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Rural Mental Health Models and Innovations

These stories feature model programs and successful rural projects that can serve as a source of ideas and provide lessons others have learned. Some of the projects or programs may no longer be active. Read about the criteria and evidence-base for programs included.

Effective Examples

Strong African American Families-Teen (SAAF-T)
Updated/reviewed April 2017
  • Need: There is a lack of interventions that addresses teenager behavioral problems, particularly for rural African American adolescents.
  • Intervention: Rural, locally trained leaders administered five 2-hour meetings for teenagers and their primary caregivers. Trainings focused on reducing risks that prevent positive development, specifically sexual risk-taking that can lead to HIV and other STIs.
  • Results: Teens reported reduced conduct problems, depressive symptoms, and substance abuse. Families were strengthened, and SAAF-T reduced unprotected intercourse and increased condom efficacy.
funded by the Federal Office of Rural Health Policy Madison Outreach and Services through Telehealth (MOST) Network
Updated/reviewed November 2016
  • 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.
Rural Telemental Health (RTMH) Program
Added July 2016
  • Need: To provide high-quality mental healthcare to rural veterans.
  • Intervention: The Rural Telemental Health (RTMH) program, stationed at the Portland VA Medical Center, reaches rural veterans in Idaho, Oregon, and Washington via telehealth.
  • Results: From 2010 to 2013, 1,754 veterans received diagnoses, therapy, medication management, and other mental health services.
Telepsychiatry Consultation Service in Nursing Homes
Updated/reviewed June 2016
  • Need: To improve health status and access for rural nursing home patients in need of mental health services.
  • Intervention: The University of Vermont Medical Center provides telepsychiatry care and education to nursing homes that face shortages of mental health professionals on site.
  • Results: Telepsychiatry consultations ease the burden on nursing home residents by saving travel time, distance, and money involved with going to the nearest tertiary facility.

Promising Examples

Kitsap Mental Health Services: Race to Health!
Added August 2017
  • Need: To improve the physical health of individuals seeking mental healthcare.
  • Intervention: Race to Health! in Washington integrates mental health, substance use disorder treatment, and primary care for individuals with severe mental illness.
  • Results: Race to Health! helps reduce emergency department visits, hospitalizations, and costs (a total savings of $5,144,000 for Medicare patients).
Mental Health First Aid
Updated/reviewed July 2017
  • Need: Rural areas face challenges in access to mental health services, including shortages of mental health providers.
  • Intervention: This 8-hour course trains rural community members to recognize mental health and substance abuse issues and learn how to help someone who is developing a mental health concern or experiencing a mental health crisis.
  • Results: Numerous studies of this method have found that course participants are better able and more likely to help others regarding mental health issues.
funded by the Federal Office of Rural Health Policy I Got You: Healthy Life Choices for Teens (IGU)
Updated/reviewed June 2017
  • Need: To improve the mental health of students in rural, east central Mississippi.
  • Intervention: An intensive community mental health outreach program was implemented for eighth graders in a nine-county area in Mississippi.
  • Results: Students improved their ability to recognize mental health issues (high risk behaviors) and their self-concept.
STAIR (Skills Training in Affective and Interpersonal Regulation)
Added December 2016
  • Need: To increase access to telemental health services for rural women veterans.
  • Intervention: STAIR (Skills Training in Affective and Interpersonal Regulation) is a 10-week program designed to reduce PTSD and increase social engagement in clients.
  • Results: Therapists reported that clients attended more sessions when offered via teleconferencing, and clients reported satisfaction with the program.
Felton Institute Prevention and Recovery in Early Psychosis (PREP)
Added November 2016
  • Need: A treatment model for those showing early signs of schizophrenia.
  • Intervention: The Felton Prevention and Recovery in Early Psychosis (PREP) program was started in rural and urban California counties. Felton PREP encourages schizophrenia remission in clients through medication and psychosocial initiatives.
  • Results: Clients’ hospitalization and psychiatric emergency room visits were reduced by 70% after 1 year of treatment. Schizophrenia symptoms also reduced significantly among Felton PREP clients.
funded by the Federal Office of Rural Health Policy Healthy Outcomes Integration Team (HOIT)
Updated/reviewed November 2016
  • Need: To provide integrated treatment planning and coordinated healthcare services to rural residents.
  • Intervention: This program was designed to treat adults who have a serious mental health condition and those who have, or are at risk of developing, chronic health conditions.
  • Results: Thus far, 84 clients have received integrated health and mental health services.
funded by the Federal Office of Rural Health Policy Cross-Walk: Integrating Behavioral Health and Primary Care
Updated/reviewed October 2016
  • Need: To address and treat substance abuse and depression in the Upper Great Lakes region.
  • Intervention: Cross-Walk, a program that integrates behavioral healthcare into primary care services, was developed in Michigan's Marquette County.
  • Results: The collaborative efforts strengthened care management services in local healthcare facilities as 344 patients were referred to a behavioral health specialist.
funded by the Federal Office of Rural Health Policy Physical and Behavioral Health Integrated Care Project
Updated/reviewed October 2016
  • Need: To provide unified and seamless access to primary physical care to adult consumers in Clearfield and Jefferson counties in Pennsylvania who have been diagnosed with Serious and Persistent Mental Illness.
  • Intervention: A “one-stop shop” of healthcare services was constructed that addressed the physical and behavioral health and medication needs of adults in the region.
  • Results: Results indicated better behavioral and physical health outcomes for participants, as well as increased adherence to medications.
funded by the Federal Office of Rural Health Policy 4P's Plus Pregnancy Support Project
Added September 2015
  • Need: To provide pregnancy support services to Native American women who struggle with substance use.
  • Intervention: An integrated behavioral health network was implemented in Lake County, California.
  • Results: As a result of this project, fewer Native American babies were exposed to alcohol, tobacco, and other drugs.
funded by the Federal Office of Rural Health Policy Northern Dental Access Center Patient Support and Outreach Program
Added September 2015
  • Need: To connect marginalized populations with oral and mental healthcare in rural, northwestern Minnesota.
  • Intervention: Expanded already-existing patient advocacy and support services to include mental health screening and referrals to patients around Beltrami County, Minnesota.
  • Results: This program increased dental and mental health screenings and reduced emergency room visits.

Other Project Examples

funded by the Federal Office of Rural Health Policy Florissa
Updated/reviewed October 2017
  • Need: To address the developmental, behavioral, and social/emotional needs of rural children ages 0-18 in northwest Illinois.
  • Intervention: A centralized facility is being developed that serves as a one-stop shop for children and families facing developmental, behavioral, and social/emotional issues.
  • Results: Florissa continues to increase its referral numbers, expand its sessions and service offerings, and provide more information resources. Additionally, work has begun with the KSB hospital to develop a pediatric patient-centered medical home (PCMH).
Fostering Futures in Menominee Nation
Updated/reviewed September 2017
  • Need: Since the late 1800’s, trauma caused by historic events have greatly affected the way of life for Menominee Indians living on the Menominee Reservation. Economic, socioeconomic, behavioral health, and physical health issues have risen and are causing direct implications for Menominee youth.
  • Intervention: Through Fostering Futures, clinic, school, and Head Start/Early Head Start staff are trained in administering trauma-informed care and building resilience among children.
  • Results: Behavioral health visits at the Menominee Tribal Clinic have increased, school suspension rates have decreased, and graduation rates have improved from 60% to 85% since 2008.
funded by the Federal Office of Rural Health Policy Stone Mountain Health Services Behavioral Health Internship
Updated/reviewed September 2017
  • Need: Increase behavioral health services and providers in rural Appalachian communities of Southwest Virginia.
  • Intervention: Implementing a behavioral health internship that is a partnership of 2 universities and a community health center, with infrastructure to also support a social work internship.
  • Results: Behavioral health services now available in the 7-county area served by the health center, with designated behavioral health staff to supervise psychology and social work interns.
Arrowhead Telepresence Coalition
Added August 2017
  • Need: Individuals in northeastern Minnesota who experience mental health crises have often taken action in ways that are harmful to themselves or others.
  • Intervention: The Arrowhead Telepresence Coalition connects behavioral health providers to rural patients in traditional and non-traditional medical settings through a telehealth platform.
  • Results: The service is used by 257 registered users in 7 Minnesota counties and 3 tribes.
funded by the Health Resources Services Administration Outer Cape Health Services Community Resource Navigator Program
Updated/reviewed August 2017
  • 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, hospital emergency rooms.
  • Intervention: The Community Resource Navigator Program works with local social services and 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. 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.
funded by the Federal Office of Rural Health Policy Worcester County Health Department Aging Initiative
Updated/reviewed August 2017
  • Need: Worcester County, Maryland's older residents were experiencing a lack of affordable and easily-accessible in-home care and behavioral health services.
  • Intervention: The Worcester County Health Department created the Aging Initiative project in order to increase access and utilization of home care and behavioral health services for older adults in the area.
  • Results: The Aging Initiative expanded access to home care services, financial assistance for medical equipment, and provided nearly 100 people with behavioral healthcare services.
Island Hospital’s Psychiatry & Behavioral Health Clinic
Updated/reviewed July 2017
  • Need: Anacortes of Washington State, has limited access to mental healthcare services. In addition, psychiatric or behavioral health services were sparse for students in the Anacortes School District.
  • Intervention: Island Hospital opened a Psychiatry & Behavioral Health Clinic that serves patients on their campus and at schools located in the Anacortes School District.
  • Results: Over 2,500 mental health and social work appointments have been facilitated at Anacortes's public schools. Thousands more appointments have been provided at the clinic to meet the mental health needs of the community.
Suicide Follow-Up Program
Added July 2017
  • Need: To reduce suicides in North Dakota and Minnesota.
  • Intervention: The Suicide Follow-Up Program provides phone calls and cards to those who have called suicide helplines or were referred by a healthcare provider.
  • Results: In 2016, FirstLink made 1,194 calls and sent 316 cards to program participants.
funded by the Federal Office of Rural Health Policy ASPIN Network: Community Health Worker Program
Updated/reviewed June 2017
  • Need: Improved approach in addressing the behavioral health and primary care disparities of Indiana’s underserved rural counties by increasing access through health insurance enrollment and providing health literacy education.
  • Intervention: A network was established to address behavioral health integration, which included the use of dually trained community health workers (CHW) and certified health insurance enrollment navigators.
  • Results: Creation of a certification process, the “Indiana Integrated Care Training Program: Community Health Worker/Certified Recovery Specialist,” for CHWs and cross-training of mental health peers to also work as CHWs
funded by the Federal Office of Rural Health Policy Butte Child Evaluation Center
Updated/reviewed June 2017
  • Need: Before 2000, Butte and southwest Montana had around 1,300 cases of child abuse a year, with only a 20% conviction rate for perpetrators of sexual abuse.
  • Intervention: Multiple agencies in the community came together to address the issue of child abuse by forming the Butte Child Evaluation Center (CEC), a Children's Advocacy Center.
  • Results: During a 3-year grant cycle, over 200 interviews and exams were performed on victims of sexual abuse and the Butte CEC became the first program in Montana to be accredited by the National Children's Alliance.
Healthy Men Michigan
Added June 2017
  • Need: Mental health assistance and resources for men in rural Michigan who struggle with depression and suicidal thoughts.
  • Intervention: The Healthy Men Michigan campaign promotes an anonymous, online screening that assesses the risk of depression and suicide in men. It also offers referrals to national and local resources specific to men’s mental health.
  • Results: More than 1,000 Michigan men have taken the screening. Healthy Men Michigan has secured partnerships with 223 partners, including healthcare facilities, small businesses, and recreational groups across the state, to promote the screening.
funded by the Federal Office of Rural Health Policy Sowing the Seeds of Hope
Updated/reviewed June 2017
  • Need: Agriculture workers and their families had high rates of psychological distress and suicide, but limited access to mental health services.
  • Intervention: The "Sowing the Seeds of Hope" (SSoH) program was created to provide affordable and culturally appropriate mental health services to individuals working in agriculture and their families in Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin.
  • Results: The regional program ran from 1999-2011 and successfully established a variety of interventions to help individuals in rural communities’ access behavioral health services.
Community Clergy Training to Support Rural Veterans Mental Health
Updated/reviewed May 2017
  • Need: To educate rural clergy and chaplains about the ways they can help improve veterans' access to physical or mental healthcare by referring veterans to available resources.
  • Intervention: Trained VA Chaplains and U.S. Army Reserve Chaplains provide free interactive training sessions to rural community clergy partners.
  • Results: Since 2010, more than 4,000 clergy members, chaplains, behavioral health professionals, and others supporting rural veterans have participated in a Community Clergy Training Program (CCTP) event.
funded by the Federal Office of Rural Health Policy Indiana Veterans Behavioral Health Network (IVBHN)
Updated/reviewed April 2017
  • Need: To address the lack of mental healthcare options for rural veterans.
  • Intervention: A telebehavioral health hub network was created to connect community mental health centers to the VA Medical Center.
  • Results: To date, 2,071 IVBHN appointments have been made, saving veterans time and money.
Regional Behavioral Health Network
Updated/reviewed April 2017
  • Need: Multiple organizations in five rural counties of east central Illinois were struggling with how to treat patients with behavioral health issues or how to access services for them in a timely manner.
  • Intervention: The Regional Behavioral Health Network was established with a 24-hour toll-free crisis line, providing immediate access to trained crisis clinicians.
  • Results: Improved access to and a higher quality of behavioral healthcare for patients in rural east central Illinois.
Start Healthy, Start Now
Updated/reviewed April 2017
  • Need: Rural childcare providers have limited resources to learn about mental and physical health promotion and obesity prevention
  • Intervention: A free health promotion training program for rural childcare providers
  • Results: Rural childcare providers are better prepared to impact children's health and well-being.
Together We Can Be Bully Free
Added April 2017
  • Need: Rural Union Parish, Louisiana experienced higher than average suicide rates among youth.
  • Intervention: Union General Hospital, a Critical Access Hospital, started a program to educate students 4th through 12th grade on the negative effects of bullying and how to model positive social behavior.
  • Results: The 1,500+ students trained have learned how to recognize, report, and react to bullying.
Hope Squad
Added March 2017
  • Need: To reduce youth suicide rates in Utah.
  • Intervention: Hope Squad is a statewide program that trains youth to look after their classmates and refer those with suicidal thoughts or other mental health concerns to adult advisors.
  • Results: Surveys indicate that Hope Squad members increase and retain their knowledge of suicide and increase help-seeking behaviors after completing training.
Pathways Vermont Housing First Program
Updated/reviewed February 2017
  • Need: To provide housing for the chronically homeless who face mental health and/or substance abuse challenges in the rural areas of Vermont.
  • Intervention: Pathways Vermont initiated a rural version of the Housing First program that provides access to permanent rental housing and numerous services to help sustain housing stability.
  • Results: Participants reported decreased time spent homeless, a significant improvement in their standard of living, and hundreds of thousands of dollars were saved on behalf of Vermont.
Lutheran Social Services of North Dakota Abound Counseling
Added December 2016
  • Need: To provide mental health services to rural residents in North Dakota.
  • Intervention: Lutheran Social Services of North Dakota provides telehealth counseling through its offices and communities' Lutheran churches.
  • Results: In the first year of practice, Abound Counseling has brought greater access to quality mental healthcare for young children.
Mobile Medication Program for Patients with Mental Illness
Updated/reviewed November 2016
  • Need: To assist individuals with mental illness in managing medication independently and to reduce hospitalization costs of treating individuals with serious mental illness.
  • Intervention: Mobile medical staff provide education, support, and skill-building to assist individuals with medication management.
  • Results: A reduction in area hospitalization costs and a reduction in the need for long-term hospitalization among program participants.
funded by the Federal Office of Rural Health Policy Western Wisconsin Mental Health Benefits Counseling Project
Updated/reviewed November 2016
  • Need: To identify and optimize mental health coverage and treatment options for people in rural western Wisconsin.
  • Intervention: ABC for Rural Health teamed up with local organizations to assist clients in navigating insurance coverage options available to those seeking mental health treatment.
  • Results: This project worked with approximately 170 people to help them receive mental health coverage and healthcare benefits.
Teck John Baker Youth Leaders Program
Updated/reviewed October 2016
  • Need: The teen suicide rate in rural Northwest Arctic Borough, Alaska, was 7 times higher than the statewide teen suicide rate.
  • Intervention: The Teck John Baker Youth Leaders Program trains student leaders to effectively give support to struggling peers and appropriately deal with social issues.
  • Results: The number of teen suicides in the Northwest Arctic Borough decreased from 8 in 2008 to 5 in 2009 (when the program first began) and has successfully dropped and remained at zero every year since.
Total HEALTH
Added April 2016
  • Need: A facility that offers both behavioral and primary healthcare services for the ease of patients in Northwestern Pennsylvania.
  • Intervention: A pilot project was launched at one behavioral health facility that added a primary care and pharmaceutical component to provide a one-stop shop for patients.
  • Results: Patients have become more willing to follow through with treatment plans and attend appointments. Partnering healthcare facilities have also experienced positive medical outcomes of enrolled patients.
Recovery-Oriented System of Care (ROSOC)
Updated/reviewed January 2016
  • Need: To serve adults in Mendocino County, California with chronic substance use disorders, mental health diagnoses, and/or complex medical conditions who frequently utilize emergency departments and jail services.
  • Intervention: A safety net organization was formed that works with medical providers and law enforcement to reduce the high cost of caring for frequent utilizers through intensive care coordination activities.
  • Results: Greater overall stability in the lives of clients, with less utilization of low-efficacy, crisis-oriented services, hospitalizations, and incarcerations.

Last Updated: 10/11/2017