Barriers to Establishing Services Integration Programs in Rural Communities

Despite the need to integrate various healthcare services and integrate healthcare with human services, rural communities may face barriers in establishing services integration programs. These barriers may include:

• Basic services are not available: Rural communities may not be able to sustain basic services, such as public transportation, homeless shelters, and related services, due to low population density.
• Services are difficult to access: Services may be administered at different locations both within and outside of the rural community. In geographically isolated areas, it may be challenging to travel to these locations. Additionally, a lack of public transportation or other transportation barriers may prevent people from seeking services.
• Lack of service providers: Rural communities may lack sufficient providers to meet the needs of the community.
• Regulations: Regulations may impact the ability of organizations to develop treatment protocols, use common forms, and exchange data.
• Lack of capacity and infrastructure: A lack of infrastructure or technology, such as broadband, may impact the ability of rural communities to support health and human services integration programs.
• Program and service silos: Programs administered by different agencies have defined funding streams and eligibility criteria. There may be limited communication between service providers. Silos may make it difficult for children, in particular, to easily transition from one program to the next as they age.
• Lack of engagement: Providers and community partners may not view services integration as a need or priority, given the other challenges that they are addressing on a daily basis.
• Geographic variation in the safety net: The rural safety net, and availability of health and human services, varies from one community to another.
• Lack of funding: A lack of revenue to support safety net programs at the local level, and resource constraints at the nonprofit and social service agency levels, can affect the local safety net.
• Low population density: Low population density in rural areas means that programs have a higher per person operating cost compared to programs that can serve a greater number of people in an urban area.

For rural communities that are interested in integrating health and human service programs, several cross-cutting program implementation considerations are discussed in Module 4: Implementation Considerations for Services Integration Programs. The Rural Community Health Toolkit discusses other common implementation challenges and facilitators that rural communities experience.