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Rural School-Based Behavioral Health

Rural Settings

Key Considerations

In the United States (US), approximately one out of every five youth experience a significant mental health disorder—meaning that more than 17 million youth in the US will be affected by one of these disorders prior to turning eighteen years old. Moreover, substance use continues to be a significant concern among youth nationally. In South Carolina (SC), these behavioral health concerns are largely comparable. 

Rural environments are receiving more and more attention as they present unique needs and challenges in terms of behavioral health service delivery. Across the US, more than 15% of youth live in areas that have been classified as rural and approximately one third of public schools in the United States are located in rural communities. As you can see in the map (left), almost all of the 46 counties in SC are categorized as rural—therefore many SC youths live and go to school in rural communities.

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Together, these statistics reflect some of the ongoing behavioral health challenges facing youth today—needs that when unmet can lead to negative health consequences and other poor social, emotional, psychological and academic outcomes. School-based behavioral health services are one potential way to address the behavioral health needs of youth in rural communities.

School-Based Behavioral Health Practice

School-based service delivery has expanded exponentially in the US, as schools are natural settings where youth spend much of their time. Particularly in rural and underserved areas, where access and availability of services may be more limited, convenient and easily accessible services are critical to ensure youth get the supports they need.

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School-based behavioral health services are often thought of along a continuum. Prevention and promotion programs are those delivered to all students in a school and often focus on building skills (e.g. social skills, peer refusal skills). Early intervention programs are those services that are provided to students who have been identified as at-risk for behavioral health challenges. Treatment programs are more intensive and are provided to students that have been identified as having a behavioral health challenge—usually provided as individualized one-on-one services.

Who is Involved? 

There are often a range of professionals who work together to provide school-based behavioral health services.

Because of this, interprofessional collaboration—or collaboration between professionals from different disciplines—becomes critical to school-based behavioral health service delivery.

Unique Considerations for Rural Communities

Beyond the often limited availability of behavioral health services in rural areas, there are other unique considerations when implementing school-based behavioral health services in rural areas. Some of these considerations include:

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  • Lack of qualified providers to provide needed services in rural areas;

  • Poverty and its impact on youth and families’ lived experiences in rural communities;

  • The small, close knit nature of rural communities that can foster close bonds;

  • The importance of building rapport within the community when you are not from that community;

  • Opportunity for dual relationships to occur;

  • Stigma associated with accessing services.

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Implications

School-based behavioral health services can be crucial to addressing the behavioral health needs of youth in rural communities. Based on the unique considerations described above, those who are interested in implementing school-based behavioral services, in rural areas, should consider the following practice tips:

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  • Conduct a needs assessment to learn the nuances of a specific rural area in order to prioritize and guide service delivery;

  • Consult with other rural professionals who may be engaged in similar work and network with them in order to gain new ideas and to problem solve existing challenges;

  • Utilize community bonds, family systems and technology to better support student’s behavioral health needs;

  • Discuss your scope of practice and ethical concerns with youth and their families in advance;

  • Use culturally sensitive language.

This work was supported by contract number 201712381A proviso 33.22(E)(4) which is a legislative grant funded by a rural health proviso with the South Carolina Department of Health and Human Services (SCDHHS). The work was approved by and developed in conjunction with DHHS and the USC school of Medicine. The points of view or opinions in this project are those of the authors and do not necessarily represent the official position or policies of the SCDHHS.

Copyright © 2018. All Rights Reserved.

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