Behavioral Health In Rural America: Challenges and Opportunities

Principal authors: John Gale, MS; Jaclyn Janis, BSN, RN, MPH; Andrew Coburn, PhD; Hannah Rochford, MPH

Prepared by the RUPRI Health Panel: Keith Mueller, PhD; Andrew Coburn, PhD; Alana Knudson, PhD; Jennifer Lundblad, PhD, MBA; Timothy McBride, PhD

The prevelence mental health and substance use diagnoses and unmet treatment needs are not equally distributed, with rural residence being one factor associated with these differences. Moreover, the rural context has proven challenging for ensuring the availability of and access to prevention, diagnosis, treatment, and recovery services in rural areas. This paper reviews the prevalence of behavioral health disorders in rural populations, rural access to behavioral health services, promising program and policy strategies targeted to improving rural BH systems, and opportunities for policy and system changes to improve rural BH systems and outcomes.

Click to download a copy: Behavioral Health In Rural America: Challenges and Opportunities – Full document

Provides an overview of the Government Accountability Office’s (GAO) review of 258 nongovernmental hospitals that participate in the 340B Drug Pricing Program and their contracts with state and local governments. Evaluates the contracts to determine if they meet the eligibility requirement to serve low-income individuals. Outlines weaknesses in the Health Resources and Services Administration’s review of the hospital contracts and offers six recommendations to improve the contract review process.

Jan 29, 2020 — The U.S. Department of Justice announced the White House task force on missing and murdered American Indians and Alaska Native held its first meeting. Describes how the task force will work with tribal governments, develop protocols, and increase awareness to address the high rates of violence towards Native community members.

Jan 30, 2020 — The Government Accountability Office is requesting nominations for the Physician-Focused Payment Model Technical Advisory Committee, which will provide feedback on physician payment models to the Department of Health and Human Services (HHS) Secretary. Nominations are due February 28, 2020.

During his remarks at the National Rural Health Policy Institute, U.S. Department of Health and Human Services (HHS) Deputy Secretary Eric Hargan announced President Trump’s new rural health plan’s four main areas of focus: preventing diseases, creating sustainable financing, using technology to improve access, and laying the groundwork for a stronger workforce. Also, the new program will attempt to tackle maternal health and opioid issues. Deputy Secretary Hargan has signaled more details to come explaining the intricacies of the plan.

During the week of February 10, 2020, the Office of the President released its federal budget proposal for the FY2021. The annual release of the President’s budget is a non-binding document that is not expected to be adopted. The President’s budget provides a roadmap of programs and initiatives being prioritized by the administration in office. Here is a breakdown of proposed Health and Human Services program spending.

During the week of February 10, 2020, Congressman Jodey Arrington (R-TX-19) announced the introduction of the Save Rural Communities Act (H.R. 5808). This legislation seeks to grant rural hospitals more flexibility in the services they provide. Specifically, it allows them to convert to an outpatient only, 24-hour emergency care center. The proposed change would allow hospitals to tailor their business model and balance their budgets, while also meeting the health care needs of their community.

Harrisburg, PA – In February 2020, the Pennsylvania Department of Human Services (DHS) released a bulletin with guidance and requirements for providers that wish to become a specialized child residential setting under the Family First Prevention Services Act.

“The Wolf Administration remains committed to protecting vulnerable populations across Pennsylvania, and the Family First Prevention Services Act will help strengthen Pennsylvania’s child welfare system in line with this goal,” said DHS Secretary Teresa Miller. “We want to be sure that every service we provide offers the necessary supports to meet children and families’ needs and help them on a path to safe, healthy lives. This certification process will help DHS ensure that specialized settings for children will be available, safe, and suitable.”

The Family First Prevention Services Act is a federal law that prioritizes keeping children with their families. It allows states to use federal payments for trauma-informed evidence-based prevention services to allow children who would otherwise be placed in foster care to stay with their parents or relatives. The implementation of this law, scheduled for October 1, 2020, aligns with the Wolf Administration’s goals of serving children safely with their families or family-like settings when necessary.

In the event placement outside the home becomes necessary, the law directs federal funding towards family-like settings or other specialized settings that are best suited to a child’s individual needs. Specialized settings are trauma-informed child residential facilities or supervised independent living programs specializing in providing care and treatment for children and youth with special circumstances, including:

• Pregnant, expecting, and parenting youth;
• Youth who are transitioning to adulthood; or
• Youth who are, or at risk of becoming, sex trafficking victims.

Specialized settings should offer programming for participants and training for staff tailored to the needs of children and youth with these special circumstances. Public and private children and youth social service agencies, providers and stakeholders that provide services to these populations are encouraged to request certification as a specialized setting.

The specialized settings emphasize a trauma-informed approach to care. This approach integrates knowledge and effects of trauma into policies, procedures, and practices while actively seeking to avoid re-traumatization. Trauma-informed care is informed by six principles: organizational safety, trustworthiness and transparency, peer support, collaboration and reciprocal relationships, empowerment among and between staff and participants, and cultural sensitivity. Standards of trauma-informed care are in line with recommendations made by the Council on Reform established by Governor Wolf’s Vulnerable Populations Executive Order and the Wolf Administration’s effort to make Pennsylvania a trauma-informed state.

More information, the bulletin, and the certification approval process can be found here. Applications to be considered a specialized setting must be submitted by March 15, 2020.

DHS’ Office of Children, Youth, and Families is hosting webinars to review the bulletin and application process for child residential facilities or supervised independent living programs providing or planning to provide services to the above identified populations. Session opportunities are 9:30 a.m. to 12:00 p.m. on February 25 and 28. To register, email cwtpreg@pitt.edu.

Visit www.dhs.pa.gov or email ra-PWFamilyFirst@pa.gov for more information.

MEDIA CONTACT: Erin James – 717-425-7606

During the week of February 10, 2020, the Trump Administration released its federal FY 2021 budget proposal, and the bottom-line impact to programs serving kids and families is stark. The silver lining, if any, is that the likelihood of the plan gaining any momentum in Congress is slim to none.

The proposed budget cuts Medicaid spending by at least $1 trillion over the next 10 years and makes further cuts to CHIP, undoubtedly impacting health care coverage for kids in Pennsylvania and across the country. While little detail is provided in the proposal, what is known is that states would be allowed to select between moving to either a Medicaid block grant program or a per capita cap option.

The budget advances a one-time increase of $1 billion for child care, but masks other elements including the flat-funding of Head Start and the Child Care Development Block Grant, as well as the elimination of Preschool Development Grants, which Pennsylvania received in 2019. While a $1 billion increase is eye-catching, it should also be noted that Congress passed a $2.4 billion increase for child care in 2018.

Read more about the Medicaid proposal from the Georgetown Center for Children and Families.

in late 2019, the Office of Advocacy and Reform was created in Pennsylvania with the intent of overhauling state systems and services and identifying strategies to better protect vulnerable individuals. In addition to convening a council of reform, the position of Child Advocate was created and has recently been filled by Nicole Yancy, J.D.  Ms. Yancy will be a liaison between the systems serving children and their families, triaging concerns and complaints, and making recommendations for system-wide improvements.

The Office of Children, Youth and Families, in partnership with the Pennsylvania Department of Human Services and the Office and Advocacy and Reform, is conducting roundtables around the state to engage local child welfare agencies, county leaders, advocates and elected officials in brainstorming ways to improve the child welfare system.  The roundtables are an opportunity to openly discuss the struggles faced by child welfare agencies, and to develop recommendations on strength-based and solution-focused outcomes. Read more about the first roundtable held in York County.