RURAL HEALTH AND SAFETY EDUCATION GRANT (OPIOID PREVENTION IN RURAL COMMUNITIES)

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: OTHER GRANTS
• Reporting Frequency: Annual
• Accession No.: 1020644
• Grant No.: 2019-46100-30278
• Cumulative Award Amt.: $317,122.00
• Proposal No.: 2019-04617
• Project Start Date: Sep 1, 2019
• Project End Date: May 31, 2023
• Grant Year: 2019
• Program Code: [LX]- Rural Health & Safety Education

Recipient Organization
UNIVERSITY OF GEORGIA
200 D.W. BROOKS DR
ATHENS,GA 30602-5016

Performing Department
(N/A)

Non Technical Summary
Opioid misuse is a growing problem in Georgia with potentially life-threatening consequences. The aim of this project is to address opioid misuse in four rural Georgia counties (Elbert, Lumpkin, Tattnall, and Washington) through a multi-pronged strategy: (1) building family strengths and youth resiliency, in order to equip youth and families with skills to resist opioid misuse; (2) preparing Extension professionals, medical providers, and social service professionals to identify individuals dealing with opioid-related mental health crises, and to refer these individuals to appropriate specialty treatment; and (3) increasing community awareness of the risks of opioid misuse and ways to reduce those risks in the local community. The project address these objectives through assessment of community needs and resources related to opioid misuse; Mental Health First Aid for Youth training for adults; training for medical professionals on screening, brief intervention, and referral for treatment (SBIRT) for risky/harmful substance use; a pilot project to build family communication through adult-youth activities; and a public education and awareness campaign to address opioid misuse prevention. The project is grounded in Social Cognitive Theory (SCT) and an ecological framework for prevention, which provide a structure for intervening at individual, family, and community levels of influence.

Animal Health Component

50%

Research Effort Categories

Basic

(N/A)

Applied

50%

Developmental

50%

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
806	6099	3020	30%
723	6099	3070	50%
802	6099	3020	20%

Knowledge Area
806 - Youth Development; 723 - Hazards to Human Health and Safety; 802 - Human Development and Family Well-Being;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3070 - Psychology; 3020 - Education;

Keywords

georgia

and opioid misuse prevention

mental health

rural health

strengthening families

youth

Goals / Objectives
The aim of this project is to address opioid misuse in four rural Georgia communities through a multi-pronged strategy: (1) building family strengths and youth resiliency, in order to equip youth and families with skills to resist opioid misuse; (2) preparing Extension professionals, medical providers, and social service professionals to identify individuals dealing with opioid-related mental health crises, and to refer these individuals to appropriate specialty treatment; and (3) increasing community awareness of the risks of opioid misuse and ways to reduce those risks in the local community.Program ObjectivesTo create a report of community stakeholder needs related to opioid misuse, as well as a list of local and nearby resources for prevention and treatment of opioid misuse, for each of the four rural Georgia counties.To prepare Extension and other community professionals working with youth to respond to youth experiencing an opioid-related mental health crisis, including referring the youth to appropriate treatment resources.To increase the capacity of health and social service professionals to address risky substance use and substance use disorder issues in youth and adults through screening, brief intervention, and referral to appropriate treatment resources.To equip youth with life skills in order to resist opioid misuse.To prepare parents/guardians to support youth in resisting opioid misuse through building family strengths, encouraging positive two-way communication, providing structured opportunities for youth and adult family members to work together, and teaching effective discipline strategies for adolescents.To increase community awareness of opioid misuse and effective community-based strategies to reduce the risk of such misuse.

Project Methods
The project will use multiple delivery methods as follows.Assessment of community needs and strengths related to opioid misuse: In order to develop an individualized approach to reducing the risk of opioid misuse in each target county, we will conductan in-depth assessment of community needs related to opioid misuse, as well as local resources available for the treatment of opioid misuse disorder. This needs assessment will include interviews or focus groups with local Extension employees and other key informants in the community (e.g., county commissioners, school administrators, non-profit agency directors, medical providers) as well as online searches to identify resources that serve each community. Because the communities are rural, we will expand our search for resources to larger communities nearby to reflect the range of options available to county residents who might travel out of county for treatment of substance abuse disorder. We will also identify common barriers to accessing these resources (e.g., insurance coverage, transportation, cost, delays in scheduling appointments). The findings from each community assessment will be compiled into a community report and shared with local stakeholders and Extension employees.Mental Health First Aid for Youth (MHFA-Y) training: In order to build community capacity to identify opioid misuse in youth, we will offer the evidence-based Mental Health First Aid for Youth training course to Extension employees, Extension volunteers, and other community members who work directly with youth in Elbert, Lumpkin, Tattnall, and Washington counties. Mental Health First Aid is an 8-hour course designed to teach adults how to identify, understand, and respond to signs of substance abuse and other mental health crises in youth. The course includes information on how to refer youth for professional help. During the first month of this project, we will send two co-PIs to the MHFA-Y instructor workshop. Once they are certified as instructors, they will work with Extension agents in the four target counties to recruit participants and hold training sessions in each of the four target counties. We anticipate offering 6-8 MHFA-Y training sessions for a total 75 adults in the four target counties.Screening, Brief Intervention, and Referral to Training (SBIRT) online course: The SBIRT course teaches medical and social service professionals how to screen patients/clients for risky or harmful substance use, perform a brief intervention for those at risk, and refer patients/clientsshowing signs of substance use disorder to specialty treatment. The course includes six modules with interactive games, case scenarios, and quizzes at the end of each module. In addition to the online course, SBIRT includes an in-depth toolkit that participants can download for later use. Early in Year 1 of this project, we will create a Georgia-specific version of the course and expand the toolkit by adding more resources specific to opioid misuse/use disorder. Resources may include fact sheets for providers, handouts for patients/clients, links to relevant online information, a list of local treatment providers (identified in the needs and resources assessment described above), and other resources tailored for medical and social service professionals. Once the expanded toolkit is complete, we will recruit 100 health and social service professionals in the 4 target counties to complete the 3.5 hour online, self-paced course.Strengthening Appalachian Families PLUS pilot program (SAFP+): In Lumpkin County, we will pilot-test the Strengthening AppalachianFamilies PLUS in-depth program for 10 families. Youth and caregivers will attend approximately two sessions per month for approximately 18 months. Session content will focus onadult-youth communication, problem solving, working together, and family communication through community activities including community gardening, food preservation, planning healthy family meals, safe food handling, and cooking together. At the end of these sessions, families will practice communication skills in a mealtime conversation format in order to strengthen family bonds and a sense of belonging.Public awareness of opioid misuse risk and prevention: The public awareness campaign for this project is designed to increase community recognition of the risks of opioid misuse and strategies to reduce that risk. The public awareness campaign includes four components.?Print resources, social media messaging, and website: We will develop and distribute print resources in each county, based on identified local needs related to opioid misuse prevention. Print resources may include fact sheets on opioid misuse, lists of local treatment resources, and publications describing simple strategies to reduce opioid misuse in rural communities (e.g., medication takeback programs). In addition, we will develop opioid-specific social media messaging (based on resources from the CDC's RX Awareness Campaign) as well as a section on the UGA Extension website with information about opioid misuse in youth and adults, strategies for reducing such misuse, and links to other resources on opioid misuse. The print resources developed for the project will be posted on the website for ease of distribution to partners. The print, social media, and website resources will be promoted statewide, with an emphasis on rural counties.Journeys magazine: Journeys is a series of magazines on a variety of topics that are distributed to middle school youth through the Georgia 4-H program. Each magazine can be used either as a stand-alone lesson or as a component within a series of lesson plans. The magazines include age-appropriate information, activities, features on youth doing service work related to the topic, features on careers related to the topic, and resources for more information. During this project, we will develop a Journeys magazine and 2-4 associated lesson plans to address opioid misuse with age-appropriate messaging based on CDC resources. The magazines will include reminders to encourage youth to share the information learned with their families. The magazine and accompanying lesson plans will be developed by Dr. Brown, Ms. Davis, and Ms. Dye and reviewed by Dr. Young, Dr. Bales, and middle school teachers/parents. The magazines will be used in both in school and after-school settings.Youth-led PSE change: In order to build community capacity for preventing opioid misuse in the four target counties, a small group of 4-H youth in each county will develop and implement a youth-led program to change local policies, systems, and/or environmental factors related to opioid misuse. The specific project will be designed and led by the participating youth, with adult support and assistance as needed. We will develop and distribute guidelines for youth-led PSE projects related to opioids during the first year of the grant, and youth will develop and implement the projects in the four target counties during the second year.Opioid-related training for local audiences: Based on the needs for information related to opioid misuse identified in each community needs assessment, we will develop localized training sessions on specific topics related to prevention of opioid misuse to targeted groups. Trainings will take place in a face-to-face "lunch and learn" format and through online webinars. Most trainings will last 1 hour. Extension agents and community partners will work with co-PIs to identify specific audiences and determine the best format for each training. An example training topic and audience is educating workers in the kaolin plant in Washington County on how to manage pain without opioid prescriptions. We will present a minimum of 4 training sessions (one in each county) to at least 50 participants during Year 2 of the project.

Progress 09/01/19 to 05/31/23

Outputs
Target Audience:Target audiences for this funding have includedExtension agents (especially those with Family and Consumer Sciences or 4-H Youth Development appointments), parents, professionals working with youth in school and out-of-school settings,and healthcare and social services professionals who may work with patients experiencing substance use disorder. Members of the general public looking for information on opioids and substance use disorder has been a secondary audience, especially of social media and website outreach. Changes/Problems: Covid-19 precautions caused a change in our original objectives, which was approved by USDA-NIFA. The pandemic alsoslowed down the implementation of Journeys in school-based programming. We began piloting the Journeys lessons in middle schools in Spring 2022, and completed the pilot in those same schools in Spring 2023. In addition, successful completion of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) self-paced course was much lower than we anticipated. Community leaders attributed the lack of participation to at least three different factors: (1) lack of comfort with the course content among professionals who registered; (2) changes in employment among potential participants; and (3) stresses related to COVID-19, which madeadditional training much more challenging to schedule and complete. What opportunities for training and professional development has the project provided? During this project, we offered 22 sessions of Youth Mental Health First Aid, and certified 2605 community members as Youth Mental Health First Aiders for a 3-year period. We made the self-pacedScreening,Brief Intervention, and Referral to Treatment (SBIRT) course available throughout the grant period. Uptake of the course was substantially lower than expected. We offered the 4 "4-H Journeys in Health and Safety: The Opioid Crisis" lessons to middle school youth in two target counties: Elbert and Washington. Approximately 130 youth participated in at least one lesson, and the majority of youth completed all four lessons. How have the results been disseminated to communities of interest?We have distributed written reports and oral summaries of needs asssessment data to focus group participants and other community leaders in thesix target counties. Needs assessment reports are also posted on our public-facing website. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Needs asssessment data were collected from six target counties (Chattooga, Elbert, Mitchell, Tattnall, Telfair, and Washington). Needs assessments focused on community attitudes about opioid misuse, community resources to address substance use disorder (SUD), and barriers to treatment for SUD. Data from the focus groupswere analyzed and used for planning programming in each county. Reports were also distributed to leaders intarget counties for their use. Over the course of the project, two co-PIs and 5 additional 4-H agents were trained as Youth Mental Health First Aid instructors. This group of instructorsoffered a total of 22 sessions of Youth Mental Health First Aid during the grant period, reaching 260Extension and other community professionals who work with youth The online Screening, Brief Intervention, and Referral to Treatment (SBIRT) self-paced course has been available for professionals in the six target counties throughout the grant period. Enrollment in the course has been low; a total of 15professionals completed the course. Many more professionals registered and completed the pre-test and started the course, but failed to complete the course for a variety of reasons (including job stresses related to COVID-19, job changes, and difficulty comprehending the material. Based on extensive feedback from leaders in the target counties, we have determined that the self-paced SBIRT course is not a good fit for the needs of professionals in the rural Georgia communities that were the focus of this project. The Journeys magazine for middle school 4-H youth, and four accompanying lessons, were developed, pilot-tested in 2 target counties, and revised based on results of the pilot. The magazine and lessons are in the curriculum review process for Georgia 4-H, and will be distributed to Georgia 4-H in all interested counties, with a focus on rural counties, as soon as the curriculum review is complete. Youth in one target county created youth-led special projects to increase community awareness of opioid misuse, including a distribution of Deterra drug deactivation kits and a distribution of medication lockboxes to secure opioid medications. A public-facing website has been developed to share information and resources about opioid misuse. The website can be found at https://site.extension.uga.edu/preventopioidmisuse/. Content is added to that site regularly. An initial social media campaign, with 4 posts on topics related to opioids, was pilot-tested on UGA Extension social media channels (including Facebook, Instagram, and Twitter) in late spring 2022.

Publications

• Type: Websites Status: Published Year Published: 2022 Citation: Bales, D., Brown, C., Brown, V., & Bowie, M.(2022). Preventing opioid misuse (site.extension.uga.edu/preventopioidmisuse/)
• Type: Other Status: Published Year Published: 2022 Citation: Brown, C., Dye, L., Sheram, C., & Bales, D. (2022). 4-H Journeys in Health and Safety: The Opioid Crisis magazine. Athens, GA: UGA Extension.

Progress 09/01/21 to 08/31/22

Outputs
Target Audience:Target audiences include Extension agents, parents, professionals working with youth in school and out-of-school settings, and healthcare and social services professionals who may work with patients experiencing substance use disorder. Changes/Problems:Covid-19 precautions caused a change in our original objectives, which was approved by USDA-NIFA. The pandemic also slowed down the implementation of Journeys in school-based programming. We are beginning that school-based programming during this academic year. What opportunities for training and professional development has the project provided? We have offered 7 sessions of Youth Mental Health First aid, and have certified 75 community members as Youth Mental Health First Aiders, during this reporting year. We are continuing to recruit healthcare and social service professionals to complete the self-paced online Screening, Brief Intervention, and Referral to Treatment (SBIRT) course. Uptake of the course has been slower than expected. Approximately 20 people have begun the course to date. How have the results been disseminated to communities of interest?A simplified report summarizing key needs asssessment findings for community stakeholders was developed. The report was distributed to community members in face-to-face meetings. The report will be posted on the public-facing website in early 2023. What do you plan to do during the next reporting period to accomplish the goals? We will continue offering Youth Mental Health First Aid training to community professionals working with youth. We will continue recruiting healthcare and social service professionals to complete the SBIRT course, using innovative recruitment strategies. We will pilot-test a scheduled group completion session in one county in early 2023. We will continue to support4-H agents across Georgia in using the Journeys magazine and lessons to teach middle school youth about opioids. We will continue and expand the social media campaign to increase awareness of opioid misuse in Georgia, based on results from the initial pilot. We will continue to expand the opioid website, including adding relevant images, graphics, and videos to capture attention of our audiences.

Impacts
What was accomplished under these goals? Needs asssessment data from sixfocus groupsin target counties were analyzed and reports distributed to target counties.? Two co-PIs and the 4 new instructors offered 7 sessions of Youth Mental Health First Aid during this reporting year, reaching 75 Extension and other community professionals who work with youth The online Screening, Brief Intervention, and Referral to Treatment (SBIRT) self-paced course is available for professionals the four target counties. Recruitment of health and social service professionals to participate is ongoing. Expanded efforts to advertise the course via social media are in the planning stages. The Journeys magazine for middle school 4-H youth, and four accompanying lessons, have been pilot-tested in 2 target counties, and revisions have been made based on results of the pilot. Journeys magazines have been distributed statewide, and lessons will be distributed in early 2023 for statewide use. A public-facing website has been developed to share information and resources about opioid misuse. The website can be found at https://site.extension.uga.edu/preventopioidmisuse/. Content is added to that site regularly. An initial social media campaign, with 4 posts on topics related to opiods, was pilot-tested on UGA Extension social media channels (including Facebook and Instagram) in late spring 2022. Data documenting the reach and effectiveness of the campaign are currently being analyzed.

Publications

Progress 09/01/20 to 08/31/21

Outputs
Target Audience:Target audiences include Extension agents, parents, professionals working with youth in school and out-of-school settings, and healthcare and social services professionals who may work with patients experiencing substance use disorder. Changes/Problems:Because of challenges to face-to-face programming that are the result of COVID-19, we have made the following changes to our original scope of work. These changes in scope have been approved by NIFA. The Strengthening Appalachian Families PLUS program will not be completed. The program was designed around a central focus of dinner-table conversation in a face-to-face group setting. The program participants had met once, for an introductory session, when COVID-19 forced us to discontinue the program because meeting face-to-face around a dinner table was not safe. In addition, the infrastructure needed to support the program is no longer in place due to the esignation of the lead faculty member (with no immediate plans to hire a replacement) and the retirement of the contract faculty supporting the project. During COVID-19, four of the original 10 families have dropped out of the project. The remaining 6 youth are beginning high school in the fall, and have stated that they will not have time to participate in the project. The student-led policy, systems, and environment (PSE) projects will not be completed. These projects were intended to happen as a result of students learning about the opioid crisis through the Journeys magazine and related lesson plans. Because of delays in face-to-face 4-H programming due to COVID-19, the schedule for pilot testing and distributed the Journeys magazine and lessons has been delayed. Because of the delays to the release timeline, we will not have sufficient time to plan and implement youth-led projects during this grant cycle. With rebudgeted funds, we will expand Youth Mental Health First Aid to reach more Extension personnel and community members in rural communities. We will expand Extension's capacity to offer YMHFA in rural communities by selecting one more Extension professional to become a YMHFA instructor. We will also expand our projected YMHFA to reach a total of 100 Extension personnel and rural community members during the grant period. With rebudgeted funds, we will pilot-test a small-scale social media outreach campaign related to opioid misuse. The campaign will include general messages about opioids, information promoting SBIRT in target counties, YMHFA promotion, information from Journeys, and other key resources. The campaign will include regular social media posts on existing Extension accounts, reposting of related content from other reliable sources, and targeted ad campaigns specifically for audiences in our four primary counties. We will also explore the feasibility and effectivenessof creating additional pages on Facebook and Instagram to expand our social media outreach related to opioid misuse in rural Georgia. What opportunities for training and professional development has the project provided? We have offered 7 sessions of Youth Mental Health First aid, and have certified 78 community members as Youth Mental Health First Aiders. We are continuing to recruithealthcare and social service professionals to complete the self-paced online Screening, Brief Intervention, and Referral to Treatment (SBIRT) course. Approximately 15 people have begun the course to date. How have the results been disseminated to communities of interest?Asimplified report summarizing key needs asssessmentfindings for community stakeholders is currently indevelopment. The report will be distributed to community members in face-to-face meetings and via the website as soon as it is completed. What do you plan to do during the next reporting period to accomplish the goals? We will finish disseminating the simplifed needs assessment reportto the four local communities. We will offer Youth Mental Health First Aid training to at least 22 more community professionals working with youth. We will recruit 85 more healthcare and social service professionals to complete the SBIRT course. We will complete the pilot of the Journeys magazine on opioids, make any necessary changes to the magazine and lessons, and print and disseminate the Journeys magazineand accompanying lesson plans with 4-H agents across Georgia for their use in teaching middle school youth. We will complete revision of the website, release it publicly, and publicize its availability in Extension and local communities. We will offer targeted training on opioid misuse in the four focus counties, based on the results of the needs assessment. We will pilot test a social media campaign to increase awareness of opioid misuse in Georgia.

Impacts
What was accomplished under these goals? An in-depth report of the needs assessment was completed. A simplified report summarizing key findings for community stakeholders is currently in progress. Two co-PIs offered 7 sessions of Youth Mental Health First Aid during this reporting year, reaching 78 Extension and other community professionals who work with youth. The online Screening, Brief Intervention, and Referral to Treatment (SBIRT) self-paced course is availablefor professionals the four target counties. Recruitment of health and social service professionals to participate is ongoing. Expanded efforts to advertise the course via social media are in the planning stages. The Journeys magazine for middle school 4-H youth has beenprinting. Because COVID-19 limited our ability to present face-to-face programming in schools last year, pilot-testing of the magazine and four lessons was delayed. Pilot testing is now underway and will be completed during the 2021-2022 academic year. Because of COVID-19 restrictions and changes in staffing, the parent preparation component will not be completed. We have received NIFA approval for a change of scope of work to eliminate this project. A comprehensive clearinghouse website has been developed to share information and resources available to address opioid misuse. This website has been shared with Extension personnel. Plans are underway to expand the website to reach broader audiences. In place of the parent preparation component, we have added pilot testing a social media campaign to increase awareness of opioids in Georgia. This campaign is currently in the planning stages.

Publications

Progress 09/01/19 to 08/31/20

Outputs
Target Audience:Target audiences include Extension agents, parents, professionals working with youth in school and out-of-school settings, and healthcare and social services professionals who may work with patients experiencing substance use disorder. Changes/Problems:Because of COVID-19, the startup of our Lumpkin County parent/youth communication and life skills program was delayed because no face-to-face programming was allowed for many months. We have adjusted the plans for the program in order to hold the same number of sessions in a shorter time frame (i.e., by holding biweekly sessions instead of the planned monthly ones). We have also developed a plan to shift the program to virtual delivery via Zoom if the COVID-19 spread in that community makes virtual programming necessary. What opportunities for training and professional development has the project provided? We have offered three sessions of Youth Mental Health First aid, and have certified 57 community members in the four target communities as Youth Mental Health First Aiders. We are currently recruiting healthcare and social service professionals to complete the self-paced onlineScreening, Brief Intervention, and Referral to Treatment (SBIRT) course. 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? We will complete needs assessment reports and disseminate them to the four local communities. We will offer Youth Mental Health First Aid training to at least 40 more community professionals working with youth. We will recruit 100 healthcare and social service professionals to complete the SBIRT course. We will print and disseminate the Journeys magazine on opioids, and share the accompanying lesson plans with 4-H agents across Georgia for their use in teaching middle school youth. We will recruit a small group of middle school youth to complete Policy, Systems, and Environment projects to reduce opioid misuse in their local communities. We will provide biweekly sessions of the parent-youth communication and life skills program in Lumpkin County. We will complete revision of the website, release it publicly, and publicize its availability in Extension and local communities. We will offer targeted training on opioid misuse in the four focus counties, based on the results of the needs assessment.

Impacts
What was accomplished under these goals? Needs assessment reports are in progress. Data have been collected, qualitative data have been transcribed and coded, and analysis of quantitative data is currently underway. Two co-PIs have been trained as Youth Mental Health First Aid instructors in both face-to-face and virtual curriculum. They have offered three sessions of Youth Mental Health First Aid, reaching 57 Extension and other community professionals who work with youth. The online Screening, Brief Intervention, and Referral to Treatment (SBIRT) self-paced course has been adapted for the four target counties. Recruitment of health and social service provessionals to participate is currently underway. A Journeys magazine for middle school 4-H youth has been developed and is currently awaiting printing. Four lessons to about opioids have been developed, and will be pilot-tested with middle school 4-Hers this fall. Because of COVID-19, the parent preparation component has been delayed due to restrictions that did not allow face-to-face programming. This component is scheduled to begin in early October 2020. The project will include biweekly face to face sessions with parents and middle school age youth, focusing on improving life skills and family communication in order to reduce the risk of opioid misuse. A comprehensive website has been developed to share information and resources available to address opioid misuse. The website is currently undergoing beta testing, and will be revised based on results of this testing.

Publications