Rural Matters

New host Michelle Rathman examines the state of rural health and the complex issue of rural hospital closures with Alan Morgan, Chief Executive Officer of the National Rural Health Association (NRHA). According to Rathman and the NRHA, about 60 million people are served by rural health care providers, running the gamut from the elderly to young families. Amid the pressures and challenges in rural health, Morgan notes there is some good news – increased innovation and a lot of new models and practices being implemented, such as utilizing the expertise of community health workers; integrating oral health into primary care; greater emphasis on chronic care management; and the growing application of telehealth solutions. New collaborations between rural hospitals and more urban and academic medical institutions are another positive development. But as Morgan explains, rural hospitals continue to close – 87 since 2010—and most of those will never re-open. In addition, more of the rural population is elderly; the need for behavioral health services is rising; the opioid crisis affects rural communities in a big way; and federal and state reimbursements for Medicare and Medicaid have been decreasing. Rathman and Morgan also discuss what happens to a rural community when its hospital closes and how stakeholders from all sectors of a community can come together to improve their health status. Morgan references recent research from the Robert Wood Johnson Foundation that highlights some “bright spots” in Appalachia where key health indicators show that some parts of this heavily rural area of the country are doing better than expected. Find it here: Bright Spots Research

The national sponsor for this episode is AASA, The School Superintendents Association. Learn more at www.aasa.org.

In her last episode as host, Mara chats about rural school leadership with Dan Domenech, executive director of AASA, the School Superintendent Association; Jule Walker, deputy state superintendent of operations for the Montana Office of Public Instruction; and Jerome Puyau, superintendent of Vermilion Parish School District in Louisiana. Domenech noted that this year AASA is focusing on professional development for rural superintendents, who comprise a majority of superintendents in the country. Walker said that her office will focus, in part, on career and college preparation as part of “redefining ready” in the upcoming school year. Puyau and Walker both noted how important it is to develop multiple pathways to prepare all students for the “real world.” Puyau described some of the difficulties in establishing those pathways, given the lack of funding. Domenech noted that many school districts are functioning with less money than they had a decade ago, and that’s why the upcoming budget discussions are so significant, in regard to Perkins funding and standards, for example. Puyau said it was important for superintendents to view their role as CEOs and creatively use Perkins funds, with alliances with local businesses, for example. He also noted that superintendent turnover is a real problem in his area. The national sponsor for this episode is AASA, The School Superintendents Association. Learn more at www.aasa.org.

Mara chats with Michael Adcock, executive director of the Center for Telehealth at the University of Mississippi Medical Center (UMMC) about using technology to connect patients and providers in rural areas. The Center has been providing telehealth services for 15 years and is one of the two Telehealth Centers of Excellence in the United States. Starting with providing emergency services, moving on to mental health, the program now offers more than 35 medical specialty services in more than 200 sites across the state. The Center is focusing on offering more telehealth services in the school settings, Adcock notes, which is a win-win for students, their parents, and for overutilized emergency rooms.  None of its services are meant to replace local physicians, Adcock points out, but to augment existing services. The cost of the service is minimal in many instances, such as mental health services, requiring only a laptop or desktop and a webcam and applicable software, which can be provided and maintained by UMMC. And there are grant funds out there for this equipment, he adds.  Patients appreciate that they don’t have to travel to Jackson, MS for services but still get to be seen by clinicians. In most cases, the Center can replicate in-person care, but if they can’t, they won’t provide those types of telehealth services. The episode concluded with a discussion of a very successful diabetes telehealth pilot program developed by UMMC. This episode was sponsored by, the Center for Telehealth at the University of Mississippi Medical Center. Learn more at www.ummc.edu/telehealth. The national sponsor for this episode is AASA, The School Superintendents Association. Learn more at www.aasa.org.

Mara chats with Victoria Bernhardt, Executive Director Education for the Future, a not-for-profit organization dedicated to building learning capacity and the deployment of data for all students. Bernhardt is author of Data Analysis for Continuous School Improvement, published by Routledge. Rural schools have particular interests in data deployment and analysis. For example, Bernhardt notes, when school leaders analyze certain data, they can determine whether students’ career preparation is really current for today’s more corporate agricultural setting and whether their students will be able to keep up with others in college. There are four types of data. Demographic and perceptual data are very valuable for rural school leaders in comparing how today’s students compare to those of previous generations and how students view what’s happening in those schools. Student learning data are important for evaluating performance. And school process data are significant for understanding what’s happening specifically in your schools. Another important issue for rural schools is accessing data, which involves the ability to analyze and deploy data in the most effective ways. This episode was sponsored by Routledge Eye on Education, an imprint of the Taylor & Francis Group. For more information, visit www.routledge.com/eyeoneducation. Our national sponsor for this episode is AASA, The School Superintendents Association. Learn more at www.aasa.org.

Mara chats with Candace Williams, executive director of Rural Community Alliance (RCA), a non-profit which organizes rural communities in the state, from Delight, Arkansas, where RCA just wrapped up its annual conference. Begun in 2002, RCA was birthed after legislative efforts to consolidate smaller school districts, but has expanded into rural economic development projects within the state to try to make rural Arkansas thrive. Among the issues facing rural Arkansas are school closures, privatization of public schools, economic development implemented by rural communities, and Internet connectivity.  Specifically, in regard to rural schools, there’s a shortage of teachers because of difficulties in attracting and retaining teachers—in short, the days when you “grew your own teachers” are disappearing. In addition, there are significant issues regarding transportation. One of the outcomes of the recent conference was to better enable members to come into contact with candidates for public office to increase their voice with elected officials in terms of education and economic development. For RCA, Williams notes, it’s important to have legislators actually see rural districts up close. Williams notes that in almost every rural area, the school is the “heart and soul” of the community, and losing your school district is heartbreaking for the entire community. Williams’s ultimate message: “There’s so much promise in rural Arkansas.” She urged legislators to “bring us to the table” as active participants. Learn more about RCA at thenewrural.org.

Mara chats with Karen Barber, CEO of Yoakum Community Hospital, a 25-bed critical access hospital in Texas, and Jim Kendrick, president and CEO of Community Hospital Corporation, a non-profit whose mission for 22 years has been sustaining health care in rural markets. In rural markets, it is often difficult to recruit enough physicians to serve the community, says Kendrick. Barber notes that her facility recently had to close their labor and delivery department as a result of an aging population, low volume for deliveries, and cuts in Medicaid reimbursement. Because of decreased reimbursement and cutbacks by the Federal Government, rural hospitals are constantly trying to do more with less and are less able to serve as a safety net for the community. Rural hospitals need to evaluate how to ration limited resources to find innovative ways to partner with other organizations, and to deal with needed capital improvements. Yoakum Community Hospital has reached out to nearby metropolitan areas to secure the services of specialists. A key point: Local hospitals are often the #1 employer in the community, and this can be a strong asset and essential for the survival of small rural towns.  In rural markets, there’s a disproportionate percentage of uninsured patients who also cannot travel to find suitable medical care. In rural areas, many hospitals are turning into free-standing emergency facilities, which is a more limited resource for the local community. This episode was sponsored by Community Hospital Corporation, www.communityhospitalcorp.com and the National Rural Education Association, www.nrea.net

Our new host, Mara Casey Tieken, author of Why Rural Schools Matter, chats with Kai Schafft, associate professor of education and director of the Center on Rural Education and Communities at Penn State University, and associate editor of the Journal of Research in Rural Education about five specific rural myths. Myth #1: Rural voters are more conservative than urban voters. A close analysis of 2016 election finds a more complex situation, in which many—though not all—rural communities and small towns leaned Republican. Myth # 2: Rural America is “white America.” While there is some truth in that generalization, about 15% of rural America is made up of people of color, and there are four states in which the majority of their rural school districts serve predominantly non-white children. In addition, rural America is rapidly growing more diverse. Myth #3: All rural areas are in economic decline. That’s true for certain areas but definitely not all. Myth #4: Rural places are all the same. There’s no truth to this myth, according to Schafft, which leads to an overgeneralization of who rural people are and what rural areas actually look like. Myth #5: Rural is the opposite of urban. While there are fundamental differences, Schafft notes, rural diversity complicates this comparison. The reality is that we live in an interconnected, global world, not in “self-contained” communities.

John chats with Sheila Boyington, CEO of Learning Blade; Lori Langdon, a computer teacher at Springboro Intermediate School in Ohio; and Jan Miller, Dean of the College of Education and an assistant Professor at the University of West Alabama about STEM education in rural school districts. Boyington talks about how Learning Blade, which includes an online learning program whose platform focuses, in part, on supporting underrepresented students. The program includes various STEM topics, including robotics, chemistry and “missions” intertwined with potential STEM careers. Langdon discusses her work in technology for sixth graders, using the Learning Blade program, which integrates different academic areas, missions, and careers, with choices ranging from “concept cars” to specific entrepreneurial ventures. Miller notes that West Alabama will be launching an Ed.D. program in rural education and is currently implementing an initiative called Rethinking Rural Education, as a result of a grant it garnered. For more information on Learning Blade, http://learningblade.com.

John chats with Lydia Dobyns, president and CEO of New Tech Network, which has about 200 K-12 schools in 28 states, and Matthew Swenson, assistant principal at Cross County (New Tech) High School in Cherry Valley, Arkansas. New Tech Network’s mission to reimagine schools using four basic pillars that apply in their two models, one for elementary, and for the secondary level: culture that empowers students; project-based learning; embedded use of technology, and schoolwide learning outcomes, both academic and non-academic. Swenson works in a rural town (population 650) in the Mississippi delta, with about 600 students in the district, which was on a state low-performing list. His students, Swenson says, need 21st Century skills, which New Tech provides. The New Tech model is meant to be applied by the community, using virtual and on-site experience, for the specific economic and other needs of the local community, notes Dobyns. In Cherry Valley, the school is the hub of the community. New Tech implements its program by building deeper understanding of the challenges faced by teachers, administrators, parents, local business leaders, in terms of culture issues. For example, the school and the network established a Virtual Internship, in which the student and a professional “build something together.” Graduating students now have a plan for what they’ll be doing after high school, Swenson notes. Here’s a link to a must-see New Tech Network video:  Turning Point

John chats with Garris Stroud, a seventh-grade science teacher in Greenville, Kentucky, which is clearly on the rural spectrum (“where any day you can see deer, turkey and other wildlife right outside your window”). Stroud is a 2017-2018 Kentucky State Teacher Fellow who writes a blog, called Kentuckyschooltalk.org, and also writes for Education Post, the sponsor of this episode of Rural Matters. Stroud notes that, in general, there’s more poverty in rural areas, and that the “equity” issue is very important in Kentucky. For example, recruiting and retaining teachers is much more difficult in rural areas, and there’s more “brain drain,” he notes. Community colleges and 2 + 2 programs offer real advancement opportunities in rural areas, Stroud says. The deterioration of coal mining jobs in Kentucky means that it is more important than ever to teach students about new technology. Kentucky is looking at several education reforms, including accounting systems, graduation requirements, and what ESSA really means for students. This episode also includes an extremely lively discussion of charter schools.