"The left hand does not know what the right hand is doing": rural and urban cultures of care for persons with traumatic brain injuries.

This qualitative study examined systems of care for individuals with brain injury, from the providers' perspective, in two Colorado communities, one rural and one small urban, from 1998 to 2001. Using a guided interview format the researchers interviewed 53 medical, rehabilitation, community, and school service providers in the two sites. Of the 53 providers, ethnicity was reported as 100% Caucasian. Client ethnicity in the rural area was 87.9% Caucasian and 6.2% Hispanic, and the urban reported 67.3% Caucasian and 29% Hispanic. Both communities noted problems with care coordination, information about other available services, housing and transportation, and large underserved groups (persons with mild brain injury, non-English speakers, and persons without or with insufficient health insurance). The two communities noted strengths in having peer support networks and options for supported recreation. The rural community demonstrated strengths in dealing with trauma care but had few resources available for long-term rehabilitation and community-integrated services for its residents with brain injuries. The urban community uniquely had an array of alternative treatment approaches available.