Case Study

How BCBSND Caring Foundation Partnered to Bring Behavioral Health to Rural Schools


The challenge

Patients in rural America often struggle to access high-quality care. For example, many North Dakota public school students don’t have access to an on-site nurse. This issue is even more prevalent in the field of behavioral health (BH), where access and stigma are still challenges for the entire nation. Even if schools do find a way to bring behavioral health care to their students, it’s often too expensive to be feasible.

The organization

Established in 1989, the Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation is a private 501(c)(3) charitable organization. Through charitable giving and investing, the Caring Foundation focuses on key issues that help improve the health and well-being of North Dakotans and their communities. Caring Foundation staff work with grantees to support nonprofit sustainability, collaborate on shared outcomes, and create lasting change.

The approach

BCBSND Caring Foundation connects schools with health systems to bring tele-behavioral health to schools. School district administrators can apply for a grant from BCBSND Caring Foundation and then use the grant to contract with BH professionals for remote services at a discounted rate. BCBSND Caring Foundation grants allow schools to negotiate with providers for the appropriate amount of behavioral health care coverage to support their needs. 

The result

The award-winning partnership from BCBSND Caring Foundation has worked with five school districts to contract with Avera Health System’s eCare program. Fourteen students have been treated so far. BCBSND Caring Foundation plans to expand the program across the state and for more conditions.



How BCBSND Caring Foundation brought behavioral health to rural schools

Instead of embedding therapists in schools, which is the typical model, BCBSND Caring Foundation awarded grants to schools, allowing them to choose their virtual provider partner. Many chose to work with Avera Health Systems to provide tele-behavioral health care to students. BCBSND caring foundation is confronting the stigma around behavioral health care by normalizing treatment for children and their communities.

The three components

BCBSND focused on three factors: why they should partner with students, which providers they should partner with, and how they should use grant funding. This case study will examine how BCBSND approached each of these questions.

  • Component

    Choose a program audience that encourages community impact

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  • Component

    Think outside the box for potential provider partners

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  • Component

    Tailor grants to each recipient to encourage appropriate care

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How we know it’s working

BCBSND Caring Foundation’s program is only three years old, but early results are promising. While the sample size is only 14 students, it’s important to note that the state has a population of only 750,000 residents in total.

In 2020, the Dakota Conference on Rural and Public Health named Avera’s eCare School Health Program the “Outstanding Rural Health Program.” The award, given by a branch of the University of North Dakota, is presented annually to a program that delivers services an innovative and collaborative way.

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