The model has shown real promise. But as rural health transformation enters a new phase, behavioral health crisis teams are confronting a threat unrelated to clinical competence. According to a national survey of 290 rural healthcare leaders commissioned by Julota and conducted by TrendCandy, the central challenge facing rural transformation programs today is no longer launching services. It is proving that those services work, and doing so across organizational boundaries that were never designed to share data.
The Scale of the Need
Before examining the proof problem, it helps to understand what’s at stake.
Rural Americans face some of the most acute behavioral health disparities in the country. According to the Rural Health Information Hub, rural communities experience higher rates of suicide, opioid overdose death, and serious mental illness than their urban counterparts, while having access to significantly fewer psychiatric providers, inpatient beds, and outpatient services. The shortage isn’t marginal. In many rural counties, the nearest behavioral health specialist may be hours away.
Into this gap stepped the behavioral health crisis team. Modeled in part on the Crisis Intervention Team (CIT) framework developed in Memphis in the late 1980s, modern rural crisis response programs vary in structure but share a common purpose: to divert individuals in mental health crisis away from emergency departments, jails, and unnecessary police escalation, and toward appropriate clinical care and community support.
These teams don’t operate alone. At their most effective, behavioral health crisis teams function as the coordinating spine of a broader community care network, linking EMS, hospitals, primary care, substance use treatment, housing services, and social supports. That complexity is part of what makes them valuable. It’s also part of what makes them so difficult to sustain.
Transformation Programs Are Raising the Bar
Rural Health Transformation Programs (RHTP), part of a broader federal push to modernize rural healthcare delivery, are accelerating both the opportunity and the pressure facing behavioral health teams. The Julota-commissioned survey found that 90 percent of rural healthcare leaders believe RHTP initiatives will significantly raise the bar for demonstrating measurable impact.
This finding reflects a broader shift across healthcare. The era of pilot innovation, where communities could launch programs on grant funding and demonstrate value through anecdotal outcomes, is giving way to an era of operational accountability. Policymakers and funders now expect standardized data, cross-agency reporting, and credible evidence that programs produce measurable results.
For behavioral health crisis teams, this shift is particularly acute. A successful crisis response intervention may prevent a psychiatric hospitalization, reduce law enforcement involvement, connect a patient to long-term treatment, and keep a family intact. Each of these outcomes touches a different organization. Each is tracked, if tracked at all, in a different system. And each requires a different set of data to document.
The Proof Problem Is Hardest Where It Matters Most
The survey’s most striking finding may be this: 61 percent of rural healthcare leaders say proving cross-agency impact is more difficult than delivering services themselves.
This cuts to the heart of rural behavioral health crisis teams sustainability challenge. Clinical staff can be recruited, trained, and deployed. Dispatch protocols can be established. Community relationships can be built. But demonstrating the cumulative impact of a crisis response intervention, across a patient’s journey through emergency services, behavioral health treatment, substance use programs, and follow-up care, requires a kind of infrastructure most rural communities simply don’t have.
The survey confirms just how manual these processes remain. Eighty-five percent of rural healthcare leaders report that at least one critical referral partner still relies on phone calls or faxes to coordinate care transitions. For behavioral health crisis teams, where 48 percent of referral coordination breakdowns occur specifically in behavioral health handoffs, these gaps are not inconveniences. They are points where patients fall out of care entirely.
When a crisis team clinician makes a warm handoff to a behavioral health provider following a field response, that referral often falls into a void, there may be no mechanism to confirm whether the patient followed through, no alert if a follow-up appointment was missed, and no way to measure whether the intervention reduced subsequent emergency utilization, all data points that funders and policymakers increasingly require to justify program continuation.
Workforce Shortages Compound the Challenge
The operational pressures on behavioral health crisis teams don’t stop at the data layer. The workforce constraints facing rural healthcare more broadly are felt with particular intensity in crisis response.
The survey found that 89 percent of rural healthcare leaders say provider shortages constrain how they design and scale transformation programs. Behavioral health clinicians ranked as the third hardest role to recruit across rural transformation programs, cited by 46 percent of respondents. When those positions go unfilled, programs don’t just scale more slowly. They collapse inward, reducing service hours, narrowing coverage geography, and placing unsustainable demands on the staff who remain.
For communities trying to stand up co-responder programs, this dynamic creates a compounding problem. The administrative burden of manual reporting and data reconciliation falls on the same clinical and operational staff already stretched thin by vacancy-driven increases in workload. As the Julota report notes, addressing workforce shortages requires not just recruitment strategies but operational systems that reduce administrative burden so clinicians can spend more time on patient engagement.
Investing in shared data infrastructure isn’t just a reporting strategy. For behavioral health crisis teams with limited staff, it may also be a workforce retention strategy.
The Financial Sustainability Question
Even programs that overcome clinical and workforce challenges face a harder question downstream: how do you pay for this after the grant runs out?
Rural healthcare leaders expect behavioral health crisis teams to rely on a patchwork of funding sources over the long term. According to the survey, 62 percent anticipate hospital shared-savings arrangements as part of their sustainability model, 52 percent expect EMS billing pathways to play a role, and 48 percent are counting on Medicaid reimbursement expansion.
Each of these funding mechanisms requires precisely the kind of outcome data that behavioral health crisis teams currently struggle to produce. A hospital shared-savings arrangement requires demonstrating how many psychiatric admissions a program prevented and what those prevented admissions were worth to the health system. A Medicaid reimbursement claim requires documentation of specific services rendered and their clinical justification. Neither is possible without an interoperable, cross-agency data infrastructure.
The economic opportunity here is substantial. Julota’s research identifies potential savings of $6.4 billion annually through hospital avoidance, $1.3 billion through reduced arrests and jail stays, and $1.2 billion through reduced EMS transports, much of it directly tied to the kinds of interventions behavioral health crisis teams are uniquely positioned to deliver. The savings are real. The problem is that most programs can’t yet prove their share of them.
What Behavioral Health Crisis Teams Must Build Next
The Julota report outlines five capabilities that rural healthcare organizations must develop to sustain transformation initiatives: shared care coordination frameworks, closed-loop referral management, standardized outcome measurement, clear data governance structures, and technology infrastructure that minimizes administrative burden on frontline staff.
For behavioral health crisis teams, each of these capabilities addresses a specific failure point in the current model. Shared care plans allow crisis clinicians, EMS, hospitals, and behavioral health providers to coordinate around a single patient rather than exchanging fragmented information through phone trees and fax machines. Closed-loop referrals create a mechanism to confirm whether patients actually receive the services they were referred to, a critical gap in behavioral health handoffs. Standardized outcome reporting produces the evidence that funders and policymakers require.
Julota’s own platform was built specifically to address these challenges in rural and community health settings, connecting behavioral health professionals with EMS, law enforcement, hospitals, and social services through a single secure, interoperable environment. For a deeper look at how rural co-responder programs are navigating coordination across multiple jurisdictions, Julota’s blog on the rural co-responder model offers a practical breakdown of how communities are structuring these programs today.
The Stakes Are Too High to Wait
Rural behavioral health crisis teams were created to fill a gap left by the formal healthcare system. They have done that, often with minimal resources and extraordinary commitment from frontline staff and community partners. But commitment alone does not make a program fundable. Impact does, and impact must be measured, documented, and communicated across organizations that have never been designed to share data.
The survey findings make clear that 82 percent of rural healthcare leaders consider cross-agency outcome reporting urgent this year. For behavioral health crisis teams, urgency is not abstract. Every unsustained program represents real people who will once again find themselves in emergency rooms, jails, or in crisis with nowhere to turn.
The communities that will sustain rural health transformation are not necessarily those with the most resources. They are the ones who build the infrastructure to prove what they are already doing. For behavioral health crisis teams, that infrastructure is the difference between a promising pilot and a permanent part of the care system their communities depend on.
Statistics in this article are drawn from The Proof Problem: Why Rural Healthcare Transformation Will Rise or Fall on Data Infrastructure, a national survey of 290 rural healthcare leaders commissioned by Julota and conducted by TrendCandy.
