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

Outputs
Target Audience:Adversity to Action's overall goal is to deliver evidence-based multi-level educational approaches and programs through distance learning platforms to improve provider practice, awareness of ACEs, and evidence-based action to prevent and mitigate ACEs. The target audiences to enroll in our Adversity to Action program are professionals from a variety of disciplines in the rural Missouri counties of Dent, Washington, Crawford, St. Francois, and Phelps. The National Extension Framework for Health Equity and Well-Being suggests dismantling the root causes of structural inequity by addressing social determinants of health through health promotion education and collaboration among organizations for collective action. Since we began recruiting for the Adversity to Action program May 20, 2024, we have targeted the following types of professionals/sectors through 371 emails: housing, job centers, law enforcement, healthcare providers (including eye doctors, chiropractors, dentists, skilled nursing, health clinics, hospitals, federally qualified health centers, home health agencies), daycares, child and family services, coroners, corrections, fire departments, elected officials, opioid settlement committee members, MU Extension, state-wide opioid listserv, local public health departments, libraries, schools, substance use facilities, veterinarians, shelters, mental health facilities, churches, social services, emergency medical services, pharmacists, and non-profit organizations. We have reached out to these roles either directly through searches for contact information to the organization, or through our partners, such as University of Missouri (MU) Extension or Missouri's Overdose Response Strategy Public Health Analyst for Midwest HIDTA (High Intensity Drug Trafficking Areas), MU's office of Health Outreach, Policy & Education (HOPE), the Missouri Rural Health Association, Missouri Hospital Association, Missouri Public Health Association, Missouri Nurses' Association, Missouri Primary Care Association, Missouri Coalition for Oral Health, Missouri Family and Community Trust, and Missouri Development Disability Council, among others. To date, professionals from every county have requested enrollment into the program (n=114), including 8.3% from Crawford, 13.0% from Dent, 31.5% from Phelps, 7.4% from Washington, and 31.5% from St. Francois. Changes/Problems:As mentioned above, we submitted an application to gain access to the Missouri Medicaid data in February 2024. We have not yet heard back from the state of Missouri. Given this lengthy delay, we plan to divest from this plan of action in favor of another way we could better measure community-level programmatic impact. We are considering cross-sector focus groups with participants who have completed the course to better understand next steps to support the communities. Potential individuals to recruit from our graduates include those from school-based therapy, early childhood education, health care, juvenile officer attorney, churches, substance use peer specialists, ambulance services, public library, high school, Sheriff's office, court programs, and criminal justice. This change in plans would remove Dr. Greever-Rice (Center for Health Policy) as a co-Investigator. Instead, we have gained Brenda Schell as a staunch advocate and partner. She is a Public Health Analyst for the Overdose Response Strategy for Missouri's Midwest High Intensity Drug Trafficking Areas (HIDTA), and has already helped circulate our recruitment email to key individuals in our target counties, significantly aiding enrollment given her prominent statewide connections. Additionally, Dr. Kathleen Quinn will be retiring in November 2024; she will continue to support the work unofficially, and we already have strong, independent relationships with MU Extension even in her absence. What opportunities for training and professional development has the project provided?We have been attending Show-Me ECHO sessions (Extension for Community Healthcare Outcomes). We have also been attending various webinars, such as Everyday Trauma by Tracey Shors, PhD, SAMHSA's Medicaid Coverage of Medications to Reverse Opioid Overdose and Treat Alcohol and Opioid Use Disorders, and CDC's Overdose Data to Action in States' Rural Overdose Prevention and Response Efforts: A Collaborative Path Forward. The project has also been extremely valuable for networking. Finally, Dr. Kapp participated in a USDA RHSE NIFA grant review panel May 2024. How have the results been disseminated to communities of interest?Press-release: Dissemination, awareness, and enrollment was aided by a press releasethat launched October 25, 2023. Based on this press release, the MU public relations team reported the following media impressions: State placement KBIA KRCG KYTV-TV (KY3) 11-23-23 Phelps County Focus (print edition, Rolla, MO, 4,000 potential reach) Unterrified Democrat (print edition, Linn, MO, 2,800 potential reach) The Reporter (Camdenton, MO, print edition, 1,200 potential reach) KMOV CBS St. Louis- 1 million potential reach KFVS-TV (Cape Girardeau, MO, 200,000 potential reach) USDA grant will help MU researchers address opioid epidemic in rural Missouri Delta Dunklin Democrat 10/28/2023 Kennett, MO 1300 National/International placements 10-31-23 DoveMed (100,000 potential reach) 10-29-23 Morning Ag Clips (95,000 potential reach) its247news (Great Britain, 600 potential reach) The Medical News (Australia, 3.9 million potential reach) Bioengineer.org (Great Britain) Science Magazine (Great Britain) EurekAlert! (American Association for the Advancement of Science news website, 500,000 potential reach) Head Topics (1.3 million potential reach) MSN (154.5 million potential reach) 11-3-23 MSN (129 million potential reach) KAIT-TV (Jonesboro, Arkansas) Totals: 19 placements, 260 million potential reach EurekAlert! page views: 402 Press release:https://showme.missouri.edu/2023/usda-grant-will-help-mu-researchers-address-opioid-epidemic-in-rural-missouri/#:~:text=Now%2C%20a%20three%2Dyear%2C,providers%2C%20and%20dentists%20%E2%80%94%20who%20serve Notable press: KRCG interview https://krcgtv.com/news/local/university-of-missouri-researchers-address-opioid-epidemic-in-rural-missouri-with-usda-grant KMOV: https://www.firstalert4.com/2023/11/03/mu-receives-3-year-funding-battle-opioid-crisis-rural-missouri/ KBIA: https://www.kbia.org/podcast/missouri-health-talks/2024-01-11/addressing-health-impacts-from-adverse-childhood-experiences-theyre-largely-unrecognized Additional dissemination included a presentation to MU Extension staff and partners in one of our counties, a video to the MU College of Health Sciences, guest lectures to health and rehabilitation science PhD students, and to public health undergraduate students. A link was shared to the national Association of Schools and Programs of Public Health (ASPPH) Friday newsletter. We also shared our work at the RHSE grantee meeting in February 2024. What do you plan to do during the next reporting period to accomplish the goals?We will continue with recruitment efforts to our five counties. We will also continue to track those enrolled and encourage them to complete the course. We will develop dissemination materials to "share back" with our partners to communicate progress and successes so far. We continue to monitor the quality of the data collected and will begin to analyze the data, which include the course enrollment tracking, the online discussion posts, the course evaluation feedback, and the pre/post test of knowledge. We will look for national conferences where we can apply to present this work. We will begin to develop manuscripts for peer-reviewed publications. We plan to develop next steps to measure the impact of the online training. We are considering focus groups with individuals from these counties. Please also see below under Changes.

Impacts
What was accomplished under these goals? Hiring: After the grant started, a position type was identified and we opened the position for applications; recruitment started in October 2023. After a national search, Dr. Ashley Douglas was hired as a Senior Research Associate to support this and another project. She started late January 2024. She has relevant expertise in substance use disorders and serves as the project coordinator. Press-release: Dissemination, awareness, and enrollment for the online training was aided by a press release that launched October 25, 2023. This was coordinated with support from the University of Missouri's public relations team. Please see the dissemination section for more information. Course development and launch: The Adversity to Action course was redesigned and updated from a previous version, and tailored to the 5-county target audience for the RHSE grant. With University of Missouri Extension as a partner, there were also processes to be completed to launch the Canvas course under the Extension arm of campus. The course launched for recruitment May 20, 2024. Pre/posttest development: We developed pre-and post-test questionnaires to measure participant knowledge and satisfaction with the training program. These were designed based on a review of the literature and coded into Qualtrics. These are collected on all enrollees. Institutional Review Board: We submitted and had approved an IRB application to use the Missouri Medicaid data (MOHealthNet) for analyses. We also submitted an application through the MU Center for Health Policy to gain access to those data (see Changes section). Course enrollment and evaluation: To date (August 5, 2024), we have sent 371 recruitment emails (see also Target Audience section), and had 114 individuals request enrollment into the Adversity to Action program. The course includes 6 modules, and requires participants to complete a pre-test, 6 discussion posts, 5 quizzes scoring at least 80% on each, and a post-test/course evaluation. Most participants are "in process" as the course is asynchronous and they have until June 2025 to complete the course. To date, 83 (72.8%) of those who requested access to the course have completed steps to enroll in the course and accessed the course. Of those who enrolled and accessed the course, 24 (28.9%) have completed the course. The course evaluation reflects that 92.3% of respondents rate the course as culturally sensitive, 100% of respondents would rate the course as excellent or very good, 100% would recommend the course to others, and 88.5% intend to apply the content to work or practice. Continuing education: The course has been certified for continuing medical education credits, as well as continuing education for licensed professional counselors, psychologists, and social workers through June 2025. By request from our participants, we are also in the process of seeking continuing education credits for: (1) teachers and educators through the Missouri Department of Elementary and Secondary Education, (2) emergency medical services, and (3) Peace Officer Standards and Training (POST) for law enforcement

Publications