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The Rural Opioids Technical Assistance Through Virginia Cooperative Extension project will build upon two current USDA-funded Cooperative Extension projects to expand training and technical assistance on opioid prevention through implementation of evidenced-based curricula targeting 6th grade students and their families and 7th grade students in middle schools to nine additional rural Virginia counties. Anticipated number of students to be served annually across nine counties is 2,500 seventh-grade students and 500 sixth-grade students and their families (total of 5,000 seventh-grade students and 1,000 sixth-grade students). The electronic (iPad-based) High-Risk Patient Education Program developed by the Virginia Rural Health Association for the USDA-funded Rural Health and Safety Education project entitled “Preventing Opioid Abuse in Rural Virginia” will be disseminated to hospitals and healthcare facilities in four additional rural counties per year. Linkages with SAMHSA State Opioid Response providers and State Targeted Response TA teams will be accomplished through local collaboration between Extension agents and staff from community services boards (CSBs) for leadership of community coalitions and for implementation of evidence-based OUD prevention programs for middle school students and their families. Additional linkages will be facilitated through existing collaboration between the Virginia Department of Behavioral Health and Developmental Services (DBHDS) and a statewide coalition of universities that has developed a menu of options for technical assistance to CSBs related to prevention, treatment and recovery for opioid misuse and addiction.

Translating Effective Opioid Harm Reduction and Wellness Training to Tribal and Rural Utah From 2013-2015, Utah ranked seventh in the nation for drug overdose deaths. Rural counties and Native American Populations are particularly hard hit. These communities lack essential, culturally responsive, educational tools to reduce stigma surrounding life-saving, evidence-based harm reduction best practices. This project will bridge that gap by delivering in-person evidence based harm reduction education to (1) rural and (2) Native American audiences, and by (3) producing virtual trainings and online materials that effectively reduce stigma and support a robust community volunteer base. Project Goals: 1. Deliver evidence-based stigma reduction education to lay rural audiences in Carbon and Emery Counties of Utah in-person and at community events. This will include stigma-reduction focused Naloxone trainings, monthly collaboration with a community advisory board, and a Rural Opioid Health & Wellness Summit. 2. Specifically target rural tribal populations in six counties including the Ute Tribe (Uintah, Duchesne and Daggett Counties), the Paiute Tribe (Iron County), the Navajo (San Juan County), and the Goshutes (Tooele County) to deliver evidence-based stigma reduction education in person and at community events. This will include stigma-reduction focused Naloxone trainings, a 7-minute culturally responsive youth education module on opioid prevention education and a Tribal Opioid Health & Wellness Summit. 3. Deliver up-to-date virtual trainings and materials on Opioid Misuse and harm reduction available to rural audiences in Utah that equip volunteers, inform the public and reduce stigma. This will include six stigma reduction focused fact sheets suitable to a lay audience, a robust social media presence, and an online Master Health Volunteer Program that provides a 40-hour training curriculum based on the SAMHSA Wellness Wheel and equips each participant to deliver 40 hours of community service following training. Number and demographics of lay populations to be served by project objective: FY1: Farm Field Days 7-minute youth curriculum (1000 Native Youth), Stigma Reduction Naloxone Trainings (200 rural community members, of which 75 belong to Native American tribes), Stigma Reduction Fact Sheets (100 downloads), Opioid Health & Wellness Summit (150 rural community member attendees), and Master Health Volunteer Training (6 pilot participants in Tooele County) delivering 240 hours of community service in rural Utah. Total FY1 participants: 1531. FY2: Stigma Reduction Naloxone Trainings (200 rural community members, of which 75 belong to Native American tribes), Stigma Reduction Fact Sheets (150 downloads), Tribal Opioid Health & Wellness Summit (150 Native American rural community member attendees) and Master Health Volunteer Training (30 community members in rural counties), delivering 1200 hours of community service in rural Utah. Total FY2 participants: 530 Lifetime project total of people served: 2061, not including daily social medial postings with an estimated total of 50,000 unique engagements with evidence-based opioid use disorder information.

Farming and ranching families provide essential services and products to the economy. However, this population also experiences unique challenges such as job-related injuries, unpredictable weather conditions, and economic changes that increase their risk of opioid misuse. To address this risk, South Dakota State University Extension and North Dakota State University Extension will partner to provide high quality, resources including virtual trainings on opioid misuse and educational materials to community members, Extension professionals, and other front-line staff working with the target population. Access to mental health providers to address symptoms of stress or depression is lacking in most rural farming/ranching communities (Mohatt, n.d.). And even where services are available, few mental health professionals understand the specific stressors related to agriculture (Hartley, Ziller, Loux, Gale, Lambert, & Yousefian, 2007). In North and South Dakota, over 80% of counties are defined as rural, and 85% of North and South Dakota counties are considered mental health shortage areas meaning the number of providers does not meet the need. Given that both states are sparsely populated, while covering a large geographic area, access to virtual trainings and educational materials is essential. The current project will address this gap in services by providing technical assistance through the Extension network at SDSU and NDSU. SDSU and NDSU Extension will work with the Opioid State Targeted Response and State Opioid Response teams in both states to accomplish two goals: 1) Increase the number of community-based professionals with training in opioid misuse prevention, and 2) Provide access to high quality print and electronic educational materials to farming and ranching families. Progress toward Goal 1 will be accomplished through the following objectives: 1) Partner with Overdose Lifeline, Inc., to provide access to 7 peer-reviewed webinars to a minimum of 150 professionals by the end of Year 2; 2) Train 20 professionals per state to deliver opioid misuse programs by the end of Year 2; 3) Train 10 Extension professionals per state to be trainers in the opioid misuse programming in Year 2; and 4) Train 100 Extension professionals to facilitate Naloxone Layperson trainings by the end of Year 2. Progress toward Goal 2 will be assessed through the following objectives: 1) Partner with Overdose Lifeline to provide 7 peer-reviewed webinars to a minimum of 150 farming/ranching community members by the end of Year 2; 2) Provide evidence-emerging opioid misuse programs to a minimum of 5,000 youth or adults per state by the end of Year 2; 3) Develop a project website to provide quarterly updates on available trainings, webinars, and access to educational materials; 4) Mail bi-quarterly newsletters to all county Extension offices and 2,000 farming/ranching households per state, per year; 5) Project staff will attend at minimum 10 rural community events targeted toward farming/ranching individuals and families to promote project awareness by the end of Year 2; 5) Collaborate with statewide partners including STR/SOR grantees, Extension offices, departments of health, and offices of rural development to develop and distribute educational materials at least once each quarter. The collaboration is expected to reach 6,500 individuals annually across ND and SD, with a total project reach of 10,000 unduplicated individuals. Given the unique risk factors associated with the agriculture industry, conditions are right for significant increases in prescription opioid misuse in ND and SD if more prevention efforts are not instituted. The proposed project will expand upon efforts to reach farming and ranching families directly through providing access to opioid misuse prevention trainings and educational materials.

The proposed Rural Opioid Technical Assistance project, entitled Growing Evidence Based Prevention In Pennsylvania to Address Opioid Misuse, will build upon the current efforts of Penn State Extension to expand the reach of effective programs for the prevention of opioid use, abuse, and addiction in rural communities in Pennsylvania. Compared with other states, Pennsylvania has been hit particularly hard with the opioid epidemic. In 2016 the death rate from opioid abuse specifically was 18.5 per 100,000, compared with 13.5 nationwide, and rural counties experienced a larger increase in drug-related deaths (42%) between 2015 and 2016, compared to the increase experienced in urban counties (34%). In order to prevent a further increase in opioid-related problems, the proposed project has three goals: (1) to update PROSPER training and technical assistance processes to enable scale up; (2) to integrate consistent messaging regarding prevention science and prevention education into the work of PROSPER and CTC in Pennsylvania communities; and (3) to expand the activities of PROSPER teams to include coordination with local drug take back initiatives. PROSPER has already been shown to significantly reduce the use of opioids in the communities in which it serves; refining the training and technical assistance model will make it easier to scale the PROSPER prevention system across Pennsylvania. Further developing and testing the PROSPER model with connections to our State Opioid Response providers and Pennsylvania’s drug take-back initiative will likely enhance PROSPER”s opioid prevention effects. Together, these activities will produce a synergy that can have a dramatic effect on preventing further opioid addiction problems. These goals will be accomplished through webinars, learning communities, trainings, advisory meetings, and the creation of publicly accessible, culturally sensitive outreach materials and resources for distribution reaching 60 communities total across the two years, for a total of 600 stakeholders. These goals will also be accomplished through the implementation of universal family-focused and school-based evidence-based prevention PROSPER programming, reaching 600 youth per year, for a total of 1,200. We will build an advisory team composed of individuals within the Cooperative Extension System, the College of Health and Human Development at Penn State, the EPISCenter, the Pennsylvania Commission on Crime and Delinquency, the Attorney General’s office, and the Technical Assistance Center at the University of Pittsburgh to provide vision, leadership, and dissemination support for these activities. Evaluation will be embedded in project activities, enabling use of a continuous quality improvement process to examine activity implementation and outcomes. Collecting outcome and implementation data will track progress and link our activities to our progress while simultaneously support reporting of required performance measures.

Our project, “Preventing Opioid Misuse and Abuse in Rural Ohio through Enhanced Family and Community Education and Training”, aims to reduce the incidence of opioid misuse in Ohio through the implementation of several evidence-based programs in nine rural Ohio counties. First, our project will implement a curriculum delivery system called PROSPER that connects community stakeholders with expertise at The Ohio State University through the Cooperative Extension system to support evidence-based drug-prevention curricula delivery to 6th and 7th grade students and their families. The second component of our project facilitates two community-based programs—Generation Rx and Mental Health First Aid (MHFA)—that aim to further expand technical capacity to address the opioid crisis in rural communities. Generation Rx is designed to educate people of all ages about the potential dangers of misusing prescription medications, while MHFA develops participant skills necessary to identify someone struggling with a mental health issue and connect them with the appropriate resources to help. Finally, our project will further increase the technical capacity of community-based extension educators and PROSPER team leaders in rural communities by facilitating their participation in CAPE - Community Assessment and Education to Promote Behavioral Health Planning and Evaluation. CAPE aims to provide skills and resources to community leaders to identify and share best practices for benchmarking community and behavioral health. We will facilitate CAPE trainings for Extension Educators and PROSPER team leaders in all nine communities that are partnering with our team to deliver curriculum through PROSPER, Generation Rx, and Mental Health First Aid®. The overarching goal of our project is to create a sustainable and effective framework to reduce the incidence of opioid misuse in each of our target communities by establishing, training, and supporting strong community-based teams within each of those communities. We anticipate we will directly serve 3,120 rural community members over the course of our two-year project, with the hope of creating self-sustaining teams that can impact many cohorts of middle-school student and adults within their communities for years to come.

NC 4-H Empowering Youth and Families Program Powerful Communities The NC EYFP Program focuses on opioid prevention education for youth ages 10-14 and their caregivers in rural North Carolina. The NC 4-H Empowering Youth and Families Program is comprised of 4 core elements which provide intensive relationship and communication education for families with a focus on providing research-based information about the impact and statistics related to opioid misuse specifically to help youth and families make informed healthy decisions. The 4 core elements include the evidence-based Strengthening Families Program 10-14; a research-based Powerful Communities Curriculum which is under development using the resilience factors identified in the research literature related to adverse childhood experiences; a family weekend Confluence during which families and their county Cooperative Extension educators work together to learn action planning and develop a plan for delivery of a focused opioid prevention event in their respective communities; and the community-based opioid prevention event which is planned and implemented by families in partnership with their Cooperative Extension educators and other community-based organizations. Program Goals and objectives include: Goal 1: Reduce youth substance use in rural NC. Target Audience: Youth ages 10-14 in rural communities. Objectives I: Increase youth knowledge related to the potential health impacts of substance use and abuse. II: Increase youth and family self-efficacy for making healthy decisions related to substance use. III: Decrease the likelihood of youth participation in substance use or abuse. Goal 2: Caregivers of youth will improve parenting skills to assist youth in making healthy choices. Objectives IV: Increase caregiver knowledge related to the potential health impacts of substance use and abuse. V: Increase caregivers’ active listening and effective communication with their youth. VI: Increase caregivers’ abilities to identify and deliver appropriate consequences calmly. Goal 3: Improving Family Relationships Target Audience: Youth ages 10-14 and parents or caregivers in rural communities. Objectives VII: Increase families’ abilities to communicate and problem solve together. VIII: Increase families’ abilities to identify the values that support the family unit. Goal 4: Empower families to lead community change, thereby leveraging support for healthier lifestyles within those communities. Objectives IX: Empower youth and adults to work with community leaders to create change. X: Educate the public about the impact of substance use in their communities. Overall, the curriculum-based program elements will reach a total of 135 families, up to 675 individuals depending on family size and composition. The community events have the potential to reach up to 6750 individuals in 10 rural counties in North Carolina. The counties targeted in this program are Pender, Onslow, Craven, New Hanover, Nash, Carteret, Jones, Yancey, Montgomery, and Brunswick.

Montana State University Extension (MSU-Extension) is the land-grant institution serving the State of Montana and is a recipient of a 2018 Rural Health and Safety Education (RHSE) grant focused on opioids therefore an eligible applicant for the Rural Opioid Technical Assistance (ROTA) grant through the Substance Abuse and Mental Health Services Administration (SAMHSA). MSU Extension is partnering with the Montana Department of Public Health and Human Services, a State Targeted Response (STR) and State Opioid Response (SOR) recipient and the Montana Tribal Opioid Response (TOR) grantees to expand the capacity to address opioid use and misuse within the State. MSU Extension has a presence in all 56 counties and 7 reservations with 90 community-based field faculty who can disseminate information on opioid use and misuse. Montana has significant challenges in reducing the effects of opioid use and misuse. In 2011, 1 in 5 Montana adults reported taking an opioid pain medication in the last 12 months. A higher prevalence of prescription opioid use was reported by American Indians than by whites and by persons reporting fair or poor health than by those reporting good or excellent health. (MT DPHHS, 2013). Opioid use is affecting the young and old. The SAMHSA proposal will build on the existing project by: ? Create an advisory group to collaborate and guide grant activities with members from the STR/SOR/TOR/RHSE/and the Montana Healthcare Foundation; ? Expanding the Extension RHSE project from five (5) targeted counties to eight (8) targeted rural counties and/or reservations; ? Utilize lessons learned from the RHSE project on assisting communities in developing opioid awareness and how communities can work to develop prescription medicine collection programs so that other Montana communities can replicate; ? Provide technical assistance to TORs that has been identified as needed for Tribal communities; ? Provide opioid awareness and education to in-home caregivers of older adults and pregnant women in partnership with the State STR/SOR, TOR and the Montana Healthcare Foundation; ? Develop short videos on opioid use/misuse in partnership with the State STR/SOR and TOR for the general public that will be located on websites for the State Department of Public Health and Human Services, the Montana Healthcare Foundation, and MSU Extension among other sites; ? Begin development of an on-line substance abuse treatment program.

Preventing Opioid Misuse In the SouthEast: The PROMISE Initiative 2.0 The Mississippi State University Extension Service-based PROMISE Initiative 2.0 builds the work of the original Rural Health and Safety Education-funded project, focusing on promoting behavior change at the educator- and consumer-level to reduce opioid misuse and abuse among rural Mississippians (adults, youth, and ag producers) by teaching individuals to identify, understand, and respond to signs of mental illnesses and substance use disorders. The overarching goal of PROMISE 2.0 is to reduce opioid misuse among rural families in Mississippi by implementing evidence-based academic detailing on behaviors that may lead to the initiation of opioid misuse approach and by providing education to health care providers on the unique risks of ag producers. The following objectives will be designed, implemented, and evaluated throughout PROMISE 2.0: - By January 31, 2019, PROMISE 2.0 Project Team will be trained as Mental Health First Aid instructors. - By January 31, 2019, PROMISE 2.0 Project Team will develop and provide primary prevention messages around opioid misuse to the STR/SORs opioid and response campaign, Stand Up, Mississippi. - By February 28, 2019, PROMISE 2.0 Project Team will develop and test an academic detailing approach that focuses on mental health and substance use disorder prevention for Extension Agents to implement when working with rural family members. - By March 31, 2019, the primary prevention messages will be posted on the SOR/STRs opioid and response campaign website, standupms.org. - By April 30, 2019, PROMISE 2.0 Project Team will have trained 80 Extension Agents in the state of Mississippi on the evidence-based approach of academic detailing and the evidence-based programs: Mental Health First Aid (MHFA) and Question. Persuade. Refer. (QPR). - By September 30, 2019, PROMISE 2.0 will have trained 80 4-H Volunteers on the evidence-based programs, Youth Mental Health First Aid and QPR, and the evidence-based approach of academic detailing. - By the end of the project, trained Extension Agents will have strategic conversations around mental health and opioid misuse with rural adults and ag producers from 75% of farm visits. - By the end of the project, trained 4-H volunteers will have strategic conversations around mental health and opioid misuse with 75% of rural 4-H youth. - By the end of the project, AgriSafe professionals will have conducted evidence-based opioid misuse prevention education for healthcare providers working with ag producers. This will all be undergirded by rigorous evaluation of the effectiveness and replicability of these educational efforts.

The “Building Rural Capacity to Develop Positive Recovery Capital” project engages with rural Minnesota (MN) counties and Tribal communities that suffer a disproportionate burden from the opioid crisis by providing a menu of in-person and on-line evidence-based technical assistance, training and education options that communities can select to develop local positive Recovery Capital. Utilizing in-person and on-line technical assistance, workshops, training and public education, this project makes research-based resources easily accessible to project partners and rural communities across the nation This project will develop partnership with individuals, practitioners, professionals, and organizations in rural (based on USDA-ERS rural-urban classification) locations in Pine, St. Louis, Aitkin and Itasca counties and will strive to change the environment of the community to support healthy living and to decrease opioid misuse. The project hub for each county is located in a remote town of less than 10,000 people, where resources are fewer but the potential for collaborative and innovative solutions is great. Building upon formative capacity-building work of the current USDA-funded Rural Health and Safety Education (RHSE) project grant to increase capacity of rural Minnesota communities to develop positive Recovery Capital, this proposal will: a. Provide technical assistance training and public education starting September 30, 2018 in two counties and two tribal communities, and make available/provide additional training/resources as they are developed in this project, to the two counties served in RHSE grant, as documented by reporting; b. Develop a menu of at least 12 training options by March 31, 2019 that will support the development of increased positive Recovery Capital in communities, documented by posting as resource on website; c. Reach 1,000 community members, as documented by completion of surveys, by August 31, 2020 with in-person education about the OUD crisis, its impact on their community and what they can do to help address/mitigate the OUD crisis in their community; d. Recruit 20 local Change Makers, through education and/or training and technical assistance, by June 30, 2019, to take action to increase positive Recovery Capital in their community and sustain the project in the future; documented by completion of CSAT GPRA measurement tool; e. Reach 160 professionals/practitioners per with in-person training and technical assistance about how they can assist in addressing the OUD crisis, 60 by August 31, 2019, 160 by August 31, 2020, documented by completion of CSAT GPRA measurement tool; f. Develop website and launch by June 30, 2019, populate as identified/developed with easily accessible and up-to-date online education and technical assistance tools to provide on-demand information and training to 3000 community members and practitioners regarding the OUD crisis.

The Multi-state OUD Training and Education Project will implement multiple strategies including 1) evidence-based training, 2) virtual/web-based modules, and 3) online education and professional development to address opioid misuse and opioid use disorder (OUD) in communities, especially those in rural counties. The project anticipates reaching nearly 4400 individuals, families, and practitioners in multiple states across the lifetime of the project. The project, Multi-state OUD Training and Education Outreach, includes participation and leadership from 3 states (Indiana, Michigan and South Dakota). The goal of the project is to educate on prevention, treatment and recovery related to opioid misuse and opioid use disorder (OUD) among individuals, families, communities, practitioners and the general public. The populations to be served across the states will include mostly adults who live and/or work in rural communities, the majority being Caucasian. Implementation of programming in South Dakota will allow the project to reach some American Indian communities. Some project activities, such as use of online education, will lend themselves to reaching individuals and professionals across the country. The measureable objectives include the following during the funding period: 1) expand efforts through Cooperative Extension by delivering an evidence-based training (Mental Health First Aid) in 2 states to address OUD prevention, treatment and recovery; 2) expand the existing Combating Opioids webinar series to offer 6 more webinars to provide resources and information on opioid misuse and OUD; 3) create 3 publicly available on-demand virtual (online) training opportunities to teach individuals, families, communities, and providers about opioid misuse and OUD; and 4) provide easily understandable and accessible information on opioid misuse and OUD to all 92 counties across the state of Indiana. The project's strategies and interventions can be combined into the following major categories: delivery of evidence-based training; hosting webinars for education, professional development, and training on various aspects of OUD; and development of virtual/web-based modules for educating about OUD. Collectively among these strategies and interventions, the project anticipates reaching an estimated 1500 individuals in year 1, 2900 in year 2 - for a total of nearly 4400 individuals across the lifetime of the project.

The purpose of this proposed project is to supplement our recent RHSE demonstration grant with additional demonstration states supporting rural county sites. These states will be implementing a multi-step, Extension-powered prevention T/TA capacity-building system guided by the scientifically-proven PROSPER Delivery System. The PROSPER Delivery System remains one of the few models proven as efficacious for the high-quality delivery of evidence-based programs, and it currently is the only system designed for use within Extension that has been shown to reduce opioid misuse through a randomized controlled trial. Our primary prevention T/TA and capacity-building goals will be pursued with an innovative partnership among Iowa State University (ISU) Extension and Outreach, the PROSPER Network Organization based in the ISU Partnerships in Prevention Science Institute, and Public Health partners. PROSPER’s positive results to date are expected to be enhanced by the proposed multi-step T/TA capacity-building system that adapts the original PROSPER model, adding programming content and prevention strategies to specifically address the risks of opioid and prescription drug misuse. The proposed T/TA capacity-building system--called PROSPERing Step-by-step, State by state (P2S)--entails: (1) Mobilizing and Organizing for the P2S System; (2) Conducting Supplemental Training at the County Level for P2S Implementation; and (3) Conducting Core Programming/ Prevention Activities. This will be followed by P2S planning that includes strategies for conducting specialty trainings (e.g., media, environmental strategies) and capacity building for sustainability. Notably, the proposed project will leverage support through a companion PROSPER Rx RHSE grant that is developing capacity-building materials, strategies and programming for community-based actions to address opioid misuse. Significantly, this project will demonstrate a T/TA model that can be readily scaled up. It will initiate groundwork for this scale up among Extension and Public Health stakeholders and prospective P2S trainees in additional states, enhancing their capacity to support a comprehensive community systems approach to address the opioid epidemic and achieve positive impacts for their youth and families.

Currently, many Extension educators do not consider substance abuse or opioid misuse prevention to be an issue of relevance to their work. Addressing this requires raising awareness and presenting options for how educators may start taking small steps toward prevention-related activities in the counties they serve. Subsequent steps must involve addressing readiness and capacity challenges. We are proposing to develop an adoption readiness and capacity-building process with an integrated capacity-coaching framework that has been used successfully in other SAMHSA-funded prevention-focused projects in Iowa. This project also plans to utilize motivational interviewing to reach county Extension educators where they are on a “stages of change” continuum, which may range from a lack of awareness of the opioid issue to currently taking action to implement and sustain evidence-based prevention programs. Employing a capacity coaching system and linking county Extension educators with STR/SOR-connected prevention professionals will allow resources to be aligned and opioid prevention capacity to be built in each participating county. We also propose to develop a series of on-demand virtual trainings and webinars covering a range of opioid-related topics that will be publicly available via the PROSPER Rx Resource Website. The Resource Website also will provide links to STR/SOR-related resources that are available, along with national resources and training opportunities. The third proposed activity includes scaling-up and disseminating the Empowering Families to Grow Together (EFGT) online educational series that was developed through the current RHSE-funded project. This series covers information addressing the risk and protective factors known to influence adolescent prescription drug misuse and how parents can identify the warning signs of mental health issues or substance abuse in preteens. The proposed project will allow us to offer it to more parents in more rural counties, thereby increasing the total number of parents being reached with opioid-related educational information. This combined approach will allow the ISU PROSPER Rx team to expand and enhance supports and tools for building and leveraging the capacity of Extension professionals, along with their state- and community-level partners, to move toward an evidence-based comprehensive community systems approach to addressing the opioid epidemic in underserved rural communities.

This project, Addressing Opioid Prevention in Rural Colorado Through Building Family, Youth and Community Strengths, uses a multi-level, integrated public health intervention approach to address the opioid crisis in 20 rural Colorado counties by altering opioid use attitudes and behaviors. The project links the Colorado State University Prevention Research Center, the Colorado State University Cooperative Extension System, the Colorado Consortium for Prescription Drug Abuse Prevention, and Rise Above Colorado, to empower rural residents to lead healthy lives and promote healthy communities. The project goals are: 1) to build capacity of regional professionals to collaborate in an efficient and effective way to implement evidence-based public health interventions targeting opioid abuse, and 2) to deliver an evidence-based family-focused preventive intervention (The Strengthening Families Program: For Parents and Youth 10-14 (SFP10-14)), implement evidence-based public awareness messaging regarding opioid use and deliver a positive youth development campaign through direct-to-youth communications, peer-to-peer engagement and resource delivery by youth-serving partner organizations in coordination with the themes of the family intervention.. Over the two years of this project, we intend to reach approximately 120 families with SFP 10-14. Our public health messages are estimated to be viewed by over 10,000 teens and 50,000 adults in these counties. This combined intervention approach is geared toward altering family practices, changing levels of health literacy in the community, influencing youth and adult attitudes toward opioid use, and reducing community levels of opioid and prescription drug misuse. The project targets rural counties from the Southwest, Northwest, Southeast, and Northeast corners of the state that have high rates of opioid and other substance use. It also capitalizes on the University Cooperative Extension System as a permanent statewide system and a train-the-trainer model to add stability to planning for sustaining these interventions in these communities.