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

Outputs
Target Audience:Target Audience Our RHSE project, Cultivating Youth Mental Health in Rural and Reservation Communities provided mental health literacy programing for middle and high school students in rural counties in Montana. This project was designed to improve quality of life for rural and American Indian (AI) youth by reducing health disparities and increasing access to mental health information and resources to decrease opioid misuse through the implementation of YAM. AI youth face significant mental health disparities compared to their non-Native peers, and these disparities are influenced by a combination of historical, socio-economic, and cultural factors (Morales et al., 2020). 1,322 students across rural and AI communities in Montana participated in Youth Aware of Mental Health (YAM) in the 2023-2024 school year and the fall of the 2024-2025 school year. Efforts YAM was delivered in five one-hour sessions, over a three-to-five-week period, to a total of 1,322 middle school and high school students by a certified YAM instructor and assistant. The YAM program aims to strengthen youth resiliency and provide youth with the skills to make healthy coping choices, thereby reducing risk for substance use and suicide. Previous research has demonstrated that YAM is an effective and sustainable way to deliver a universal prevention program through Extension personnel (Bailey et al., 2021), to youth who otherwise would not have access to vital mental health education. The core of the program consists of an opening lecture, three role-play sessions, and a closing lecture with particular emphasis on connections to local, state, and national resources. YAM is a research-based, non-formal education prevention program delivered by Extension faculty and trained community partners using a strengths-based perspective to promote rural and native youth mental health and reduce opioid misuse. This project addresses intersecting factors of mental health, opioid and substance misuse, and suicide and provides training for Extension faculty and community partners who are uniquely positioned to contribute to collaborative efforts to deliver prevention education to rural and indigenous youth. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Training 10 new YAM Instructors attended a week-long training and completed all the requirements to become certified YAM Instructors by Mental Health in Mind (YAM Founders in Sweden). Professional Development Debrief and Consultation with Trainers There have been several opportunities for YAM Instructors to hone their skills through professional development. YAM Instructors are required to participate in debrief/instructional calls with YAM trainers while teaching YAM. These debrief/instructional calls allow for YAM Instructors to share teaching strategies, discuss solutions to problems that may arise in the classroom, and to reflect on their experience teaching the program. In addition, all instructors join a yearly meeting via zoom with Mental Health in Mind (YAM founders in Sweden) where they educate instructors on any new research findings, changes to materials, and updates on the program. RHSE Meeting Program leaders presented at the virtual meeting in the winter of 2024. Topics presented on program approach, challenges (i.e. youth opioid misuse, mental health), implementation progress, adaptations needed, and goals moving forward. YAM Advisory Board In February of 2024, we convened the MSU YAM Advisory Board to provide a current status report on our YAM activities and outcomes and receive feedback and guidance from key stakeholders. How have the results been disseminated to communities of interest?A partner school/reservation specific YAM report and statistical analysis of the survey results and program evaluation has been sent to each school and tribal council that allowed the CRRE team to administer the IRB approved self-report surveys and/or the project evaluation. Furthermore, regarding community outreach, for schools that may be interested in having YAM for the first time, the CRRE team has offered to hold community stakeholder meetings. Here, we have educated the community about the YAM objectives and goals and have answered any questions that may have arisen about the program. What do you plan to do during the next reporting period to accomplish the goals?The Center for Research and Rural Education (CRRE) reaffirms its commitment to serving our partner schools by supporting the continued implementation and expansion of the YAM program. Recognizing the unique challenges faced by rural and American Indian youth, we are dedicated to fostering mental health literacy and resilience through culturally responsive and accessible programming. We will continue to: Communicate with partner schools in order to continue to teach YAM Engage in community outreach to share information with new schools to implement YAM Recruit Extension Agents and Community Partners to become YAM Instructors and/or Assistants Work closely with and listen to tribal councils and communities to meet their youth mental health needs

Impacts
What was accomplished under these goals? Impact Statement Research has demonstrated that the current opioid crisis is disproportionately affecting low-income, rural communities (Magidson et al., 2019) such as those found across Montana. Rural areas have high prescription rates and tight social networks that allow for faster dispersal of opioids among at-risk populations, including youth, making misuse more likely (Cerdá et al., 2016). Research also indicates that increased opioid misuse is associated with mental health disorders (Davis et al., 2017). There is an urgent need to increase mental health literacy (MHL) among rural and American Indian (AI) youth, as MHL is a vital protective factor against mental health challenges and substance misuse (Kelly et al., 2007). Early intervention is critical to minimizing the poor outcomes associated with adolescent mental illness (McGorry et al., 2007). Youth Aware of Mental Health (YAM), a universal evidence-based MHL literacy program, was brought to Montana to be taught to rural and AI youth. Our RHSE grant has trained 10 new YAM instructors, delivered YAM to 1040 students at 23 rural and reservation schools. Participants are reporting decrease in mental health stigma and increases in mental health literacy, healthy coping and resilience skills, and help-seeking behaviors. 1. Train 10 new YAM Instructors Activities: 10 new instructors were trained over the course of the grant. Data: Mental Health in Mind (founders of YAM, located in Sweden) confirmed that 10 new YAM Instructors had completed all requirements necessary to receive Instructor Certification. Results: The certification of these 10 new instructors increased the number of YAM Instructors in MT from 46 to 56. Outcomes: Increased capacity to deliver YAM 2. Deliver YAM to 23 Rural and Reservation Schools Activities: The program was delivered at 21 schools. Data: All 21 schools completed MOU and reported their student participants to the CRRE for record keeping. Results: At the time of this report, more than half of the 2024-2025 school year remains, and at least 5 more schools are planning on having YAM or have expressed an interest in YAM for this school year. We anticipate by the end of the 2024-2025 school year that we will surpass our goal. Outcomes: Delivery of YAM programming leading to improved quality-of-life for youth in rural and reservation communities 3. Reach 1040 students a year Activities: We have delivered the YAM program to 1322 rural and American Indian youth, surpassing our goal of reaching 1040 rural and American Indian youth. Data: The CRRE collected two types of data for the 2023-2024 school year: 1) voluntary and anonymous program evaluation data and 2) IRB approved participant self-report data for research purposes. Research is ongoing for the 2024-2025 school year. Results: Of the 188 students who completed a voluntary anonymous program evaluation in 2023-2024: 89% reported that they believe mental health should be taught in schools; 81% reported that what they learned in YAM was useful, highlighting the effectiveness and relevance of our efforts; 91% reported they can recognize the signs of depression; 80% reported that YAM had increased their knowledge and awareness about mental health; 75% reported that because of YAM, they were more likely to reach out to an adult and seek help for themselves; 89% reported that because of YAM, they were more likely to reach out to an adult to get help for a friend. Furthermore, results from the 48 students who completed an IRB Approved Participant Self-Report pre-post program survey in 2023-2024 found: a statistically significant increase in help seeking behaviors for Depression, Anxiety, other Emotional Problems; increase (non-significant) in help seeking behaviors for Drug Related Problems; increase in coping skills (non-significant), statistically significant increase in Sharing Feelings; and an increase in Collaborative Problem Solving and Self-Confidence (non-significant). Sharing Feelings, Collaborative Problem Solving, and Self-Confidence are all considered healthy coping and resiliency skills. There was also a statistically significant decrease in Depression Interfering with Daily Life. Outcomes: We exceeded our goal for number of participants by 282 students. Findings indicate strong level of student satisfaction with the delivery, content, and impact of YAM. 4. Participants report reduction in misuse of opioids Activities: 1322 rural and American Indian youth participated in YAM. Data: Montana Youth Behavior Risk Survey Results: The 2023 Montana Youth Risk Behavior Survey shows an overall reduction in opioid misuse among high school survey participants. We have not yet been granted access to individual school data which would allow us to assess opioid misuse data for schools that participated in YAM. Outcomes: Overall reduction in opioid misuse among MT high school students. 5. Students report decrease in mental health stigma Activities: 1322 rural and American Indian youth participated in YAM. Data: See #3 above. Results: See #3 above. The increase of mental health knowledge and help-seeking behaviors reflect a reduction of mental health stigma. Outcomes: Decreased mental health stigma for rural and American Indian youth. 6. Participants report increase in mental health literacy Activities: 1322 rural and American Indian youth participated in YAM. Data: See #3 above. Results: See #3 above. The increase of mental health knowledge and help-seeking behaviors reflect an increase in MHL. Outcomes: Increased rural and American Indian youth mental health literacy. 7. Students report increase in healthy coping and resilience skills Activities: 1322 rural and American Indian youth participated in YAM. Data: See #3 above. Results: See #3 above. There was an increase in coping skills when comparing the mean response scores on the pre survey to the post survey. Sharing Feelings, Collaborative Problem Solving, and Self-Confidence are all considered healthy coping and resiliency skills. Outcomes: Increased rural and American Indian youth skills in healthy coping and resilience. 8. Participants report an increase in help-seeking behavior Activities: 1322 rural and American Indian youth participated in YAM. Data: See #3 above. Results: See # 3 above. Participants were more likely to reach out to an adult and seek help for themselves or a friend. Outcomes: Increased rural and American Indian youth help-seeking.

Publications