The overall age-adjusted death rate in rural areas has been greater than that of urban areas over the last two decades Alachua County reported the county experienced an age adjusted death rate of about 80 more deaths than the Florida average for the same year (Florida Department of Health, 2020). A confluence of predisposing and reinforcing psychological and socioeconomic risk factors at the individual, community, and public policy levels are responsible for the disparities in preventable deaths in rural areas. Among these, adverse childhood experiences (ACE’s) play an important role as they are strongly correlated with increasing mortality and adverse health behaviors. Additionally, individuals in rural areas are more likely to be older, current smokers, uninsured, and further from primary care clinics which contribute to increased risk for mortality and lower utilization of preventative and curative care Targeted, trauma informed interventions to rural areas that identify ACE’s, increase healthy behaviors, and improve access to care are needed to address ACE’s and their derivative adverse health effects including excess mortality. A safety net mobile clinic that provides trauma-informed primary care and care coordination can address many of the trauma related factors that contribute to mortality rural, medically underserved areas. This project will screen for ACEs, trauma-related symptoms and barriers to care present in the lives of patients seen by the program. Subsequent provision of trauma informed primary care and care coordination will help address individual, relationship, and community determents of health and reduce the perceived burden of those events or symptoms. Addressing barriers to care and trauma in a mobile clinical setting has the capacity to provide primary, secondary, and tertiary prevention for conditions related to adverse health behaviors like smoking and substance abuse. Reduction of these behaviors may eventually contribute to reduced morality in rural areas targeted.
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