In 1999, Goodfellow began looking at the differences in rural and urban homeless service providers (Goodfellow, 1999). She discovered that there may be more differences among homeless service delivery systems in rural and urban areas than among the persons experiencing homelessness in the two areas. Through interviews with clinicians, Post (2002) identified rural service models that vary in size and distance from urbanized areas. In larger areas, strategies include community partnerships that link formal and informal support systems, multi-service centers, and hub-and-spoke models of outreach to and referrals from outlying rural and urban communities. In smaller rural or frontier areas, where there are only minimal services for people who are homeless, clinicians have two strategies: mobile outreach units and, as a last resort, Greyhound referrals or Greyhound therapy, that is, transport to urban areas that have the needed services (Post, 2002).
Clinicians have recommended strategies to overcome barriers to health care and to prevent rural homelessness. These include:
- integrating behavioral health care with primary care services to reduce or eliminate the powerful social stigma associated with mental illness in rural areas;
- providing transportation assistance to address the scarcity of public transportation in rural areas;
- expanding health coverage and facilitating access to covered services;
- expanding health care entitlement programs to cover low-income persons who are homeless or at risk of homelessness;
- developing a service delivery infrastructure in rural communities responsive to needs of people who are homeless (including temporary shelter services and basic health and social services);
- coordinating rural service delivery systems to maintain continuity of care;
- increasing outreach to hidden homeless people in remote rural areas;
- using community networks and indigenous workers to facilitate mobile outreach;
- promoting cultural competence of service staff to address communication and other cultural barriers;
- conducting early interventions for youth, families with children, and single adults who are newly homeless or at risk for homelessness; and
- focusing on prevention of homelessness by addressing structural causes of poverty (Post, 2002).