HRSA/Office of Rural Health Policy Resources:
HRSA: www.hrsa.gov
Office of Rural Health Policy: www.ruralhealth.hrsa.gov
Rural Eligibility: http://datawarehouse.hrsa.gov/RuralAdvisor/RuralHealthAdvisor.aspx
State Office of Rural Health Contact:
 The State Offices of Rural Health Grant (SORH) Program creates a focal point within each State
for rural health issues. The program provides an institutional framework that links communities
with State and Federal resources to help develop long-term solutions to rural health problems.
The three core functions of the SORH program are to: 1) Serve as a clearinghouse of information
and innovative approaches to rural health services delivery; 2) Coordinate State activities related
to rural health; 3) Identify Federal, State, and nongovernmental programs that can afford
technical assistance to public and private, nonprofit entities serving rural populations. A list of
SORH directors for each State can be found on: www.ruralhealth.hrsa.gov
Rural Assistance Center: www.raconline.org
 RAC is a one-stop shop for rural health issues that helps rural communities and other rural
stakeholders access the full range of available programs, funding, and research. The information
communities can find on here can enable them to provide quality health and human services to
rural residents. RAC offers a variety of services which includes funding opportunities,
information guides, news, publications and maps and State resources. The RAC is supported by
funding from HRSA/Office of Rural Health Policy.
Office of Rural Health Policy Funding Opportunities:
FY 2013:

Rural Network Planning Program: This one-year program focuses on the development of a
network in a rural area. The program provides up to $85K and allows applicants to develop a
business or strategic plan, conduct a needs assessment, conduct a HIT readiness and ultimately
form a network.
o Eligibility: The lead applicant has to be non-profit and in a rural area or a Federallyrecognized tribal organization or an organization that provides services exclusively to
migrant farm workers. In addition to this, the lead applicant has to form a network with at
least two other organizations. These two other organizations can be rural, urban, nonprofit or for-profit.
o Availability: This funding opportunity is expected to be available in FY 2013 with the
Request for Proposal (RFP) being available in summer, 2012.
o Program Contact: Eileen Holloran, eholloran@hrsa.gov or 301-443-7529.

Small Healthcare Provider Quality Program: The purpose of the Small Health Care Provider
Quality Improvement (SHCPQI) Grant Program is to improve patient care and chronic disease
outcomes by assisting rural primary care providers with the implementation of quality
improvement (QI) initiatives using the Chronic Care Model and electronic patient registries
(EPR). This program is a 3-year grant program with individual grant awards limited to a
maximum of $100,000 per year.
o
o
o
Eligibility: The lead applicant has to be non-profit and in a rural area or a Federallyrecognized tribal organization or an organization that provides services exclusively to
migrant farm workers.
Availability: This funding opportunity is expected to be available in FY 2013 with the
Request for Proposal (RFP) being available in winter, 2012.
Program Contact: Ann Ferrero, aferrero@hrsa.gov or 301-44-3999.
FY 2014:

Rural Network Development Program: The primary objective of the Rural Health Network
Development Grant Program (RHND) is to assist health oriented networks in developing and
maintaining sustainable networks with self-generating revenue streams. These networks should
provide activities that benefit both network partners and the community served by the network to
increase access and quality of rural health care and ultimately, improve the health status of rural
residents. Networks should have a significant history of organizational collaboration and must
have a memorandum of understanding (MOU) prior to applying to this program. This program is
a three year grant program with individual grant awards limited to a maximum of $180,000 per
year.
o
o
Eligibility: The lead applicant has to be non-profit and in a rural area or a Federallyrecognized tribal organization or an organization that provides services exclusively to
migrant farm workers. In addition to this, the lead applicant has to form a network with at
least two other organizations. These two other organizations can be rural, urban, nonprofit or for-profit.
Program Contact: Leticia Manning, lmanning@hrsa.gov or 301-443-8335.
FY 2015:

Rural Health Care Services Outreach Program: The purpose of the Outreach program is to
promote rural health care services outreach by expanding the delivery of health care services to
include new and enhanced services in rural areas. Applicants have to demonstrate the need in
their community by providing local data compared to State and National level data. Applicants
can use the funds to conduct health screenings, health fairs, education and training of providing
and any other health service delivery activities that does not involve inpatient care. This program
is a three year grant program with individual grant awards limited to a maximum of $150K in
Year 1, $125K in Year 2 and $100K in Year 3.
o Eligibility: The lead applicant has to be non-profit and in a rural area or a Federallyrecognized tribal organization or an organization that provides services exclusively to
migrant farm workers. In addition to this, the lead applicant has to form a network with at
least two other organizations. These two other organizations can be rural, urban, nonprofit or for-profit.
o Availability: This funding opportunity will be available in FY 2015.
o Program Contact: Kathryn Umali, kumali@hrsa.gov or 301-443-7444.
Rural Health Research Center Information: http://www.ruralhealthresearch.org/
a. WICHE Center for Rural Mental Health Research (Previously funded by the Office of Rural
Health Policy)
Director: Dennis Mohatt
Deputy Director: Mimi McFaul, PsyD
Western Interstate Commission for Higher Education
Mental Health Program
3035 Center Green Drive, Suite 200
Boulder, Colorado 80301-2204
Phone: 303.541.0311
Web site: http://www.wiche.edu/wicheCenter
The objective of the WICHE Center for Rural Mental Health Research is to develop and
disseminate scientific knowledge that can be readily applied to improve the use, quality
and outcomes of mental health care provided to rural populations. As a General Rural
Health Research Center in the Office of Rural Health Policy, the WICHE center selected
mental health as its area of concentration because care models that cost-effectively
improve mental health outcomes in the urban delivery settings need to be thoughtfully
tailored before adoption by rural delivery systems. Within mental health, the WICHE
Center proposes to conduct the research development and dissemination efforts needed to
ensure that depressed rural populations benefit from the new care models currently being
adopted to improve the depression care in urban populations.
b. South Carolina Rural Health Research Center (General center funded by the Office of Rural
Health Policy, Fiscal Years 2005-2008 and 2008-2012)
Director: Janice C. Probst, PhD
Deputy Director: Amy Brock-Martin, DrPH
Arnold School of Public Health
University of South Carolina
220 Stoneridge Drive, Suite 204
Columbia, SC 29210
Phone: 803.251.6317
Web site: http://rhr.sph.sc.edu/index.php
The South Carolina Rural Health Research Center works to shed light on persistent
inequities in health experienced by minority and poor populations in the rural US. Center
goals include developing the methods and conducting the research necessary to
understand health status, health care needs, health services use and health outcomes
among vulnerable rural residents. The Center includes in its focus rural institutions, such
as hospitals, community health centers, and rural health clinics, essential to the health of
low-income and minority rural populations. The Center is based in the Department of
Health Services Management and Policy, Arnold School of Public Health, University of
South Carolina.
c. Maine Rural Health Research Center ( General center funded by the Office of Rural Health
Policy, Fiscal Years 2005-2008 and 2008-2012)
Director: David Hartley, PhD, MHA
Deputy Director: Andrew F. Coburn, PhD
Institute for Health Policy, Muskie School of Public Service
University of Southern Maine
PO Box 9300, Portland, Maine 04104-9300
Phone: 207.780.4513
Fax: 207.228.8138
Web site: http://muskie.usm.maine.edu/ihp/ruralheal/
Established in 1992, the Maine Rural Health Research Center draws on the
multidisciplinary faculty, research resources and capacity of the Institute for Health
Policy within the Muskie School of Public Service, University of Southern Maine. Rural
health is one of the primary areas of research and policy analysis within the Institute for
Health Policy, and builds on the Institute's strong record of research, policy analysis, and
policy development.
The mission of the Maine Rural Health Research Center is to inform health care
policymaking and the delivery of rural health services through high quality, policy
relevant research, policy analysis and technical assistance on rural health issues of
regional and national significance. The Center is committed to enhancing policymaking
and improving the delivery and financing of rural health services by effectively linking
its research to the policy development process through appropriate dissemination
strategies. The Center's portfolio of rural health services research addresses critical,
policy relevant issues in health care access and financing, rural hospitals, primary care
and behavioral health. The Center's core funding from the federal Office of Rural Health
Policy is targeted to behavioral health.
Research Publications:
a. Availability, Characteristics, and Role of Detoxification Services in Rural Areas
Funder: Office of Rural Health Policy (ORHP)
Research center: Maine Rural Health Research Center
Phone: 207.780.4513
Lead researcher: John A. Gale, MS
Contacts: John A. Gale, MS, 207.228.8246, jgale@usm.maine.edu
Jennifer Lenardson, MHS, 207.228.8399, jlenardson@usm.maine.edu
Research staff: Melanie Race
Project funded: September 2006
Project completed: December 2009
Topic: Substance abuse
Detox is an important modality in the treatment of substance-abuse as it serves as the
gateway to longer term treatment. Detox involves alleviating short-term symptoms of
withdrawal (e.g., extreme discomfort and medical instability) from alcohol or drug
(AOD) dependence. Successful detox requires both medical management of a client's
withdrawal process and therapeutic intervention to prepare the client to engage in active
treatment of his/her AOD dependence. A review of the literature revealed little nationallevel data on the availability and delivery of rural detox services. Anecdotal evidence
from past work suggests that rural detox services, particularly for drugs such as opiates
and meth, are typically unavailable to patients in rural areas. Using the Inventory of
Substance Abuse Treatment Services (I-SATS), a comprehensive listing of substance
abuse treatment facilities in the US, we identified 2,203 facilities providing detox
services of which 76% are located in urban areas, 13% in nonmetro micropolitan/large
town areas (e.g. areas with an urban cluster of 10,000-49.999 persons), 8% in nonmetro
small towns (e.g., areas with an urban cluster of 2,500-9,999), and 4% in nonmetro
isolated areas. This project will involve a telephone survey of a random sample of rural
detox services stratified by type of rural area.
Using secondary data from the I-SATS and the primary data from our survey, this project
will address the following questions:





What are the organizational, practice, staffing, financial, and clinical
characteristics of rural detox providers?
What are the access issues related to detox services in rural communities?
What are the issues related to the referral of patients once their course of detox
care is complete?
How do rural detox services fit within the greater health care delivery system at
the local level and within the SA treatment system?
What are the major challenges facing rural detox providers? What policy
incentives and support might help to overcome these challenges?
The products for this project include a working paper and related journal articles
describing the distribution and characteristics of rural detox providers, access issues, the
role of detox services within local rural delivery systems, barriers to the delivery of detox
services by rural providers, and policy and regulatory incentives needed to encourage the
development of rural detox services.
http://muskie.usm.maine.edu/Publications/rural/wp41/Detox-Services-Rural.pdf
http://muskie.usm.maine.edu/Publications/rural/pb41/Rural-Detox-Brief.pdf
b.
Effects of Alcohol Use on Educational Attainment and Employment in Rural Youth
Funder: Office of Rural Health Policy (ORHP)
Research center: South Carolina Rural Health Research Center
Phone: 803.251.6317
Lead researcher: Janice C. Probst, PhD , 803.251.6317, jprobst@mailbox.sc.edu
Project completed: October 2005
Topics: Children and Substance abuse
As they pass from teens to early adult-hood, a significant portion of American youth
initiate alcohol use. The rates of alcohol use rise dramatically, from 3 percent at age 12 to
49 percent at age 20. Previously, it was believed that strong social connections present in
rural areas reduced youthful consumption of alcohol and substance abuse, but recent
studies suggest that the rural-urban gap has closed. Alcohol use in youth has been
demonstrated to lower educational attainment, but little is known about whether or not
youthful alcohol use affects employment opportunities and lower wages. This study
proposes to examine the effects of alcohol use during the teen years on subsequent
educational attainment and employment in a panel of rural residents. If the effects of
youthful alcohol use are more severe and more long lasting in rural areas, then programs
targeting these locales should be researched and advocated by the Substance Abuse and
Mental Health Administration. This study will use a longitudinal panel study design for
the period 1979 to 1998, employing the National Longitudinal Survey of Youth-1979
data set, which is an ongoing annual panel survey of persons who were between the ages
of 14 and 22 in 1979.
Publications
Early Alcohol Use, Rural Residence, and Adulthood Employment
Author(s): Michael Mink, Jong-Yi Wang, Kevin J. Bennett, Charity G. Moore, M. Paige
Powell, Janice C. Probst
Date: 10 / 2005
Findings indicate that drinking during youth and early adulthood was common in the
early 1980's. Nearly half (47.6%) of respondents reported drinking before age 18, and
55.3% reported binge drinking. Drinking behaviors did not differ significantly between
rural and urban residents, and rural youth surveyed in 1979-1983 were as likely as their
urban counterparts to start drinking before the age of 18, binge drink before 18, and
report that work or school was impacted by drinking.
http://rhr.sph.sc.edu/report/%2836%29%20Early%20Alcohol%20Use,%20Rural%20Residence,%20and%20Adulthood%2
0Employment.pdf
c.
National Study of Substance Abuse Prevalence and Treatment Services in Rural Areas
Funder: Office of Rural Health Policy (ORHP)
Research center: Maine Rural Health Research Center
Phone: 207.780.4513
Lead researcher: David Hartley, PhD, MHA
Contact: John A. Gale, MS, 207.228.8246, jgale@usm.maine.edu
Project funded: September 2004
Project completed: January 2008
Topics: Health disparities
Health services
Rural statistics and demographics
Substance abuse
Substance abuse is a major and growing threat to the health and well-being of rural
individuals, their families, and their communities. It frequently co-occurs with mental
and/or physical health problems and is detrimental to effective school, job, and parenting
performance and highly correlated with anti-social and criminal behavior. These
problems may be more pervasive in rural areas given that higher rates of substance abuse
are associated with higher levels of poverty and unemployment and lower levels of
income. Substance abuse strains rural service systems which are often overextended and
under-resourced relative to urban systems. The ability to organize effective substance
abuse delivery systems in rural communities is hampered by limited supplies of
specialized providers and services, low population densities, and long travel distances for
rural persons to obtain care.
Given the apparent disparity between need and the availability of services in rural areas,
this project is exploring these issues through the use of two national surveys sponsored by
the Substance Abuse and Mental Health Services Administration. The National Survey
on Drug Use and Health was used to examine the prevalence of the use of different
substances across rural areas, demographic groups, and regions of the country. The
National Survey of Substance Abuse Treatments Services was used to document the
distribution of substance abuse treatment services across rural areas and geographic
regions and to describe the extent to which rural substance abuse treatment providers are
offering a comprehensive array of services as well as services targeted to the needs of
special populations.
Presentations to regional and national audiences on this topic as well as a rural substance
abuse briefing paper will be prepared identifying national and regional issues for future
rural substance abuse research and policy. A journal article will also be submitted to a
peer-reviewed publication.
Publications
Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban
Continuum
Author(s): Jennifer D. Lenardson, John A. Gale
Report Number: Working Paper No. 35
Date: 10 / 2007
Considering recent growth in substance abuse among rural populations and the
documented scarcity of rural health resources, this study examines the distribution of
substance abuse treatment services across the continuum of rural and urban counties,
identifying the type and intensity of services provided. Using the 2004 National Survey
of Substance Abuse Treatment Services linked to the 2003 Rural-Urban Continuum
Codes, we found few substance abuse treatment facilities operating outside of urban and
rural adjacent areas and limited availability of intensive services across rural areas. This
situation is particularly striking for opioid treatment programs, which are nearly absent in
rural areas. The narrow range of services available in rural areas may preclude an
individualized treatment approach and long-term follow-up recommended by
professional organizations and other experts. The greater proportion of rural-based
facilities accepting public payers and providing discounted care may reflect higher rates
of uninsurance and underinsurance.
Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban
Continuum (Research & Policy Brief No. 35B)
Author(s): Jennifer D. Lenardson, John A. Gale
Date: 02 / 2008
This Research & Policy Brief highlights findings from a recent study examining the
distribution of substance abuse treatment facilities in rural and urban counties and
identifying the type and intensity of services provided. Key findings include:
Access to substance abuse treatment is limited in rural areas by fewer treatment beds.
Less populated rural areas contain a small proportion of facilities offering a range of core
services and varying levels of outpatient and intensive services.
Opiod treatment programs are nearly absent in rural areas.
Substance Abuse Among Rural Youth: A Little Meth and a Lot of Booze
Date: 06 / 2007
Research and policy brief examining substance abuse among rural youth, with ruralurban comparisons methamphetamine, oxycontin, and alcohol abuse.
http://muskie.usm.maine.edu/Publications/rural/wp35b.pdf
http://muskie.usm.maine.edu/Publications/rural/pb35bSubstAbuseTreatmentFacilities.pdf
http://muskie.usm.maine.edu/Publications/rural/pb35a.pdf
d. Differences In Antipsychotic Medication Prescribing Patterns Between Rural And Urban
Prescribers
Funder: Office of Rural Health Policy (ORHP)
Research center: WICHE Center for Rural Mental Health Research
Phone: 303.541.0311
Lead researcher: Scott Adams, PsyD , 303.541.0257, sadams@wiche.edu
Project funded: September 2006
Project completed: October 2008
Topics: Mental health
Pharmacy and prescription drugs
Second-generation ("atypical") antipsychotics have become the treatment of choice for
persons with schizophrenia and other serious mental illnesses. Compared to first
generation ("conventional") antipsychotics, many second generation medications reduce
symptoms with fewer problematic side-effects (with the exception of clozapine, which
can have life-threatening side effects if not monitored regularly) and related major health
problems (e.g., obesity, diabetes, and hyperlipidemia). Introduction of atypical
antipsychotics has impacted 1) prescribing patterns across physician specialties, 2) type
of drug prescribed (i.e., first or second generation antipsychotics) based on case-mix
factors, such as age, race, and type of insurance coverage and 3) medication and/or total
treatment costs. It has also facilitated significant discussion of the therapeutic value of
"polypharmacy," meaning, the simultaneous prescription of more than one antipsychotic
medication to a single patient. However, one aspect that has seen little empirical attention
is how longitudinal trends, benefits, and costs may differ between urban and rural areas.
Publications
Differences in Prescribing Patterns of Psychotropic Medication for Children and
Adolescents between Rural and Urban Prescribers
Author(s): Scott J. Adams, Stan Xu, Fran Dong
Date: 10 / 2009
Reports that prescriptions of all psychotropic drug categories increased significantly for
both urban and rural populations over the 10-year period of the study. Urban youth were
far more likely to be prescribed psychotropic medications by psychiatrists as opposed to
generalists or other prescribers. In contrast, rural youth were far more likely to have
psychotropics prescribed by generalists.
http://wiche.edu/info/publications/AdamsWorkingPaperYr4Proj2.pdf
e.
Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban
Primary Care Patients
Funder:
Office of Rural Health Policy (ORHP)
Research center:
WICHE Center for Rural Mental Health Research
Phone: 303.541.0311
Lead researcher:
Kathryn Rost, PhD , 850.645.7367, Kathryn.rost@med.fsu.edu
Project funded: September 2004
Project completed:
September 2005
Topic: Mental health
Rural primary care practices encounter greater challenges than their urban counterparts
when they try to improve the quality of care their depressed patients receive. Rather than
assume that "one size fits all," investigators need to evaluate whether depression
treatment quality intervention has comparable effectiveness in improving outcomes in
rural and urban patients. This project will explore whether rural populations achieve
outcomes with intervention comparable to their urban counterparts, and whether
differences are explained by treatment mediators (e.g., evidence-based care) or
psychosocial mediators (e.g., stressful life events and social support). This project will
test pre-specified hypotheses by conducting secondary analyses of an RCT known as the
Quality Enhancement for Strategic Teaming (QuEST) study, consisting of a
consecutively sampled cohort of 479 depressed primary care patients recruited from 12
practices in 10 states (Colorado, Michigan, Minnesota, New Jersey, North Dakota, North
Carolina, Oklahoma, Oregon, Virginia, and Wisconsin); 160 of these depressed primary
care patients are recruited from practices in non-MSA counties in four states (Minnesota,
North Dakota, Oregon, and Wisconsin). The study's strength is its ability to extend
preliminary explorations the research team has conducted to a definitive study of
differential intervention effectiveness, identifying mediators that explain any differential
effects of the intervention on outcomes. These mediators can then be targeted for
intervention refinement before these initiatives are disseminated to rural populations.
This project will produce a manuscript for peer-reviewed publication, a working paper, a
research summary, a brochure, and a conference/grand rounds presentation.
Publications
Differential Effectiveness of Depression Disease Management for Rural and Urban
Primary Care Patients
Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
Date: 09 / 2005
Examined whether or not there is a differential impact of enhanced depression care on
patient outcomes in rural versus urban primary care settings and whether differences any
are mediated by receiving evidence-based care (pharmacotherapy and specialty care
counseling). Findings indicate that enhanced care for depression improved mental health
status over 18 months for urban primary care populations, but not rural patients. Full
report available on request.
f.
Identifying At-Risk Rural Areas for Targeting Enhanced Depression Treatment
Funder: Office of Rural Health Policy (ORHP)
Research center: WICHE Center for Rural Mental Health Research
Phone: 303.541.0311
Lead researcher: John C. Fortney, PhD , 501.257.1726, fortneyjohnc@uams.edu
Project funded: September 2004
Project completed: December 2005
Topic: Mental health
This project will identify rural areas that should be targeted for early adoption of
evidence-based depression treatments based on community need. The goal is to provide
health plans with a scientifically-based method to identify counties in greatest need and
to inform national, regional, and local decision-makers about distributing scarce
resources to areas which would most benefit from enhanced depression treatment. The
results of this research will benefit health plans that cover these communities, particularly
if adoption of evidence-based depression treatments can reduce the elevated rates of
hospitalization observed in depressed rural residents. The rate of depression-related
hospitalizations is the best nationally available proxy for a population's need for
enhanced depression care programs.
Project staff will conduct a secondary database analysis of the Statewide Inpatient
Database (SID), containing the universe of hospital discharge records from all
community hospitals in participating states. De-identified hospitalization data will also be
collected from other national databases such as claims records from managed behavioral
health plans (i.e., carve-outs) as well as encounter data from the Department of Veterans
Affairs. In addition, the project will investigate the degree to which geographic areas at
risk for depression-related hospitalizations can be predicted by rurality, economic factors,
access to care, and demographics. Although prevalence rates have not been found to
differ across rural and urban areas, it is expected that rurality is associated with
hospitalization rates due to a number of reasons including poor access to outpatient
specialty care and poor economic conditions. In combination with small area variation
analysis methodologies, a Geographic Information System (GIS) will be used to examine
spatial variation in need across geographically defined populations and to identify
geographic areas of high risk. Specifically, the GIS will be used to spatially reference
data from various sources and geographically join layers of spatially referenced
information to create community health profiles. Two papers will be generated from this
project. The first paper will describe community-level risk factors for depression-related
hospitalizations. The second paper will identify those counties in the U.S. were residents
at the highest risk for a depression-related hospitalization. Future research projects will
focus on developing strategies to implement evidence-based care for depression in these
high risk communities.
g.
Locally Managed Behavioral Health Organizations: How Do They Affect The Capacity of
Medicaid Managed Behavioral Health Programs to Serve Rural Populations?
Funder: Office of Rural Health Policy (ORHP)
Research center: Maine Rural Health Research Center
Phone: 207.780.4513
Lead researcher: David Lambert, PhD , 207.780.4502, davidl@usm.maine.edu
Project completed: November 2001
Topics: Medicaid and S-CHIP
Mental health
Networking and collaboration
Responsibility for Medicaid managed care has shifted from the Health Care Financing
Administration to the states, fostering the development of locally managed behavioral
health organizations (LMBHOs) to deliver behavioral health care to general (TANF) and
vulnerable (SSI) Medicaid populations. LMBHOs are locally based networks that assume
financial and management responsibilities for delivering Medicaid managed behavioral
health services in their areas. LMBHOs are important to policymakers because they: (1)
affect access to and quality of behavioral health care received by these populations; (2)
have the potential to transform rural mental health delivery system; and (3) raise
questions about responsibility for assuring quality and financial viability of services.
Information about the types, characteristics, and experience of rural LMBHOs is limited.
This study is designed to help federal, state, and local policymakers understand the issues
underlying the development of rural LMBHOs. Toward this end, the proposed study has
three goals:



to identify and profile types of rural LMBHO models developed;
to compare relative advantages and disadvantages of each model in providing
MMBH within the context and constraints of rural service delivery; and
to describe current and future issues LMBHOs raise for policymakers.