Performing Department
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Non Technical Summary
most Americans feel overwhelmed by adversities (APA, 2022). According to the CDC, "...The COVID-19 pandemic has had a seismic effect on communities across the country, and young people have been especially impacted by the ways in which their everyday lives have been altered. The disruptions were widespread; school buildings closed, opportunities for connecting with peers were limited, communities were dealing with loss and upheaval." (2022a). A U.S. representative sample of students surveyed by the CDC indicated that more than 30% reported their mental health to be most of the time or always not good in the prior 30 days (CDC, 2022b). Stressors clearly documented to affect youth (e.g., labor shortages, inflation, social justice) are expected to persist. For example, 64% of teenage students believe "...the experience of COVID-19 will have a lasting impact on their generation's mental health..." (National 4-H Council, 2020).Rural youth have been especially negatively impacted by the pandemic. Notably, 79% of rural teens surveyed earlier in the pandemic "...wish there was an inclusive environment or safe space for people in school to talk about mental health." and 70% wish their school taught them more about mental health and coping mechanisms (National 4-H Council, 2020). In December 2021, the U.S. Surgeon General issued an advisory of the "urgent need to address the nation's youth mental health crisis." This call to action recommends innovative solutions to address the problems described above, particularly those adversely affecting our rural youth, to address critically important gaps in service and evidence-based program availability.Behavioral health service and programming gaps are larger in rural states such as Iowa, where a "perfect storm" stems from rapidly increasing levels of exposure to adversity, increased isolation, and resultant behavioral health issues, combined with increasingly inadequate access to evidence-based behavioral health (see Manderscheid, 2018). This is especially true regarding services and programming specifically designed to enhance resilience in youth, families, and communities. For example, youth living in rural communities are particularly at risk for service inequities. Rural youth are diagnosed with behavioral health conditions later in their lives than are urban or suburban children; they also are more likely to experience longer waiting periods before receiving intervention services (Robinson, et al., 2017). Nearly 40% of Iowa's population is considered rural (US Census Bureau, 2020). Of those youth needing behavioral health services, many are not accessing services each year (e.g., Major Depressive Episodes; <50%; Reinert, et al., 2022) . In addition, rural communities experience unique challenges to maintaining capacity and sustainability for implementation of resilience-oriented prevention and behavioral health programs. Limits in behavioral health service capacity in rural communities further suggests that collaboration among community members is essential in fully addressing the behavioral health needs for rural youth in Iowa.Over the past year, the Resilience Zone Initiative has formed unique partnerships among University Extension, schools, behavioral health, and prevention scientists to deliver youth- and family-focused evidence- and research-based programs.participating counties (1) identify and train Resilience Champions, (2) develop a team of Linking Agents to support programming led by Resilience Champions, (3) develop a plan to address gaps in programming, (4) train facilitators and key personnel, and (5) facilitate evidence- and research-based resilience-oriented strategies and programs to address youth behavioral health and substance misuse issues, including opioid misuse. By the end of the three year project, five RZIs will be positioned to continue systematic planning, implementation, and evaluation of selected programs and strategies from an expanded menu of available programs.This project will address resilience-related behavioral health and opioid/other substance misuse issues in an additional three counties (totaling to five with the original two rural counties), potentially impacting up to 125,000 residents through the development of sustainable, community-based resilience and prevention capacity-building and training. Our approach expands the delivery of research- and evidence-based programs that address pandemic-related rural community needs through a sustainable community-driven model, guided by a proven delivery system. In turn, our approach meets a need identified through the COVID-19 Recovery initiatives supported by ISU Extension and Outreach Extension, as previously described.?
Animal Health Component
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Research Effort Categories
Basic
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Applied
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Developmental
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Goals / Objectives
1. Increase the capacity of the PROSPER Network Organization (PNO) to support five, rural, county-based, school-focusedResilience Zone Initiatives and an additional state infrastructure both during the funded project period, as well as sustaining and expanding beyond the project period. 1. Build capacity to support Resilience Zone Initiatives 2. Expand training and technical assistance capabilities and systems for Resilience Zone Initiatives NLT August 1, 2023. 3. Develop the RZI infrastructure in one additional state2. Assess, select, and train Resilience Champions in three rural Iowa Counties. 1. Develop and implement site selection process and provide an orientation to 3 new ssites 2. Develop plans for Resilience Zone Initiatives implementation sites NLT December 31st, 20243. Apply the proven PROSPER and WeCanPROSPER technical assistance/coaching system to support local ResilienceChampions' efforts to implement county-based Resilience Zone Initiatives 1. Implement the Resilience Zone Initiative plans and training/technical assistance processes 2. Utilizing the Resilience Zone Initiative Scorecard, county-based Champions will work to implement at least two iterations of the evidence- and research-based programs NLT the end of the project, August 30th, 2026.
Project Methods
This project leverages and builds upon our flagship Resilience Zone Initiatives (RZI) project funded through the Rural Health and Safety Education Program. It addresses the documented, substantial declines in mental health confronted by rural youth (CDC, 2023), exacerbated by limited access to effective behavioral health programs. It accomplishes this purpose though the systematic delivery of research- and evidence-based resilience enhancement programming.Three interrelated conceptual frameworks have guided the operationalization of this proposed project; the Diffusion of Innovation Framework, the PROSPER Partnership Model for delivery of evidence-based preventive interventions (see Spoth et al. 2004), and the framework for building capacity in Cooperative Extension System in behavioral health programming (Spoth et al., 2021). The literature clearly demonstrates how community-university partnerships like PROSPER are effective in achieving community-level impact thorough dissemination of innovative programs to rural communities, as indicated by a variety of behavioral health and wellness indicators (Mersky, Topitzes, & Blair, 2017; Northmore & Hart, 2011; Spoth, 2007). PROSPER, which is unique in its inclusion of Extension-assisted partnerships, is identified as one of three "evidence-based prevention strategies that work" for rural opioid misuse prevention (Office of National Drug Control Policy's 2020 Rural Community Action Guide). In rural communities, use of the PROSPER Delivery System to implement behavioral health programs found PROSPER increases cost effectiveness and sustainability of programs (Spoth et al., in press). Moreover, youth participating in programs implemented through PROSPER show increases in youth protective factors associated with resilience (e.g., positive relationships, prosocial peer affiliations, and competencies like problem solving) along with long-term reductions on a number of negative behavioral outcomes (e.g., substance misuse and conduct problems), up to 14 years past the baseline assessment (Spoth & Greenberg, 2011; Spoth et al., 2013; 2015; 2022; in press). Importantly, especially given the focus of this project, longitudinal study of outcomes suggests that PROSPER strengthens youth resiliency portfolios (Feinberg et al., 2022). These outcomes are achieved through implementation of the core components of the PROSPER Partnership Model, the first of which is a three-tiered structure that links university-based experts with community-based teams, representing a key aspect of our primary conceptual framework, as illustrated in the figure. Diffusion of Innovation (Rogers, 1995) provided the theoretical underpinnings for PROSPER (Spoth et al., 2004) and is of direct relevance to this project. That is, the current crisis calls for new strategies to address mental health and substance misuse problems in rural communities and has underscored the need for an adaptive innovations approach to addressing these issues. ISU Extension and Outreach COVID-19 Recovery efforts are responsive to this call. This represents a key component of the Diffusion of Innovation framework that highlights the use of existing systems to promote adoption of new programs and behaviors. This project also focuses on the use of the existing communication structures and networks of "Resilience Champions" and "Linking Agents" (Rogers, 1995) to optimize the adoption and sustainability of selected programs at the community level. Linking Agents are individuals from key community sectors who are critical to the implementation of programs and strategies related to resilience-oriented project goals. They function to support change by connecting schools with resources needed to achieve resilience enhancement or behavioral health goals (see Rogers, 1995).Training Resilience Champions and providing ongoing technical assistance to them, along with innovation-adopting Linking Agents, is expected increase the likelihood of success in quality, sustainable programming (Rogers, 1995, Spoth et al., 2004; Spoth & Greenberg, 2011). It is expected that participating communities will see increases in (1) readiness to address the deleterious consequences of rural youth adversities, (2) awareness of related issues and solutions, (3) accessibility of programs and other resources that typically are sparse in rural communities and (4) engaged youth and adults participating in resilience enhancing activities.This project will build on the successful formative stage development of the RZI in Iowa, funded through USDA/RHSA Grant #2022-46100-38164. Over the past year, the Resilience Zone Initiative has formed unique partnerships among University Extension, schools, behavioral health, and prevention scientists to deliver youth- and family-focused evidence- and research-based programs. As noted, the Resilience Zone Initiative has a strong foundation in PROSPER. PROSPER is the only community-based delivery system designed specifically for application within Cooperative Extension that has been shown to prevent opioid misuse long-term and has been recognized by the Office of National Drug Control Policy (Spoth et al., 2022; ONDCP, 2020; 2022). Grounded in PROSPER, the RZI provides County Extension and local stakeholders with an evidence-informed system of capacity building for local resilience enhancement. Ultimately, participating counties (1) identify and train Resilience Champions, (2) develop a team of Linking Agents to support programming led by Resilience Champions, (3) develop a plan to address gaps in programming, (4) train facilitators and key personnel, and (5) facilitate evidence- and research-based resilience-oriented strategies and programs to address youth behavioral health and substance misuse issues, including opioid misuse. By the end of the three year project, five RZIs will be positioned to continue systematic planning, implementation, and evaluation of selected programs and strategies from an expanded menu of available programs.This project will address resilience-related behavioral health and opioid/other substance misuse issues in an additional three counties (totaling to five with the original two rural counties), potentially impacting up to 125,000 residents through the development of sustainable, community-based resilience and prevention capacity-building and training. Our approach expands the delivery of research- and evidence-based programs that address pandemic-related rural community needs through a sustainable community-driven model, guided by a proven delivery system. In turn, our approach meets a need identified through the COVID-19 Recovery initiatives supported by ISU Extension and Outreach Extension, as previously described.