Late last month the U.S. Department of Health and Human Services announced funding for the Mental and Behavioral Health Education and Training Program, an initiative meant to increase the number and availability of social workers and psychologists in rural areas, specifically to assist military veterans and their families. Nearly $10 million in grants were awarded to institutions (including two in eastern Pennsylvania and one in West Virginia) to support study and clinical training in the areas of trauma and abuse, combat-related stress and substance abuse. Although about 28 percent of the 22 million veterans in the United States reside in rural areas, treatment for PTSD and other combat-related conditions remains difficult to find and may lack the required intensity. These grants aim to increase both the availability and intensity of trauma–related mental health care, as well as services to families of persons with chronic illnesses in rural areas.
According to Census 2010 data, over a ¼ of the population of Pennsylvania (27 percent) is located in rural areas, and a considerable amount of our region of western Pennsylvania is considered rural. Yet in my admittedly anecdotal experience, it seems that much of the mainstream discussion in the sector focuses on urban organizations. The challenging issues faced by rural nonprofits, accessibility (a dispersed population), transportation (rarely any of a public sort), technology (reliable connections and coverage) and needs specific to non-metropolitan areas may be a bit of a mystery (hopefully not an afterthought) to the thinkers and influencers in the nonprofit and philanthropic sectors.
A report from The Bridgespan Group, Small but Tough: Nonprofits in Rural America by Alex Neuhoff and Andrew Dunckleman, turns the lens on rural nonprofits in the United States to examine what these organizations look like, identify their most pressing challenges and determine how they differ from their urban peers. Some highlights of the study:
- Rural nonprofits are funded at a lower rate per capita than their urban counterparts. Rural areas make up 18 percent of the total population of the United States, have a higher rate of poverty overall (22 percent of the country’s poor reside in rural areas) but represent 8 percent of the total spending in the nonprofit sector (including human services).
- In spite of the above, overall, rural nonprofits appear to be in a better fiscal state than urban nonprofits and are less likely to run an operating deficit.
- Data suggest that rural nonprofits have learned to be both nimble and aggressive, prioritizing and pursuing strategies perhaps different from those of urban nonprofits used to the close proximity of both clients and funders. The authors point out that rural organizations collaborated, merged and otherwise partnered with each other or a larger network, had strategic approaches to grants (private and public) and emphasized relationship-building outside of their communities.
- A major obstacle faced by rural nonprofits is leadership recruitment and retention, an issue Pennsylvania grapples with per a recent study on the challenges associated with rural leadership development.
The study (available for download at The Bridgespan Group website) provides an excellent initial picture of rural nonprofits, including a comparative case study of similar programs operating in two very different locations. I hope this type of organizational research continues, as there may be much to learn from the nonprofits operating 60 miles outside of Pittsburgh, but seemingly a world away.
Rural areas, while offering residents many appealing benefits, face unique cultural, logistical and economic challenges in the provision of health services to a disperse population. With approximately one fifth of this country’s population living in rural areas, it is imperative to continue research on and programming specific to the needs of rural America.
According to a 2007 brief from the Maine Rural Health Research Center, youth in rural areas are more likely to participate in heavy or binge drinking and driving under the influence than urban youth. They also have a higher rate of methamphetamine and Oxycontin use. Unfortunately, according to a 2009 brief from the Center, there are only 235 detoxification service providers in all of rural America. Even in regions that have a detox center, geographical distance, financial hardship or a lengthy wait list may impede access to services.
The substance abuse segment of the Rural Healthy People 2010 report by the
Southwest Rural Health Research Center at the Texas A&M Health Science Center takes a closer look at the scope of the problem of substance abuse in non-urban areas as well as various program models that address this critical health issue.