Rural counties face a number of challenges when it comes to behavioral healthcare, including a lack of resources, far-flung facilities and providers, transportation issues, and economic hurdles. While every county is different, there are some common approaches that can help foster innovative solutions for those challenges.
Chief among them: collaborating with other local agencies. That was the message of the Centene Foundation’s Improving Health in Rural Counties/Parishes program. Last year, the Foundation (part of health plan Centene Corp.) awarded $360,000 in grants to three programs in California, Kansas and Louisiana for innovative health improvement initiatives.
The rural health program was launched through a relationship with the National Association of Counties (NACo). The program was designed from the start to encourage collaboration across agencies, an important strategy for providers and other stakeholders in rural areas.
“We asked them to identify an issue that was particular to rural counties, and find a solution that involved as broad a scope as possible in terms of engaging other stakeholders in the community,” says Marianne Burdison, senior director of strategic alliances and development at Centene’s Cenpatico subsidiary that offers managed behavioral healthcare services. “We didn’t just want the county to step up; we wanted them to assess needs across the community, identify who the resources and stakeholders are, and come up with innovative solutions. Partnerships across stakeholders are a key part, and that’s the best way to get innovative solutions. No one entity is going to have as great an impact.”
Although the grant program was focused on a whole health approach, behavioral healthcare issues were at the forefront in many submissions. Grants did not specifically target behavioral health, but between two-thirds and three-quarters of the applications addressed mental illness in some way.
While the awardee from Iberia Parish in Louisiana was focused on nutrition among school-age children, the other two grant-awarded programs involve behavioral health efforts.
The program in Tuolumne, Calif., is the most complex and ambitious of the three. The Tuolumne SOAR Collaborative is a cooperative effort that includes the county behavioral health department, the California Institute for Behavioral Health Solutions, and 15 other community agencies and stakeholders focused on the homeless.
The program will leverage the grant funds for transitional housing, a common challenge in rural areas, especially for homeless clients with disabling mental illness or co-occurring disorders.
“They built upon the SOAR effort under SAMHSA that was already underway,” Burdison says. “That model works to engage the homeless, and help them to apply for Supplemental Security Income or Social Security Disability benefits. If you are homeless, completing that process can be nearly impossible.”
According to Burdison, the county’s proposal won, in part, because leaders clearly identified existing resources that could be leveraged and extended via the grant. Tuolumne also created a sustainable model for providing transitional housing.
“They are using the grant funds to lease temporary housing for two years,” Burdison says. “As folks come into the program, they contract with the program so that when they receive their initial Supplemental Security Income lump sum payment, they repay a small portion of the transitional housing cost. Then those funds can pay for housing future program participants.”
Pawnee County in Kansas has developed a program to promote public awareness of mental illness and substance abuse treatment disorders, improve access to services, and broaden access through technology such as telemedicine. The Pawnee County Health Department teamed with the Center for Counseling & Consultation (The Center) to coordinate with the County Health Departments and Court Services/Community Corrections Programs of Central Kansas across four counties.
“There is one center serving these four counties, and although they have satellite offices, there was still limited accessibility,” Burdison says. “They invested in a technology solution that would allow the program to continue beyond the scope of our partnership.
Local hospitals and law enforcement will have access to tablet computers that can be used for telemedicine assessments 24 hours a day. That will eliminate screening delays that created a lag time in getting patients into the appropriate in-patient treatment facility. The county and The Center will also advertise and promote services, and deploy mental health self-assessment kiosks for the public that are similar to ones used in a successful program in Philadelphia.
Across the range of applicants, Burdison says many counties clearly identified a need for coordination between providers and corrections departments. Other applications identified public health departments, social service agencies, charitable organizations, non-profits, and community specific resources as potential partners.
“The more stakeholders you engage, the more likely you are to pool resources and create innovative solutions,” Burdison says.
It is especially important for behavioral healthcare providers in rural areas to better integrate themselves into the local healthcare fabric. “Behavioral health cannot be terminally unique,” Burdison says. “It has to be part of the whole health solution. Especially for smaller providers, find a way to partner with others in the health system and in the community. You have to figure out how to connect and be part of how people get healthy and stay healthy beyond just clinical services.”