Meeting the Challenge of Social Service Delivery in Rural Areas
By Pamela Friedman
Although much of the policy debate on welfare reform
has concentrated on the urban poor, nearly 20 percent of welfare recipient
families reside outside of central cities and metropolitan areas. They,
along with other rural working families, rely on various social services
to help them move toward self-sufficiency. Affording rural residents
access to social services is a challenge even in the best of times. With
the decline in state revenues expected to continue, the challenge will be
Many of the challenges to social service delivery in
rural areas are similar to those faced in central cities and metropolitan
areas. Other social service delivery challenges are more formidable in
rural locations. For example, ensuring access to affordable and adequate
child care and convenient and reliable transportation is especially
difficult in geographically isolated areas. Encouraging economic
development in these areas is also a challenge (Pindus 2001). Rural
communities often lack the infrastructure needed to attract businesses,
and the expenses associated with development can be high; both factors
limit job opportunities. Less commercial development and lower per capita
incomes limit local tax revenue in rural areas which may mean fewer
resources for social services. Rural employers are less likely than urban
and suburban employers to provide health insurance, and access to
affordable health care is limited in rural locations. Rural welfare
recipients who are making the transition from cash assistance to work
rarely continue to make use of Medicaid benefits. Furthermore, rural
agency staff sometimes find it hard to identify families in need because
the sociological and psychological deterrents to reliance on public
assistance are more prevalent in rural communities (Weber, Duncan and
The costs per capita associated with service delivery
tend to be higher in rural areas because of their lower population
density. With the current decline in state revenues, state agencies are
reexamining their priorities in service provision. As state agencies
strive to provide the most comprehensive support in the most
cost-effective manner, low-income residents of rural communities could
bear the brunt of diminished services.
The definition of “rural” has an impact on the
study of social service provision in these communities. The Census Bureau
defines “rural areas” as incorporated and unincorporated areas with
fewer than 2,500 residents and open space, but most researchers
distinguish between metropolitan and nonmetropolitan counties in their
studies. Nonmetropolitan counties are located outside the boundaries of
metropolitan areas and have no cities with 50,000 or more residents. This
definition, however, does not account for the variation among
nonmetropolitan areas. For example, residents of rural communities located
in close proximity to urban or suburban centers are more likely to have
access to a wider range of job opportunities and social services than are
residents of more isolated communities.
This Issue Note
explores the challenges facing social service agencies in delivering
services to meet the special needs of rural area residents. It offers
suggestions on how to design programs and policies to address those needs.
For more information, visit http://www.financeprojectinfo.org/rural/rural.asp.
and Program Issues
states want to consider developing social service policies that target
The demographics of rural working families differ significantly from those
of urban families, and these demographics influence their attitudes about
accessing social services as well as their need for support. Compared with
their urban counterparts, rural welfare recipients are more likely to be
white, living in two parent families, and already working. Rural
employment opportunities tend to be more limited and offer fewer benefits.
Many rural welfare recipients work more than one job and still live in
poverty. Education levels tend to be lower among rural workers, making it
more difficult for them to meet minimum job requirements (Findeis et al.
2001). In addition, rural residents approach the challenges associated
with poverty differently. For example, to make ends meet, many rural
workers participate in the informal economy, which is not recognized as
meeting the work requirement under the Temporary Assistance for Needy
Families (TANF) program. Efforts to participate in allowable work
activities may disrupt their informal work arrangements, ultimately
causing additional economic hardship. Moreover, many rural residents are
reluctant to admit they need government assistance, even if they qualify
for help, because dependency on programs such as TANF, Medicaid, and food
stamps carries a stigma.
Some research contends the current funding formula
for TANF penalizes states with large rural populations (see Findeis et al.
2001). This formula is based on expenditures under the previous Aid to
Families with Dependent Children program that were largely driven by
state-set welfare grant levels.States
with below-average welfare grants per person are disproportionately rural.
In addition, the seasonality of many rural jobs results in greater TANF
recidivism among rural recipients. States are facing a decline in revenue
that is negatively affecting budgets nationwide. According to the
Rockefeller Institute of Government, state revenue fell by 10.4 percent
between April and June 2002, compared with the same period in 2001; this
represented the fourth consecutive quarter of decline. Kraybill and Lobao
(2001) note that 38 percent of rural counties reported a decrease in
federal revenue, and the counties view this decrease as a major challenge
to service provision. Although many states were able to set aside rainy
day funds during the economic expansion of the late 1990s, policymakers
may hesitate to spend these funds because they expect economic conditions
to worsen. Moreover, recent changes in federal and state revenue sharing
had significant impacts on both urban and rural areas at the same time the
demand for services increased. Therefore, states might want to rethink
service provision strategies. Targeting programs to meet specific rural
needs could result in a more effective use of dwindling funds.
needs might be addressed by social service policies that target rural
social service policies could address such local needs asjob creation and economic development, access to support services,
infrastructure support, and a greater emphasis on human capital
Low population density and the lack of basic
infrastructure in rural areas hinder economic development efforts that
could bring new jobs to these communities. Unlike major metropolitan
areas, rural areas are more likely to be dependent on a single employment
sector. Wages tend to be lower in rural jobs, and many of these jobs are
seasonal. Rural employers are more likely to know one another and
informally share information about their workers. Adults with barriers to
employment may therefore find it harder to obtain or keep jobs (see
Whitener et al. 2002). Lower population density also makes it more
difficult to provide services that support work.
Working families in rural areas must rely on
transportation not only to access work, but also to access the supports
necessary to maintain employment. Whether they drive their own cars or use
public transportation, rural residents face longer commutes to their
workplaces, child care providers, and job training sites. Because they
spend more time commuting, their children spend more time in child care,
resulting in added expenses. Residents dependent on public transportation
face even greater challenges. Dewees (2002) notes that nearly 40 percent
of all rural residents live in areas with no public transportation and
another 28 percent live in areas with limited levels of service.
Relatively few rural welfare recipients own cars, so access to dependable
public transportation is vital. Strategies to improve access to
transportation include providing assistance so recipients can purchase and
maintain private vehicles, vanpooling, using other agencies’ vehicles,
and encouraging employer-provided transportation.
Access to reliable and affordable child care is
another challenge for rural families. The number of skilled and available
child care providers in rural areas is limited. Child care centers are
widely scattered, so center-based care is typically not an option. Rural
welfare recipients are more likely to work nontraditional hours, further
limiting access to child care. In addition, many rural residents rely on
informal arrangements with family and friends. Cultural concerns also
influence their choices. Many parents believe family and friends are more
apt to instill similar beliefs and provide more individualized attention
to children in their care. Although these child care arrangements are less
expensive and more flexible, caregivers are generally not licensed,
typically lack formal training, and frequently are less reliable. Rural
child care providers may also lack access to available resources and
supports, and they may not adequately prepare the children in their care
for success in school. Social service agencies may address these concerns
by helping providers become licensed and by building a training
infrastructure that includes basic training on child safety and
According to the National Rural Health Association
(1999), rural areas have a much more limited supply of primary care
practitioners and other health care providers. In addition, low population
density makes it difficult to deliver services targeted to persons with
special health needs. Residents of more remote areas are less likely to
have coverage. The uninsured are also more likely to go without or
postpone health care, resulting in their illnesses becoming more critical
and more costly to treat. Employers who provide insurance to their rural
workers incur greater expenses in providing coverage; this leads to
demands for higher copayments from employees and larger employee
contributions to insurance premiums. Rural children are more likely to be
uninsured and to have had at least one spell of uninsurance during a given
period. However, because their families anticipate they will obtain
insurance with the next job, they are less likely to take advantage of
programs such as the State Children’s Health Insurance Program (SCHIP).
States may want to redesign SCHIP so it bridges gaps in coverage, for
example, by eliminating the waiting periods some states have implemented
to address the risk of families that otherwise would have private coverage
applying for SCHIP. Collaboration with other assistance programs such as
the Special Supplemental Nutrition Program for Women, Infants and Children
(WIC), child support programs, school lunch programs, and Head Start can
help with outreach efforts. States can also collaborate with
community-based and faith-based organizations to increase public awareness
of SCHIP and assist with enrollment efforts. Such collaborations can
decrease the stigma and cultural barriers that may prevent a family from
enrolling in SCHIP. For example, states looking to target hard-to-reach
rural children may want to collaborate with community action agencies that
can act as liaisons to other organizations such as Future Farmers of
America, 4-H clubs, and home extension clubs.
Social networks in rural communities are more
integrated but smaller in scope. Nonprofit service providers incur greater
costs per client, which results in less service provision. Many rural
communities rely on part-time local officials and are less likely to have
the human and fiscal resources needed for public administration (Rural
Policy Research Institute 1998). These circumstances can result in more
innovative programs, but significant planning and careful administration
are required to provide needed services. Encouraging organizations to
share staff and work cooperatively can help meet community needs. For more
information, see Relave 2000.
What role can
state agencies play in meeting the social service needs of rural families
making the transition from welfare to work? States may want to consider these options to
better meet the social service needs of rural working families.
Promote interagency collaboration and service coordination within
and among rural counties.
Expand collaboration beyond traditional social welfare programs to
include ties with workforce and economic development programs.
Target financial support and funding formulas for contractors and
sub grantees by factoring in rural area characteristic.For example, develop a distribution formula that takes into
consideration square miles covered along with population served.
Define program eligibility requirements for rural residents. For
example, ease sanction restrictions, modify time limits in areas of high
seasonal unemployment, or count part of the commute time as work for
recipients with long commutes.
Increase the use of electronic benefits transfer to help clients
overcome the stigma associated with the receipt of public assistance.
Provide specialized training for frontline staff.
Use alternative forms of service delivery, such as the web, the
telephone, outstationing, and home visits.
Approach social service delivery from a business perspective.
Employers may be encouraged to expand or relocate to communities with more
comprehensive and cost-effective services.
Expand one-stop centers beyond their role in workforce development
to serve as points of community access.
Standardize assessment tools to determine clients’ multiple
Although many rural agencies operate with reduced
staff, frontline staff are more likely to have personal relationships with
their clients. Staff should be encouraged to use these relationships to
identify specific needs and provide appropriately targeted services on a
case-by-case basis whenever possible.
How can social
service providers more effectively serve the needs of rural clients? Providers
can consider tailoring their programs to meet the specific needs of rural
clientele. Low population density and customs that discourage dependence
on government support should be taken into account. Providers may have to
develop client data tracking and management systems because many rural
agencies lack the funds and expertise to develop extensive systems
themselves. Service providers may also want to tie into successful
community partnerships that link formal and informal support systems.
Many rural residents may be discouraged from looking
for work because they believe no jobs are available close to home.
Providers can take an active role in disseminating information about
nearby employment opportunities. Because local jobseekers are more likely
to use informal networks to find work, providers should be encouraged to
work very closely with local employers to identify and make job
placements. Moreover, because employment opportunities are more limited in
rural areas, providers may want to work with local employers to identify
employers’ skill needs and design training to impart these skills. To
promote job retention, providers may also want to provide extensive backup
support to new employees through coaching and mentoring.
can states use to support comprehensive social service provision in rural
Service demands in rural counties have risen at rates similar to those in
metropolitan counties. During the past few years, most counties have noted
an increase in administrative workloads related to devolution-related
social programs. For example, Kraybill and Labao (2001) found that
administrative duties related to child care increased in 78 percent of
metropolitan counties and in 70 percent of rural counties that administer
child care programs. Duties related to food stamp administration increased
in 40 percent of metropolitan counties and in 38 percent of rural counties
that administer food stamp programs. The Medicaid administrative workload
increased in 69 percent of metropolitan counties and in 61 percent of
rural counties that administer Medicaid programs. The same study found,
however, that the grant-seeking capacity of social service agencies in
rural areas is much lower than the grant-seeking capacity of their
counterparts in metropolitan areas. Only 28 percent of rural counties
employ grant writers. States may want to explore opportunities that enable
rural counties to share grant writers or to hire consultants to perform
this function on an as-needed basis.
Rural counties are also much less likely to engage in
economic development activities, which impedes efforts to provide jobs.
However, states can take advantage of the flexibility in programs such as
TANF to create linkages among programs and develop innovative approaches
to social service delivery. States and localities can use several
mechanisms to define the responsibilities among the agencies involved, as
well as ensure their accountability, in collaborative activities. These
mechanisms include formal contacts, interagency memoranda of agreement,
and joint planning processes.
States may want to expand their efforts to meet human
service delivery needs through collaboration. For example, to simplify the
application process, they can use common definitions across programs, set
similar asset limits across programs, and use common reporting forms
across programs. Cross-program staff training can also be effective. By
concentrating on programs that share common goals and serve similar
populations, integration will be more easily achieved. Collaboration can
also result in improved formal and informal communication among frontline
and management staff.
However, social service programs’ varying
performance measures and different regulatory and reporting requirements
will need to be addressed. Reauthorization efforts to increase state
flexibility to pool funds from different federal sources and agencies or
to shift funds from one program to another may also aid collaboration.
Simplified and unified cost accounting and reporting systems, as well as
other administrative modifications across agencies and programs, would
support expanded state flexibility.
States can also encourage program collocation in a
one-stop environment. Federal welfare reform legislation and workforce
development legislation allow states and localities to integrate or
coordinate the administration and/or delivery of welfare and workforce
services, but the laws do not require interagency collaboration. The
Workforce Investment Act requires several programs to be partners in the
one-stop delivery system. TANF is a suggested partner, so states can
require TANF to be a partner. Ragan (2002) found that collocation with
other program staff, managers, and service providers improves
communication and creates bonds among staff from different offices.
Collaborative efforts to expand support services range from pediatric
clinics to family crisis intervention. He cites a number of successful
local collaboration examples, including initiatives in San Mateo County in
California, Anoka and Dakota Counties in Minnesota, and Mesa County in
Colorado. In Mesa County clients who visit the workforce center and
express a need for benefits in addition to employment assistance can
attend classes that describe the various programs and assist with
applications. Community-based, faith-based, and for-profit providers
provide many of the social services.
Prior to the implementation of welfare reform, human
service programs were not always viewed as part of a unified system, nor
were they designed to act as such. They were created at different times
and administered by different government agencies and organizations. The
passage of the Personal Responsibility and Work Reconciliation Act
accelerated the devolution of program administration to states. Some
states opted to devolve programs to local counties and communities.
Although substate devolution affords greater flexibility in program
development, many rural areas lack the infrastructure necessary to
effectively implement services and cannot meet the service needs of local
Kraybill and Labao (2001) compared county governments
in five key areas¾financing,
welfare reform, economic development, land use planning, and public
service provision. They found an increase in the administrative workload
for devolved social programs such as health, child care, workforce
training, and transportation. The increase was particularly acute for
rural counties. At the same time, states are facing budget shortfalls and
staffing changes that limit their ability to address social service
delivery challenges. In addition to escalating budget deficits, state
agencies are losing expertise as growing numbers of state workers reach
retirement age (Dohm, 2000). These changes may negatively impact program
implementation as demands for service delivery continue to grow.
While rural counties report less of a funding shortfall than their urban
counterparts, they also report less expansion in business attraction,
economic development, and workforce development; less expansion in these
sectors negatively affects job growth. From a national perspective, trends
in rural poverty, earnings, and welfare receipt have paralleled urban
patterns. However, the national trends mask important differences (Weber,
Duncan and Whitener, 2002). Rural welfare recipients are more likely to
cycle on and off welfare because the available jobs are often seasonal.
Furthermore, because many rural jobs are low-wage jobs, workers cannot
meet their daily living expenses. Henry et al. (2002) stress the
importance of identifying which industry sectors influence welfare
dynamics at the local level. Policymakers can use that information as they
work with employers to develop employment options in off-seasons.
County, Arkansas, the welfare office offers clients expanded hours of
operation during daylight savings time. The office is open from 7:00 a.m.
to 5:30 p.m., enabling clients to obtain assistance prior to reporting for
work. The office is fully staffed during these hours, and a supervisor is
always on site. Clients can also use a drop-off box to deposit forms and
other paperwork during off-hours. Whenever possible, clients can schedule
a phone interview in lieu of an on-site appointment. The TANF office also
provides transportation assistance to clients through a collaborative
effort with a local hospital. Whenever the hospital is not using its van,
the welfare office can use it to transport clients to work or job training
classes. The van is also used to transport seniors to and from adult day
care. TANF, hospital, and state transportation department funds support
the collaboration. Because the van service has been so successful, funds
have been made available to cover the purchase and operation of a second
van. For more information, contact Linda Smith at 501-354-2418 or Linda.Smith@mail.state.ar.us.
County, California,as with
many rural counties, low-income families are largely dependent on
government agencies for basic health and human services. An Interagency
Coordinating Council was established in 1979 to facilitate multi-agency
collaboration. Under the council’s lead, an interdisciplinary governance
system was established to serve the needs of area youth. The council chose
to target youth services after a countywide survey conducted in 1995
identified substance abuse and juvenile crime as two major areas of
concern to residents. It created and formalized the Health Improvement
Partnership to address these issues. Through the planning process, it
became apparent that the issues of crime and substance abuse extended
beyond the criminal justice system, affecting education, social services,
mental health, and public health, too. Consequently, the partnership
designed an implementation strategy that included a combination of
resources and client services. Working together, the council and
partnership developed a coordinated governing system that provided direct
services, policy development, and implementation. The direct services
component, known as the Multi-Agency Treatment Team (MATT), redesigned
case system operations. MATT I is composed of direct service providers
from several agencies and serves as an interdisciplinary case management
team. Members of the team meet twice weekly to address the needs of
at-risk children and youth. Collaborating agencies work together to
develop, coordinate, monitor, and evaluate individualized service plans
designed to prevent out-of-home foster placement and reduce the cost of
group home care. Staff training for the MATT I team included case
management, team building, cultural competency, and team approaches to
high-risk youth services. MATT II, the program development component,
developed programs designed to address gaps in services while maximizing
collaboration. Programs include the Early Response Team, which provides
assistance to youth referred to protective services; Standing Tall Against
Teen Issues, which stresses prevention; and Whatever it Takes; which is a
mentoring program for preteens. The Health Improvement Partnership was
also instrumental in implementing a common data management system for use
across agencies. The county has been able to provide a greater number of
resources for families and achieve a more equitable distribution of
services throughout the area. For more information, contact Valerie Lucero
The Southeast Kentucky
Community Access Program (SKYCAP) is a collaborative demonstration
program designed to improve access to housing, health care, and social
services for the uninsured and underinsured residents of Harlan and Perry
Counties. The program, launched in September 2000, is recognized as a
national model. It is a community partnership that includes the University
of Kentucky Center for Rural Health, Hazard Perry County Community
Ministries, and Harlan Countians for a Healthy Community. Two unique
features of the program are the trained family health navigators (FHNs)
and a management information system. FHNs, who are community natives,
conduct home visits and perform health, mental health, and social service
assessments of uninsured and underinsured families. They provide referral
information to clients and their families and act as liaisons between
clients and service providers. Family health navigators receive continuing
education in wellness action, adult mental health case management,
diabetes management, and eligibility training, all provided by the
department of social services. The management information system is a
unique product that pulls together information from sources that address
health care for the target population for ambulatory diseases such as
asthma, diabetes, hypertension, heart disease, and mental illness. The
system tracks client activity across health and social service providers,
including diagnoses, medications, treatment plans, test results, and
barriers to health and access. During its first year of operation, SKYCAP
received more than 5,000 referrals and provided more than 9,200 services.
Other programs are reviewing the SKYCAP process of case management and
information tracking. The Rural Appalachian Cancer Demonstration Program
serving Tennessee, West Virginia, and Eastern Kentucky is developing a
complementary system, and Kentucky legislators are studying the case
management and management information system tracking process for
potential adaptation by the Medicaid program. For more information,
contact Fran Feltner at 606-439-3557.
Child Care Services Association of North
Carolina operates two programs to address child care deficits in the
state. Both programs were developed to address the negative effects that
low teacher education rates and high teacher turnover rates have on
children’s development. T.E.A.C.H.
Education and Compensation Helps) Early Childhoodâis a
statewide initiative that offers an array of scholarships directly to
eligible child care personnel to help support their professional
development in early care and education and offers incentives
incrementally as a strategy to reduce turnover. It was developed in
response to statewide workforce data that revealed most teachers in child
care programs had only a high school education, were earning low hourly
wages, and left their programs at a rate of 42 percent per year.
Participation in this scholarship program requires ongoing support from
the child care employer and scholarship recipient as well as from the
Child Care Services Association, the administrative home for T.E.A.C.H. In
North Carolina scholarship funds support coursework at the community
college level or four-year college level leading toward credential or
degree attainment. More than half of the recipients (52 percent) for the
first fiscal year were from rural counties. The program is currently
administered in 21 states. For more information, contact Edith Locke at
919-967-3272 or edithL@childcareservices.org.
The Child Care WAGE$âproject provides education-based salary supplements to child care
providers, teachers, and directors working with children from birth to age
five, without affecting parental fees. The program compensates child care
providers who have higher education and who remain steadily employed in
their child care program over time. The statewide turnover rate of WAGE$âparticipants for fiscal 2001-2002 was 17 percent. The preprogram
statewide teacher turnover rate for a comparable period was 31 percent. In
addition, 15 percent of the active population of participants earned
education to move up to a new level on the supplement scale, and 188
providers earned a two-year, four-year, or graduate degree in early
childhood education or its equivalent. Child Care WAGE$â
is also licensed in Florida, Kansas, and Oklahoma. For more information,
contact Allison Miller at 919-967-3272 or
rural West Virginia, CHANGE
Inc., a local community action agency, was instrumental in organizing a
collaborative effort that serves many of the area’s low-income workers
without access to employer-sponsored health insurance. The partnership
includes the Weirton Medical Center Foundation, the West Virginia Northern
College Student Nursing Program, the West Virginia School of Osteopathic
Medicine, a local pharmacy, and the Ohio Valley Medical Center’s
Residency Program. The CHANGE Inc. Health Care Center also allows
physician residents and student nurses, who volunteer their services, to
complete the requirements for their degrees under the supervision of the
center’s medical director and a nurse practitioner. Doctors routinely
refer families to other community resources so total well-being can be
achieved. Patients must provide proof of no health insurance to receive
assistance. A rural transportation program enables patients without access
to cars to get to local and regional hospitals. The center not only has
increased the numbers of patients served, but has also increased its
network of health professional volunteers. Two additional initiatives, a
dental clinic and a patient assistance program, have grown out of the
effort. For more information, contact Judy Raveaux at 304-797-7733 or firstname.lastname@example.org.
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Children.” Working Paper, no. 26 (November 2001). Maine Rural
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Jennifer L. Noyes. “Enhancing the Capacity for Cross-System Innovation:
A Project Overview.” Working paper, Institute for Research on Poverty,
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Individuals.” Rural Welfare Issues Brief (April 2002). Macro
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Lucero. “The Tehama County Health Partnership: Systems Change in the
Provision of Human Services.” In
Systems Change in the Provision of Human Services, ed. Stephen Isaacs.
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Rural? Washington, D.C., December 13, 2000. Available at
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Reform Reauthorization and Rural America: Implications of Recent Research.
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Whitener, eds. Dimensions of Welfare
Reform. Kalamazoo, Mich.: W. E. Upjohn Institute for Employment
Research, 2002. Contact 269-343-5541.
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“As the Dust Settles: Welfare Reform and Rural America.” In Dimensions
of Welfare Reform, ed. Bruce A. Weber, Greg Duncan, and Leslie A.
Whitener. Kalamazoo, Mich.: W. E. Upjohn Institute for Employment
Research, 2002, 113-46.
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Information Network is supported by grants from the Annie E. Casey Foundation,
the Charles Stewart Mott Foundation, the David and Lucile Packard Foundation,
the William and Flora Hewlett Foundation, the Ford Foundation, and the Rural
Policy Research Institute.
The U.S. Department of Health and Human Services has funded the
establishment of a national information resource, the Rural Assistance Center
(RAC) for providers of human service assistance, decision makers and others
seeking information on health and human services for rural communities.RAC is a partnership of the University of North Dakota Center for Rural
Health, the Rural Policy Research Institute at the University of Nebraska
Medical Center and the University of Missouri-Columbia, and the Welfare