Current RTC8 Projects
Projects in this category are from the RTC8 grant awarded in September 2023. These projects represent timely research topics in the field of rural disability and highlight RTC:Rural’s continued commitment to community-based participatory research. This research will be active through 2028.
U.S. population data shape policies and programs that serve people with disabilities at the local, state, and national levels. However, quality data about rural communities and people with disabilities who live there are often lacking or challenging to use. Limited rural disability data reduces the effectiveness of policies, programs, and resources that serve rural people with disabilities. For instance, disparities that are not measured cannot be addressed and strengths that are not captured cannot be leveraged. We need to look towards expanding the quality and scope of rural disability data for the future, while also conducting rigorous and relevant analyses using data that is currently available.
- Improve access to accurate and current data about disability experiences in rural communities.
- Conduct rural data analyses that matter to rural disability stakeholders.
- Host a Rural Disability Summit to identify quality data for measuring community capacity to support people with disabilities in rural communities.
- Collaborate with Disability Statistics and Demographics Rehabilitation and Research Training Center (StatsRRTC) to develop an annual rural component for the Disability Statistics Compendium and topical rural factsheets and publications.
- Improve rural recruitment into the National Survey on Health and Disability (NSHD); include survey questions in the NSHD that are relevant and valued by rural people with disabilities; and collaborate on NSHD analyses focused on underserved communities.
- Expand Disability Counts to fit with community-informed data needs.
Data analyses often focus on urban outcomes and do not consider the status of rural services and contexts. This can result in recommendations that do not apply to rural settings and can even lead to negative outcomes. It is important to elevate the experiences of rural people using national data sets.
- Use publicly available national data to provide information to policymakers, researchers, consumers, providers, and advocates about:
- The status of VR services for underserved groups, including rural and racial subgroups.
- The status of rural transportation services and funding.
- The geospatial relationships between nursing homes, nursing home closures, community characteristics, and CIL locations (whose services include linking transitioning people with community-based supports).
- Using Rehabilitation Services Administration (RSA) case services data, conduct comparative analyses and regression models to predict receipt of VR services for different sized places (urban, large rural, small rural, and remote) and underserved groups.
- Compare rural and urban differences in travel patterns using the National Household Transportation Survey and in transit funding using linked National Transit Database and American Community Survey data.
- Develop a logistic regression model that predicts nursing home closure status and a spatial network analysis that demonstrates CIL distance from recently closed nursing homes.
The U.S. is facing a dire worker shortage in personal assistance services (PAS) and the issue is even worse in rural places. Personal Care Aides (PCAs) provide home and community-based PAS that are essential for millions of people with disabilities. Going without these services results in harsh outcomes such as sitting in soiled clothing, missing meals, risking injury, and going without needed healthcare. The COVID-19 pandemic exacerbated these issues, forcing states to acknowledge the long-standing problem of unmet needs for services.
In 2020, there were 4.6 million direct care workers providing personal and basic healthcare in nursing homes, group residential settings, and personal homes. Long-term care employers project they will need to fill 7.4 million openings by 2029. By 2031, the U.S. Bureau of Labor Statistics estimates that there will be 4.5 million openings for home health and personal care aides – one of the fastest growing occupations.
- To understand the impact of the COVID-19 pandemic on rural PAS workforce capacity.
- To understand what community, state, and federal factors are associated with differences in rural workforce capacity across different geographies.
- Establish a national work group of 5-7 members with expertise and lived experience related to rural PAS.
- Spatially analyze national data to compare workforce shortage areas before and after the onset of the COVID-19 pandemic.
- Use participatory methods to identify community and systemic factors expected to be associated with rural PAS workforce capacity.
- Identify appropriate data sources for these indicators and analyze their relationship to rural PAS workforce capacity.
- Use the findings to create products that will elevate the issue of rural PAS worker shortages and potential solutions for ensuring these services are available.
Many health conditions can be reduced through self-management activities. Health promotion programs targeting people with disabilities can promote self-management and reduce the incidence and severity of many secondary health conditions, reduce the frequency of unhealthy days, and lower healthcare utilization costs. Group and one-on-one health promotion interventions are useful for improving people’s health-related knowledge, and interventions that include social support have been shown to be more effective than those without.
- Expand opportunities for people with disabilities to receive health promotion services in rural communities.
- Improve health outcomes and health-promoting behaviors among rural people with disabilities.
- Develop a website-based health coaching curriculum to train coaches in the one-on-one model.
- Implement two health promotion delivery models (i.e., remote facilitated peer-group or remote one-on-one health coaching) based on the Living Well in the Community curriculum and evaluate them on selected outcomes.
- Integrate CIL stakeholder (i.e., facilitators and coaches) perspectives into the interpretation of evaluation findings.
- If one or both programs are promising, conduct focus groups with CIL stakeholders (i.e., facilitators and coaches) to assess the long-term sustainability of these remote delivery models within their CILs.
Self-employment represents an important alternative to wage and hourly employment for people with disabilities, particularly in rural and reservation communities where job opportunities are limited. Self-employment is an attractive option for people with disabilities because it offers a means to economic independence while overcoming disability-related employment barriers. Self-employment is particularly valued on American Indian reservations and Alaska Native villages because it creates economic independence, reduces out-migration, and builds upon cultural traditions and identity.
- Expand AIVRS consumer and counselor capacity to explore and pursue self-employment opportunities.
- Develop a sustained approach to supporting self-employment through collaborations with the American Indian Vocational Rehabilitation Training and Technical Assistance Center (AIVRTTAC).
- Develop tailored in-person training based on the Tribal Vocational Rehabilitation Self-Employment Toolkit (TVR SET) with AIVRS advisors.
- Conduct two pilot tests of the tailored regional training model and conduct interviews with pilot participants to learn how the training supported their use of TVR SET materials.
- Develop regional-specific training with regional experts (e.g., at least one AIVRS stakeholder from each region) and deliver in-person training in collaboration with the AIVRTTAC.
- Conduct informant interviews with counselors about (a) how they have utilized the TVR SET materials to help consumers progress through the self-employment process, (b) barriers they encountered, (c) gaps in the process, and (d) perceptions of outcomes in terms of self-employment readiness, feasibility, and business development.
- Collect and analyze survey data from training participants about training effectiveness and self-employment activities within their practices.
- Analyze AIVRS annual reports to the Rehabilitation Services Association (RSA) to track changes in self-employment outcomes for programs that have received regional training compared with those that have not.
- Work with the AIVRTTAC to sustain the TVR SET curriculum and training into the future.
Nearly 30% of disabled Americans do not drive and more than 3.6 million Americans with travel-limiting disabilities never leave home. This issue is compounded for people with disabilities living in rural areas where public transportation is often lacking. Transportation voucher models offer a solution to this problem.
Transportation voucher programs provide eligible consumers with a voucher checkbook and an allocation of miles they can use to pay for rides. Depending on how the program is organized, consumers can use these vouchers to access public transit, get rides from volunteer drivers, or use them to reimburse family or friends. Voucher models are a cost-effective strategy for increasing transportation access, addressing lack of transportation, improving access to employment and community participation opportunities, and increasing independence and quality of life. Current resources for operating and sustaining voucher programs, however, are outdated and under-supported. The purpose of this project is to develop a contemporary Rural Transportation Voucher (RTV) Toolkit that supports the organizational capacity to establish, operate, and sustain a rural transportation voucher program and support the effective use of vouchers by consumers.
- Build organizational capacity for operating rural transportation voucher programs.
- Support effective use of transportation vouchers for people with disabilities.
- Establish an advisory group of seven stakeholders, consisting of rural disability leaders and rural transportation experts, that meet quarterly to inform project activities.
- Identify key barriers, solutions, and strategies for establishing, operating, and sustaining a rural transportation voucher program.
- Conduct key-informant interviews with transportation voucher program managers and voucher consumers.
- Develop a web-based rural transportation voucher toolkit that integrates content from our existing toolkit, knowledge from key-informant interviews, and expertise of our stakeholder advisors.
- Recruit two pilot sites to test implementation of the updated RTV Toolkit.
- Document use and impacts of the updated RTV Toolkit among managers, drivers, and consumers.
- Disseminate findings, develop recommendations, and provide technical assistance to additional organizations.
People with disabilities often live in homes that are not designed for their bodies and abilities. The Home Usability Program (HUP), offered by Centers for Independent Living, addresses many of these barriers to improve quality of life and participation among people with disabilities. Unfortunately, CILs, like many community-based organizations in rural communities, struggle with program sustainability, specifically program funding and support. One method for promoting program sustainability is through building an organization’s capacity to effectively measure and communicate outcomes through evaluation capacity building (ECB). ECB has been identified as a strategy that can impact program funding and organizational support, particularly in rural areas where there is an increased dependency on federal and state funding (i.e., government grants) where evaluation is increasingly a reporting requirement. ECB strategies can be used by CIL staff to build a shared organizational and programmatic story that builds community-based relationships and outcomes for funding sustainability.
The goal of this project is to scale up the existing evidence-based HUP into a sustainable model using evaluation capacity building strategies.
- Use community-based participatory methods to build out ECB training components for building HUP evaluation capacity with two CILs.
- Pilot the training and evaluation data collection strategies iteratively in two CIL sites to inform needed ECB training modifications.
- Conduct key-informant interviews with program staff, and community partners to understand CIL evaluation capacity, evaluation impacts on sustainability efforts, and rural implementation considerations to further inform ECB training modifications.
- Test resulting ECB training and evaluation activities at four additional CILs with the goal of examining their ability to collect and use evaluation data for sustainability. This will include examination of evaluation data and qualitative feedback about the ECB process.
- Measure the effectiveness of ECB procedures and HUP sustainability.
The outcomes and relevance of disability-focused research are improved when people with disabilities and other stakeholders inform the research process. RTC:Rural collaborates with the Knowledge Translation for Disability and Rehabilitation Research (KTDRR) to engage stakeholders in shaping the rural knowledge translation (KT) research agenda through rural needs assessment and rural focus groups. This engagement helps identify key points and future research topics, as well as insights on messaging and strategies for reaching target audiences.
- Positively impact rural disability community capacity by transferring knowledge to rural people with disabilities.
- Build upon KTDRR’s efforts to promote uptake of knowledge in underserved rural communities.
- Serve on KTDRR’s Equity and Access Team to shape the survey about rural needs and collaborate with KTDRR on rural focus groups, including under-resourced rural subgroups.
- Perform qualitative analysis to inform rapid evidence reviews completed by KTDRR that will inform our work.
- Participate in the KTDRR conference on tailoring KT strategies for under-resourced groups.
- Work with KTDRR to share research findings to create a multimedia Did You Know series that will serve as a PSA for disability research.
- Participate in KT peer-to-peer technical assistance (TA) calls.
To speak for rural people with disabilities, we first need to speak with them. These roundtables offer an impactful opportunity to share and receive information with a variety of stakeholders. The conversations will inform our research goals and approaches, potential partnerships, and set the stage for future research forums that are informed by those most impacted.
- To better understand rural disability perspectives and apply them to our research and KT activities.
- Recruit participants who are well-informed on the individual roundtable discussion topics (e.g., 2023 – the magical power of data).
- Conduct annual, in-person roundtable sessions at APRIL conferences.
- Synthesize feedback from roundtables to bridge research to policy to practice and inform KT activities.
Each year, RTC:Rural determines a timely rural disability-related topic on which to center a forum. This provides our team with an avenue to not just share our current research but also talk about emerging trends with a variety of stakeholders. These forums provide a foundation for how we can collectively move research into policy and practice. They also complement the roundtables, providing us with an ideal combination of gathering and communicating information on rural disability.
- To share knowledge that we have gained from KT2 and other research projects with our broader audience.
- To expand the availability and use of quality data within the rural disability community.
- Recruit consumer and service provider stakeholders to serve on the co-planning committee.
- Plan and execute annual forums to share and discuss opportunities to apply RTC:Rural research to policy and practice.
- Produce and disseminate fact sheets or white papers summarizing each forum.
The goal of every RTC:Rural project is to identify strategies that ensure applicable knowledge is transferred to identified target audiences in an appropriate way. Research, training, and technical assistance activities are all geared toward community stakeholders as the end knowledge users. We create a wide variety of outputs and deliver them through multiple methods, leveraged by our organizational partners. Our current focus is on the sustainability of projects and building new capacity for our training activities.
- Continued support of past RTC:Rural products and interventions for long-term capacity.
- Build new service delivery capacity for emerging products and findings.
- Training to VR state agencies to support self-employment exploration and business planning using the VR Self-Employment Guide (vrselfemploymentguide.org).
- Training to CIL staff to support delivery of the Living Well in the Community and Working Well health promotion workshops, Community Living Skills Training, and Facilitating Groups Training (see HCL suite: healthycommunityliving.com).
- Training to support CIL capacity building on the Advocacy Toolkit, Deep Conversations Exercise, and Rural Community Resource Maps.
- Training for CILs to support one-on-one health promotion coaching.
- Regional training to AIVRS programs to support self-employment exploration and business planning on reservations lands using the Tribal Vocational Rehabilitation Self-Employment Toolkit.
- Rural agency-based training to support use of the Rural Transportation Voucher Toolkit.
- Training to support CIL Evaluation Capacity Building to support the Home Usability Program.
- Training for policymakers, researchers, and disability stakeholders through webinars, presentations, and forums.
- Academic training and mentoring of students from a variety of disciplines to introduce them to disability issues and participatory-based research.
- Technical assistance for project-related stakeholder requests.
- Proactive TA through surveys to discover stakeholder needs and interests.
- Continued TA for established programs.
- TA to increase rural disability data:
- Developing tailored data reports and maps.
- Using the Disability Data Dashboards and maps.
- Using data to engage policymakers, apply for grants, and inform community capacity building activities.