Strategies for Building Rural Coalitions and Networks

Jim Armstrong, C.S.A.C., C.A.S.
Administrative Director
Fountainhead Treatment Program and Counseling Center
Bullhead City, Arizona

This paper is based upon personal experience. Having worked in large and small communities, I have been able to examine the needs specific to rural populations and to try many different approaches to fill these needs. The methods suggested here have been proven—they work.

When I first arrived in the Tri-State area at the intersection of Arizona, Nevada, and California (see figure 1), only a few counseling offices were available. Most of the substance-abusing population was sent to larger cities—Las Vegas, Nevada or Phoenix, Arizona. The problem in this community, as well as in other small communities, is that rural coalitions and networks needed to be built to provide proper, professional treatment.

Figure 1. This map shows the service delivery area (in the circle) of The Fountainhead Treatment Program and Counseling Center located at Bullhead City, Arizona. This program serves a Tri-State area in Arizona, Nevada, and California.
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Setting Up a Treatment Network

Mohave County (13,341 square miles), where our program is located, is the fifth largest county in the United States. When an area like ours has many small communities, most professionals will not relocate there because of the lack of large-scale business. When you create a proper network, a solution is created for everyone—the caregiver and the community.

Before developing a coalition or a network, one of the first priorities is to take an assessment of the needs in the community. The first step is to contact employers, insurance representatives, and nearby State mental health facilities about what is lacking in the community and surrounding areas. In the past in our area, numerous professionals relocated here to open offices, but most had to close their practices and move away because of lack of funds. Also, many left because they had not networked with any of those professionals who were having reasonable success. Two major treatment centers had set up satellite offices in this area, but they only lasted 6months before closing. The reasons for these closures were the same as for the professional practitioners.

Professional substance abuse treatment in rural areas can be accomplished, of course, provided that there are adequate substance abuse benefits. However, that is only part of the solution. Having benefits without having available treatment options is one of the many problems to look at when creating a treatment/counseling center.

Providing Office Space

In setting up a treatment/counseling center, check with the community hospital in your area with regard to possible office space available either in the hospital or close to it. Considering the number of substance-abusing patients admitted or seen in their emergency rooms, most hospitals could and probably would be interested in having a professional close by to help assess and possibly treat these patients. In our community, our small hospital sees approximately 800 patients a month through the emergency room alone. Imagine what percentage of these cases are related to substance abuse!

Providing Professional Counselors

In most small communities, counseling services for substance abuse and related issues are in demand. Many professionals practicing in large cities would be willing to relocate to a rural area if steady employment were available. And such steady employment can be made available by creating rural networks that provide all modalities of treatment.

If only one professional is available to serve a small, populated 50-mile area, one solution could be that the professional travel to each community on a regular basis. At one time, two professionals from Las Vegas would spend 2 days a week in our area, stay in a motel, and see patients most of the day. These professionals contacted physicians in the area for referrals, which worked quite well until the demand for their services heightened. They worked for a managed care company to provide services for their clients. When I contacted these professionals about possibly providing these services for them, they were agreeable because of the cost of their travel and lodging expenses. These professionals have since become a major referral source.

State-funded facilities are also a good resource when networking. Their staffs usually have a good knowledge of what the needs are in their geographic area.

Providing a Meeting for All Professionals

In rural areas, when a person wants and needs help, where does that person go? Many will not seek help because it is too far and they will be away from work and family for too long. In a rural area, you need to designate a 50-mile radius to work on, then contact counselors, psychologists, and other healthcare professionals and set up a meeting for all. If there are a limited number of Ph.D. practitioners in the area, see whether they have at least 1 day a week when they can come to your office to see clients. In our area, there was a lack of psychiatric help and we invited a psychiatrist to see people in our offices 2 days a week. This worked well. Community hospitals within rural areas might also want to refer patients to such a therapeutic source.

Setting Up an Outpatient Treatment Program

Today, the cost for opening intensive inpatient programs in rural areas is cost prohibitive. But if a community hospital is available in the area to provide detoxification supervised by the medical director of your center, then intensive outpatient and day treatment is the answer.

If you are going to be starting an outpatient treatment program, you will be able to treat patients on a daily basis who live within a 50-mile radius. First, contact physicians in the area and find an interested physician to provide histories, physicals, and medication monitoring, who is willing to become the medical director for an outpatient program. The physician will also be a primary referral source for the program. Also, when contacting other professionals in this 50-mile radius, be sure that clients will be referred back to the original referring professional upon discharge from the program. Otherwise, you will not receive continuing referrals.

Planning With Professional Colleagues

After the initial contact with professionals in your area, plan to meet these professionals on a face-to-face basis to provide information on your strategies, secure information on theirs, and to determine comfortable solutions that will meet both of your needs while building a full scope of treatment modalities for rural area residents. A rural populace should not be lost in terms of finding available treatment, and working together with other professionals will provide services for this population.

Meeting space should be provided so that all professionals in the area can meet once a month to share information regarding their modalities. The idea behind these meetings is to fill the unmet needs of rural communities. This can only be accomplished if there is a willingness by professionals to work as a team to provide quality care.

Finding Answers when Professionals Are Not Available

How do we give quality, affordable treatment in small communities that do not have an available staff of professionals? Mainly the answer is to look at the services that can be provided, then enhance these services and add to them by building networks and coalitions to provide these services. It is not a simple task; it takes a person who is concerned about the substance abuse population and is willing to devote some effort and time to coordinating the proper modalities for treatment.

The Future of Rural Treatment Under a National Healthcare Plan

Will there be a need for the State-funded substance abuse treatment services if there is a national healthcare plan? Probably not. What would be the need if everyone has benefits? For all treatment, there would be an insurance billing under substance abuse benefits. Of course this would not happen immediately. But projecting into the near future, the chemically dependent would have a choice in their treatment, rather than only one option dictated by lack of benefits or financial support.

With a national healthcare plan, many positive things would occur with regard to treatment that would have an immense impact on the substance-abusing population of the United States. Research shows that substance abusers evidence a 33 percent higher rate than others in their use of healthcare benefits. Research also shows that, after completing treatment and staying off mind-altering drugs, most substance abusers have become productive members of society. So cost effectiveness for the employer and society is an issue in healthcare reform.

In our center over the past couple of years, we have had many success stories illustrating the cost-effectiveness of treatment. After being referred by their employers for substance abuse treatment, we have had three clients receive Employee-of-the-Month awards, one receive an Employee-of-the-Year award, and two have been promoted to supervisory positions. This does not include our unemployed clients who became employed and the separated families that became whole again. Substance abuse treatment works, and with the proper modalities it works well. Creating these modalities in rural areas can only be done by building rural coalitions and networks to provide and enhance treatment for all.

Conclusion

Drug and alcohol abuse in our society is not decreasing but instead is increasing for all age groups. The only proven method for overcoming this problem is treatment, which must include education in schools, in the home, and in the workplace. Imagine what it means—if it's even close to being true—that 1 of every 10 Americans has a problem with alcohol or drugs and that each one of these substance abusers affects 10 people around them, such as family, friends, and coworkers.

Then how much of the population of the United States is affected by substance abuse? For a problem of this magnitude, can treatment really be made available in rural areas without networking and coalitions? Statistics and experience prove that it cannot be done. Additionally, the magnitude of this problem means there is no need for professionals to compete for patients; there are far too few competent professionals in the substance abuse field as it is. Working together and problem solving is the answer.

In the near future, changes will be made in our area, as in most areas of the United States. The Department of Veterans Affairs and the Indian tribal communities are looking at contracting services for substance abuse treatment to outside agencies. The opportunities for rural programs to provide these treatment services are there through proper networking techniques. Coalitions in rural areas can play a major role in providing these services.

If we can provide quality treatment services in rural areas, perhaps one day there will not be so many children born into substance-abusing families and communities. And through the positive influences and support of their environment, they will have a better chance of living a life free of substance abuse.

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