In the latest of a series of reports on child mental health, the Center for Disease Control and Prevention documents that rural children from small communities have more mental, behavioral and developmental disorders (MBDDs) than those living in cities and suburbs. A Perspective article, published in the New England Journal of Medicine, outlines the disparities and how they could potentially be addressed.

The authors cite poverty, perinatal or early–childhood teratogen exposure from extraction and processing industries, and a lack of evidence–based, early intervention programs compared to urban areas as possible contributing factors to the burden of MBDDs among rural children. They call for further research about why this disparity exists and outline how to potentially help families affected in the meantime.

“We believe that rural communities should partner with agencies that operate in alternative settings, use telehealth services, and employ primary care and alternative providers to coordinate care and deliver low–intensity interventions,” write co–authors from Nationwide Children’s Hospital and the Centre for Child Mental Health Services and Policy Research, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.

“It’s possible to expand care by delivering behavioral and developmental health care in settings other than medical offices, but there are financial and regulatory issues to consider so we wanted to address those,” said co–author Kelly Kelleher, MD, MPH, director of the Center for Innovation in Pediatric Practice and vice president of Health Services Research at The Research Institute at Nationwide Children’s.

“We are using videoconferencing to help train primary care physicians to deliver complex mental care to kids in isolated rural areas in Canada,” said co–author William Gardner, PhD, who is director of the Centre for Child Mental Health Services and Policy Research, Children’s Hospital of Eastern Ontario Research Institute.

“Our goal in writing this, especially now that the future of American health care reform is uncertain, is to draw the attention of the medical community to a rural need that is too often out of sight and out of mind,” said Dr. Kelleher, who is also a faculty member at The Ohio State University College of Medicine.”