PABI Plan - The Sarah Jane Brain Project

CHAPTER 8: Category of Care: Rural/Tele-Health
In order for the system of care to be universally accessible no matter where the PA/TBI family
lives, a strong emphasis must be made to reach the rural and frontier regions of the United States.
For the purposes of this grant proposal, the term “frontier,” like rural, suburban and urban, is
intended to categorize a portion of the population spectrum; frontier is considered the most
remote end of the spectrum. The Office for the Advancement of Telehealth defines “frontier
regions” as ZIP code areas whose calculated population centers are more than 60 minutes or 60
miles along the fastest paved road trip to a short-term non-federal general hospital of 75 beds or
more, and are not part of a large rural town with a concentration of over 20,000 population.
States vary significantly in the percentage of their population designated as frontier, from 0
percent (e.g., Delaware and Connecticut) to over 15 percent [Alaska (49%), Wyoming (39%),
Montana (38%), and North Dakota (19%)]. Unless otherwise noted, for the purposes of this
grant proposal, the word “rural” will constitute both the rural and frontier regions of the country.
According to the Bureau of the Census (2001), Rural America makes up over 75% of the
landmass of the United States and contains approximately 25% of the U.S. population (over 75
million Americans).
According to one of the leading organizations in the country dealing with rural health issues, The
National Rural Health Association, “The obstacles faced by health care providers and patients in
rural areas are vastly different than those in urban areas.” Rural Americans face a unique
combination of factors that create disparities in health care not found in urban areas. Many
factors need to be taken into consideration to ensure universal accessibility for children/young
adults and their families within Rural America, such as improving access to financing of health
and education needs and increasing the awareness of PA/TBI among health (including behavioral
health) and education professionals. Only ten percent of physicians practice in Rural America,
and rural poor are less likely to be covered by Medicaid benefits than their urban counterparts.
In addition, cultural and social differences, lack of recognition by legislators and the sheer
isolation of living in remote rural areas compound the challenges rural American PA/TBI
families face in their struggle to provide for their child/young adult suffering from PA/TBI. The
pervasive disparities related to race, ethnicity and socioeconomic status are exacerbated in
isolated rural and frontier areas of America.
Excerpts below from “Rural and Frontier Mental and Behavioral Health Care: Barriers,
Effective Policy Strategies, Best Practices” by Dr. Donald Sawyer, Dr. David Lambert and John
Gale (2006). Many of the issues raised in this paper are equally relevant for PA/TBI:
“Recent estimates indicate that 16-20 percent or at least 15 million rural residents
struggle with significant substance dependence, mental illness, and medical-psychiatric
co-morbid conditions. While recent studies indicate that the prevalence and incidence of
behavioral health problems are similar in rural and urban areas, a notable exception is the
significantly higher rate of suicide and suicide attempts in rural America. For rural
elderly residents in some regions, the rate is 3 times higher than the national average in
non-rural settings. In addition, rural residents experience many more obstacles to
obtaining behavioral health services, which results in distinct mental health disparities.
The mental health needs of rural America are immense. Although national data suggest
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