Rural Project Examples Addressing Health conditions

Pathways Vermont Housing First Program

Updated/reviewed April 2021

Need: Ending a local Vermont population's homelessness experience.
Intervention: In 2010, Pathways Vermont implemented a first-of-its-kind, rural-focused Housing First program in order to provide housing and support services to those with mental health and substance use conditions experiencing homelessness.
Results: Since its initial start-up, Pathways Vermont has assisted over 560 Vermonters — about 70% from rural areas — experiencing homelessness using the Housing First model. The organization has collaborated with the state mental health department, corrections department, local healthcare systems and providers, and other organizations to end homelessness. In addition, programmatic work has expanded to reach other local populations, including veterans and at-risk families.

Updated/reviewed March 2020

Need: Comprehensive cancer services for residents of an 8-county, 3-state area in Appalachia.
Intervention: Using a Cancer Patient Navigation Tool Kit, a Maryland acute care facility led a multidisciplinary collaboration that provided the area's patients with expanded cancer treatment services.
Results: In addition to several new cancer-related programs, expanded services are now available for cancer patients, families, and cancer survivors.

Updated/reviewed February 2020

Need: To help reduce diabetes, depression, and stroke risk in rural residents.
Intervention: A collaborative care model was implemented in the Idaho counties of Clearwater, Idaho, and Lewis.
Results: Increased number of patients with controlled blood sugar, controlled blood pressure, and higher depression screening rates.

Updated/reviewed December 2019

Need: Organized effort targeting COPD patients' medical needs in order to prevent hospital readmission in Zanesville, Ohio.
Intervention: Creation of an integrated system model using nurse navigators that incorporates evidence-based chronic disease care management approaches to COPD care.
Results: Improved readmission rates and overall improved acute and chronic care for the area's COPD patients.

Updated/reviewed December 2019

Need: A healthcare delivery model to improve health and well-being of Pennsylvania patients with serious mental illness in Pennsylvania, especially those in rural settings.
Intervention: County human service administrators, patients, families, a behavioral health provider network, and a nonprofit behavioral health managed care organization implemented 2 versions of a behavioral home health model focusing on a complete culture of wellness.
Results: These unique models significantly increased patient activation, engagement in both primary and specialty care, and improved client perception of their mental health status.

Added March 2019

Need: Pediatric behavioral health services in Delta County, Colorado.
Intervention: Multi-organizational and community-wide effort to increase healthcare access for underserved children and to integrate behavioral health care into the area's primary care clinics.
Results: Sustainable increases in access to pediatric behavioral health services.

Added October 2018

Need: Prevention of type 2 diabetes in adolescents living in rural parts of Louisiana.
Intervention: Through screenings, the Adolescent Pre-Diabetes Prevention Program detects the onset of prediabetes. Through nutrition and physical activity education, the program teaches high school students and staff how to adopt healthy lifestyles.
Results: The program has seen an increase in enrollment and continues to see decreases in body weight, body mass index, and A1C levels among participants.