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Rural Health Information Hub

Aug 13, 2013

Technology in Rural Human Services: The Good, the Bad and the Ugly

Kathleen Belanger, Challenges for Human Services columnistby Kathleen Belanger

Technology has, in many ways, brought tremendous advantages to rural human services. Many states have made it much easier for those in need to apply for benefits online, to apply for employment and, particularly, to access higher education. Many state and private colleges and universities provide programs that are fully online, and several social work programs provide online advanced degrees.

Telehealth and telemental health have been wonderful assets to rural communities. People in some rural towns suffering severe mental illness who would otherwise need to be transported to metropolitan centers can be “seen” through secure web conferencing, diagnosed, and have appropriate prescriptions, reducing their pain and the costs for families, local mental health providers, local hospitals and, at times, even local law enforcement. Human services personnel can often make supervisory visits via teleconferencing. And, continuing education for social workers has been simplified by online courses and webinars.

But technology can have a downside, particularly when it removes jobs, reduces local responsibility, ignores local relationships and produces worse outcomes.

Statewide, centralized call centers have not been that successful for rural communities. Although there are 211 information and referral centers across the country designed to connect local callers with services in their area, the local listings in rural areas are often incomplete, or even inaccurate. I called this morning to determine whether the information about food pantries, mental health services and family violence center referrals in my area were accurate. None was. The closest referral for mental health services was 104 miles away, the local women's shelter was not listed, and none of the local food pantries was listed. These call centers rely on local agencies to provide them with information. But local rural agencies have their hands full meeting the needs of local residents. In addition, local agencies may have short lives and service disruptions because of poor funding and dependence on cyclical grants. It would be better to send some of the call center funding back to locals. Even a small portion of it would enable one of the human services to host and maintain the community's information and referral service, also enabling the community to gather its own centralized data, while coming to know the kinds of calls received and the needs that are not being met.

According to J.A. Steen, Child Protective Services in 21 states have centralized “intake” or call centers for reporting abuse and neglect. However, several states, including Indiana, Tennessee, Texas and Illinois have been in the news in the last several years, reporting long hold times for callers and high frequencies of “hanging up,” particularly problematic for “mandated reporters”—those who, by law, must report any suspected abuse or neglect. Doctors, nurses and teachers simply cannot leave their patients or classrooms for extended periods. Even online reporting solutions are inadequate—they take quite a bit of time, are standardized, require the names of reporters who otherwise could make the complaint anonymously, and ask for information that reporters may not have. And because of time pressures, online centers may fail to ask relevant follow-up questions of the caller. Calls are then simply forwarded for investigation in local communities—the ones who are familiar with many of the situations to begin with, and the ones who are required to re-contact the caller to investigate the allegation.

While technology makes call centers possible, the consistency afforded by centralized centers replaces local knowledge, which results in loss of rural jobs, loss of local context and local frustration. While screening in all or nearly all calls may be consistent, it simply adds another level of work to already stressed systems.

There is also a more subtle and possibly even more serious outcome: the local community loses responsibility for its children and families. If the work stays in town, local staff and local administrators have to answer to frustrated doctors and teachers. But in the case of 211 call centers, the local community loses a chance to gain a better perspective on the needs and resources offered to help children and families stay safe, to avoid poverty and its outcomes, and to gain or regain independence.

Technology, expertise and standardized procedures are wonderful. Technology has been able to connect people in small towns with experts across the country. The psychiatrists assessing, diagnosing and prescribing for patients miles away, the online faculty member with expertise in specific subjects, and the intake worker who has been trained in information collection and telephone inquiry are all experts in their area. However, centralized call centers fail to capture a specific kind of expertise: knowledge of the local community. And they fail to keep the responsibility and the jobs necessary to protect children and to help their families where they belong: in the local community. While local knowledge may not be as important in a psychiatric evaluation, it may be very important in understanding child abuse and the availability of local resources. Centralized call centers fail to provide local communities with adequate feedback loops to help communities evaluate their delivery of human services.

We need local jobs in human services, human beings to be responsible for our local human residents and the technology to link them to resources and information that isn't available locally. It's a simple as that.

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 2013 Issue