Improving Rural Mental Health Service Quality Through Partnerships and Innovation

Matthew Milette-Winfree, Trina Orimoto, Hannah Preston-Pita, Gary Schwiter, Brad J Nakamura


In rural areas, poverty, geographic isolation, cultural differences, limited availability of providers, and other barriers can prevent the engagement and retention of clients. As a result, individuals living in rural areas often enter care later in the course of their illness with more serious symptoms, and require more intensive services. The Big Island Substance Abuse Council (BISAC) has attempted to reduce the effects of these barriers by implementing several innovative, agency-wide quality improvement efforts within a five-year span from 2012-2017: (a) a research partnership with a local university, (b) prioritization of leveraging information technology and electronic health records for a wide array of decision-making, (c) rebranding and grass roots marketing, (d) cultural competence in service delivery, and (e) routinized training and supervision. The methods by which these initiatives have developed within a rural behavioral health setting offer both suggestions and optimism for the proliferation of similar approaches elsewhere. This paper provides an account of BISAC’s infrastructure and program improvements, and illuminates several thematic lessons learned across implementation efforts. As described here, such innovations might provide clues for utilizing data to help guide decision making, integrating cultural values, and monitoring operations within rural mental health settings.

Keywords: substance use treatment, community, program development, rural, program improvement, implementation

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The Journal of Rural and Community Development is supported by SSHRC.