Please fill out the survey using the embedded form, below. If your device does not display the form, please click on the button to be redirected to a website version.

National Rural Health Service Providers COVID-19 Resources Survey

Help us understand the resource needs of RHSPs

Cardea, Community Education Group, and TruEvolution are partnering to learn how COVID-19 is impacting Rural Health Services Providers (RHSPs) so they can better facilitate conversations with policymakers and advocate to expand access to resources to support client care.

RHSPs are a vital component of American public health infrastructure that often serve as entry points into care for populations that may not otherwise engage in health or social services. RHSPs provide healthcare-related services in rural counties, as designated by the Health Resources Services Administration (HRSA), or rural census tracts in urban counties. RHSP is a broadly defined term, and they can be:

• Public or private
• Non-profit or for-profit organizations and corporations
• Faith-based or community-based
• Located in rural, suburban, or urban areas

Despite the critical services they provide, they do not meet any existing federal designations designations set forth by the HRSA, the Centers for Medicare and Medicaid Services (CMS), and/or any other federal entity.

Do you operate an RHSP? Please consider participating in this 10-minute, voluntary, and confidential survey to share your experiences. Findings from this survey will be summarized in a brief report and will inform planning and policy conversations. This survey will close on September 7, 2020.

This survey will ask whether your organization has received several different types of resources to support COVID-19 response. The CARES Act created a couple of different pools of funds that health care providers might be able to access. For example, the CARES act Provider Relief Fund enables CMS to distribute federal funds to health providers in response to COVID-19. The Paycheck Protection Program (PPP), which has received wide media coverage, was also established by the CARES Act and provides small businesses with funds to pay up to 8 weeks of payroll costs including benefits. PPP funds can also be used to pay interest on mortgages, rent, and utilities. Several state and local governments as well as community foundations have also provided funding to service providers to respond to COVID-19.

If you would like to participate in this survey, please click the ‘Next’ button below.

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By: Marcus J. Hopkins

In March of this year (2020, in case this is being read in some post-apocalyptic hellscape where Internet access has finally been restored), I attended a conference in Raleigh, NC, along with CEG’s Founder & Executive Director, A. Toni Young. The day before we got on the plane, we both conferred over the phone:

 “So…have you heard anything about this conference being cancelled,” asked Toni.

“Nope, which actually surprises me, given that this is a conference about preventing the spread of infectious disease among People Who Inject Drugs (PWIDs),” I relied.

“Well, you’re still going, right?”

“Unless you tell me that we shouldn’t go, I plan on being there,” I hedged.

“I’ll see you, tomorrow.”

By the day the conference was scheduled to end, the organizers had fundamentally changed the final day’s activity to discuss COVID-19, and the fact that many of us were headed back to states where the public health infrastructures were not prepared to deal with a pandemic outbreak – Kentucky, North Carolina, Tennessee, Virginia, and West Virginia. Outside of the handful of urban areas, once you get outside the suburbs, access to healthcare in Appalachia becomes not only scarce, but virtually non-existent.

But our discussions on that final day weren’t about the spread of COVID-19, itself, but how potential shutdowns were going to impact the lives of those whom our organizations were committed to serving.

When looking at rural and suburban areas where opioid (and occasionally meth) addiction is high, there are certain factors that tend to coalesce to create an environment ripe for the growth of addiction: lower incomes, higher rates of unemployment, areas where industries have left, lower levels of educational attainment, less access to economic resources, and areas where industries that require hard labor are the drivers of the economy (Office of Disease Prevention & Health Promotion, 2020).

Those factors essentially are Appalachia.

An economy built upon hard labor? Coal mining, logging, and agriculture.

Areas where industries have left? Coal mining’s not quite dead, yet, but it’s been dying for decades, and the fossil fuel industry’s hold on this part of the country is lessening, every day.

Lower levels of educational attainment? For the percentage of residents reporting less than high school completion, Kentucky (15.5%), Tennessee (14.2%), and West Virginia (14.4%) all have percentages of their population higher than the national average (13.1%) (Appalachia Regional Advisory Committee, 2016).

Less access to economic resources? Most of Appalachia is typified by bucolic scenery, the majority of which is geographically isolating.

Lower incomes? While the national poverty rate is 15.6%, the combined Appalachian regions of Alabama, Kentucky, Tennessee, Virinia, and West Virginia is 19.7% (Federation of Appalachian Housing Enterprises, n.d.).

When I brought my last partner, a born and bred Los Angeleno, to West Virginia to visit family over the holidays, in 2010, we drove up from Tennessee, through Virginia and West Virginia, to get to Morgantown. Along the way, he got an education in what “poverty” means, in Appalachia, versus Southern California.

For him, his perception of poverty existed in an urban desert: rundown apartment complexes, neighborhoods whose shopfronts were mostly boarded up or empty, and food being bought from “liquor stores,” because grocers had long since departed the area.

While driving through Preston County, WV, he turned to me and asked in horror, “Is that a shack?!”

“No…that’s someone’s home, and they likely have neither electricity, nor running water.”

Many of the clients served by 501(c)(3) organizations, Community-Based Organizations, and other non-profits in Appalachia live in these kinds of conditions. Whenever I go to conferences on HIV, Viral Hepatitis, and other infectious diseases, I keep trying to explain to people that the numbers coming out of West Virginia (e.g. – the highest rates of new Hepatitis B and Hepatitis C infectious in the U.S. per 100,000) are only a fraction of the story.

Because of the geographically isolated nature of Appalachia, there are tens of thousands of residents who are not reached for testing, alone, much less treatment. This is where small, community-based organizations – Rural Health Service Providers (RHSPs) – come into play. They serve as the links that get isolated populations to services, or, in most cases, take those services to the isolated.

So, when shutdown protocols were being announced, we immediately predicted two outcomes:

1. Feelings of social isolation would increase, driving many people to overindulge in drugs, thus increasing the number and rate of overdose deaths;
2. Delivering services to these people would become both more vital, and more difficult to achieve, as the delivery model largely depends upon isolated people coming to more central areas to access services (meaning that house calls would become necessary.

Though both predictions came to fruition – overdose deaths did increase, particularly in Appalachia – the second issue has proven to be the most difficult to overcome.

The issue that exists, for many of these small groups, is that their entire operations often rely upon both volunteers, and individual donations, meaning that there are no consistent sources of revenue. A lot of these organizations are put together by local people doing their best to bring resources to local residents, and they all have day jobs. In the past month, I received an E-mail from one of these organizers asking for a personal donation; another organizer told us that her group received a grant of $350 to purchase supplies.

$350 is awesome, but it falls extremely short of what is needed to combat the problem.

Moreover, while the people who organize these groups have hearts full to bursting and are dedicated to their missions, what they often lack are the kinds of resources they need to apply for and receive private and federal grant monies that could support their organizations.

Whenever federal funds are allocated for use in “rural health,” they are almost instantly gobbled up by Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Look-a-Like (LALs) who have staff members whose jobs are dedicated to finding, applying for, and receiving grants.

So, how do these organizations compete?

Right now, they largely don’t, and that is a serious problem that CEG, along with TruEvolution, Inc. (Riverside, CA), is trying to address.

In the coming month, we will be unveiling a new national project that is aiming to create a way for these organizations to access federal, state, and local funds that would allow them to build, repair, expand, modernize, and mobilize their operations to meet clients and patients where they live, rather than expecting them to travel to urban areas to access services.

That’s all I can say, right now, but look forward to this unveiling in the coming weeks, because I think this one has a lot of great potential.

References

Appalachia Region Advisory Committee. (2016, October). Identifying and Addressing Regional Education Needs, Figure 1. Educational attainment by state, 2014. A-1. Washington, DC: United States Department of Education: Appalachia Regional Advisory Committee. Retrieved from: https://www2.ed.gov/about/bdscomm/list/rac/appalachian-region.pdf

Federation of Appalachian Housing Enterprises. (n.d.) Appalachian Poverty. Berea, KY: Federation of Appalachian Housing Enterprises: Appalachian Poverty. Retrieved from: https://fahe.org/appalachian-poverty/

Office of Disease Prevention and Health Promotion. (2020). Substance Abuse Across the Life Stages. Washington, DC: United States Department of Health and Human Services: Office of Disease Prevention and Health Promotion: Leading Health Indicators: 2020 LHI Topics: Substance Abuse: Life Stages & Determinants. Retrieved from: https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Substance-Abuse/determinants

Disclaimer: Blog posts on CEG’s Community Perspectives blog do not necessarily reflect the views of the Community Education Group, its grantors, its corporate sponsors, or its organizational partners, but rather they provide a neutral platform whereby each author serves to promote open, honest discussion about issues specific to their personal expertise, lived experience, and perspective. Please note that some of the content on Community Perspectives may be graphic due to the nature of the issues being addressed by the author.

For the inaugural entry in our new video series, #PeopleWorthKnowing, we decided to feature Gabriel Maldonado, Founder and CEO at TruEvolution, Inc., in honor of CEG’s recent partnership with TruEvolution on a national sign-on letter to members of Congress, asking for a $5 billion federal grant appropriation dedicated to supporting, expanding, and mobilizing Rural Health Service Providers (#RHSPs) and the long neglected and underfunded public health infrastructures in rural America (read more), and a newer collaboration to form the Rural Health Service Providers Network (RHSPN).

As the Founder and CEO of TruEvolution, Gabriel Maldonado has led the organization’s efforts for the last eleven years to now include comprehensive HIV prevention and care services, a mental health clinic, and an emergency supportive housing program.

As a former member of the U.S. Presidential Advisory Council on HIV/AIDS under President Obama, Gabriel works to elevate the representation of minority community-based organizations in state and federal policy priorities. In addition to his work at TruEvolution, Gabriel continues his advocacy serving on regional boards, such as Borrego Community Health Foundation – the 2nd largest federally-qualified health center in the U.S. – and global organizations such as the AIDS Healthcare Foundation.

Bringing a passion for business and consultancy, Gabriel works to advise industry leaders as an advisory board member for Viiv Healthcare and Merck & Co.

Gabriel believes that the needs and priorities of marginalized populations should be heard in every room and at every table impacting those communities. What drives Gabriel’s passion is his experiences in witnessing the devastating impacts of the industrialization of poor urban communities. Raised in the City of Compton, Gabriel watched not only his health but the health of his family and neighborhood be affected by the corrosive effects of refineries, smog, logistics and chemical facilities.

Now as a person living with HIV, Gabriel is firmly-rooted in advancing the quality of life and human dignity of people of color in the LGBTQ experience.

#CEGInWV is proud to serve alongside #TruEvolution as we work to ensure that rural Americans across the nation have access to the services provided by #RHSPs.

You can visit TruEvolution’s website by clicking on the logo, below, and links to their various social media pages will be listed below.

• TruEvolution Facebook Page
• TruEvolution Instagram Account
• TruEvolution Twitter Account

I’ve been thinking about the impact of COVID-19 on communities, on networks of people, on families and individuals. In addition to its direct toll on the health of older and medically vulnerable people, on the economy, and on people’s day-to-day lives, this pandemic has also highlighted a number of social ills. Essentially, it has aggravated “pre-existing conditions” in our society, like disparities in access to medical care and services, and lack of access in some communities to necessary resources.

Whether it’s access to Medically-Assisted Treatment (MAT) for persons with Substance Use Disorder (SUD), or syringes for trans folks on hormone therapy, during this pandemic, how do we have a productive conversation about those being essential needs and essential services? CEG is doing work in a very rural setting in West Virginia, and also in urban Washington, DC, but the challenges seem similar in both places. The biggest challenge before us is equity.

That’s the challenge going forward: equity in resource allocation, equity in service delivery, equity in information dissemination, equity in the availability of testing and treatment not just for COVID-19, but for ongoing health threats like HIV, Viral Hepatitis, and others. And the other thing this situation has highlighted for me is that none of us can go at this alone. No one individual — no one population — can attack this problem of access and equity on its own. If we want to get those services and resources to the people and communities that need them — whether that’s testing for COVID, or access to syringes, or just access to clean water because you don’t have running water in your home — we are going to have to work together in coalition.

For the rural segment of this initiative, Community Education Group is now working with TruEvolution in Riverside, California to ask Congress for a $5 billion federal grant allocation in the current or next iteration of the CARES Act to help vulnerable populations in rural communities across America. The goal is to help people access services, and to build the rural public health infrastructure needed to respond to COVID-19 and to future outbreaks and diseases. In conjunction with this effort, we are starting up the Rural Health Service Providers Network (RHSPN) to help direct funds and resources to where they are needed most.

We need to figure out a truly collaborative model for black communities, as well — one that accomplishes the same goals via community-specific strategies on issues such as PrEP education, HIV screening, access to care and treatment, follow-up, and workforce development. We need a Black strategy, but so often we get locked into a, “What about me? What about mine?” mindset, and we don’t get much traction, or maybe a few get it, but others are left behind. The bottom line, in both Rural America, and in Black America, is that we need to do this in a collaborative way, or it’s not going to get done.

That’s what I’ve been thinking…