dakota Developmental Center (as well as Kristin!) on how my role as a clinical psychologist could be in a town like Redfield. I would suggest for other students in the mental health care field to take part in this rural health care immersion experience.

In our free time, Kristin and I have continued to check out the local restaurants. We managed to get in breakfast at Leo’s, which had been highly recommended from everyone we talked to (it was delicious!). We visited Simply Charming, a coffee shop with cute home decor and jewelry made by South Dakota artists. We also went to wing night and burger night at the American Legion. Redfield has some great food options!


On Saturday we went to Aberdeen to participate in “Crazy Days’” by shopping downtown and enjoying the live music and food stands. Several vendors did not show up due to the heat but it was still a fun experience! Kristin and I went in every boutique and purchased some great clothes for a bargain! In Aberdeen we also picked up our pottery from last week… and they turned out great! I’d love to do another one at the pottery studio, or even a painting canvas but we are already running short on time!  On Sunday we toured the Historic Chicago & Northwestern Railroad Depot Museum; the staff there was very welcoming and generous with their time as they led us on a mini tour of the building.

Kristin and I decided on our community project! We will be presenting at the local senior center next week! More on that to come with the next journal update! We have 2 weeks and only 1 weekend left! My time in Redfield is flying by!

Week Three:

I continued shadowing clinic providers throughout my third week at Redfield. I went to a partner clinic in Doland for an afternoon where several patients came in for brief visits. Kristin and I spent a large portion of this week with the Home Health staff. I went on numerous home visits with nurses who managed patients’ medications, checked health vitals, provided foot hygiene care, and sometimes some basic home cleaning. The Home Health staff hold a “foot clinic” where folks who have difficulties in foot and toenail upkeep can come in and receive foot hygiene care. This foot clinic provides preventative care that is extremely important and is needed in order to keep feet healthy! This week I spent a large portion of my time at the South Dakota Developmental Center (SDDC). I participated in a training on Trauma Informed Care for the behavioral therapists, counselors, psych aids, and other SDDC staff. This training only occurs once or twice a year, so I lucked out! I sat in on several different therapy groups for the patient population.  I talked with the psychologist working at SDDC and was able to observe assessment testing; I had not heard of this particular test, so it was very interesting to learn more about it! I finished out this week by spending a full day with the SDDC’s psychiatrist and medical residents. I met with patients throughout the day and I listened to discussions on adjusting medications. I learned about residents’ medical history, current medication use, and past and current challenging behaviors. Kristin and I presented at the Senior Center for our REHPS community project over lunch time. We talked with seniors on ways to continue to live independent while being safe and healthy. We talked about nutrition, fall prevention, hygiene practices, memory aids, and mental health.

Week Four:

My time in Redfield has gone by so fast! I spent my last week in Redfield at the South Dakota Developmental Center (SDDC). SDDC is a unique long-term patient care facility for people with behavioral challenges and/or impaired cognitive and psychological functioning. At SDDC I was able to interact with patient populations I normally would not be able to with my current educational program.

Kristin and I were able to observe afternoon medication pass to the patients at SDDC. I sat in on six different types of therapy groups and I was able to observe the same group several times throughout my time at Redfield. The patients were curious about my presence and welcomed me to observe their progress at SDDC.

I talked with several providers at SDDC about their journey’s working in Redfield. The commitment and compassion the behavioral health team has for their patients is touching. I am deeply grateful for REHPS providing me this opportunity to shadow SDDC’s operations.

Kristin and I presented on our time spent at Redfield. So many happy memories were made as we experienced rural health for the past four weeks! Saying goodbye to the people who helped make this such an enjoyable experience was hard, but I will use my journey in Redfield to fuel my passion for improving access to mental health care in rural areas!