PolicyLab

Reading the news nowadays, I am struck by how often people talk about the “urban-rural divide.” I have strong ties to both urban and rural America, having grown up in the forests and farmland of Northwest Pennsylvania and, more recently, calling Philadelphia home. While there are certainly some differences, I am struck more by the similarities between rural and urban America—both in the challenges that families face and their resourcefulness in addressing them.

In my years engaging in grassroots initiatives in Philadelphia, I have witnessed the effects of poverty, neighborhood disinvestment, systemic discrimination, and language barriers firsthand, along with the impact these factors can have on a person’s health. Impressed by the resilience of the families I worked with, I remain dedicated to finding solutions that further their well-being.

At the same time, I often think of the families where I grew up. I remember childhood friends living in unsafe housing, small farmers struggling to make ends meet and driving through towns without a single grocery store. Access to health care was often limited: some patients drove over two hours to visit my mother, the closest endocrinologist.

Against the backdrop of these various experiences and in my new role as PolicyLab’s strategist for the Intergenerational Family Services Portfolio, I am excited by how our work can help support all families, regardless of where they live, and I’m particularly interested in exploring the potential impact among rural communities.

Health care challenges for families in rural areas

Taking a closer look at parts of the country even more remote than what I’ve experienced, access to health care is challenging with exceptionally long travel times, waves of hospital closures, and severe shortages of primary care providers and obstetric services. Many families living in rural areas are not screened or treated for health issues or concerns and can experience negative outcomes as a result.

When parents aren’t getting the care they need, we know their kids are at risk too, with effects going well beyond the difficulties in accessing care. For instance, rural mothers often struggle to get help with postpartum depression, a condition that can impact a child’s development and well-being—and an area where I was eager to read about PolicyLab’s ongoing research projects. For many caregivers, their only interaction with the health care system may be doctor visits for their children. Providing services within pediatric and community settings allows us to meet families where they are, opening up the opportunity to provide care not just to children, but to proactively address caregiver health and social needs.

Overcoming barriers through intergenerational care

In my first weeks at PolicyLab, I’m getting to know all of the exciting work our researchers are doing to identify the most effective ways to support both children and their caregivers. Most of our projects that take an intergenerational approach would be beneficial to families everywhere—but in particular, as I think about the region where I grew up, could help address some of the distinct barriers rural families may face when seeking care. Here’s a sampling of just a few:

• Home visiting programs provide support to at-risk pregnant women and families through direct education in the home, and through connections to health and social services. In an evaluation of home visiting programs in Pennsylvania, PolicyLab researchers have highlighted how these programs broadly support rural families, going beyond just health. For instance, home visitors organize transportation to help families get to doctor’s appointments, but also address isolation by planning local social events. Our research will continue to identify practices that address the specific needs of rural families—I encourage readers to check out recent blog posts from my colleague Jennifer Whittaker who has written extensively on this topic.
• Online services offer another way to overcome geographic barriers. PolicyLab experts Drs. James Guevara and Rhonda Boyd led a pilot project of a social media intervention to teach parenting skills to mothers with postpartum depression. Relative to mothers assigned to in-person classes, those in the social media group had significantly higher participation, improved confidence in their parenting and lower severity of depression. A larger study of this intervention is underway, and we hope that such online programs could eventually be available to all mothers who struggle to get in-person support.
• Finally, contraception is often difficult to access in rural areas. Our researchers are exploring ways to improve women’s access to long-acting reversible contraception (LARC), the most effective form of birth control. Offering LARCs during pediatric infant visits may improve outcomes for mothers who are unlikely to visit their own physicians. Together with the Philadelphia Department of Public Health, the Pennsylvania Department of Human Services, and other experts, PolicyLab has proposed policy recommendations that would expand the ability to provide these services.

As urban and rural areas face ongoing challenges with health care access, and as even suburbs face growing poverty, we must consider the needs of all families in designing health and social service interventions. As a student of public health with a strong interest in policy, and with my years working in both research and community engagement, I know how important research is for meaningful change. I look forward to working with PolicyLab’s experts to inform programs and policy to ensure that they are evidence-based and meet the needs of children and caregivers. From my hometown to Philly, I can see how PolicyLab’s diverse intergenerational research is shedding light on strategies to support all families, regardless of where they live.

Caroline La Rochelle, MPH, is a former policy and strategy senior associate at PolicyLab.