Skip to main content

Rural Project Examples: Social determinants of health

Healthy Adams County
Updated/reviewed September 2019
  • Need: Health initiatives in rural Pennsylvania communities to address locally-identified health disparities.
  • Intervention: Healthy Adams County was created by its rural community members to promote community-wide health.
  • Results: Community task forces have been formed to address breast cancer prevention, food policies, behavioral health, health literacy, oral health, tobacco prevention, and other rural, community-identified needs.
funded by the Federal Office of Rural Health Policy Northern Dental Access Center Medical-Legal Partnership
Updated/reviewed January 2019
  • Need: To help low-income patients in rural Minnesota overcome legal barriers to oral healthcare and self-sufficiency.
  • Intervention: The medical-legal partnership of Northern Dental Access Center and Legal Services of Northwest Minnesota provides free consultations and support services.
  • Results: The innovative and collaborative approach has been recognized regionally and nationally, and over 9,000 new patients have been screened for legal issues.
Super-Utilizer Pilot Project
Updated/reviewed November 2018
  • Need: To address patients' complex physical, behavioral, and social health needs with the goal to reduce unnecessary visits to the emergency department and reduce inpatient admissions.
  • Intervention: A registered nurse and community health worker use technology to address patients with high risk and high costs in their home setting through a 90-day intensive intervention.
  • Results: The healthcare team in Kalispell saved more than $1.8 million in hospital costs with the project's first 36 patients.
funded by the Health Resources Services Administration Outer Cape Health Services Community Resource Navigator Program
Updated/reviewed September 2018
  • Need: Improving outcomes for Outer and Lower Cape Cod residents in need of social, behavioral health, and substance abuse services while reducing the burden and costs to town agencies and hospital emergency rooms.
  • Intervention: The Community Resource Navigator Program works with local social services, town agencies, faith-based institutions, hospitals, the criminal justice system, and others to identify and connect clients to needed services.
  • Results: Clients are gaining access to the care they were once lacking, as measured by improvements in self-sufficiency. The program also helps community partners and stakeholders work together to reduce the impact of risks associated with behavioral health symptoms, substance use disorder, and social determinants of health.