In my last column, I discussed the minimal donations by American philanthropy to rural communities. One of the barriers to donating, cited in the report, Rural Philanthropy: Building Dialogue from Within (no longer available online), is the perceived and actual capacity of rural non-profits to deliver programs effectively, and to demonstrate evidence of effective service delivery. In the last several years, there’s been an increasing emphasis on evidence-based practice in health and human services. This emphasis has evolved from the writings of social scientist Donald Campbell, who promoted the idea of science informing policy and the examination of social problems using rigorous scientific methods, and by the passage of The Government Performance and Review Act, signed into law in 1993 and revised in 2010, which requires performance planning, and monitoring and evaluation of federal programs.
For example, in the fall of 2011, HHS announced the availability of $224 million in formula and competitive grants to support evidence-based home visiting programs to help at-risk families. Home visiting programs have demonstrated excellent outcomes, including reducing child maltreatment, improving child development, and even helping families engage in the workforce. However, the emphasis on evidence-based programs can also place rural communities at a disadvantage.
Some evidence-based programs require professionals with advanced degrees to deliver services (public health nurses, Master’s level psychologists and social workers, and/or oversight of physicians or Ph.D.s). Others require specific visiting frequencies, caseloads or training requirements that increase costs substantially for rural delivery, especially when the costs and time allocations for travel are considered. But possibly the greatest challenge is the gathering of evidence related to rural programming, to determine which programs are evidence-based—tested and found to deliver positive outcomes, and in which kinds of rural communities. How much adaptation can there be in programming before positive outcomes are lost altogether? What kinds of adaptations can or should be made for “typical” rural circumstances (i.e., importance of place to the community; importance of local relationships; limited human service resources; limited numbers of professionals with advanced degrees; low population density…). Or is this another situation of “rural need not apply”?
The solution is not to turn a deaf ear to the need for evidence, but to find ways to collect it. In 2011 ORHP published Rural Behavioral Health Programs and Promising Practices. The study examined challenges to evaluating rural behavioral health programs with the goal of moving the most promising of them toward demonstrated effectiveness. The first step was to conduct a nominating process to identify promising behavioral health programs, followed by interviews with program staff to clarify their practices and to identify barriers to becoming evidence-based practices. The process developed themes for more promising or “successful” rural programs, and suggested that these themes or characteristics provide a foundation for programs to move toward promising or evidence-based status.
A similar study or studies could be conducted for specific rural human services: rural child welfare practices, rural hunger prevention or food delivery programs, rural support for the elderly, etc. In addition, this process could be use to clarify evidence-based practices that integrate health and human services along a continuum.
Another barrier toward evidence-based rural programs is that there is a large body of rural research “hidden” within other research. For example, a study of safety services, or employment training, or after school services may have included a rural component, but only as an addition, or a dissertation may have found differences in rural vs. urban responses. This research is a potential body of evidence that could be used to assist rural programs if it were analyzed and accessible.
Finally, it is important to fund research that is sensitive to the rural context (including limited access to specialists and supporting resources, low population density and rural culture), driven by theory appropriate for an understanding of rural human services, and with the purpose of building evidence and highlighting promising and evidence based programs.
This is a role for both the federal government and an excellent opportunity for American philanthropy to redirect funding to rural communities by:
- engaging scholars, particularly rural scholars in mining current and past studies for rural information;
- engaging scholars to assist in modifying current data bases for rural analysis and conducting studies related to rural needs and programming;
- working collaboratively (non-competitive grants) with rural communities to design and test evidence-based strategies particularly for human services or integrated health and human services;
- providing consultation to rural communities and evaluation resources for moving current promising practices and programs toward evidence-based programs; and,
- assisting rural non-profits in polishing programming and listing programs as evidence-based.
Philanthropy has the opportunity to not only correct lagging contributions, but to provide leadership in identifying evidence-based rural programming.
If we are moving in the direction of funding only evidence-based programs, and if there is only limited evidence for rural human service programming, then let’s build and house the evidence that can help struggling programs, struggling communities, and struggling families.
Kathleen Belanger, Ph.D., is Associate Professor of Social Work at Stephen F. Austin State University in Nacogdoches, Texas, and is a member of the RUPRI Human Services Panel, co-chair of Child Welfare League of America (CWLA) National Advisory Committee on Rural Social Services, and recipient of CWLA’s Champion for Children award in 2005 for her work in rural child welfare. Belanger has published and presented on human services issues in a variety of publications and forums. In addition, she has worked for more than 20 years with rural communities, where she has helped found several non-profit organizations and advocated for rural resources.
Opinions expressed in this column are those of the author and do not necessarily reflect the views of the Rural Health Information Hub.
Back to: Summer 2012 Issue