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Rural Health Information Hub

Madison Outreach and Services through Telehealth (MOST) Network

  • Need: More mental health and substance abuse prevention and treatment services in rural Texas.
  • Intervention: A network was formed to bring counseling services through telehealth systems and community health workers to Brazos Valley, Texas.
  • Results: The program improved health outcomes, increased general knowledge of the impact of substance abuse, and raised awareness of services among Hispanic residents.


Effective (About evidence-level criteria)


Madison County, Texas is a part of the 7-county region known as the Brazos Valley. The area is both a mental health and primary care Health Professional Shortage Area (HPSA), as the closest medical facility is at least 40 miles away for most residents.

Almost 20% of residents surveyed have been diagnosed with depression or anxiety, and 35% reported that they cannot easily get access to needed services. Madison County's growing Hispanic population is unfamiliar with services offered and hesitant in seeking medical assistance. Many residents have turned to using alcohol and other substances as coping mechanisms.

The Center for Community Health Development (CCHD) came together in 2011 to identify local organizations that could help start mental health and substance abuse prevention and treatment services for Brazos Valley residents. This collaboration became known as the Madison Outreach and Services through Telehealth (MOST) Network.

The MOST Network's primary focus became finding a way to link behavioral and mental healthcare services in urban communities to rural residents. Based on multiple studies that have found telehealth mental health counseling to be as effective as in-office visits, the MOST Network replicated a neighboring community's model and brought it to Madison County. In order to better serve the Latino community, the Network also trained community health workers (CHWs) to introduce Spanish-speaking residents to health and social services.

This video highlights the MOST Network's impact through their telehealth services and CHWs.

Partners involved in the MOST Network include:

This program received support from a 2012-2015 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant.

Services offered

Telehealth Services

Under supervision, doctoral-level psychology students from Texas A&M offer counseling services in both English and Spanish from the Telebehavioral Care Program. Counselors connect with patients who are located in rural clinics electronically via video or phone.

  • Telephone counseling – is an attractive alternative to traditional face-to-face counseling because it allows for clients to stay anonymous.
  • Televideo counseling allows the counselor to observe the client during treatment sessions and obtain additional visual cues.

The MOST Network found that telehealth-based counseling circumvented obstacles to counseling such as client physical disabilities, social anxiety, geographic isolation, and financial and time constraints.

The MOST Network also partnered with BVCASA to provide 2 educational classes for residents that focused on substance abuse: Choices Not Chances (CNC) and Youth Sobering Facts. Classes for adolescents and adults were led in small groups via telehealth methods.

Community Health Workers

Community health workers (CHWs) are lay members trained to bring general healthcare direction to community members with whom they usually share ethnicity, language, socioeconomic status, and life experiences.

In partnership with the BVCASA, the Network trained CHWs whose duties included various outreach tasks, including transporting residents to and from counseling services, client visits, and conducting classes for Hispanic residents on the Madison Health Resource Center (MHRC) and MOST services.


After the 3-year grant period, the MOST Network saw the following results:

Assessments showed that telehealth-based mental health services improved the overall mental health among clients in Madison County. In all, 44 unique clients were seen via telehealth, with an average of 8 mental health counseling sessions each and a total of 487 sessions.

CHWs led classes for 27 adults and 19 adolescents. By the end of their course, adult attendees saw a 27-point average increase in knowledge related to substance abuse, and a 7-point average increase in adolescent clients.

Prior to MOST, there were no Latino-focused services related to health and social services within Madison County. Throughout the course of the grant, 2 individuals completed the 160 hour training certification program to become CHWs.

CHWs met with 24 Hispanic individuals and were able to refer their clients to various services. Hispanic clients made up 9% of those who received telehealth services and 18% of those who received CHW services.

Client outcomes were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Clinical Outcomes in Routine Evaluation-Short Form B (CORE-B).

For further information on the MOST Network Program:

McCord, C. E., Saenz, J., Armstrong, T., & Elliott, T. R. (2015). Training the next generation of counseling psychologists in the practice of telepsychology. Counseling Psychology Quarterly. 28 (3), 324-344. Article Abstract

Tarlow, K.R., McCord, C.E., Elliott, T.R., & Brossart, D.F. (2014). Health-related quality of life of rural clients seeking telepsychology services. International Journal of Telemedicine and Applications, 2014, 1-7.

McLeroy, K. R., Burdine, J. N. (2012, April). Madison County Receives Rural Health Services Outreach Grant. Communitas, 8 (2) 1-2.


  • Consistency among staff varied as project directors and supporting partner staff resigned from their positions throughout the grant period
  • Connectivity between rural communities and the urban area where the services originate continues to be a challenge
  • The cost of point-to-point connectivity, which can exceed $6,000 per year, can steer rural communities away from signing up for telehealth services
  • The occasional dropping of a video feed due to a network outage was frustrating for network partners when using telehealth services
  • The MOST Network originally adapted the South Texas promatora/CHW model that did not translate well to Madison County


  • Implement an educational process regarding the role and scope of the CHWs to inform providers and community members how to fully take advantage of their services.
  • Consider paying your CHWs as an incentive and to increase retention rates.
  • Develop a strong referral and care coordination system to ensure that clients are not lost in service delivery system gaps.
  • Determine how to recruit and train individuals who will stay within the community long-term.
  • Increase awareness of the purpose of CHWs among residents.

Contact Information

Lara Meece, Executive Director
Madison Health Resource Center

Behavioral health
Community health workers
Hispanic or Latino
Mental health
Substance use and misuse

States served

Date added
November 5, 2015

Date updated or reviewed
December 13, 2018

Suggested citation: Rural Health Information Hub, 2018. Madison Outreach and Services through Telehealth (MOST) Network [online]. Rural Health Information Hub. Available at: [Accessed 2 February 2023]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.