It is self-evident that transportation in rural areas will be a problem for low income and disabled people as they try to get to medical appointments, travel to work, or manage basic life necessities like grocery shopping. The problem is less severe for people living in urbanized areas, by which we mean Central Pennsylvania towns with more than 2500 residents since those places are likely to have grocery stores, some jobs people can get, and helping networks where people will provide rides. But even in towns it is hard for people to get to medical appointments or jobs if these activities are only available in a town ten or fifteen miles away.
While it seems self-evident that transportation is a problem for people seeking health care or for low income people trying to find work, we have done two community needs assessment surveys (the ACTION Health needs assessment from 2009 and the Community Action Agency/Selinsgrove survey of 2015) and in neither one of them did citizens report that transportation was a top ten problem from their points of view.
We think that transportation was not reported a problems because of the people who answered these questionnaires. The Community Action Agency survey was conducted with people attending food distribution sites in Union, Snyder, Juniata, and Mifflin Counties and to reach a food distribution site people must have somehow managed transportation—for them transportation might not be a problem. The ACTION Health survey was a mailed sample survey conducted by Geisinger and we suspect that the respondents were comparatively upscale. A very small percentage reported that transportation was a problem for them.
Despite these findings, health institutions and social service providers are emphatic in viewing transportation as one of the major problems confronting citizens in Central Pennsylvania. Needs assessments conducted by hospitals in our area consistently rate transportation as a top three problem, even though the data they use to carry out their needs assessments (primarily the ACTION Health data) do not support this claim. Similarly, social service agency staff members also uniformly report that transportation problems are serious for low income, elderly, and disabled people as well as for people living in isolated rural locations and people who have been incarcerated or who are mentally ill.
Beginning early in 2016 a regional consortium of health and social service agency personnel, transportation providers, university people, and Commonwealth of Pennsylvania agency leaders have worked to define transportation problems and have sought to collect data on the nature and extent of transportation problems. Several participants have been key:
Data and Research
Consortium members all have felt the need to collect some data. As we have found in other policy areas, there simply are no reliable data that tell about the transportation situation of residents in small towns and rural areas. The group centered on Geisinger has thought about assembling data they routinely collect about missed appointments, but there is concern that medical records and administrative records will be fragmented and not systematic in terms of collecting the particular kinds of data we want (this is not a failing of Geisinger but rather has to do with the purposes for which medical records are created—our group has lots of frustrating experience trying to use medical records for research purposes).
Meanwhile, Rabbit Transit has begun planning a study that would take place in the York area that would involve focus groups of their service users to learn more about their needs and the challenges they perceive in terms of using the Rabbit Transit service. This has seemed to other consortium members as a sensible and important sort of research to conduct. However, the focus would mostly be on medical transportation needs.
The United Way and Community Action Agency partners are less concerned with medical users (well, they are concerned but they figure these users have other determined advocates) than they are with the daily living transportation problems of poor, elderly, and disabled people. University partners joined in, helping to figure out how to do a research project and getting to work on executing that research.
We began by asking why needs assessment respondents did not vote that transportation is a major need. We noted that maybe the way we got respondents eliminated people who have transportation problems from our survey group. But we also concluded that the nature of the “transportation problem” (no car, no money) was not as simple as we thought it was at first.
We realized that some social service agencies may build “make dos” into their operating procedures, so they recognize transportation problems as inherent in the way their programs are set up and they solve those problems for particular groups of their clients who would be unable to receive services if there were no transportation help.
We also realized that by defining transportation need in terms of income, we may be excluding some people who have enough money but who just cannot get around—disabled and elderly people and especially those living in isolated locations.
With these concerns in mind, we created a team of two United Way staff members and two Bucknell faculty and we conducted two-hour interviews with representatives from six social service agencies located in Lewisburg, Sunbury, and Selinsgrove. The results of our qualitative study, representing results as of 15 March 2017, are presented below.
This study is incomplete. The purpose of the overall project was to use the qualitative interviews to allow us to build a web-based survey. We have a draft questionnaire in hand and we now can send this around to a larger population of social service and medical organizations in the Central Susquehanna Valley. From their responses we will be able to produce a data-based report that we can make public on this web site and that we also can feed back to other members of the consortium.