Progress 09/01/22 to 12/31/24

Outputs
Target Audience:In 2022 and 2023, Kansas was ranked 50th out of 50 states and the District of Columbia by Mental Health America (Reinert, Fritze, & Nguyen, 2024). This grant targeted mental health prevention in rural Kansas, specifically focusing on nine rural counties in Southeast Kansas (i.e., Woodson, Allen, Bourbon, Wilson, Neosho, Crawford, Montgomery, Labette, and Cherokee). The target areas for this work included a total of 57 RUCA codes, distributed as follows: RUCA-4 N=17; RUCA-5, N=5; RUCA-7, N=16; RUCA-8 N=5; RUCA 10, N=14. Of the 59 RUCA codes associated with the nine counties of interest, only two State-County-Tract FIPS areas were below a 4, and as such, no project activities occurred within those two tracts in Cherokee County. These counties were selected due to their shared proximity (i.e., they are a contiguous cluster of nine counties and based on their Social Vulnerability Index (SVI) (CDC/ATSDR, 2021) rankings in Kansas. The Center for Disease Control and Prevention (CDC) recommends using SVI to guide community-based health promotion initiatives. The SVI was the primary reason for our targeting with all nine counties ranking in the top third of SVI, with seven of the nine counties in the top 20 in the state. Southeast Kansas extension agents and area specialists were identified to recruit community stakeholders (including additional mental health connected professionals and law enforcement) to build social capital and community capacity within this targeted area. Changes/Problems:The nature and topic of this project, suicide prevention, presented unique challenges due to the deep stigma surrounding this issue, as an inherently relational and emotionally charged topic. Not all community members felt ready or comfortable participating, particularly in an area with high prevalence and personal connections to suicide. These dynamics impacted recruitment efforts and contributed to the project not fully reaching its original participant goals. Staffing turnover and inconsistencies in maintaining relationships with local providers also affected program continuity and hindered collecting data. Additionally, losing a PI to another institution limited the ability to share data across institutions and follow-up work for publication purposes. Significant deviations from the original research schedule occurred, particularly in pre- and post-data collection. While the intent was to build strong feedback, the extended timeline for participant engagement and for distributing stipends to trainers created a lag that affected momentum and enthusiasm. Future efforts should explore more trainer-friendly, streamlined processes that continue to support rigorous data collection and measure long-term impact more effectively. Finally, the evaluator didn't have a relationship with the stakeholders who were interviewed about their experiences with this project. While this eliminates bias, it also impacts rapport and comfort, especially on a sensitive topic. Moving forward, other evaluation methods may be explored such as using internal evaluators to facilitate interviews, including a relationship-building phase at the beginning of the evaluation process, or offering options for stakeholders to share their experiences anonymously in writing. What opportunities for training and professional development has the project provided?Identified community stakeholders completed QPR and behavioral rehearsal training to prepare themselves to deliver suicide prevention training to others in their communities. The QPR certification remains valid for one year, enabling trainers to continue offering training beyond the project period and associated stipends, should they choose to do so. How have the results been disseminated to communities of interest?Results from the pre- and post-surveys will be shared with collaborating partners, including local K-State Extension offices, mental health providers, and trained gatekeeper facilitators, to support ongoing community-based efforts in suicide prevention. The PI wasinvited to participate in university research events for the 2024-2025 academic year and will be featured in the Research Spotlight at Kansas State University in Summer 2025. Additionally, the graduate assistant presented preliminary findings at a rural university in the Midwest, helping to raise awareness and build local capacity for evidence-based mental health initiatives. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Aim 1 increased coordination of efforts to address suicide in rural communities in SE Kansas. The co-co-principal investigators (co-PIs) and Kansas State Extension agents developed strategic partnerships with key stakeholders to support suicide prevention efforts in rural communities across the targeted nine counties in SE Kansas. Through a series of five collaborative meetings and several individual follow-up meetings, outreach was established with local community leaders to promote engagement in suicide prevention training. These meetings focused on coordinating community-based opportunities by intentionally identifying and preparing trusted community members to recognize, respond to, and refer individuals at risk. Question, Persuade, Refer (QPR) Suicide Gatekeeper Training and behavioral rehearsal sessions were conducted by the co-PIs in year 1, and the PI and graduate assistant in year 2, to build community capacity and enhance access to mental health support. Aim 2 increased capacities of local communities to support suicide gatekeeper training programming for rural residents. The co-PIs, graduate assistant, and ten identified key stakeholders completed suicide gatekeeper instructor training to implement evidence-based Question, Persuade, Refer (QPR) Suicide Gatekeeper Training which equips individuals to recognize warning signs of suicide and effectively engage with those who may be at risk. The 8-hour instructor training, provided by the QPR Institute, was completed online, and all participants received certificates of completion. In addition to completing instructor certification, the co-PIs in Year 1 - and the PI and graduate assistant in Year 2 - provided instruction on role-play formation and behavioral rehearsal sessions to strengthen community instructors' capacity to implement QPR programming. All trained stakeholders signed letters of commitment to co-facilitate at least two suicide prevention training sessions for rural residents, with a target of reaching fifteen participants. To support this effort and encourage broader community engagement, trainers received a stipend for each group of fifteen community members trained. Through this effort, the ten trained instructors provided programming that reached and built capacity among 126 community members in the nine identified counties in SE Kansas. Aim 3 increased capacities of local communities to refer suicidal individuals to appropriate local mental health resources. The co-PIs, K-State Extension agents, and the graduate assistant identified and collaborated with mental health providers in the nine counties serving SE Kansas. The co-PIs and graduate assistant built strategic connections with each provider to inform them of the collaborative plan to increase suicide gatekeeping in each community and to seek permission to include the provider on a list of referral sources, as well as provide emergency resources and crisis hotline contact information. The graduate assistant maintained ongoing communication with local SE Kansas providers to establish, build, and sustain relationships and to keep the mental health referral list current. Additionally, the graduate assistant developed a referral resource handout developed for the SE communities of current available local providers when a stakeholder must refer. This provided current knowledge and options for local resources for additional community support. Aim 4 empowered rural community members in SE to identify and engage with potentially suicidal individuals in their communities. 126 participants were trained, and 36 community members completed the online pre-survey, the evidence-based gatekeeper training, and an online post-survey. Data was run by an outside evaluator. Outcomes indicate that those that completed the training and pre-post survey reported statistical significance with more comfort in working with individuals expressing suicidal ideation. Finding: Following the training, participants demonstrated a statistically significant increase in their understanding that youth ages 10-24 are at higher risk for suicide compared to adults aged 65 and older. This shift--from previously identifying the statement as "false" to "true"--reflects a meaningful gain in suicide knowledge, and awareness about youth suicide risk, highlighting the effectiveness of the training in addressing this critical area. Finding: Participants also demonstrated increased comfort in working with suicidal individuals with all questions focused on suicide gatekeeper self-efficacy and communication showing a positive statistically significant increase from "strongly disagree" to "strongly agree". Beyond the pre-post survey, the outside evaluator interviewed two trainers on their experiences to gather their perceptions of the grant and gather qualitative data. Major reported themes of the interviews indicated (1) confirmation that interactive, role-playing components of the training were the most beneficial, (2) participants expressed continued need for support in their communities, (3) more suicide prevention training, (4) personal connections to suicide that drive participants to want additional training, prompting them to participate in this project.

Publications

Progress 09/01/23 to 08/31/24

Outputs
Target Audience: Nothing Reported Changes/Problems:Some timeline adjustments and personnel changes impacted the project. First, the need to ensure our graduate student was adequately compensated and received full benefits and tuition forced our timeline to require a NCE. Additionally, staff turnover impacted the schedule, project manpower, and consistency inrelationships with local community members.Data across two completely different educational climates and communities would have been cumbersome impacted publication potential. What opportunities for training and professional development has the project provided?Identified community key stakeholders underwenttraining to provide training to community participants. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Stakeholders will provide the training to implement Aim 4. Aim 4 will empower rural community members in SE Kansas to identify and engage with potentially suicidal individuals in their communities. The PI and graduate student will promote the expansion of training by encouraging key stakeholders through email reminders and stipends to plan and implement in-person training to rural community stakeholders, through the evidence-based suicide gatekeeper program QPR. Participantswill complete an online pre-survey prior to starting the evidence-based gatekeeper training and an online post-survey upon completion. In addition, participants will be asked to complete a 6-month follow-up survey to assess longitudinal changes.

Impacts
What was accomplished under these goals? Aim 1:The co-PIs and KSU Extension made strategic connections with key stakeholders who are well-positioned to identify individuals at-risk for suicide in rural communities throughout nine counties in SE Kansas. Approximately twocollaborative meetings and several individual follow-up meetings were held with key stakeholders to develop collaborative plans to implement QPR suicide gatekeeper training in rural communities across SE Kansas. Aim 2: The PIand graduate student identified key stakeholders to provide suicide gatekeeper instructor training, to implement evidence based Question, Persuade, Refer (QPR) programming, which teaches individuals to recognize the warning signs of suicide and to effectively communicate with potentially suicidal individuals. In addition to the 2 original co-PIs, the graduate student andthreekey stakeholders were trained in year two as QPR instructors. The 8-hour training provided by the QPR Institute was completed online by all participants by September 15. The PIand graduate student increased capacity by providing role-play formation and behavioral rehearsal training to key stakeholders to enhance QPR programming in July and September 2024. The identified 3key stakeholders signed a letter of commitment to co-facilitate at least two training courses for rural residents within six months of completing the instructor training. Aim 3: The co-PIs, KSU Extension, and the graduate student collaborated and identified mental health providers in the nine counties serving SE Kansas. The PIand graduate student built strategic connections with each provider to inform them of the collaborative plan to increase suicide gatekeeping in each community and to seek permission to include the provider on a list of referral sources, as well as provide current emergency resources and crisis hotline contact information.The graduate student frequently updated community resources and deseminated them to participants.

Publications

Progress 09/01/22 to 08/31/23

Outputs
Target Audience: Changes/Problems:Some timeline adjustments have been made in Aim 2 since our initial submission, and have been adjusted from Quarter 3 to Quarter 4. The items, to ensure all key stakeholders have completed QPR instructor training and implement and evaluate behavioral rehearsal training were adjusted to best meet participant needs and summer schedules. We do not foresee either of these adjustments impacting our overall project timeline. What opportunities for training and professional development has the project provided?Identified community key stakeholders are currently undergoing training to later provide training to community participantsin the future. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Stakeholders will provide the training to implement Aim 4. Aim 4will empower rural community members in SE Kansas to identify and engage with potentially suicidal individuals in their communities. The co-PIs, KSU Extension, and key stakeholders will plan and implement in-person training to 360 rural community stakeholders, over two years through the evidence-based suicide gatekeeper program QPR.All participants in Aim 4 will sign up for the training through K-State Qualtrics Survey. They will complete an online pre-survey prior to starting the evidence-based gatekeeper training and an online post-survey upon completion. In addition, participants will be asked to complete a 6-month follow-up survey to assess longitudinal changes. Expected outcomes for rural residents includes increased suicide gatekeeper self-efficacy, increased suicide knowledge, increased suicide communication skills, and increased number of referrals of suicidal individuals to mental health care providers.

Impacts
What was accomplished under these goals? Aim 1:The co-PIs and KSU Extension made strategic connections with key stakeholders who are well-positioned to identify individuals at-risk for suicide in rural communities throughout nine counties in SE Kansas. Approximately 3collaborative meetings and several individual follow-up meetings were held with key stakeholders to develop collaborative plans to implement QPR suicide gatekeeper training in rural communities across SE Kansas. Aim 2:The co-PIs and identified key stakeholders to provide suicide gatekeeper instructor training, to implement evidence-based Question, Persuade, Refer (QPR) programming, which teaches individuals to recognize the warning signs of suicide and to effectively communicate with potentially suicidal individuals. In addition to the 2 co-PIs, 8 key stakeholders are currently being trained as QPR instructors. The 8-hour training will be provided by the QPR Institute andcompleted online by all participants by September 1. The co-PIs will increase capacity by providing role-play formation and behavioral rehearsal training to key stakeholders to enhance QPR programming on Wednesday, September 27th. The identified 8key stakeholders signed a letter of commitment to co-facilitate at least two training courses for rural residents within 24 months of completing the instructor training. Aim 3:The co-PIs, KSU Extension, and the graduate studentcollaborated and identifiedmental health providers in thenine counties serving SE Kansas. The co-PIs and graduate student builtstrategic connections with each provider to inform them of the collaborative plan to increase suicide gatekeeping in each community and to seek permission to include the provider on a list of referral sources, as well as provide emergency resources and crisis hotline contact information.

Publications