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Background
Although much of the policy debate on welfare reform has concentrated on the urban poor, nearly 20 percent of welfare recipient families reside outside of central cities and metropolitan areas. They, along with other rural working families, rely on various social services to help them move toward self-sufficiency. Affording rural residents access to social services is a challenge even in the best of times. With the decline in state revenues expected to continue, the challenge will be greater.
Many of the challenges to social service delivery in rural areas are similar to those faced in central cities and metropolitan areas. Other social service delivery challenges are more formidable in rural locations. For example, ensuring access to affordable and adequate child care and convenient and reliable transportation is especially difficult in geographically isolated areas. Encouraging economic development in these areas is also a challenge (Pindus 2001). Rural communities often lack the infrastructure needed to attract businesses, and the expenses associated with development can be high; both factors limit job opportunities. Less commercial development and lower per capita incomes limit local tax revenue in rural areas which may mean fewer resources for social services. Rural employers are less likely than urban and suburban employers to provide health insurance, and access to affordable health care is limited in rural locations. Rural welfare recipients who are making the transition from cash assistance to work rarely continue to make use of Medicaid benefits. Furthermore, rural agency staff sometimes find it hard to identify families in need because the sociological and psychological deterrents to reliance on public assistance are more prevalent in rural communities (Weber, Duncan and Whitener, 2002).
The costs per capita associated with service delivery tend to be higher in rural areas because of their lower population density. With the current decline in state revenues, state agencies are reexamining their priorities in service provision. As state agencies strive to provide the most comprehensive support in the most cost-effective manner, low-income residents of rural communities could bear the brunt of diminished services.
The definition of “rural” has an impact on the study of social service provision in these communities. The Census Bureau defines “rural areas” as incorporated and unincorporated areas with fewer than 2,500 residents and open space, but most researchers distinguish between metropolitan and nonmetropolitan counties in their studies. Nonmetropolitan counties are located outside the boundaries of metropolitan areas and have no cities with 50,000 or more residents. This definition, however, does not account for the variation among nonmetropolitan areas. For example, residents of rural communities located in close proximity to urban or suburban centers are more likely to have access to a wider range of job opportunities and social services than are residents of more isolated communities.
This Issue Note explores the challenges facing social service agencies in delivering services to meet the special needs of rural area residents. It offers suggestions on how to design programs and policies to address those needs. For more information, visit http://www.financeprojectinfo.org/rural/rural.asp.
Policy and Program Issues
Why might states want to consider developing social service policies that target rural areas? The demographics of rural working families differ significantly from those of urban families, and these demographics influence their attitudes about accessing social services as well as their need for support. Compared with their urban counterparts, rural welfare recipients are more likely to be white, living in two parent families, and already working. Rural employment opportunities tend to be more limited and offer fewer benefits. Many rural welfare recipients work more than one job and still live in poverty. Education levels tend to be lower among rural workers, making it more difficult for them to meet minimum job requirements (Findeis et al. 2001). In addition, rural residents approach the challenges associated with poverty differently. For example, to make ends meet, many rural workers participate in the informal economy, which is not recognized as meeting the work requirement under the Temporary Assistance for Needy Families (TANF) program. Efforts to participate in allowable work activities may disrupt their informal work arrangements, ultimately causing additional economic hardship. Moreover, many rural residents are reluctant to admit they need government assistance, even if they qualify for help, because dependency on programs such as TANF, Medicaid, and food stamps carries a stigma.
Some research contends the current funding formula for TANF penalizes states with large rural populations (see Findeis et al. 2001). This formula is based on expenditures under the previous Aid to Families with Dependent Children program that were largely driven by state-set welfare grant levels. States with below-average welfare grants per person are disproportionately rural. In addition, the seasonality of many rural jobs results in greater TANF recidivism among rural recipients. States are facing a decline in revenue that is negatively affecting budgets nationwide. According to the Rockefeller Institute of Government, state revenue fell by 10.4 percent between April and June 2002, compared with the same period in 2001; this represented the fourth consecutive quarter of decline. Kraybill and Lobao (2001) note that 38 percent of rural counties reported a decrease in federal revenue, and the counties view this decrease as a major challenge to service provision. Although many states were able to set aside rainy day funds during the economic expansion of the late 1990s, policymakers may hesitate to spend these funds because they expect economic conditions to worsen. Moreover, recent changes in federal and state revenue sharing had significant impacts on both urban and rural areas at the same time the demand for services increased. Therefore, states might want to rethink service provision strategies. Targeting programs to meet specific rural needs could result in a more effective use of dwindling funds.
What specific needs might be addressed by social service policies that target rural areas? Rural-specific social service policies could address such local needs as job creation and economic development, access to support services, infrastructure support, and a greater emphasis on human capital enhancement.
Low population density and the lack of basic infrastructure in rural areas hinder economic development efforts that could bring new jobs to these communities. Unlike major metropolitan areas, rural areas are more likely to be dependent on a single employment sector. Wages tend to be lower in rural jobs, and many of these jobs are seasonal. Rural employers are more likely to know one another and informally share information about their workers. Adults with barriers to employment may therefore find it harder to obtain or keep jobs (see Whitener et al. 2002). Lower population density also makes it more difficult to provide services that support work.
Working families in rural areas must rely on transportation not only to access work, but also to access the supports necessary to maintain employment. Whether they drive their own cars or use public transportation, rural residents face longer commutes to their workplaces, child care providers, and job training sites. Because they spend more time commuting, their children spend more time in child care, resulting in added expenses. Residents dependent on public transportation face even greater challenges. Dewees (2002) notes that nearly 40 percent of all rural residents live in areas with no public transportation and another 28 percent live in areas with limited levels of service. Relatively few rural welfare recipients own cars, so access to dependable public transportation is vital. Strategies to improve access to transportation include providing assistance so recipients can purchase and maintain private vehicles, vanpooling, using other agencies’ vehicles, and encouraging employer-provided transportation.
Access to reliable and affordable child care is another challenge for rural families. The number of skilled and available child care providers in rural areas is limited. Child care centers are widely scattered, so center-based care is typically not an option. Rural welfare recipients are more likely to work nontraditional hours, further limiting access to child care. In addition, many rural residents rely on informal arrangements with family and friends. Cultural concerns also influence their choices. Many parents believe family and friends are more apt to instill similar beliefs and provide more individualized attention to children in their care. Although these child care arrangements are less expensive and more flexible, caregivers are generally not licensed, typically lack formal training, and frequently are less reliable. Rural child care providers may also lack access to available resources and supports, and they may not adequately prepare the children in their care for success in school. Social service agencies may address these concerns by helping providers become licensed and by building a training infrastructure that includes basic training on child safety and development.
According to the National Rural Health Association (1999), rural areas have a much more limited supply of primary care practitioners and other health care providers. In addition, low population density makes it difficult to deliver services targeted to persons with special health needs. Residents of more remote areas are less likely to have coverage. The uninsured are also more likely to go without or postpone health care, resulting in their illnesses becoming more critical and more costly to treat. Employers who provide insurance to their rural workers incur greater expenses in providing coverage; this leads to demands for higher copayments from employees and larger employee contributions to insurance premiums. Rural children are more likely to be uninsured and to have had at least one spell of uninsurance during a given period. However, because their families anticipate they will obtain insurance with the next job, they are less likely to take advantage of programs such as the State Children’s Health Insurance Program (SCHIP). States may want to redesign SCHIP so it bridges gaps in coverage, for example, by eliminating the waiting periods some states have implemented to address the risk of families that otherwise would have private coverage applying for SCHIP. Collaboration with other assistance programs such as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), child support programs, school lunch programs, and Head Start can help with outreach efforts. States can also collaborate with community-based and faith-based organizations to increase public awareness of SCHIP and assist with enrollment efforts. Such collaborations can decrease the stigma and cultural barriers that may prevent a family from enrolling in SCHIP. For example, states looking to target hard-to-reach rural children may want to collaborate with community action agencies that can act as liaisons to other organizations such as Future Farmers of America, 4-H clubs, and home extension clubs.
Social networks in rural communities are more integrated but smaller in scope. Nonprofit service providers incur greater costs per client, which results in less service provision. Many rural communities rely on part-time local officials and are less likely to have the human and fiscal resources needed for public administration (Rural Policy Research Institute 1998). These circumstances can result in more innovative programs, but significant planning and careful administration are required to provide needed services. Encouraging organizations to share staff and work cooperatively can help meet community needs. For more information, see Relave 2000.
What role can state agencies play in meeting the social service needs of rural families making the transition from welfare to work? States may want to consider these options to better meet the social service needs of rural working families.
Although many rural agencies operate with reduced staff, frontline staff are more likely to have personal relationships with their clients. Staff should be encouraged to use these relationships to identify specific needs and provide appropriately targeted services on a case-by-case basis whenever possible.
How can social service providers more effectively serve the needs of rural clients? Providers can consider tailoring their programs to meet the specific needs of rural clientele. Low population density and customs that discourage dependence on government support should be taken into account. Providers may have to develop client data tracking and management systems because many rural agencies lack the funds and expertise to develop extensive systems themselves. Service providers may also want to tie into successful community partnerships that link formal and informal support systems.
Many rural residents may be discouraged from looking for work because they believe no jobs are available close to home. Providers can take an active role in disseminating information about nearby employment opportunities. Because local jobseekers are more likely to use informal networks to find work, providers should be encouraged to work very closely with local employers to identify and make job placements. Moreover, because employment opportunities are more limited in rural areas, providers may want to work with local employers to identify employers’ skill needs and design training to impart these skills. To promote job retention, providers may also want to provide extensive backup support to new employees through coaching and mentoring.
What resources can states use to support comprehensive social service provision in rural areas? Service demands in rural counties have risen at rates similar to those in metropolitan counties. During the past few years, most counties have noted an increase in administrative workloads related to devolution-related social programs. For example, Kraybill and Labao (2001) found that administrative duties related to child care increased in 78 percent of metropolitan counties and in 70 percent of rural counties that administer child care programs. Duties related to food stamp administration increased in 40 percent of metropolitan counties and in 38 percent of rural counties that administer food stamp programs. The Medicaid administrative workload increased in 69 percent of metropolitan counties and in 61 percent of rural counties that administer Medicaid programs. The same study found, however, that the grant-seeking capacity of social service agencies in rural areas is much lower than the grant-seeking capacity of their counterparts in metropolitan areas. Only 28 percent of rural counties employ grant writers. States may want to explore opportunities that enable rural counties to share grant writers or to hire consultants to perform this function on an as-needed basis.
Rural counties are also much less likely to engage in economic development activities, which impedes efforts to provide jobs. However, states can take advantage of the flexibility in programs such as TANF to create linkages among programs and develop innovative approaches to social service delivery. States and localities can use several mechanisms to define the responsibilities among the agencies involved, as well as ensure their accountability, in collaborative activities. These mechanisms include formal contacts, interagency memoranda of agreement, and joint planning processes.
States may want to expand their efforts to meet human service delivery needs through collaboration. For example, to simplify the application process, they can use common definitions across programs, set similar asset limits across programs, and use common reporting forms across programs. Cross-program staff training can also be effective. By concentrating on programs that share common goals and serve similar populations, integration will be more easily achieved. Collaboration can also result in improved formal and informal communication among frontline and management staff.
However, social service programs’ varying performance measures and different regulatory and reporting requirements will need to be addressed. Reauthorization efforts to increase state flexibility to pool funds from different federal sources and agencies or to shift funds from one program to another may also aid collaboration. Simplified and unified cost accounting and reporting systems, as well as other administrative modifications across agencies and programs, would support expanded state flexibility.
States can also encourage program collocation in a one-stop environment. Federal welfare reform legislation and workforce development legislation allow states and localities to integrate or coordinate the administration and/or delivery of welfare and workforce services, but the laws do not require interagency collaboration. The Workforce Investment Act requires several programs to be partners in the one-stop delivery system. TANF is a suggested partner, so states can require TANF to be a partner. Ragan (2002) found that collocation with other program staff, managers, and service providers improves communication and creates bonds among staff from different offices. Collaborative efforts to expand support services range from pediatric clinics to family crisis intervention. He cites a number of successful local collaboration examples, including initiatives in San Mateo County in California, Anoka and Dakota Counties in Minnesota, and Mesa County in Colorado. In Mesa County clients who visit the workforce center and express a need for benefits in addition to employment assistance can attend classes that describe the various programs and assist with applications. Community-based, faith-based, and for-profit providers provide many of the social services.
Research Findings
Prior to the implementation of welfare reform, human service programs were not always viewed as part of a unified system, nor were they designed to act as such. They were created at different times and administered by different government agencies and organizations. The passage of the Personal Responsibility and Work Reconciliation Act accelerated the devolution of program administration to states. Some states opted to devolve programs to local counties and communities. Although substate devolution affords greater flexibility in program development, many rural areas lack the infrastructure necessary to effectively implement services and cannot meet the service needs of local residents.
Kraybill and Labao (2001) compared county governments in five key areas financing, welfare reform, economic development, land use planning, and public service provision. They found an increase in the administrative workload for devolved social programs such as health, child care, workforce training, and transportation. The increase was particularly acute for rural counties. At the same time, states are facing budget shortfalls and staffing changes that limit their ability to address social service delivery challenges. In addition to escalating budget deficits, state agencies are losing expertise as growing numbers of state workers reach retirement age (Dohm, 2000). These changes may negatively impact program implementation as demands for service delivery continue to grow.
While rural counties report less of a funding shortfall than their urban counterparts, they also report less expansion in business attraction, economic development, and workforce development; less expansion in these sectors negatively affects job growth. From a national perspective, trends in rural poverty, earnings, and welfare receipt have paralleled urban patterns. However, the national trends mask important differences (Weber, Duncan and Whitener, 2002). Rural welfare recipients are more likely to cycle on and off welfare because the available jobs are often seasonal. Furthermore, because many rural jobs are low-wage jobs, workers cannot meet their daily living expenses. Henry et al. (2002) stress the importance of identifying which industry sectors influence welfare dynamics at the local level. Policymakers can use that information as they work with employers to develop employment options in off-seasons.
Program Examples
In Conway County, Arkansas, the welfare office offers clients expanded hours of operation during daylight savings time. The office is open from 7:00 a.m. to 5:30 p.m., enabling clients to obtain assistance prior to reporting for work. The office is fully staffed during these hours, and a supervisor is always on site. Clients can also use a drop-off box to deposit forms and other paperwork during off-hours. Whenever possible, clients can schedule a phone interview in lieu of an on-site appointment. The TANF office also provides transportation assistance to clients through a collaborative effort with a local hospital. Whenever the hospital is not using its van, the welfare office can use it to transport clients to work or job training classes. The van is also used to transport seniors to and from adult day care. TANF, hospital, and state transportation department funds support the collaboration. Because the van service has been so successful, funds have been made available to cover the purchase and operation of a second van. For more information, contact Linda Smith at 501-354-2418 or Linda.Smith@mail.state.ar.us.
In Tehama County, California, as with many rural counties, low-income families are largely dependent on government agencies for basic health and human services. An Interagency Coordinating Council was established in 1979 to facilitate multi-agency collaboration. Under the council’s lead, an interdisciplinary governance system was established to serve the needs of area youth. The council chose to target youth services after a countywide survey conducted in 1995 identified substance abuse and juvenile crime as two major areas of concern to residents. It created and formalized the Health Improvement Partnership to address these issues. Through the planning process, it became apparent that the issues of crime and substance abuse extended beyond the criminal justice system, affecting education, social services, mental health, and public health, too. Consequently, the partnership designed an implementation strategy that included a combination of resources and client services. Working together, the council and partnership developed a coordinated governing system that provided direct services, policy development, and implementation. The direct services component, known as the Multi-Agency Treatment Team (MATT), redesigned case system operations. MATT I is composed of direct service providers from several agencies and serves as an interdisciplinary case management team. Members of the team meet twice weekly to address the needs of at-risk children and youth. Collaborating agencies work together to develop, coordinate, monitor, and evaluate individualized service plans designed to prevent out-of-home foster placement and reduce the cost of group home care. Staff training for the MATT I team included case management, team building, cultural competency, and team approaches to high-risk youth services. MATT II, the program development component, developed programs designed to address gaps in services while maximizing collaboration. Programs include the Early Response Team, which provides assistance to youth referred to protective services; Standing Tall Against Teen Issues, which stresses prevention; and Whatever it Takes; which is a mentoring program for preteens. The Health Improvement Partnership was also instrumental in implementing a common data management system for use across agencies. The county has been able to provide a greater number of resources for families and achieve a more equitable distribution of services throughout the area. For more information, contact Valerie Lucero at 530-527-6824.
The Southeast Kentucky Community Access Program (SKYCAP) is a collaborative demonstration program designed to improve access to housing, health care, and social services for the uninsured and underinsured residents of Harlan and Perry Counties. The program, launched in September 2000, is recognized as a national model. It is a community partnership that includes the University of Kentucky Center for Rural Health, Hazard Perry County Community Ministries, and Harlan Countians for a Healthy Community. Two unique features of the program are the trained family health navigators (FHNs) and a management information system. FHNs, who are community natives, conduct home visits and perform health, mental health, and social service assessments of uninsured and underinsured families. They provide referral information to clients and their families and act as liaisons between clients and service providers. Family health navigators receive continuing education in wellness action, adult mental health case management, diabetes management, and eligibility training, all provided by the department of social services. The management information system is a unique product that pulls together information from sources that address health care for the target population for ambulatory diseases such as asthma, diabetes, hypertension, heart disease, and mental illness. The system tracks client activity across health and social service providers, including diagnoses, medications, treatment plans, test results, and barriers to health and access. During its first year of operation, SKYCAP received more than 5,000 referrals and provided more than 9,200 services. Other programs are reviewing the SKYCAP process of case management and information tracking. The Rural Appalachian Cancer Demonstration Program serving Tennessee, West Virginia, and Eastern Kentucky is developing a complementary system, and Kentucky legislators are studying the case management and management information system tracking process for potential adaptation by the Medicaid program. For more information, contact Fran Feltner at 606-439-3557.
The Child Care Services Association of North Carolina operates two programs to address child care deficits in the state. Both programs were developed to address the negative effects that low teacher education rates and high teacher turnover rates have on children’s development. T.E.A.C.H. (Teacher Education and Compensation Helps) Early Childhood is a statewide initiative that offers an array of scholarships directly to eligible child care personnel to help support their professional development in early care and education and offers incentives incrementally as a strategy to reduce turnover. It was developed in response to statewide workforce data that revealed most teachers in child care programs had only a high school education, were earning low hourly wages, and left their programs at a rate of 42 percent per year. Participation in this scholarship program requires ongoing support from the child care employer and scholarship recipient as well as from the Child Care Services Association, the administrative home for T.E.A.C.H. In North Carolina scholarship funds support coursework at the community college level or four-year college level leading toward credential or degree attainment. More than half of the recipients (52 percent) for the first fiscal year were from rural counties. The program is currently administered in 21 states. For more information, contact Edith Locke at 919-967-3272 or edithL@childcareservices.org. The Child Care WAGE$ project provides education-based salary supplements to child care providers, teachers, and directors working with children from birth to age five, without affecting parental fees. The program compensates child care providers who have higher education and who remain steadily employed in their child care program over time. The statewide turnover rate of WAGE$ participants for fiscal 2001-2002 was 17 percent. The preprogram statewide teacher turnover rate for a comparable period was 31 percent. In addition, 15 percent of the active population of participants earned education to move up to a new level on the supplement scale, and 188 providers earned a two-year, four-year, or graduate degree in early childhood education or its equivalent. Child Care WAGE$ is also licensed in Florida, Kansas, and Oklahoma. For more information, contact Allison Miller at 919-967-3272 or allisonm@childcareservices.org.
In rural West Virginia, CHANGE Inc., a local community action agency, was instrumental in organizing a collaborative effort that serves many of the area’s low-income workers without access to employer-sponsored health insurance. The partnership includes the Weirton Medical Center Foundation, the West Virginia Northern College Student Nursing Program, the West Virginia School of Osteopathic Medicine, a local pharmacy, and the Ohio Valley Medical Center’s Residency Program. The CHANGE Inc. Health Care Center also allows physician residents and student nurses, who volunteer their services, to complete the requirements for their degrees under the supervision of the center’s medical director and a nurse practitioner. Doctors routinely refer families to other community resources so total well-being can be achieved. Patients must provide proof of no health insurance to receive assistance. A rural transportation program enables patients without access to cars to get to local and regional hospitals. The center not only has increased the numbers of patients served, but has also increased its network of health professional volunteers. Two additional initiatives, a dental clinic and a patient assistance program, have grown out of the effort. For more information, contact Judy Raveaux at 304-797-7733 or wvchangeinc@yahoo.com.
Resource Contacts
Administration for Children and Families, National Child Care Information Center, visit