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Focus on Rural Health

Investing in Rural Health: Nearly 14,000 Students and Millions of Dollars

By Jena Pierce on

Students learning to give injections at the
Turtle Lake Scrubs Camp.

Imagine, you're a 6th grader learning how to provide lifesaving CPR or administer an EpiPen for someone having an allergic reaction. This scene played out for fifty 6th graders this past March in Turtle Lake, North Dakota, where students spent the day learning about different careers available in the healthcare field, including nursing, dentistry, public health, emergency medical services, chiropractic medicine, and behavioral health.

These experiences were part of the Rural Collaborative Opportunities for Occupational Learning in Health (R-COOL-Health) Scrubs Camp program through the North Dakota State Office of Rural Health (SORH) at the Center for Rural Health (CRH), housed within the University of North Dakota (UND) School of Medicine & Health Sciences (SMHS).

Nicole Threadgold

"Getting students involved at a young age is an effective way to grow the rural healthcare workforce and inspire them to consider a career in health," said Nicole Threadgold, director of SORH. "These camps are great examples of community organizations working together to demonstrate the variety of professions youth can pursue."

Since its inception in 2009, over 14,319 students in grades 5-12 have been introduced to dozens of careers in the healthcare field, with over 4,740 volunteers helping with the program. Another 690 students have taken part in the SORH Scrubs Academies: four day/three night immersive experiences for junior high or high school students, largely held on the UND campus.

"Scrubs" is just one of many examples of how the North Dakota SORH is impacting the state.

Dr. Jacob Warren

"Establishing the North Dakota SORH within the UND SMHS was actually how the CRH got its start, so the work of SORH is at the heart of so much of what we do," said Dr. Jacob Warren, director of CRH.

"Our work in health workforce, hospital and clinic support, working with tribal communities, behavioral health resources training, community engagement, and information sharing all have their origin in becoming North Dakota's SORH. Our strong work continues today because of that designation," Warren said.

Building Healthier Communities

Another important program under SORH is the Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation Building Healthier Rural Community (BUILD) Grants Program, which SORH has facilitated since 2001.

For the 2025 award year, $44,598 was awarded to eight communities, allowing these communities to provide veteran peer support, care kits to patients in need, safety education and screenings at rural schools, room renovation for nursing mothers, and increased community engagement in physical activity.

Over the life of the BUILD program, a total of $3,264,516 has been provided to North Dakota communities through this project.

Amber Blomberg, executive director of the BCBSND Caring Foundation, emphasizes the importance of investing in the health of rural North Dakota communities.

Strong, vibrant communities are built on access to care, support for well-being, and opportunities to thrive, regardless of ZIP code.

"Strong, vibrant communities are built on access to care, support for well-being, and opportunities to thrive, regardless of ZIP code. Our BUILD grants and partnership with CRH address social drivers of health by supporting behavioral health services, reducing sedentary lifestyles, and ensuring access to nutritious foods where we live, work, and play," said Blomberg.

She continued, "These efforts positively impact a wide range of health and quality of life outcomes. Supporting rural communities is not just philanthropy – it's a sustainable investment in our shared future and truly makes a difference."

Community Health Needs Assessments

SORH also supports hospitals across North Dakota in completing Community Health Needs Assessments (CHNA). Not-for-profit hospitals are federally required to conduct an assessment every three years to help them meet the needs of their communities. The CHNA surveys the community and describes the health of local people, identifies areas for health improvement and the usage of local healthcare services, determines factors that contribute to health issues, prioritizes community needs, and helps healthcare leaders identify potential action items to address the community's health needs.

The local Critical Access Hospital, Rural Health Clinic, and public health district generally take part in the process, which can last up to six months. CRH has a longstanding history of conducting CHNAs since the first required three-year cycle in 2011-13. CRH has facilitated between 15-30 CHNAs during each three-year cycle since.

"It is vitally important for CAHs to understand the current health of its community," said Threadgold, "where they are exceeding and where there are areas that could be improved. This allows for new ideas and innovations to take place, to increase the health of the people being served. We are proud to be able to offer the service of facilitating these reports."

HIPAA Training

As a part of Scrubs Camps and Scrubs Academies, SORH offers Health Insurance Portability and Accountability Act of 1996 (HIPAA) training. The training may be given to North Dakota middle and high school students or instructors, and attaining HIPAA certification is one of the benefits for students attending a Scrubs Camp or Academy.

"It's important for students considering a health career to understand a patient's medical information is private," continued Threadgold. "Many facilities require students to complete HIPAA training prior to participating in Scrubs Camps or job shadowing."

HIPAA training is provided to students and instructors free of charge, with all costs paid for through SORH.

In-A-Box For Educators

Brain In-A-Box.

Part of the K-12 educational resources available through SORH includes the In-A-Box Program, which educators can check out through a loan process, at no charge. From the different boxes available, teachers can use the materials to teach health and science activities for grades 4-12. With the help of this program, students get to explore aspects of scientific careers, the body, and the environment that they might not otherwise have the opportunity to learn about.

Boxes currently available include bones and muscles, the brain, dentistry, ear, eyes, guts, and nutrition. Each box contains hands-on activities, models and technology, books, handouts, and additional lesson ideas.

Direct Assistance

We offer technical assistance in areas such as grant development through grant writing workshops.

The nuts and bolts of the SORH program is largely the technical assistance offered. "We are here to help build the capacity in North Dakota," said Threadgold. "We offer technical assistance in areas such as grant development through grant writing workshops. We will teach someone how to write a grant, and will help assess what is written to ensure it is as strong as an application can be."

Adding that SORH can be a convener of stakeholders, help facilitate meetings and focus groups, and conduct key informant interviews, Threadgold added that "We are that extra set of hands for facilities that may not have the bandwidth or the workforce to do some of these very important aspects of being a healthcare entity."

There is no charge for any of the training or assistance SORH offers.

About SORH

SORH is a federal-state partnership that helps rural communities build their healthcare services through collaborations and initiatives with a wide range of partners across the state. For 45 years, SORH has supported North Dakota's rural communities, including programs such as:

Overall impact

Because of its origins and its ongoing status as North Dakota's State Office of Rural Health, the millions of dollars, thousands of contacts, hundreds of connections and collaborations, hours of training and education that have occurred through CRH have allowed CRH to be a leader in providing resources, education, and information about behavioral health, rural healthcare, healthcare workforce, Tribal aging issues, and rural healthcare research for the people of North Dakota.

The impact that SORH has had on North Dakota in 45 years has been tremendous.

"The impact that SORH has had on North Dakota in its more than 45 years has been tremendous," said Warren. "The investment in rural communities, the projects it has helped fund, and the foundations that have been put into place to strengthen health for the people of the state are all a testament to the important work that SORH does every day to build a healthier North Dakota."

Jena Pierce Jena Pierce is the communications manager at the Center for Rural Health at the University of North Dakota School of Medicine & Health Sciences in Grand Forks.