Volunteers lay pipe along a rocky ridge to bring clean water to their tiny community in western Virginia. Helicopter pilots swoop critically ill infants from rural Alabama counties to Birmingham hospitals. West Virginia counties entice European tourists to hike their mountains, while small firms in Pennsylvania learn how to compete in markets across the globe. Eighth-graders in Georgia use school-issued laptop computers to surf the Internet from their classrooms and their homes.

These and other stories of innovative local solutions to local problems highlighted the Ideas That Work Conference sponsored by the Appalachian Regional Commission (ARC) October 12–13 in Wheeling, West Virginia. The conference focused on the needs of distressed counties, using reports on 14 successful projects selected from all 13 Appalachian states, to stimulate discussion and generate new ideas.

West Virginia Governor Cecil H. Underwood, ARC states' co-chairman, opened the conference by citing Appalachia's extraordinary economic progress since the late 1960s, including a 51 percent growth in employment, compared with an actual loss of jobs between 1950 and 1960. But he also noted that 111 counties, most of them in Central Appalachia, remain distressed, and that pockets of severe poverty remain elsewhere in the Region.

"While I know that we are winning the struggle," Governor Underwood said, "we must do more to address the needs in these distressed communities. I'm especially concerned about the children of these communities who are growing up in a world of poverty. That should not be acceptable to any of us."

Governor Underwood noted that the Ideas That Work Conference grew out of a meeting held a year earlier between him and ARC Federal Co-Chairman Jesse L. White Jr. That led to a strong effort to stimulate local initiatives in McDowell County, one of West Virginia's most distressed counties.

"The McDowell County initiative," Governor Underwood continued, "led me to ask all the Appalachian governors to look at programs in their respective states to evaluate them on their potential to assist distressed communities. We want you to examine the elements that have made their programs successful. Take these successes and look at the larger picture. Your recommendations, your insights will help all of us to develop the necessary steps to eliminate poverty in your communities and across all Appalachia."

"It's amazing," White said, "that a governor took one of his worst counties, in terms of economic indicators, to try to do something about. It reminds me of the biblical verse that we should adopt the least among us as our challenge. The work in McDowell County is a microcosm of what we should be about in ARC—to work with the least of us and get all of us to the table of the American economy."

A Region of Contrasts

White suggested that the title of a report by the Southern Growth Policies Board, Halfway Home and a Long Way to Go, applies to the work of ARC. The number of distressed counties, he said, has been halved since ARC was created, and the regional high school graduation rate now equals the national average. Yet these regionwide statistics require disaggregation to focus attention on the work still to be done.

"We have moved," White said, "from a region of almost uniform distress to a region of contrasts in which some areas are doing well, some are in a transitional state, and others are still in our distressed category. We have got to concentrate our resources on the areas left behind. That's increasingly what we've been doing. As you know, we take 30 percent of our nonhighway money and allocate it to distressed counties. The issue isn't whether to target distressed counties, but how best to use the money.

"What we'll hear about today are local solutions to local problems," White said. "That encapsulates the ARC model when it's working at its best—a process where ideas are developed locally, come up through the governor's office, and reach the federal desk last."

White stated that ARC was founded on a "growth center" model that assumed economic benefits would spread from prospering areas to less prosperous ones. This model, he said, has been reexamined during the past six years and resources have increasingly been targeted to distressed counties. In that context, he praised the commitment of Appalachian governors to a regionwide focus on need without regard to state politics. He noted that the allocation formula reserving at least 30 percent of nonhighway funds for distressed counties must be approved annually by the states. "There has never been a negative vote," White said, "despite the fact that about eight of our states are net losers in that allocation. Not an easy vote for some of our states to cast, but it is done in the spirit of helping the least of us.

"The ARC story," White concluded, "is an unfolding story. It's a story that's still being made and still being told. We're here to sharpen our thinking, look at models that work, and continue to sharpen the tools that we have and finish the job and be able to say to the nation one day, 'Appalachia is like the rest of America, and we're fully at the table of the American economy.' "

The projects highlighted at the conference, selected from a list of "ideas that work" nominated by the Appalachian governors, reflected the five goals of the ARC strategic plan. These goals are:

1: education and workforce training;

2: physical infrastructure;

3: civic capacity and leadership;

4: dynamic local economies; and

5: health care.

A Model for Self-Help

A special mid-conference presentation focused on McDowell County, West Virginia, which Governor Underwood described as a potential model for local self-help efforts built around training local leaders as "spark plugs"—individuals who coordinate and motivate community effort. Local grassroots efforts are being assisted by the Rensselaerville Institute. (The institute provided technical assistance to volunteers in Smith Ridge, Virginia, who completed a water line installation project in record time and at about one-fourth the estimated cost of professional contractors.)

McDowell residents described several small projects, including incentives for students to improve academic performance, renovation of a small town's grassy park, creation of neighborhood computer labs for children, and a "Hoops for Hope" project using basketball as a strategy for changing the lives of children and teenagers at risk for failure in school and elsewhere. The goal of the project was to get at least ten kids off the streets; it regularly attracts at least 30 participants, and usually around 100 on weekends.

Dewey Wimmer, who served as the spark plug of the Hoops for Hope project in the small town of Jolo, said that his motivation came from "watching kids buy drugs and cigarettes. We decided that we didn't want that to be anymore. We wanted our county back."

Hal Williams, Rensselaerville Institute president, said that successful self-help efforts emphasized planning and acting simultaneously (i.e., acting on good ideas immediately without waiting for comprehensive plans to be completed), involving many people, making decisions based on concrete results, and "betting on spark plugs."

"In McDowell County," Williams said, "you've got an extraordinary group of people whose energy has not been tapped by the social service system, which in many cases has encouraged them to be passive."

All project reports and subsequent discussions reached regional, national, and international audiences via a live, day-long simulcast produced by Kentucky Educational Television. It was made available nationwide by satellite and worldwide over the Internet.

The conference workday closed with a survey of conference participants, including those joining online, on how ARC resources should be allocated with respect to strategic plan goals. Respondents pinpointed education, the first goal, as needing significantly more resources in distressed areas. They attached equal importance to the third goal, civic capacity and leadership, while commenting that its support required a relatively low level of financial commitment. Respondents felt that more money would be desirable for physical infrastructure, enhancement of local economies, and health care, but felt that these goals are receiving appropriate emphasis within the limits of ARC's resources.

Fred D. Baldwin is a freelance writer based in Carlisle, Pennsylvania.

Conference Presentations: Ideas That Work

GOAL 1
Education and Workforce Training

EXPANDING THE CLASSROOM:
TOWNS COUNTY MIDDLE SCHOOL LAPTOP COMPUTER PROJECT
Georgia

Recognizing the importance of helping students develop computer skills before they enter high school, Towns County Middle School, in Hiawassee, Georgia, launched an innovative project that is helping students, parents, and teachers become more computer literate. In 1998, the first year of the pilot program, Towns County gave every middle school student and teacher a specially designed laptop computer. The goal of the program was to create a "computer-friendly" environment, both at school and at home, in which computers are an integral part of every student's life.

The school offered training for teachers, students, and parents and provided access to the Internet from school and home through a school-based network. The project also created a Web site offering quick and easy access to school information such as the parent-student handbook and the school's calendar of events.

The results so far have been promising. School officials report that school attendance improved last year, disciplinary problems declined, and more parents of Towns County students enrolled in adult education courses. Students and parents both report that the children are spending less time watching television and more time doing homework. School officials say the project reflects their belief that students can maximize their potential if they can work in an environment that makes learning critical skills fun and relates this learning to students' lives at home and in their community.

Presenter: Stephen H. Smith, principal of the Towns County Middle School.

PREPARING CHILDREN FOR SCHOOL:
REGION A PARTNERSHIP FOR CHILDREN (SMART START)
North Carolina

In the early 1990s, many children in North Carolina were physically and socially unprepared to start school. Rather than mandate a solution to the problems, the state in 1993 created Smart Start, a statewide early childhood initiative that required counties to establish local community nonprofit boards to create and run local programs. This was a challenge for all counties, especially for those in Appalachian North Carolina. However, most of the 29 Appalachian counties had programs in place by 1996, in part because ARC provided funds to help them analyze, plan, and create partnerships to secure additional funding. The goal of the program is to ensure that all children are healthy and prepared to succeed when they enter school.

The Region A Smart Start project was developed to address three pressing needs in the seven westernmost counties of North Carolina and on the Qualla Boundary Cherokee Indian reservation. It seeks to provide:

• high-quality child care that is affordable and accessible for families;
• easier access to health care, especially dental services, for young children; and
• greater family support services, such as parent education on best practices in child rearing and on addressing behavioral and emotional challenges in young children.

Presenter: June T. Smith, executive director of the Region A Partnership for Children.

MOTIVATING MORE STUDENTS TO ATTEND COLLEGE:
OHIO APPALACHIAN CENTER FOR HIGHER EDUCATION (OACHE)
Ohio

Concerned about the low percentage of high school graduates from Appalachian Ohio who were enrolling in college, the state commissioned a study in 1992 to identify the barriers preventing these students from enrolling. Low self-esteem was found to be the most prominent barrier.

As a result of the study, the Ohio General Assembly established and funded the Ohio Appalachian Center for Higher Education (OACHE), a consortium of ten public colleges and universities, in 1993. Member institutions and public schools were invited to submit proposals to help Appalachians overcome the barriers delineated in the study. To date, OACHE has sponsored 40 partner school projects, and the college-going rate for partner schools has increased by an average of 34 percent.

The consortium has sponsored training programs to help teachers advise students on career and education choices. It also has encouraged more students to visit college campuses and has offered them assistance with college and financial aid applications. With recent support from the U.S. Department of Education, the consortium has encouraged more adults to enter or re-enter college and has worked to create distance learning centers linking member institutions.

In 1996, the consortium Community Colleges of Appalachia decided to promote similar centers in other parts of the Appalachian Region. The first, the North Central Appalachian Center for Higher Education (NCACHE), was opened in the fall of 1998 at Bluefield State College in Bluefield, West Virginia. NCACHE, like OACHE, has clearly demonstrated that students from rural areas of Appalachia can be motivated to participate in post-secondary education.

Presenters: Wayne White, executive director of the Ohio Appalachian Center for Higher Education at Shawnee State University in Portsmouth, Ohio; and Sarita A. Gattuso, director of the North Central Appalachian Center for Higher Education at Bluefield State College in Bluefield, West Virginia.

GOAL 2
Physical Infrastructure

COLD-BOOTING THE MOUNTAINS:
BIG SANDY TELECOMMUTING SERVICES
Kentucky

In 1994, determined that the new Information Highway not bypass Pike County and neighboring counties in eastern Kentucky's Big Sandy area, community leaders organized a nonprofit corporation, Big Sandy Telecommuting Services, and launched a regionwide cyber-interest assessment. The new organization sought to develop public access services not yet available in the region and to serve as an applications lab, introducing new communications technologies not only to area businesses and local governments, but also to average citizens.

The project initially developed an Internet service provider (ISP), a small computer lab, and a teleconferencing facility. It has since sponsored an array of computer training courses designed for both entry-level and more advanced users, including courses on designing Web pages and on using the Internet. Responding to changes in the marketplace, the corporation sold its ISP in 1998 and began focusing resources on assisting small businesses and entrepreneurs with e-commerce and on providing telecommunications and training programs for local government and individuals.

By 1997 Big Sandy had outgrown its facility, and approached the Pike County Public Library District, which was also seeking new space. A partnership was struck, and soon after, the Pikeville College School of Osteopathic Medicine was invited to join the partnership.

A 30,000-square-foot building is now under construction in Pikeville and is nearly 50 percent completed. With its new headquarters, the center anticipates expanding its reach throughout the Big Sandy community.

Presenter: Roger Recktenwald, member of the board of directors of Big Sandy Telecommuting Services, Inc., and executive director of the Big Sandy Area Development District in Prestonsburg, Kentucky.

BUILDING A NEW LOCAL ECONOMY:
ADVANCED TECHNOLOGY CENTER AND TECHNICAL
INNOVATION CENTER
Maryland

In the mid 1980s, after Fairchild Industries closed its aircraft manufacturing operations, people in Washington County began working to develop and attract new high-tech industries. Their goal was to help develop a better-trained, more adaptable workforce.

The Advanced Technology Center was opened at Hagerstown Community College in 1990, and the Technical Innovation Center, a major $2 million addition, was completed in 1994. By 1995, six high-tech enterprises were using the new facilities in fields such as chemical production, electronics, and computer software engineering. At the center, entrepreneurs can take an idea through the stages of computer-aided design, development, test marketing, and production. In addition, local businesses have access through the center to the expertise of state-supported economic development agencies.

Today, the Advanced Technology Center continues to offer manufacturing and technology firms access to the latest in cutting-edge technology. The Technical Innovation Center, one of the few self-sustaining business incubators in the nation, is a net provider of resources to Hagerstown Community College and Washington County's Economic Development Commission. The center has provided start-up resources to nearly 30 new or expanding businesses and helped these firms create over 140 technology-related employment opportunities.

Presenter: Douglas E. Leather, director of the Advanced Technology Center/Technical Innovation Center in Hagerstown, Maryland.

EMPOWERING RURAL RESIDENTS TO HELP THEMSELVES:
SMITH RIDGE SELF-HELP WATER PROJECT
Virginia

For a hundred years or more, the residents of Smith Ridge—a rural community of about 150 people in Tazewell County—got their water from cisterns, springs, or wells. When the wells ran dry in the summer, some families were forced to buy fresh water hauled in by a fire truck. Given its small population and remote, mountainous location, the community saw little prospect of improving its water supply. In the summer of 1998, however, that changed as a result of an innovative program that helps people in small towns help themselves. With support from the state's Department of Housing and Community Development, residents were able to participate in the Self-Help Virginia program, an extension of the national Small Towns Environment Program operated by the nonprofit Rensselaerville Institute.

Under the program, residents worked together to construct a seven-mile water-line extension to serve their homes. More than 70 residents, nearly all of the community's able-bodied adults, volunteered to help. The Tazewell County Public Service Authority loaned the volunteers the heavy equipment, including a trencher, a backhoe, and a tamping machine.

The project was completed much sooner than expected and at a much lower cost than that of a traditional water-line construction job. The final cost was about $250,000—one-fourth the cost estimated by a contractor—and the extension took only three months to complete, as opposed to the 24 months specified in the grant agreement. Another major benefit: the project brought the community closer together and motivated residents to plan future community self- help efforts.

Presenters: Mike and Pauline Taylor. The Taylors led the Smith Ridge effort to bring clean water to the community, and Mike Taylor served as one of the project's "spark plugs."

GOAL 3
Civic Capacity and Leadership

MAKING SERVICES MORE EFFICIENT:
SOUTHERN TIER WEST COMMUNITY ASSISTANCE PROGRAM
New York

Most small municipal governments do not have the financial resources to meet the ongoing professional development needs of their officials, many of whom are not full-time employees. In addition, many governmental functions, from purchasing to records management, could be done more efficiently if carried out on a wider scale than is possible for small rural communities. To address these issues, the Southern Tier West Regional Planning and Development Board established the Community Assistance Program (CAP) to help officials in Allegany, Cattaraugus, and Chautauqua Counties.

CAP has two principal objectives—to improve the professional capacity of regional municipal government and to encourage cooperative activities among local governments to achieve greater economies of scale and more efficient use of tax dollars. To meet these objectives, CAP developed a number of continuing developmental and cooperative activities for regional elected officials and professional employees. It also has sponsored unique demonstration projects, technical assistance programs, and professional educational opportunities to meet emerging needs.

Begun in 1987, CAP was so successful that it was given more permanent financial support in 1991, with annual state funding and membership dues from regional municipalities. Cooperative activities were intensified in 1993, when the regional Municipal Purchasing Alliance was created in cooperation with the Municipal Clerks Association and the New York Department of State. Through the alliance, 78 local governments buy goods collectively to receive lower prices. In 1994, CAP began working with local universities to help local government officials and employees share information on best management practices.

What began as a simple mechanism to help government officials become more efficient and responsive has evolved into one of the most comprehensive technical assistance and training programs in the state. Today, 116 of the region's 130 municipalities are members.

Presenter: Eric Bridges, director of the Center for Local Government and Community Services with the Southern Tier West Regional Planning and Development Board in Salamanca, New York.

DEVELOPING PRACTICAL APPROACHES TO ECONOMIC
DEVELOPMENT IN SMALL COMMUNITIES:
HANDMADE IN AMERICA'S LEADERSHIP DEVELOPMENT INITIATIVE
North Carolina

Four communities along the Craft Heritage Trails in western North Carolina wanted to improve and revitalize their main streets, but were too small to qualify for existing national revitalization programs. They turned to HandMade in America, a nonprofit organization helping build the crafts traditions of the region into a force for economic development. Other towns expressed interest, and by 1998 the Rural Small Town Revitalization Project was under way.

Most of the participating communities were too small to have professionally trained town managers and planners. To meet the need for strong leaders, HandMade created the Leadership Development Initiative. Its goal is to create a civic leadership corps that can successfully undertake challenging but feasible improvement projects in small communities.

By taking part in eight training sessions, participating representatives from small towns plan and conduct local community projects, using their new leadership skills to recruit others. Training emphasizes teamwork, project management, and resource management. At the end of the training, graduates become mentors for participants from other towns joining the Leadership Development Initiative program.

The initiative matches a comprehensive training and support program with a strong base of community interest. During the initiative's first year, community projects included new parks and public facilities, as well as renovation and beautification efforts. As these were selected, planned, and implemented, interest grew, and in 1999 the program expanded to include 11 towns. The initiative has received national recognition and become so popular that there is now a waiting list of small towns that want to participate in the program.

Presenter: Rebecca Anderson, executive director of HandMade in America, based in Asheville, North Carolina.

BUILDING NEW ALLIANCES FOR GROWTH:
APPALACHIAN REGIONAL ECONOMIC DEVELOPMENT
STRATEGIC INITIATIVE
South Carolina

In the mid 1990s, local leaders in the six counties of Appalachian South Carolina recognized the advantages of linking independent communities through jointly planned economic- growth and regional-infrastructure projects. By creating the Appalachian Regional Economic Development Strategic Initiative, key leaders in the region sought to identify and take advantage of new regional strategies to overcome such challenges as poor roads and inadequate water and sewer services.

A steering committee was formed, comprising top local governmental and private-sector economic development leaders from each of the six counties in the region. This group brought together more than 500 key leaders and citizens to develop a strategic action plan. The partnership presented more than 70 recommendations, including many that focused on major capital projects in water, sewer, and highway infrastructure.

As a result of the strategic planning process, over $100 million in state funds has been allocated or designated for water, wastewater, and transportation infrastructure in the six counties. Over 50 of the recommended projects have either been completed or are under way. An ongoing regional steering committee oversaw implementation. At this time, approximately five years after the completion of the initial plan, the region is in the process of re-forming the steering committee to identify a second round of projects.

Presenter: Sam Cargill, director of the Community Grants Division of the South Carolina Department of Commerce.

GOAL 4
Dynamic Local Economies

CREATING PARTNERSHIPS FOR SMALL BUSINESS GROWTH:
TEAM PENNSYLVANIA ENTREPRENEURAL NETWORK INITIATIVE
Pennsylvania

The vision of the Team Pennsylvania entrepreneurial network initiative is to create a public-private alliance that will stimulate new value-added services, new market opportunities, and regionally market-driven activities to enhance the awareness of entrepreneurship and increase the rate of new business formation and expansion.

The program consists of three core activities that take place in seven local development districts, which cover 52 counties:

• Implementing a "Training the Trainers" program targeted toward economic development specialists to ensure awareness of the Commonwealth's technical and financial resources available to entrepreneurs and small businesses;
• Conducting in-depth financial management seminars for start-up and small and medium-sized companies; and
• Building seven entrepreneurial networks to identify core competencies of providers, perform regional analyses of entrepreneurial climate, initiate focus groups to identify gaps and impediments, and create a marketing plan to enhance awareness of resources.

The three-stage initiative is based on the belief that planning and research generate viable and market-driven action plans for future years. Networks enable providers to keep pace with growing demand. Ongoing collaboration will be stressed because it has been proven that strong, responsive working relationships become a unique source of advantage - a "collaborative advantage."

Presenters: David Black, deputy secretary for community affairs and development for the Pennsylvania Department of Community and Economic Development in Harrisburg, and Pennsylvania's ARC state alternate; and Linda Goldstein, director of the Pennsylvania Department of Community and Economic Development's Entrepreneurial Assistance Office.

USING HIGH-TECH RESOURCES TO HELP ENTREPRENEURS: TECHNOLOGY 2020
Tennessee

When Oak Ridge National Laboratory was established as the country's principal research and development site for nuclear weapons technology, the Oak Ridge region became almost totally dependent on federal government jobs. Local community leaders began trying to diversify the local economy in the early 1980s with the creation of the Valley Industrial Park, now home to a number of technology-based firms. The end of the Cold War brought new urgency to their mission.

Established in 1994, Technology 2020 is a public-private partnership that seeks to leverage the unique information technology resources in the region to incubate new businesses, create private-sector jobs, and improve the prospects of economic growth. Serving all of Tennessee's Appalachian counties, including ten distressed counties, Technology 2020 is

• growing new technology businesses. Technology 2020 supports a network of business incubators, offers business planning and counseling, and is developing debt and equity funds to provide client companies with capital.
• developing a high-speed information infrastructure. Technology 2020 has established a regional Internet traffic exchange and a high-speed regional ATM network. It is also developing a "digital crossing" that will provide state-of-the-art telecommunications services to companies across the region.
• establishing a pipeline of qualified information technology talent. The Jobs21.net service on Technology 2020's Web site helps regional companies find the workers they need, identify the training required to keep their skills current, and apply for state training dollars to help offset training expenses.

Presenter: Thomas C. Rogers, president and chief executive officer of Technology 2020 in Oak Ridge, Tennessee.

BRINGING EUROPE TO APPALACHIA:
A REGIONAL TOURISM PROMOTION
West Virginia, Ohio, and Kentucky

All of Appalachia's 13 states consider tourism an important part of creating a dynamic economy. Tourism is seen as particularly important in rural areas of Appalachia because it supplements the local economy through expenditures of funds from outside the Region. It also diversifies and supplements the economy through the creation of jobs. Recognizing that more repeat foreign visitors—Germans in particular—were traveling to the United States, the tourism offices of West Virginia, Ohio, and Kentucky began a special coordinated effort in 1994 to promote Appalachia as a tourist destination.

Focusing on the Appalachian Mountain and River Region, the three states promoted the area as offering diverse experiences for tourists—from history-related activities and cultural events to outdoor activities such as hiking, biking, rafting, golfing, and fishing. Initially, the three states took steps to educate tour operators and travel agents on the region, at the same time hosting trade media in the region in exchange for free coverage in German newspapers and magazines and on German radio and television. Seminars were held in the three states to better prepare the tourism industries for international visitors.

Already this project has more than met its goals. More foreign visitors are coming to the region, and the local tourism industry has become increasingly attuned to the need to expand its own international marketing.

Presenter: Betty Cutlip, international marketing representative for the state of West Virginia.

GOAL 5
Health Care

EXPEDITING EMERGENCY CARE FOR INFANTS:
CARRAWAY LIFE SAVER PROGRAM
Alabama

Alabama is a state of sharp contrasts. Its largest urban area, Birmingham, is one of the country's leading medical centers, yet its largely rural Appalachian counties remain medically underserved. Children born in remote, rural counties of Appalachian Alabama are often several hours away from critical neonatal-care facilities in Birmingham. To improve health-care services for premature and critically ill infants in these remote counties, two medical institutions in the city have launched a collaborative effort to provide emergency helicopter transport for these infants to the care they need.

This program is an expansion of the Life Saver program of Carraway Methodist Health Systems, one of the oldest and most successful emergency helicopter programs in the country. Under a cooperative agreement between Children's Hospital of Alabama and Carraway Methodist Health Systems, critically ill children are transported by helicopter from Appalachian community hospitals to critical care units at Children's Hospital in Birmingham.

Providing air transport by helicopter has helped reduce delays in providing life-saving medical care to infants. Life Saver helicopters have flown 50 critically ill infants from 20 Appalachian Alabama counties since the program began. Smaller hospitals have embraced the program, regarding it as a way of extending the vast resources of Children's Hospital in Birmingham into their own facilities and helping them achieve their mission to provide outstanding care to the people they serve.

Presenter: Warren Callaway, executive vice president and chief operating officer of Carraway Methodist Health Systems in Birmingham, Alabama.

IMPROVING HEALTH CARE AMID SEVERE RURAL POVERTY:
HICKORY FLAT CLINIC
Mississippi

In 1978, the only health care in Hickory Flat, a small town in Benton County, was provided by a public health nurse one day a month, in one room of a dilapidated clinic building. A community committee, established with ARC funding and technical assistance, soon organized as the Hickory Flat Clinic Association to rehabilitate, properly equip, and operate the old clinic. A full-time nurse practitioner was hired, and the renovated clinic reopened in 1979. The goal of the project was to make health care much more accessible for rural residents in the area.

Over the years, the clinic has become a mainstay of health care in this distressed area of northern Mississippi. Primary care is available daily for all age groups. Services range from immunizations to advanced cardiac life support during emergencies. An infant mortality project includes education by a clinic nurse practitioner, who also serves as a health teacher at the Hickory Flat School.

Now in its twentieth year, the Hickory Flat Clinic averages 3,500 patient visits each year and also provides home health visits and periodic community health screenings. During the past year, the patient caseload included 482 people who had never been to the clinic before. In addition, over 40 nurse practitioner students have received mentoring and clinical experience at the clinic, giving them skills they need to assist people in the community. The clinic is considered a model for rural areas seeking to create a health-care clinic that will provide consistent, quality health care.

Presenter: Sue Morrison, director of the Hickory Flat Clinic in Hickory Flat, Mississippi.