From One Day a Week to a Full Department: How We Helped HCMC Expand Mental Health Care in Rural Nebraska
When I first began working with Howard County Medical Center (HCMC) in January 2022, their outpatient mental health service was just one clinician, one day a week. No full department. No paperwork systems. No supervision structure. No roadmap.
What they did have was vision—and they asked Blue Elephant Counseling to help make it real.
Three and a half years later, as my contract ends this August, that vision has become a functioning, sustainable mental health clinic that now serves the St. Paul and surrounding communities full-time with both in-person and telehealth services.
Here’s how we got there.
Building From the Ground Up
We weren’t stepping into an existing clinic. We were building it. That meant starting with the basics:
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Creating all clinical documentation, assessments, and billing processes
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Setting up workflows that met compliance and operational standards
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Applying for funding to support growth—successfully securing over $300,000 in BHECN ARPA grants to get the department staffed and moving
This work wasn’t just behind-the-scenes. It impacted real people.
Training the Next Generation
One of the most meaningful parts of this project has been developing new clinicians right in the community. Over the course of the contract, I:
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Trained the incoming clinic supervisor from intern through full licensure
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Supervised two additional interns—one of whom now works there full-time
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Oversaw two provisionally licensed therapists who are now providing care
These are now local providers, equipped and embedded in their community, ready to carry the work forward.
Sustainability > Quick Fixes
The goal was never to temporarily plug a gap. It was to make the department self-sufficient, with leadership and infrastructure that would outlast my time there.
That’s exactly what’s happening. As of August 23, 2025, the department will transition to full local leadership—with trained staff, systems in place, and momentum to keep growing.
What’s Next for Blue Elephant
This milestone doesn’t mark an end. It’s part of our larger mission.
Blue Elephant Counseling continues to provide online mental health care across Nebraska and consulting for clinicians looking to build or grow private practices—especially in rural communities where the need is high and the resources are often scarce.
If you’re a clinician or organization looking to build something sustainable, I’d love to talk.
You can reach me directly at Katie@blueelephantcounseling.com or learn more at www.BlueElephantCounseling.com.
Helping rural mental health systems grow from the inside out—that’s the work I’m proud of. And it’s just the beginning.