USDA Seeks Applications for Nearly $12 Million in Broadband Grants for Rural Communities

Lincoln, Neb., April 26 2016 – USDA is soliciting applications for grants to establish broadband in unserved rural communities through its Community Connect program. Community Connect is administered by USDA’s Rural Utilities Service and helps to fund broadband deployment into rural communities where it is not economically viable for private sector providers to provide service.

USDA plans to award up to $11.7 million in grants through the Community Connect grant program. The grants fund broadband infrastructure to help foster economic growth by delivering connectivity to the global marketplace. The grants also fund broadband for community centers and public institutions.

USDA has invested $160 million in more than 240 projects to bring broadband to unserved rural communities since the Community Connect Program was created in 2002.

The minimum grant is $100,000 for FY 2016. The maximum award is $3 million. USDA announced new rules in 2013 to better target Community Connect grants to areas where they are needed the most. To view the rules, go to https://www.gpo.gov/fdsys/pkg/FR-2016-04-18/pdf/2016-08931.pdf

Prior Community Connect grants cannot be renewed. However, existing Community Connect awardees may submit applications for new projects, which USDA will evaluate as new applications.

For more information on how to apply for grants, see page 22567 of the April 18, 2016 Federal Register.

In Nebraska contact Roger Meeks at (402) 416-4936 or roger.meeks@wdc.usda.gov.

UNMC, ECDHD join forces in effort to prevent smoking

Courtesy photo Representatives of East Central District Health Department and the University of Nebraska Medical Center pose for a photo. The two health care providers are partnering on a research project focused on tobacco use.

Courtesy photo
Representatives of East Central District Health Department and the University of Nebraska Medical Center pose for a photo. The two health care providers are partnering on a research project focused on tobacco use.

COLUMBUS — What do different medical professions such as dentistry, radiography and nursing have in common? The unfortunate answer is tobacco.

When the University of Nebraska Medical Center and East Central District Health Department were deciding on a subject for an interdisciplinary research project, ECDHD executive director Rebecca Rayman said one of the reasons they ultimately chose tobacco and smoking prevention is because it applies to many medical disciplines and many of the health issues ECDHD treats.

“When this opportunity came to us, we looked at what are the major causes in the community for population mortality. The big two are heart disease and cancer, both of which are related to smoking and tobacco use,” Rayman said. “Then we looked at what if we could reduce smoking. We’d save millions of dollars and improve quality of life.”

The three UNMC students have seen the effects of tobacco in their rotations at rural hospitals.

Erica Boyd, a dentistry student, has done a rotation at ECDHD before. She’s seen the consequences of tobacco use and the lack of access to medical care in rural areas firsthand.

“What I found stunning is how far some people from the country will let their cancers get before coming to the doctor,” she said. “It’s hard to wrap my head around how they won’t come in until they’re not able to eat or breathe.”

Nursing student Paula Schaefer seconded that based on her experiences.

“We’ll see people coming into the hospital that their disease has progressed to an extensive level. Whether it’s cancer or cardiovascular disease, whether it’s respiratory disease, it magnifies it when they’re from a rural setting, and they’re less able to or less likely to seek medical treatment until it gets to a certain threshold where they have to,” Schaefer said. “And there’s many diseases that if you reach that tipping point, you’re on the way down and there are limited things we can do as interventions.”

Even though Tori Bailey, a radiography student from Norfolk, may not come into direct contact with patients, she sees the effects tobacco has.

“I do a lot of chest X-rays. You’ll get (the patients) coming in, and they’ll be coughing and everything and its COPD (chronic obstructive pulmonary disease). Their lungs just look terrible,” Bailey said. “You’ll see the radiograph, and it’s just like, ‘Wow.’ You can tell how much it’s affecting their body.”

For their three-week public health rotation at ECDHD, Bailey, Boyd and Schaefer are researching smoking prevention measures, what legislation has been passed and what has been effective.

Next semester’s group of UNMC students will conduct community-based research to help ECDHD and its affiliated health organizations develop strong, research-based legislation to reduce tobacco use in Nebraska.

“These three students will have the potential to have the biggest impact on the health of Nebraskans than any single physician if this project leads to legislation that reduces tobacco use,” Rayman said. “It’s a health issue, it’s an economic issue and a family issue.”

The project also indirectly addresses two other important medical issues. First is the difficulty rural communities have attracting medical professionals, even in a larger city like Columbus.

Patrik Johansson is director of the Rural Health Education Network at UNMC, which collaborates on rotations in rural clinics and facilities.

“Part of it is providing students the opportunity to work in a rural setting, which will hopefully raise awareness of opportunities and careers in rural care,” Johansson said.

Boyd said the walk-in dental clinic at ECDHD is always full because of the scarcity of dentists in surrounding areas. She just completed a rotation at a private dental practice in a town smaller than Columbus.

“The need is just much higher,” she said. “He’s booked out six months in advance.”

The project is also meant to encourage collaboration between different medical disciplines and counter the siloing that occurs when disciplines don’t communicate with one other.

“Everyone has unique gifts that come to the table. They’re trained in a specific path, but when you’re only using your path, you might miss something that they would be able to pick up,” Schaefer said. “It becomes a dynamic interchange. And the patient or the person you’re serving is the one who wins on that because they’re going to have the latest evidence and the best information instead of someone just guessing.”

“Anytime you pull in multiple perspective, multiple schools of thought or even multiple colleges of thought, it’s going to be beneficial to a project,” Boyd said.

The students will complete their three-week project next week, when they’ll give a presentation on their research.

By Christina Lieffring | Apr 16, 2016
Original Post »

This research project is one of the Rural Futures Institute’s 2015 Teaching & Engagement funded projects. Patrick Johansson is the principal investigator and the proposal is titled “Rural Interprofessional UNMC Student Rotations.” 

Kate Likens selected as ambassador for Agriculture Future of America

Kate Likens, a sophomore agriculture education major from Swanton, has been selected as a campus ambassador for Agriculture Future of America. Likens is one of just 15 campus ambassadors in the United States selected through a competitive application process to serve as AFA’s student voice and represent peers on a national level. In addition to serving as a liaison between AFA, their respective campuses and AFA corporate partners, the ambassadors will assist the student advisory team in delivering the 2016 AFA Leaders Conference Nov. 3-6 in Kansas City. Agriculture Future of America is a professional development organization for collegiate leaders and young professionals, providing leader development, intern support and scholarships.

Likens is an Engler Entrepreneurs student and soon-to-be RFI summer intern.

New Position: Communications and Public Relations Director

The Communications and Public Relations Director is responsible for developing, implementing and leading effective internal and external communications strategies for the Rural Futures Institute that communicate the vision and work of the institute both domestically and internationally, including support for efforts to influence a more positive narrative regarding rural people and places. The Director works with the Executive Team, Central Administration, other NU Institutes and others in the RFI in developing strategy and will have the opportunity to shape and build the brand and reputation of the RFI both domestically and internationally by using print, digital and a wide variety of other platforms. Because the RFI is a university-wide institute, the Director must build and maintain close collaborative relationships with administrators, communications staff and faculty on all four campuses of the University as well as in Central Administration. The Communications and Public Relations Director is also responsible for managing the communications and marketing team.

Apply Today!

Helping Small Towns Succeed

Engaging Leaders. Building Communities. Sustaining Success.

30th Anniversary Celebration of the
Heartland Center for Leadership Development

October 11-13, 2016
Snow King Resort, Jackson Hole, Wyoming
 


 

Connie copyConnie Reimers-Hild, Associate Executive Director of the Rural Futures Institute at the University of Nebraska, is one of nine featured presenters at the annual institute in October.  Connie’s session is entitled “The Future of Leadership.”  

While many are struggling to keep up with the rapid rate of change, future-focused leaders are growing their communities by blending technology with the human experience.  Leaders who utilize emerging technologies and use an inclusive approach to leadership while creating meaningful experiences, will innovate community engagement in ways not yet imagined.  This presentation will provide practical information on megatrends designed to help rural people and places change the conversation from one focused on challenges to a dialogue filled with endless opportunities.

Follow Connie’s blog as well as her Twitter feed @askdrconnie.

Registration

Register today to receive the Early Bird rate of $295, a $100 discount, offered to the first 50 paid registrants.  Your conference registration fee covers the opening reception, lunch on Wednesday, breaks on Wednesday and Thursday and all of your learning and networking materials. Click on the link below for registration.

Lodging

Snow King Resort is offering our participants a preferred rate of $139 per night. This rate is valid through September 10 or until the reserved room block has filled. On-site Resort features include a restaurant serving local cuisine, spa and fitness facility and an outdoor swimming pool.  For visitors who want to visit nearby natural amenities, Grand Teton National Park is just a short drive north of the town of Jackson and Yellowstone National Park is about three hours away.  Click here to reserve your lodging.

Get more information »

Register Now!

Rural Futures Institute Establishes New Partnership: Kaskie to lead the RFI Fellows Program

April 13, 2016 — The Rural Futures Institute (RFI) at the University of Nebraska is proud to welcome Shawn Kaskie and Aliese Hoffman to the RFI Team.  Kaskie will lead efforts in developing and expanding the RFI Fellows Program. He will be assisted by Aliese Hoffman, administrative specialist.

In the new partnership Kaskie will hold joint positions with the RFI and the University of Nebraska at Kearney’s Center for Rural Research and Development (CRRD) in the College of Business and Technology. Shawn is a certified Professional Community and Economic Developer, and a former Gallup Entrepreneurship Acceleration System Guide, a business retention and expansion consultant, and NxLevel entrepreneurship instructor.

Hoffman will also have a shared RFI/CRRD position and will assist Kaskie as program assistant for the development of the Fellows program.  Hoffman is a Red Cloud native and UNK graduate.

“Kaskie will join the RFI team with the goal of launching and growing a RFI Fellows Program“ said Chuck Schroeder, executive director of the Rural Futures Institute.

Kaskie has a Master’s degree in regional planning and undergraduate majors in public administration, sociology, and psychology from Hastings College.  He has experience in providing community economic development and market research.

“We are very excited to welcome Shawn and Aliese to the RFI team and look forward to developing even closer working relationships between the four University of Nebraska campuses as well as community and organizational partners as the RFI Fellows program evolves” said Connie Reimers-Hild, associate director of the Rural Futures Institute.  The Memorandum of Understanding between the RFI and the University of Nebraska at Kearney is the first for the Institute.

“Shawn will be in a position to advance the agendas of both the RFI Fellows Program and the Center for Rural Research and Development on the UNK campus. This is a collaboration of tremendous potential that is emerging at exactly the right time and in a most effective way” said Charles Bicak, Senior Vice Chancellor for Academic and Student Affairs at UNK.

The Rural Futures Institute is one of four interdisciplinary institutes at the University of Nebraska that leverages the talents and research-based expertise from across the system. The institute, through a culture of innovation and entrepreneurship, encourages bold and futuristic approaches to collaboratively address state, national and global challenges.

For more information about the Rural Futures Institute, visit ruralfutures.nebraska.edu. For the latest information follow Rural Futures on Twitter at twitter.com/rural_futures or Facebook at facebook.com/ruralfutures.

Klein joins NU’s Rural Futures Institute team

The Rural Futures Institute (RFI) at the University of Nebraska is proud to welcome Theresa Klein as executive associate to the RFI Team. She will work directly with the executive team to drive progress in all areas of the Institute in pursuit of its bold objective of being a world-class center for exploring and impacting all things rural.

Klein resides on a small farm west of Wahoo, Neb., and has grassroots leadership experience and perspective that adds another rural dimension to the RFI’s executive team. She joins the team from her previous role as development director for Bishop Neumann High School in Wahoo, Neb.

Klein has been engaged in a wide variety of community leadership roles including: Wahoo Chamber of Commerce, Teammates Board, Public Library Foundation and Friends of Saunders County 4-H and Extension Foundation. She currently serves on the Saunders County Ag Society and is a trustee of the Saunders Medical Center.

Klein’s previous experience includes serving as the public relations and communications coordinator for the Nebraska Department of Agriculture, followed by joining the University of Nebraska Foundation where she served as director of communications for 11 years. Klein is a graduate of the University of Nebraska-Lincoln and studied animal science and ag economics.

“Klein has a strong working knowledge of rural areas which will provide valuable insight when working with the RFI team to create synergies and to provide feedback from the community perspective,” said Chuck Schroeder, executive director of the Rural Futures Institute. “We are very excited to welcome Theresa. Her background, along with her ability to connect to people, is a great fit for our team.”

The Rural Futures Institute is one of four interdisciplinary institutes at the University of Nebraska that leverages the talents and research-based expertise from across the system. The institute, through a culture of innovation and entrepreneurship, encourages bold and futuristic approaches to collaboratively address state, national and global challenges.

For more information about the Rural Futures Institute, visit ruralfutures.nebraska.edu. For the latest information follow Rural Futures on Twitter at twitter.com/rural_futures or Facebook at facebook.com/ruralfutures.

Addressing Rural Healthcare Disparities

Addressing Rural Healthcare Disparities
Using Behavioral Economic Insights

Nonmetropolitan residents, those living outside central urbanized areas greater than 50,000 in population, are one of the largest medically underserved populations in the United States. Twenty percent of the U.S. population lives in nonmetropolitan areas, yet only nine percent of primary care providers are practicing in such areas (Rosenblatt and Hart 2000, 348). In addition to a geographic imbalance of healthcare practitioners, nonmetropolitan residents suffer from higher rates of chronic diseases and disability, report higher levels of obesity, are older on average, and are more likely to report being in fair or poor health than their metropolitan counterparts (Ricketts 2000, 640 and USDA ERS 2009, 43).

In response to this rural healthcare disparity, federal and state programs have been established to incentivize healthcare providers to practice in geographic regions that have been identified as having a shortage of primary care, dental, and mental healthcare providers. These geographic areas are called Health Professional Shortage Areas (HPSA), and over 60 million Americans live in a shortage area for primary care. Nationally, over half of these HPSA designations are in nonmetropolitan counties, while in Nebraska, over 85 percent of these designations are in nonmetropolitan counties (U.S. DHHS 2016) [1]. Additionally, the State of Nebraska designates counties as state-designated shortage areas to further identify healthcare provider needs within the state.

Being designated a shortage area makes these areas eligible to benefit from programs that incentivize providers to practice in such areas. In Nebraska, two incentive programs are administered from state funds, 1) the Nebraska Student Loan Program (SLP), and 2) the Nebraska Loan Repayment Program (LRP). Under the SLP, the state awards forgivable student loans to medical, physician assistant, dental, and graduate-level mental health students who agree to practice one year in a state-designated shortage area for every year they accept the forgivable loan. Under the LRP, physicians, physician assistants, nurse practitioners, dentists, pharmacists, occupational and physical therapists, and mental healthcare providers receive funds to pay back student loans for three years once they begin to practice in a shortage area. Both programs require the participants to practice in a state-designated shortage area for a certain period of time in exchange for the financial incentive (NE DHHS 2015). A table summarizing the differences between the programs is provided below.

 

table

 

Although both programs exist to alleviate the rural healthcare disparity, the programs have important differences in the structure and timing of the healthcare provider’s decision to commit to serve in a state-designated shortage area in return for the incentive, which may influence their effectiveness. Additionally, the SLP has implemented changes in the administration of the program over time: in 1998, participants began receiving semi-annual letters reminding them of their practice obligation to the State of Nebraska until their obligation was completed; in 2007, the cost of defaulting on the obligation was changed from 24 percent simple interest to 150 percent principal + 8 percent simple interest. In the LRP, the cost of default has remained constant at 125 percent[2] of funds received.

Initial analysis suggests that the effectiveness of the two programs in recruiting healthcare providers into nonmetropolitan shortage areas differs significantly. Since its inception, nearly 45 percent of SLP participants have failed to complete their practice obligation, compared to only eight percent of LRP participants. However, the SLP default rate has decreased over time, suggesting that the administrative and financial changes mentioned above have positively influenced the completion rate.

This difference in completion rate, given the structural differences of the programs, may be explained, in part, by a behavioral economic concept known as projection bias. Projection bias refers to an individual’s tendency to exaggerate the degree to which their future preferences reflect their current preferences (Loewenstein, O’Donoghue, and Rabin 2003, 1210). One common manifestation of projection bias is grocery shopping while hungry. In a state of hunger, an individual is likely to purchase more food and a greater amount of unhealthy options that their future, satiated self may not prefer. Hungry shoppers act as if their future taste for food will reflect such hunger (Loewenstein, O’Donoghue, and Rabin 2003, 1215).

In these incentive programs, the differences in timing of the decision to participate in a program, thereby obligating oneself to practice in a state-designated shortage area, may lead to a higher probability of projection bias in the SLP compared to the LRP. In the SLP, individuals receive the incentive while in training, and by participating in the program, agree to practice in a nonmetropolitan, medically underserved area. In this scenario, an individual is predicting their future preferences years in advance (up to seven years in the case of a medical student), compared to LRP participants, who receive the incentive once they are practicing, and make their decision to participate in the last year or two of training. New experiences or maturation can lead to discovery of or changes in preferences, while an individual’s background—e.g., whether that person has lived in a rural area before or not—may also affect prediction of future preferences. Both changes and lack of experiences may make it more difficult for SLP participants to accurately predict their true future practice preferences, resulting in SLP participants being more likely to exhibit projection bias.

Additionally, projection bias may be influenced by the participants’ perception of how binding their decision to participate is. Early on in the SLP, there was no follow-up or reminder of their service obligation during the course of the participant’s education and training. Under this condition, an individual may not have perceived that receiving the incentive binds them to actually fulfill their service obligation. As participants began to be reminded of their service obligation, participants likely viewed their decision to participate as more consequential, and spent greater time considering their future practice preferences because predicting incorrectly would result in potentially significant loss of utility. Research shows that prompting individuals to think more carefully about future preferences reduces bias (Loewenstein et al. 2003, 1213), and it is probable that individuals are more likely to devote more cognitive resources to decisions that have greater consequences for their future selves. Thus, the greater cognitive effort put into considering future preferences, and how such preferences might change over the course of professional school, is expected to decrease projection bias among participants. Those who spend less time contemplating their future preferences may naïvely assume that their current preferences accurately represent their future ones, choose to participate in the SLP, and end up defaulting if changes in their practice preferences occur.

The high buyout rate of the SLP suggests that projection bias may reduce the effectiveness of this program. The differences in completion rate, coupled with structural differences between and within programs, suggest that there is reason to believe a particular design of incentive programs may be more useful in recruiting healthcare providers to practice in medical shortage areas. Other factors may also contribute to projection bias. For instance, individual differences, such as growing up in a rural location, should help some decision makers more accurately predict their future preferences. Apart from other potential sources of projection bias, studying the efficacy of program design can provide useful insights in addressing rural healthcare disparities. By identifying what factors contribute to the highest probability of completion, similar state and federal rural health incentive programs can adapt policies to positively influence the success rate of recruiting healthcare providers to serve populations in high need.

[1] Healthcare facilities in metropolitan areas may also be designated a Health Professional Shortage Area or state-designated shortage area and may be eligible to receive state and federal funds.

[2] Default cost in the LRP has changed from 125% since 2015, but does not affect the sample of the proposed research.


PDF

Jordyn Bader
M.S. candidate
Department of Agricultural Economics
University of Nebraska-Lincoln
jbader@nebraska.edu

Christopher Gustafson
Assistant Professor
Department of Agricultural Economics
University of Nebraska-Lincoln
cgustafson6@unl.edu

References

Citations Loewenstein, George, Ted O’Donoghue, and Matthew Rabin. 2003. “Projection Bias in Predicting Future Utility.” The Quarterly Journal of Economics, 118(4), 1209–1248.

NE Department of Health and Human Services. “Nebraska Rural Health Advisory Commission’s Annual Report and Rural Health Recommendations.” December 2015. Accessed on March 8, 2016. .

Ricketts, Thomas. 2000. “The Changing Nature of Rural Health Care.” Annual Review of Public Health 21: 639–657.

Rosenblatt, Roger and L. Gary Hart. 2000. “Physicians and Rural America.” Western Journal of Medicine 173, no. 5 (November): 348–351.

United States Department of Agriculture, Economic Research Service. “Health Status and Health Care Access of Farm and Rural Populations.” Carol Jones, Timothy Parker, Mary Ahearn, Ashok K. Mishra, and Jayachandran Variyam, Bulletin No. (EIB-57). August 2009, 72.

U.S. Department of Health and Human Services. 2016. “Designated Health Professional Shortage Areas Statistics.” HRSA Data Warehouse. Last modified January 1, 2016. Accessed on March 8, 2016. Report generated at http://datawarehouse.hrsa.gov/topics/shortageAreas.aspx.

 

Small Giants Conference

Small Giants Conference | Feb. 17, 2016 | Lincoln, NE

A conference centered on the business and community principles of “Small Giants” has applications for rural business people and farm and ranch owner-operators. Visit www.angus.media to continue watching this special episode of The Angus Report, brought to you by our friends at the Engler Agribusiness Entrepreneurship Program at the University of Nebraska–Lincoln.
Meet some of rural America’s “Small Giants,” including Garden City Coop in Garden City, Kan., and the enthusiastic next generation of community business leaders.
The future of rural America is bright thanks to entrepreneurial-minded young people — and a few practiced core values that can make all the difference in developing a thriving business.
Why do some rural areas thrive while others decline? We talk about Small Giant leadership principles with Chuck Schroeder, executive director of the Rural Futures Institute, and how communities can create a vision for economic growth.