Big Springs Medical Association, Inc.

•Goal 1: Address structural- and system-level barriers to improve Southeast Missouri residents’ access to quality, integrated SUD and other behavioral health care services. •Goal 2: Improve the quality and sustainability of rural behavioral health care services through supporting rural health care providers to offer coordinated, evidence-based and trauma-informed SUD, and other behavioral health care services. •Goal 3: Improve the capacity of the behavioral health care system to address rural community risk factors and social determinants of health affecting the behavioral health of the target rural area. The area has been plagued by hospital closures, including the closing of two rural hospitals: one located in Reynolds County in 2016, and one located in Ripley County in 2018. In addition, Iron County Medical Center (ICMC), a Critical Access Hospital, filed for Chapter 9 bankruptcy in 2018 and is restructuring due to financial losses. Although ICMC remains open, financial challenges persist due to serving an impoverished region. Because of these rural hospital closures, Poplar Bluff Regional Medical Center, located in Poplar Bluff, Missouri, and ICMC are the only hospitals located in the region, so many residents must travel over an hour to access hospital care. Target rural counties are located in the Ozark Mountains, with rolling hills and numerous traversing streams which result in many geographically-isolated areas. Five of the seven counties are considered Level 4 Frontier and Remote Areas, thereby having the highest degree of geographic remoteness. Target area counties are also located in the Missouri Delta Region—an area prone to frequent flooding. Poverty throughout the Delta area is more than 10% higher than the nation, and counties in the Delta region also have disproportionately worse health outcomes compared to the nation. The combination of scare resources, pervasive poverty, and substantial risk factors for OUD/SUD and mental health issues, as well as overall poor health outcomes of the region, requires emergency responders/law enforcement, health care providers, courts, and community organizations to proactively work together in order to mitigate the adverse effects of opioid use disorder.