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Washington State University (WSU) proposes the Center for Rural Opioid Prevention, Treatment, and Recovery (CROP-TR). CROP-TR will expand ongoing collaborations between WSU Extension and faculty experts in substance use prevention (Human Development Department) and treatment and recovery (Colleges of Medicine & Nursing) to provide training and technical assistance (TTA) to reduce the burden of opioids in rural Washington communities. We have implemented the Strengthening Families Program for Parents and Youth aged 10-14 (SFP) to prevent drug use, reaching 11,000 youth in 632 communities through Extension over the last 15 years. We are also implementing the 4-H Youth Participatory Action Research (4H-YPAR) program. YPAR provides TTA to 4-H youth, their parents and communities so they can conduct health needs assessments and youth-led community health promotion projects. CROP-TR will add opioid specific curriculum and treatment and recovery resources to SFP and provide opioid related TTA to the 4H-YPAR program to enable communities to generate their own solutions to the opioid epidemic. In partnership with Human Development and Extension faculty, members of the Program of Excellence in Rural Mental Health and Addiction Treatment (RMHSAT) from the Colleges of Medicine & Nursing will conduct a rural need assessment to identify opioid prevention, treatment and recovery TTA needs of communities in Washington. Based on results of the needs assessment, we will provide TTA in treatment and recovery resources through a website, social media, and virtual and in-person trainings. We will also harness our expertise in American Indian and Latinx health to assure that TTA provided is culturally relevant to these communities. Our goals are to: 1) Create an Advisory Board (AB): The AB will guide our work to assure high quality TTA that addresses the needs or rural communities. Our AB will include SAMHSA Pacific Northwest Addiction, Prevention, and Mental Health Technology Transfer Centers (TTCs) leadership, our State and Tribal Opioid Response leaders, and other stakeholders. 2) Create Model Programs: Partner with Extension sites implementing SFP and 4H-YPAR to adapt these models to focus on opioid misuse prevention. Provide TTA for the adapted interventions and provide linkages to treatment and recovery services so that prevention participants who need treatment can receive it (e.g., parents). 3) Conduct Needs Assessment & Develop TTA Resources: Work with the AB and Extension partners to develop and administer an opioid TTA needs assessment survey to rural communities through Extension. Use needs assessment results to develop TTA resources (e.g., webinars, in-person trainings) in coordination with TTCs to improve community capacity to prevent, treat, and facilitate recovery from opioids. 4) Disseminate TTA: Disseminate TTA through online, virtual, and in-person methods. 5) Evaluate- Evaluate the impact of CROP-TR by collecting GPRA performance measure data and record the number of individuals reached by CROP-TR resources.

The Community and Economic Development Initiative of Kentucky and the Family Consumer Sciences Extension Program both housed under the University of Kentucky Cooperative Extension System has proposed a multi-faceted approach to preventing and reducing opioid misuse via research-based public education (Addiction 101), implementation of evidence-based prevention programming (Life Skills Training and Communities that Care), and the provision of recovery support services (Financial Education curriculum) as well as a novel arts-expression program to support at-risk individuals. This proposal is designed to address the following four substance use prevention and recovery goals and related objectives. Goal 1: Increase the capacity of local community leaders to reduce risk factors, including improving the community's awareness of mental health issues that contribute to substance abuse. Goal 2: Decrease the prevalence of substance use in communities by implementing evidence-based programs. Goal 3: Improve rates of recovery by addressing and minimizing the economic and social barriers to successful re-entry. Goal 4: Provide up-to-date resources and information on the prevention and treatment of substance use disorder easily accessible to the public.

Strengthening the Capacity in Rural Maryland to Address Opioid Misuse University of Maryland Extension (UME) will strengthen the capacity of rural communities to recognize, understand, and respond to opioid issues in Maryland by a) delivering evidence-based training on opioid prevention and treatment, building upon UME programs and partnerships and b) providing current and scientific information, resources, and training in person and virtually on opioid misuse for individuals, families, practitioners, and communities. This proposed project will mobilize UME programs such as Agriculture, FCS, Environment and Natural Resources, and 4-H including extension educators, community partners, leaders, and volunteers, located in rural MD: Western Maryland (Garret, Allegany, Washington), Upper Eastern Shore (Harford, Cecil, Kent, Queen Anne’s), and Mid/low Eastern shore (Caroline, Dorchester, Talbot, Somerset, Worcester, and Wicomico counties). In collaboration with Center for Substance Abuse Research, School of Public Health, MayaTech, Maryland Rural Health Association, the program goals and activities for the next two years will include: Goal 1 Increase community capacity to reduce OUD and opiate-related overdose and deaths by delivering evidence based program (EBP) Mental Health First Aid (MHFA). a) MHFA instructors training will be provided for 120 educators (60 each year), and b) MHFA (8-hour) curriculum will be delivered to 500 community leaders and service providers (250 each year). Goal 2 Decrease youth substance use susceptibility by implementing Botvin Lifeskills (EBP) to strengthen youth social skills and behaviors and decrease substance use initiation. Training will be provided for a) 40 educators (20 each year), b) 650 middle school students (250 in year 1; 400 in year 2) and c) their parent/caregiver. Goal 3 Increase community capacity by providing TA/T. a) Establishing an advisory group on Rural Maryland Opioid Issues and creating a virtual network of Extension and community educators, partners, and local practitioners; b) Provide 6 virtual training on up-to-date resources and information for educators and practitioners (Y1: 150 Y2: 150 Total: 300 ) and 8 webinars for individuals, families, practitioners and communities (Y1: 200 Y2: 200 Total: 400 ) and in-person (Y1 240: Y2: 360 Total: 600); and c) Web-based content that supports virtual on-demand training for public, resources in rural Maryland, and SAMHSA’s State Targeted Response TA resources. The project will increase the number of trained community educators to address opioid misuse, strengthen the collaboration and coordination among educators and practitioners, and increase the information dissemination and relevant resources on opioid prevention and treatment for individuals, communities and practitioners.

To address the growing opioid crisis, particularly in rural and farm communities in RI, the University of Rhode Island (URI), through its Cooperative Extension (CE) program, seeks to create a Community First Responder Program. The goals of the Community First Responder Program are as follows: 1) educate rural communities about substance use disorder and opioid misuse, and 2) provide resources to these communities to help address opioid misuse. The proposed Community First Responder program will be built on URI Cooperative Extension’s expertise and existing connections to the rural community. To achieve these goals the program collaborators will develop modules for community members and practitioners on the CE website related to understanding substance use disorder, harm reduction strategies and recover options. Additionally, the project team will work with existing programs of CE, including its volunteer-based programs such as the Master Gardener Program, 4-H, and Watershed Watch, where volunteers will be trained on substance use disorder and opioid use. They will also be given informational resources to connect families to the modules, offer educational workshops and other resources hosted on the URI Cooperative Extension website. The project team will build on other existing resources available at the University, including its mobile health unit, were we will provide information on the CE programs, fentanyl testing strips, syringe disposal units, HIV/hepatitis testing, and materials for referral to recovery programs and behavioral health. In addition, we will provide naloxone education and kits to combat an overdose, along with screening, brief intervention and referral to treatment services (SBIRT) using an online tool housed on the CE website. Through this program, we seek to increase the capacity of CE faculty, staff, and volunteers to share science-based information with the public about substance use disorder and opioid misuse. By the end of year one of the project, 75% of CE faculty, staff and interested volunteers will improve their knowledge of substance use disorder and opioid misuse by completing the training modules and by year two, will share information at least 10 times about substance use disorder and opioid misuse through public education programs. The mobile health unit will visit rural community events at least 20 times to allow public engagement with health professionals related to substance use disorder and opioid misuse. The mobile health unit staff will also have engaged at least 200 members of the public related to substance use disorder and opioid misuse, and resources on the CE web portal will have been accessed 250 times by all users (i.e. CE faculty, staff, volunteers and the public). Data will be gathered through web data, surveys, and on-site data collection.

Project Name: Oklahoma State University Opioid Technical Assistance (TA) Project Populations to be Served: Choctaw, Haskell, Latimer, Le Flore, McCurtain and Pushmataha Counties in southeastern Oklahoma Oklahoma State University (OSU) Cooperative Extension Service (OCES) in partnership with the OSU Center for Wellness and Recovery (CWR), seeks funding to provide technical assistance (TA) support for rural communities addressing opioid use disorder (OUD). The OSU Opioid TA Project will target six rural counties in southeastern Oklahoma and provide TA assistance by identifying model programs, developing materials related to prevention, treatment and recovery (PTR) of OUD, and ensuring high quality training. This unique partnership will build upon OCES experience to expand the existing reach and focus on opioid issues that are adversely affecting rural Oklahoma communities. Demographics and Health Disparities: Choctaw County, 15,205 total population and 16.5% Native American; Haskell County, 12,769 total population, and 15.9% Native American; Latimer County, 11,154 total population, and 20.4% Native American; Le Flore County, 50,384 total population, and 12.3% Native American; McCurtain County, 33,151 total population, with 15.1% Native American; and, Pushmataha County, 11,572, with 17.6% Native American. In contrast, 8.6% of the State’s total population are Native American. Additionally, all counties are designated by HRSA as rural or extremely rural, and are all medically underserved, with health professional shortages. The median household income for most of the counties falls between 12,000 - 20,000, well below the State median household income of 50,051. The overarching goal of the OSU TA Project is to provide TA in order to reduce morbidity and mortality associated with opioid abuse in high-risk rural communities. TA will provide support to targeted rural communities at highest risk for OUD, as all six targeted counties are within the top 15 counties in the state with the most pressing opioid problems. The proposed OSU TA Project will use a three-tiered approach to reach 1) providers, physicians, and pharmacists; 2) families; and 3) the community. Because the six counties have relatively high numbers of Native American residents, the OSU TA Project will ensure that the TA training, supports and services are culturally relevant and culturally sensitive to the tribal nation. By building skills to meet the identified needs of rural communities, the OSU TA Project will increase the numbers of individuals trained in PTR from OUD; increase understanding and knowledge of proper prescribing methods for providers; and will increase overall understanding of the opioid epidemic as it relates to each individually targeted county.

This project develops standardized state-of-the-art trainings plus print and online technical assistance materials addressing the epidemics of opioid use disorders (OUD) in rural MI. The approach is educational and includes training to increase awareness of community OUD issues, addiction and misuse symptoms, treatment options for OUD, and recovery support. Title: Evidence-Based Training to Prevent OUD and Support Treatment and Recovery in Michigan’s Rural Communities. Populations to be served: Rural health professionals and rural underserved adults that either suffer from OUD or are at increased risk to succumb to it due to risk factors and socially determined health disparities, e.g., isolation and unemployment. The primary goal is to develop and disseminate training for the public and for health providers and public health professionals to increase awareness about OUD and available rural resources. The project is an opportunity for MSU Extension to combine efforts with MSU College of Human Medicine faculty. The project brings together highly skilled experts in OUD-related issues and rural health on the medical side with community-based professionals charged with addressing the clinical and social impacts from such use. The project builds on MSU Extension’s current rural opioid misuse prevention educational initiatives (MDHHS SOR) but includes new staff and different outreach approaches to expand the focus from solely on prevention to include treatment options and recovery. Strategies: The project leverages an already established collaboration in Northwest MI. For the project, these partners will convene as an Advisory Board to compile, create, and standardize trainings; together we will align and incorporate work from the partners’ existing virtual toolbox project, their technical expertise, and existing STR TA resources. The project will engage SAMHSA State Opioid Response providers in the relevant jurisdictions and include them in dissemination plans. Stakeholders will have online access to resources for on-demand downloads of information on the prevention and treatment of OUD via a new MSU website. The project will link to SAMHSA’s State Targeted Response Technical Assistance Teams (STR) and ensure shared information from STR in support of MSU Extension’s OUD prevention, treatment, and recovery activities. Project Goals and Objectives: By September 2021, the project will reach 1,150 rural adults and participants will exhibit improved short-term changes in awareness and knowledge of OUD. Participants will complete surveys prior to and immediately after the training. Participants will exhibit a proportion of correct responses greater than 75% post-training. A 30-day post-training survey will measure action outcomes. Michigan State University (MSU) Extension is collaborating with the MSU College of Human Medicine Family Medicine (MSU-CHM) and the Health Department of Northwest Michigan (HDNW) to create and deliver evidence-based trainings on opioid misuse prevention, treatment, and recovery that reaches 1,000 rural community members in 25 trainings and 150 health professionals in an additional 10 trainings to improve awareness and knowledge of OUD issues.