Barriers to Establishing Services Integration Programs in Rural Communities

Despite the need to integrate health and human services, rural communities may face barriers in establishing health and human 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 and homeless shelters and services, due to low population density.
Services are not accessible: Services may be administered at different locations both within and outside of the rural community. In geographically isolated communities, 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 awareness: Rural communities may not be aware of the full spectrum of services available across local, state, and federal levels. Additionally, individuals may not know that they are eligible for health and human service programs.
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 local revenue: 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 mean 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 3: Implementation Considerations for Services Integration Programs.

Resources to Learn More

The 2008 Report to the Secretary: Rural Health and Human Services Issues
Document
The section "Challenges in Providing Rural Human Services" within chapter 3 describes key challenges including data limitations, workforce considerations, and utilization trends.
Organization(s): National Advisory Committee on Rural Health and Human Services
Date: 4/2008

The Intersection of Rural Poverty and Federal Human Services Programs
Document
The policy brief highlights the experiences of two counties that successfully integrated human services.
Organization(s): National Advisory Committee on Rural Health and Human Services
Date: 1/2014

Place-based Policies in Public Health: The Road to Healthy Rural People and Places
Document
This paper explains the meaning of place-based policies and why they are more appropriate than population-based policies for services integration in both rural and urban areas.
Author(s): Mueller, K.J., MacKinney, A.C., Gutierrez, M., & Richgels, J.
Organization(s): Rural Policy Research Institute (RUPRI)
Date: 3/2011

Rethinking Rural Human Service Delivery in Challenging Times: The Case for Service Integration
Document
This report provides background on the need for services integration specific to rural communities and a potential opportunities to begin services integration.
Author(s): Gutierrez, M., Belanger, K., Clark, V., Friedman, J., Redfern, J., Weber, B., Fluharty, C., & Richgels, J.
Organization(s): Rural Policy Research Institute (RUPRI)
Date: 2/2010

The State of Human Services in Rural America
Document
Summary of the report of the National Advisory Committee on Rural Health and Human Services, describing challenges and recommendations for human service delivery in rural communities.
Citation: Perspectives: On Poverty, Policy & Place, Vol. 5, Winter 2008-2009
Organization(s): Rural Policy Research Institute (RUPRI)