Extra Episode | Rural Health on Life Support
Michelle Rathman: Hello, and welcome to a very special Rural Impact Extra. I'm Michelle Rathman, and you know, as always, I want you to know how appreciative I am that you've joined us for this conversation. Now, a quick programming note, our extra episodes are really an opportunity for us to continue the important conversations we have in our regular in depth series and today's discussion, for example, is connected to our rural health and life support series.
And I think we can all agree there's very few challenges impacting rural health like America's devastating and ongoing opioid crisis. But this conversation is not about the problem, rather it's about the solutions and especially the solutions that can only be found through policy and the funding that policies afford rural communities to support resources and programs that help address substance use disorders and its many impacts.
So with that said earlier today I spoke with two of a team of three award winning members from HRSA's Federal Office of Rural Health Policy team, Megan Meacham, Director of the Rural Strategic Initiatives Division, and Sarah O'Donnell, Team Lead for Program Development. I know you're going to learn so much from these two, so I invite you to get comfortable for this extra conversation.
Thanks for listening. Let's go.
Michelle Rathman: Megan Meacham, Director of HRSA's Federal Office of Rural Health Policies, Rural Strategic Initiatives Division, and Sarah O'Donnell, Team Lead for Program Development, welcome to The Rural Impact for this special extra episode focused on the Rural Communities Opioid Response Program. We are so happy to have you both join us.
Thank you again for being with us on this really important subject.
Megan Meacham: Thank you so much for having us.
Sarah O'Donnell: Thank you so much. So excited to be here.
Michelle Rathman: Well, we say it's my pleasure. There are so many heavy subjects. This is not a light subject. And really our goal today through this extra episode is to help bring some additional light to not just the problem of this opioid addiction misuse and the deaths that we have in this country.
So I want to just give a little bit of context before we move on, because you're going to share, as I said, connect the dots to solutions, but I found this of all the things, and all you have to do is Google or use any search engine and type in opioid response or opioid crisis, and you're going to see endless, thousands of pages talking about this.
But according to the Centers for Disease Control and Prevention, as of March of 21, that's a couple years ago, but drug overdose death rates continue to rise in both rural and urban areas in five states. And this, to me, was really staggering. California, Connecticut, North Carolina, Vermont, and Virginia, the rate of drug overdose deaths in rural counties were higher than those in urban counties.
And in addition to that, in December 2017, a survey by the National Farmers Union, it's so incredibly tragic, and the American Farm Bureau Federation found that as many as 74 percent of farmers have been directly impacted by the crisis. And so, as I said, for a very long time now, we've known that this opioid epidemic is devastating, it's victims and their families. It's a compounding ripple effect throughout communities, affecting quality of life. Of course, economic opportunity, rural prosperity, and we also understand that there is absolutely no corner of this country that has not been impacted. And in fact, you're hard pressed to travel anywhere.
As I was sharing with you before we went on today, you're hard pressed to find anyone in a rural community who hasn't known someone, whether it's a family friend or neighbor or a colleague who has not been impacted. So, with that said, I would really just like to start the conversation and talk to us a little bit Megan, if you can, what is the, Opioid Response Program? What's the reason behind it, obviously, than just the numbers that I just shared with you?
Megan Meacham: Yeah, and actually those numbers are a great segue to what we're doing at HRSA. So just a little bit of background on RCorps, the Rural Community's Opioid Response Program. We call it RCorps, and it is an initiative within the Health Resources and Services Administration in the Federal Office of Rural Health Policy to bring substance use disorder, prevention, treatment and recovery services to rural communities that may not have those services or may not have adequate access to those services, and the mission at HRSA, just for a little bit more background is really aims to improve outcomes and increase health equity and access to care for underserved and geographically isolated populations. And HRSA does things like what we do in the Federal Office of Rural Health Policy, but there's also a lot of broader activities as well, supports the health workforce, federally funded health centers, maternal and child health services, HIV, AIDS services. And then so HRSA is the home to the Federal Office of Rural Health Policy. So our office specifically works to bring healthcare services and improve access in rural communities. And so, going to some of the data you stated, the backdrop of 2017, where the opioid epidemic wasn't anything new, but we were starting to see new data, kind of really staggering data about the overdose death rates at that time.
And back in 2017, 2018, the overdose death rates were actually higher in rural communities nationwide, not just in those 5 states that you mentioned. And so HRSA came together collectively, like all of the bureaus and offices working on all sorts of different initiatives and we came up with this proposal of like, where is there a need that HRSA collectively can work together to address?
So you can't address substance use disorder if you're not also thinking about, you know, the healthcare workforce or the health centers where services are being provided, and because it was a rural specific program, the Federal Office of Rural Health Policy was fortunate enough to be able to own and manage and administer this program.
And so, while the data has shifted a bit and it kind of fluctuates we do know that overall overdose death rates are higher in urban generally right now. As you stated, there are a few states where the rural rates are higher. And we also know that the overdose death rates, even if they're overall lower and rural right now, they're actually raising at a faster rate.
So, unfortunately, even though the rates are lower, they're seeing a worsening impact than urban communities. So it was really important for us to address this crisis in rural communities, because even though the crisis is nationwide, rural communities are just faced with, you know, more difficult challenges, geographic barriers to getting to care, lack of specialists, just limited access to treatment in general. And then we also encourage like we really emphasize the importance of partnering with other organizations, so we have grantees who come in and work through this program to provide these life saving services in rural communities, and they're not doing it alone.
It's so important that they're leveraging other funding sources. They're working with, SAMHSA has a wonderful block grants. There's a lot of other local and state funding available. And so we really encourage our grantees and we help tap them into these resources as well. So over the past five years, we've just been really pleased with the, we feel like we're making an impact and that's why we do what we do.
Michelle Rathman: And you are, and I talked to some of your grantees and I, you know, I have firsthand knowledge of that. Let's kind of parlay into the next question here, which is, what I love so much about this program is, right now we have the chatter if you will, is focus on the border, focus on the root. Yeah, we have to understand where these are coming from. And that's another those are other agencies to take care of that. But through this program, there are, as I understand it, 9 programs involved with grants available through RCORP. And so some of these are like Medicaid, assistant treatment, expansion, neonatal syndrome addressing that those and of course, the overdose response, but behavioral health is a part of this. And while we're finding where to stem the tide of access to these terrible life-destroying drugs, it's important for us to address the root causes. Correct? And so that's, I think, the impetus for how you've done kind of parsing out these, I don't know what you would call them, but, kind of parallel tracks here to address it from all sides.
Megan Meacham: Absolutely, we have 7 currently active cohort programs, and over time, we've really shifted because the most important thing in how we're managing these programs is that we're meeting the needs of the rural communities. This is direct funding out to rural communities. So, as you said, there are agencies doing things that we aren't, we're not dealing with the border crisis.
We really want to make sure that rural communities are equipped with the resources that they need to address the substance use disorder, opioid epidemic as it's impacting their communities. So one of the ways that we've done that is we really just, we listen to the grantees and we also look at data and we keep a pulse on the CDC data and other data that we have available.
But, so a perfect example of that is we started our initiative with a planning program to help communities really just build capacity to be able to even think about addressing this crisis. We also have our kind of cornerstone implementation program, which provides funding for direct prevention, treatment and recovery services.
But then we also have these, we call them the pilot programs that are really topically specific. So as you mentioned, we have the medication assisted treatment access program really, that aims to build. Access to medication assisted treatment services in rural communities. We have a neonatal abstinence syndrome program.
We have a psycho stimulant support program and for neonatal abstinence syndrome and psycho stimulants, in particular, we were hearing from our early grantees, “Hey your programs are great, we're able to do a lot with this. Here are other areas with the opioid crisis that we continue to have challenges, but we don't really feel like we have the resources to address these.”
So our team has been really amazingly responsive in being able to take both that qualitative feedback as well as looking at quantitative data. So, for instance, with psychostimulants, at the same time we were hearing from our partners and our grantees about psychostimulant, meth being a challenge and telling us that they didn't have the resources to address it, was around the same time we started to see data that the overdose death rates from psychostimulant misuse was far greater in rural than it was in urban.
So, it's again it's just really nice to know that we're able to manage this program and get resources out to rural communities that really meet their needs and it's directly getting out to them to address this challenge.
Michelle Rathman: I think for any for anybody and Megan, we'll talk about the numbers in just a moment. But Sarah, I think for anybody, people want to understand when we say this program is funded, it's like, here's the program, but talk to us a little bit about the grantees, Sarah, because, every day we've just come off it.
Each year we dedicate a day to remember those who've overdosed from dangerous drugs and, we all take to social media and we, we share their stories and so forth, but I wonder, Sarah, if you could give us a bit more perspective on some examples of how the strategies have been implemented, deployed and some rays of hope of what you're seeing in terms of, you know, it's some things in healthcare, it's like whack a mole, you had it down and then another problem comes up. But in this case, my sense is that you're really getting to the heart of, and it's not just about temporary fixes, it's about sustainable. And I'm curious if you could share some about how that's working on the ground?
Sarah O'Donnell: Yeah, yeah, for sure. It's hard. I would say to. Pick just a few examples, because the grantees who receive our core funds are just incredibly creative and resilient and they're doing just amazing work across the country day in day out. It's the hardest work, you know, some of the hardest work that I could probably even imagine but they're so dedicated.
And so it makes it difficult to choose a couple of examples. But I will just share one or two stories that really thank you. I think illustrate what you were getting at the first, I'll share is about a grantee that serves communities in central Utah and this community was able to hire with our core funds, a community health worker to help with the local jail.
And so this individual conducts screening and intake interviews when individuals have to go to jail and assess the risk of substance use disorder to make sure that they're able either to be referred if they're at risk and they need some help or to continue treatment while they're in while they're incarcerated.
And then on the back end, she helps to make sure that people who are leaving the jail and going back into the community are successful. So she provides referrals to therapy, referrals to continue treatment, making sure kind of what you said earlier about how root causes are such a huge issue when you talk about substance use disorder.
So she makes sure that these individuals are connected with housing and jobs and helps them apply for Medicaid and Social Security and driver's licenses and everything that they need to make sure that when they go back into the community, they have. The tools that they need to be successful.
And so, so exciting because it's, this is working. So, what the community has seen is that the number of repeat offenders has decreased from 30 in July, 2022 to 11, um, last March. So, just, an amazing indicator of this success. What I really love about this story is that this individual who supported with our core funds she doesn't just work in the jail kind of environment, the incarceration environment.
She also outreaches to the community. And so she does a lot of community events, including recovery socials, which is like a safe substance free place for families and individuals impacted by substances to come together and socialize and she's becoming such an important part of the community that, the person on our team who works with them shared that she was out at a community event. I think it was a car show or something and people were asking to take photos of her because she's become such an institution in the community and representing all of the, the progress that they've made with substance use disorder. So I really love that story about how, you can have impact just not on individuals, but also in the whole community and really kind of raising awareness of substance use disorder and how we all need to work together to help address it.
Michelle Rathman: Yeah, I think what to your point, it is all about the storytelling, you know, and I had the privilege of we were talking earlier to travel to D. C. this year and help co-facilitate session on the impact of storytelling and how powerful it is because, Megan, I'm going to come back to you for a second because Sarah, I want to hear a few more stories.
But at the end of the day, you know, the funding doesn't just fall off the trees. Okay, so, in August, if that were the case, we wouldn't be having this conversation. In August of this year, The Biden Administration announced 80 million and awards allocated to rural communities in 39 states to support key strategies to respond to the overdose risk from fentanyl and other opioids.
So, at the end of the day, what can you tell us about how these funds are directly impacting rural communities, and with that, why, in your estimation, is it so important for those who are allocating the funds to understand connecting the dots between the decisions they're making to support funding and how important are those stories to their decision making?
Megan Meacham: Yeah, I mean, just to quickly speak to the second part we don't control the federal budget. We are federal employees. So we, we do the best with what we are given to impact the populations that we're trying to serve. I think that, the overarching stories always go so far because every individual in this country is represented by someone.
So I think that's where the connection is made there. I think to go back to, just the importance of that direct impact of the investment that we were fortunate to get in for the FY 2023 year that we did get funding out to 39 states, and we've had funding across 47 states and two territories throughout the entire initiative.
But again, it's really just to continue to meet those direct rural community needs and to ensure that the funding is getting out to the rural communities and they're not having to go through multiple layers to try to get access to some of the funding because it's always easier to put the funding out in large population centers where you have more bang for your buck, but it's just as important and sometimes more vital to make sure that those smaller populations are still getting all of the support they need. So we're really happy that we were able to make awards through six programs and communities will be able to expand access to medication assisted treatment they didn't previously have as a result.
They will be able to support the child and adolescent population and, help hopefully try to help. Mitigate early ACES and address the behavioral health so we can prevent future substance use.
So meeting the needs of that youth population is so important. And then the overdose response program is really allowing communities to address, immediate emerging needs that they, might, it's like a quick gap filler.
So fentanyl things that, that kind of that we just need a quick, nothing's quick and easy, but it's just some funding to help them quickly respond to something that might be an emerging need to hopefully prevent it from becoming a longer term, larger issue. Another round of the neonatal abstinence syndrome program to really, again, address the pregnant parenting population and help infants that might have been born exposed to opioids.
So again, just overall, ensuring that we are allowing rural communities to meet their needs, to address substance use disorder, save lives, all awards are helping to continue HRSA in meeting its mission to bring life saving behavioral health resources to rural communities, and just so proud it.
Michelle Rathman: We all can agree that the best laid plan is to provide the conditions, the resources, the support required to not be on the other side of this. We were always going to need to have response programs. We have to catch up with that and find a way to address it. And so with that said, again, Sarah, if you could just share some examples of some of the cohort members and, the sustainability, I recognize it's been, it's a 5-year cycle, right, for you guys this time this program? What are you able to see some early trends in terms of, like, not only have we addressed the problem, we're close to getting to whatever that other side looks like, because we've got these, these really great measures in place, these really great, anchors in place to help us identify something before it.
I say this a lot and I'm a broken record, we deal with that which we choose or cannot manage. And sometimes if we can't manage it, cause we don't have the resources. So talk a little bit about sustainability. Cause I don't think, people talk about the word resiliency. I don't believe. I've come to know this so much more in the last three years.
Resiliency is not being able to constantly get up and brush yourself off. Resiliency is creating an environment that's strong enough to resist being overcome by disparity, if you will.
Sarah O'Donnell: So I actually, I'm excited because I think that this other example that I have to share really speaks to that. And I just want to preface it by saying that one of the things that we really emphasize with all of our awardees is that nothing in substance use disorder happens in a vacuum and so we really encourage for sustainability and also just for general effectiveness that our awardees partner with other organizations in different sectors to make sure that first, if you're creating these partnerships, you're enhancing the ability to sustain, right?
Because it's just not one person doing everything in a vacuum. And also, you're making sure that all of the dots are getting connected. And by doing that, you can make sure that an individual who needs support before they, in advance of a potential overdose is connected with all of the supportive services that they need and prevent any further challenges that they might experience or even, prevent them from overdosing.
And so, I think that we have an exciting grantee in Illinois, who's really kind of taken this idea of connection and creating networks for supporting responses to substance use disorder and just really ran with it. And so with this grant, he's done is they've created a network of over 40 sites throughout their service area throughout their rural community where individuals can go to get connected with resources. And so these sites are kind of indicated with a sign on the outside. And I think hearing about this, you would assume, oh well, they're hospitals are there, you know, there are places where it might be awkward to walk into. But no, these are places. They include hospitals, but also libraries, and community health and wellness centers, those types of places where you go to work out, faith based organizations, social services organizations, and the individuals working at these sites have been trained. So that when someone comes and says, I need help, I need connection to resources they can so just making that availability of help.
And instituting it into the community through these networks, I think, is so effective for sustainability. And then on top of that, what they've done is they've integrated their services. So the medication assisted treatment, which is the evidence based treatment for opioid abuse disorder and behavioral health care providers are co-located in one spot.
And so, not only can they go to anywhere in their community to get help, but they can also then be referred to this place where they can get everything they need in one spot, which I think is just such a great approach for making sure that we're supporting people in their time of need and preventing kind of any further.
I don't want to say deterioration, but, things escalating further for them. So we think that's one really example. I'll just brag about them for one more thing, because I think this is also really cool. Is that, in a 6-month period, so just 6 months earlier this year, this organization managed to distribute 1,860 doses of Narcan, which is the life saving drug that if someone overdoses can revive them and save their life. And they've trained individuals, providers and community members to how to administer it. Again dissemination of knowledge and now we're building awareness and making sure that there is a sustainable approach to helping people who are impacted by this really terrible disease.
Michelle Rathman: It sounds for me, that's what I connect in my head is that. If we don't understand, every rural community has a completely different set of circumstances. They have a different access to resources depending on where they're geographically located. So really what these programs help to do and maybe help as not a strong enough word, it really helps to identify the gaps. Because if you know that you have a model of something that's working somewhere else, that doesn't mean it can't work in another place. But if that other place doesn't have a community health worker program, or if they don't have a strong partnership with their county sheriff, or their city police, so my gosh, in the time we have left, I have, I want you both to answer the question here because, I just, first of all, we're going to make sure that we put as many resources as we can on our website and we'll share it with our listeners. We'll connect the dots because we want them to learn. You don't want this to be the best kept secret. I know it. You want other people to know about it. So it's clear we have a tremendous need.
It's clear that we have a long way to go. If we wake up one morning and say, this crisis is over, it's that's going to be some time. Those are things that none of us here in this room can control. But what do you think is the most important message to rural community leaders? Because this doesn't live in a vacuum.
It's not just the people who work at the hospitals who are seeing this. It's touching everybody. So, what do you want them to know about what's available to them, how to access resources, give them a starting point.
Megan Meacham: I will go ahead and start, and then Sarah, please jump in. I think the most important thing we want anyone to know you are not alone. There is a lot of help out there. It can be very intimidating to try to navigate all of the help because there is a lot of help out there. So the HRSA website, HRSA.gov is a good place to start for our specific programs. And just recognizing that every community is dealing with different challenges. But there's other resources aside from just the federal funding. So our TA provider has a website and that you can access some of those best practices or ideas.
It's really important to get that conversation started, start thinking about partners you might want to pull from, and then there's other resources out there that can help you access them. I would also just add to watch grants.gov. Again, the federal funding process can seem very daunting, and it is, but there's also grant writing resources available. So we, every state has a State Office of Rural Health. We have available resources through health information hub. And so there are grant writing resources, there are examples, many more than the that Sarah shared, available for others to go and look through see, hey, this might work in our community too, that gives me a new idea, or I never thought to engage that partner, maybe I go have this conversation.
Michelle Rathman: I think it's a great point. It all starts with having a, I tell people we're all hungry for a change. What's your appetite for actually being, you know, picking up that phone or sending out that first email?
Sarah, what are your words of wisdom for leaders who know they need something, don't know where to start?
Sarah O'Donnell: Yeah, I think I think my biggest of wisdom is, first, to echo Megan, you're not alone. There are so many communities out there that are struggling with this. Second, it is hard and it, it's just hard, it's really hard and it's hard for everyone, and you are not alone in that being so difficult.
And I think the third is that we're here and maybe it's that the thought of applying for grant is really overwhelming. Maybe we're starting with looking to see what's available, and, not underestimating the importance of having the conversations and talking with your community. And, finally, that it is not hopeless. I know that, sometimes it can just, it's just so overwhelming.
The challenge is so insidious and difficult to address and so complex, but there are communities out there that are having success and there is a way forward and there are effective ways to be found to kind of help the individuals and help the communities that are really struggling. So there is hope for, addressing it, no matter how difficult and complex it might seem and we're here.
And our partners are here to help you identify the best path forward for your community.
Michelle Rathman: And I'm not going to let either of you go without mentioning a little something, something. Because, so much of your work is, people in rural communities don't know your names. They don't understand the depth and the level of commitment and resources and expertise and research that you all do.
However, very, very recently you two and another colleague of yours, Alison Hutchings were named winners of the 2023, I voted for you, Samuel J. Hyman Service to America Medals People's Choice Award by the Partnership for Public Service. And, just, congratulations! I saw the photos. You were both and your fanciest red-carpet attire.
What does that mean to you personally and professionally to know that your contributions are making such a profound impact. To countless many.
Sarah O'Donnell: Megan, if you don't mind I'll maybe kick it off. It is. It's just amazing. It is so incredibly humbling and wonderful and just overwhelming. And I think what makes it, so, it is not that it's the three of us, but that it's the representation of all of the work that has been done, not just by me and Megan and Allison, but we wouldn't have been there had it not been for the team.
So, all of our project officers in our amazing division that work day in and day out with the grantees on a one to one basis to make sure that they are able to address any challenges and be successful in their work plans from the leadership of HRSA that supported this initiative from the beginning to our grants office, who crunch all the numbers and help us figure out like the tricky financial questions that we can't manage.
They're amazing. And just the fact that it's shining a light on this issue, both kind of the challenge that rural communities face and how difficult it is. And also, the hope and, the progress that's being made and the innovation that is happening. And so to just see that whole body of work front and center is so exciting.
Michelle Rathman: Awesome. Anything to add?
Megan Meacham: I mean, everything echo, everything Sarah said, it has been such it's amazing in the sense that don't to work to be recognized. We go to work because we want to serve. And so to know that we are making impact and to be recognized in this way, and know that however thousands people voted for us to get the People's Choice Award are now aware of what we at HRSA are doing to be able to have the opportunity to come on to podcasts like yours and share the amazing work of our grantees.
It's just, it's so humbling. There's not really any other, it's career achievement and highlight, and still have a lot of career ahead of us. So hopefully this won't be the last you've seen of us. But it's just, for me, it's the acknowledgement and the recognition of issue and the work not the recognition of the, like us three, as Sarah said.
Michelle Rathman: Well, you are, I've just had a conversation with two of HRSA's is finest and, um just really thank you so much for the work that you're doing. It impacts the communities, I am fortunate to work with. I know several of your grantees have benefited from it, so thank you again. We're so appreciative of your time.
We will continue to amplify the work that you're doing because it is that important. No corner, as we said of this country is not impacted by this, and it's in their homes. It's in their schools. It's in their community centers, it's everywhere, and so this is not a health-specific challenge that we face, but rather a life-specific challenge that we all face together.
So, I just want to share with anyone, we love when you subscribe, we love when you share, we love when you like us, you rate and tell others about this podcast. So with that said, I'm going to tell you, we're going to see you next time on a new episode of The Rural Impact. Take good care.