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Coast to Forest Hub: Community Resources to Promote Mental Health and Reduce Opioid and Stimulant Use Disorders in Rural Oregon is an initiative of Oregon State University Family and Community Health Extension. Coast to Forest Hub builds on lessons we are learning from a pilot Rural Health and Safety Education program underway in four rural Oregon counties (USDA NIFA Award No. 2019-46100-30280 From Coast to Forest: Building on Community Strengths to Promote Mental Health and Reduce Opioid Abuse in Rural Oregon), and expands training and technical assistance through the Extension service pipeline to build capacity in rural Oregon to reduce opioid and stimulant use disorders and their sequelae. This new Hub will serve all 36 Oregon counties -- all 23 counties with full HRSA- and RUCC- rural designation and 13 counties with partial rural designation. The Coast to Forest Hub will offer training, tools, and technical assistance for all Oregon Extension faculty and their community partners to prevent opioid and stimulant use disorders and move communities to recovery. Coast to Forest Hub is an exclusively online program, beginning 08.31.2020, running two years. Program activities include (1) monthly, virtual, free, 8-hour Mental Health First Aid (MHFA) trainings; (2) county-specific substance use disorder prevention and treatment resource guides; (3) a local Extension radio program to share resources and personal stories of resilience and recovery, to educate listeners about opioid, stimulant, and other substance use disorders (SUDs); (4) a robust and free-to-access web-based library of on-demand trainings, tools, and technical assistance materials; (5) a 90-minute virtual media training on best practices for covering SUD prevention, treatment, and recovery; (6) a 12-hour self-paced online Substance Use Disorder 101 & Peer Support Fundamentals (SUD 101 & PSF) training course; and, (7) quarterly meetings with SOR and TOR grantees, and three advisor/partner organizations. By the end of the project period (08/30/2022), (1a) 300 Extension faculty or partners will have completed the MHFA training (100 YR 1; 200 YR 2), (5a) 75 Extension faculty, partners, or journalists will have completed the media training (25 YR 1; 50 YR 2), and (6a) 45 Extension faculty or partners will have completed the SUD 101 & PSF training (10 YR 1; 35 YR 2). After the trainings, (1b) 50% of MHFA participants will demonstrate an increase in confidence in performing helping behaviors, (5b) 75% of media training participants will have identified at least one way that the training impacts practice, and (6b) 75% of SUD 101 & PSF trainees will demonstrate increased KSAs related to SUD & PSF. Finally, (2) 300 unique users (100 in Y2; 200 in Y2) will have accessed online resource guides, (3) 18 radio programs will have aired, (4a) 500 unique users will have accessed web-based library resources, (4b) Google analytics will show downloaded materials from all 36 counties, (7a) the C2F Hub will have hosted 8 quarterly SOR/TOR/Partner meetings, and (7b) collected SOR/TOR/Partner feedback on 100% of developed trainings and materials.

The Tribal and Rural Opioid Initiative (TROI) of Utah State University will expand harm reduction education and outreach into six Utah and two New Mexico counties, including the reservation lands of four tribes (Ute, Skull Valley Goshute, Paiute, and the Confederated Tribes of Goshutes). While whole person health is a tenant of harm reduction, many programs focus largely on naloxone trainings, medication treatment, testing services and syringe distribution. In Utah and New Mexico, opioid overdose deaths exceed national averages, and mortality in rural areas from overdose deaths related to opioid and stimulant use exceed urban mortality rates. These mortality rates suggest an immediate need for harm reduction expansion and education, which hinges upon reducing stigma toward harm reduction interventions. TROI will administer a series of training and technical assistance opportunities, focusing on on-demand and real-time offerings that take advantage of online platforms, seeking to better bridge harm reduction and holistic health approaches. Target audiences will range from health professionals working in the area of chronic pain, to community members, to health professionals who may hold stigmatizing beliefs about harm reduction and substance use disorders. Deliverables include a teleconference, podcast, online and in-person book discussion groups, capacity-building webinars, active social media, and an online Master Health Volunteer Program that trains community members on opioid use disorders and the SAMHSA wellness wheel, before readying them to return 40-hours of service to their communities. In-person activities, particularly with tribal partners, will supplement online activities, and include a Tribal Opioid Summit, naloxone and related education, and harm reduction needs assessments with four targeted tribes. All activities will be facilitated through a Community Based Participatory Action framework, centering community members, locally determined priorities and the voices of tribal members and persons in recovery in rural areas. A Holistic Health Coalition will guide a statewide needs assessment and action plan process, while persons in recovery will co-lead community advisory boards for all major activities. Tangible outputs will include two graphic novels that contain stories of the treatment and harm reduction experiences of persons with opioid/stimulant use disorders, because hearing the stories of persons in recovery has been shown to reduce stigma. Book groups will be supported by the SOR provider in New Mexico and Utah Humanities in Utah, leveraging networks to increase the likelihood that people interested in the arts who might not otherwise engage with this content may be drawn to participate. Overall, this program seeks to leverage networks in Utah and New Mexico to increase acceptance of harm reduction best practices, and ultimately reduce overdose mortality in both states. Over 1000 rural residents will be directly served by these grant activities with an estimated additional 10,000 reached through the podcast, social media, graphic novel readership or other indirect channels.

The purpose of this proposed project PROSPER Step-by-Step, State-by-State (P2S): Expansion of an Extension-Based Opioid Prevention Capacity-Building System is threefold; 1) to continue the capacity building of current PROSPER states; 2) to expand P2S into two new states (Kentucky and Tennessee); 3)increase sustainability by building the PROSPER Network Organization’s (PNO) capacity for scale up through increased evaluation, train-the trainer, and learning community capacity. The project affects 10 states Extension systems and the communities they work with (CO, KY, TN, MO, UT, VT, IA, VA, OH, PA). Like other states implementing PROSPER, TN and KY 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 the PROSPER Network Organization based in the ISU Partnerships in Prevention Science Institute, The University of Tennessee, the University of Kentucky, the National Guard Counterdrug Task Force, the Midwest Counterdrug Training Center, 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. Significantly, this project will demonstrate a proven and sustainable T/TA model that can continue to scale nationally. This project will continue the capacity building for the 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.

The NC EYFP Program focuses on opioid prevention education for middle school aged youth and their caregivers in rural North Carolina. The NC 4-H Empowering Youth and Families Program (EYFP) provides intensive relationship and communication education for families that includes research-based information about the impact and statistics related to opioid misuse. The primary goal of the program is to help youth and families make informed, healthy decisions, especially related to substance use and misuse. The NC 4-H EYFP has 4 core elements: 1) the research-based Powerful Families Curriculum which incorporates protective factors identified within trauma-informed literature to strengthen family communication and relationships; the evidence-informed Powerful Communities Curriculum which provides a locally relevant approach to opioid misuse education and is build upon the resilience factors identified in the research literature related to adverse childhood experiences; a family weekend Confluence during which families and their community-based 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 include: 1) Reduce the likelihood of youth substance use in rural NC; 2) Caregivers of youth will improve parenting skills to assist youth in making healthy choices; 3) Improving Family Relationships; 4) Empower families to lead community change, thereby leveraging support for healthier lifestyles within those communities. Program Objectives include: 1) Increase youth knowledge related to the potential health impacts of substance use and abuse; 2) Increase youth and family self-efficacy for making healthy decisions related to substance use; 3)Decrease the likelihood of youth participation in substance use or abuse; 4) Increase caregiver knowledge related to the potential health impacts of substance use and abuse; 5) Increase caregivers’ active listening and effective communication with their youth; 6) Increase caregivers’ abilities to identify and deliver appropriate consequences calmly; 7) Increase families’ abilities to communicate and problem solve together; 8) Increase families’ abilities to identify the values that support the family unit; 9) Empower youth and adults to work with community leaders to create change; 10) Educate the public about the impact of substance use in their communities. Overall, the curriculum-based program elements will reach a total of 165 families, up to 660 individuals depending on family size and composition. The community events have the potential to reach up to 1650 individuals in 11 rural communities in North Carolina. The communities targeted in this program are the Eastern Band of Cherokee Indians and Onslow, New Hanover, Nash, Carteret, Yancey, Montgomery, Brunswick, Burke, Pender and Lee counties.

Through statewide collaborations with MSU Extension, partner schools, and existing opioid response networks, this project will provide outreach, education and technical assistance in an effort to lower the instance of prescription opioid and stimulant misuse among rural and tribal youth throughout Montana. Specifically, this project will complete the following: 1) gather youth-focused data (via surveys and focus groups) to inform the development of education and outreach materials that will be disseminated statewide and to all nine Montana tribes, 2) create and promote two sets of training (an online, self-paced curriculum designed for rural youth, and a culturally significant ‘opioid and stimulant reduction/mental wellness curriculum’ designed for Native youth), and 3) host four Technical Assistance trainings with project partners (including the State and Tribal Opioid Response Teams) focused on youth prevention of prescription opioids and stimulant use. In addition to lowering rates of misuse among adolescents, the secondary goal of this project is to work towards reducing the stigma of substance misuse among youth. Through our efforts, we aim to provide youth and their caregivers (whether at school or at home) with the tools to converse honestly and openly about this issue, and information about treatment and recovery options to support youth who may need such services.

The project will focus on 10 target rural counties over the two-year grant period – five counties in the first year -- Franklin, Gadsden, Gulf, Jackson and Jefferson; and five counties in the second year – Columbia, Hamilton, Hernando, Madison and Suwannee. These 10 counties located in the Florida Panhandle have suffered the impact of three sequential hurricanes (Hermine, 2016, Irma, 2017 and Michael, 2018) which caused widespread physical devastation and economic hardship and had a negative impact on health. The ongoing Covid-19 pandemic has just added to the economic hardships and has negatively impacted health conditions of area residents. The complexity of opioid use in rural communities calls for community-based organizing and engagement strategies that tap into the expertise of local, rural stakeholders to enhance community and individual resilience to reduce Opioid Use Disorder (OUD) and related harms. This project will use the current Florida Agricultural and Mechanical University Cooperative Extension Program and DISC Village (a State Opioid Response, SOR, provider) to deliver evidence-based training and related materials tailored to the needs of rural communities in the Florida Panhandle, targeting school officials, high school students, parents, nonprofit organizations and pastors. Specific virtual and in-person training, infographics, online resources guides, fact sheets, and toolkits will be developed on prevention strategies to reduce OUDs, harm reduction initiatives to reduce overdose deaths and exposure to bloodborne infectious diseases; and recovery resources (available in the area or remotely) to support individuals in maintaining the gains made during treatment. These resources will be provided to a youth, adults, community stakeholders and practitioners in easily accessible formats utilizing easy to understand content. Training will be made available on demand virtually and in person in five counties in the first year and five counties in the second year. Resources such as fact sheets and infographics will be also made available online and copied for distribution in the 10 targeted counties. The project will utilize paraprofessionals as community educators in each of the target counties. These persons, as community educators, will provide training in various venues that are suitable for reaching underserved or vulnerable populations, including schools, churches, community centers and one-on-one. As community liaison, these persons will conduct train-the-trainer sessions to enhance capacity for communities to train and reinforce dissemination themselves. The trainings and materials will include science-based information from such sources as SAMHSA, National Institutes of Drug Abuse, the Centers for Disease Control and the Rural Health Hub’s Rural Prevention and Treatment of Substance Use Disorders Toolkit.

Rural, agricultural-based communities in the North and South Dakota provide essential services and products for the economy. However, this population also experiences unique challenges such as job-related injuries, limited access to health care, and lack of confidentiality within their communities that increase their risk of opioid/stimulant misuse. To address this risk, South Dakota State University Extension and North Dakota State University Extension will partner to expand programming efforts established in 2018 that provide virtual trainings and resources on opioid/stimulant misuse to rural community members, Extension professionals, and other front-line staff working with the target population. Access to mental health services to address symptoms of stress is lacking in most rural farming/ranching communities, with 90% of North and South Dakota counties considered mental health shortage areas. And even where services are available, few mental health professionals understand the specific stressors related to agriculture (Hartley, Ziller, Loux, Gale, Lambert, & Yousefian, 2007). Given that both states are sparsely populated, while covering a large geographic area, access to virtual trainings and educational materials is vital. The current project will address this gap in services by providing rural technical assistance through the Extension network at SDSU and NDSU, and through established partnerships with community-based agencies. SDSU/NDSU Extension will work with the State Opioid Response teams in both states to accomplish the following goals: 1) Increase access to research-informed educational tools related to opioid/stimulant misuse to Extension professionals and healthcare providers in rural SD and ND communities, and 2) Increase knowledge and empathy related to opioid/stimulant misuse among members of rural communities in SD and ND. Progress toward Goal 1 will be accomplished through the following objectives: 1) Host 2 virtual conferences, one annually, related to the prevention, treatment, and recovery from opioid/stimulant misuse for at least 100 attendees per conference; 2) Hire addictions specialists to develop 5 research-informed, virtual modules for an online repository of training materials related to the prevention, treatment, and recovery from opioid/stimulant misuse by the end of Y1; 3) Train 10 Extension, prevention, or mental health professionals to facilitate the addictions treatment and recovery simulation by the end of Y2; and 4) Train 60 facilitators in the CRAFT intervention by the end of Y2; and 5) Collaborate quarterly with statewide partners. Progress toward Goal 2 will be assessed through the following objectives: 1) Provide an evidence-emerging opioid misuse prevention curriculum to a minimum of 3,000 youth or adults per year; 2) Provide the CRAFT intervention to 36 families by the end of Y2; 3) Develop an addictions treatment and recovery simulation by the end of Y1; 4) Provide the addictions treatment and recovery simulation to at least 1,000 individuals by the end of Y2; 5) Mail quarterly educational resources to all county/regional Extension offices, rural schools, partner agencies, and rural community members in each state; 6) Develop and maintain an online repository of research-informed training materials related to the prevention, treatment, and recovery from opioid/stimulant misuse by the end of Y2; 7) Maintain a project website and social media platforms to promote online trainings and up-to-date educational resources through at least 15 posts/updates per quarter; and 8) Collaborate quarterly with statewide partners. The collaboration is expected to reach approximately 3,500 individuals annually across ND and SD, with a total project reach of 5,000 unduplicated individuals. The proposed project will expand upon successful statewide efforts established over the past two-year collaboration to provide materials and services directly to rural community members and service providers.

The “Virginia Cooperative Extension Partnerships for Rural Opioids Technical Assistance” project will build upon two current USDA-funded projects Virginia Cooperative Extension (VCE) projects and a SAMHSA-funded VCE project to reduce misuse of opioids and stimulants in rural Virginia. Training and technical assistance through implementation of evidenced-based universal prevention curricula will be expanded to target students in 3rd to 9th grades and their families in 13 additional rural counties across Virginia. Five regional Extension project coordinators Project will facilitate implementation of project activities and will support local community groups and coalitions that focus on substance use disorder. Approximately 231 teachers will be trained to deliver evidence-based universal prevention school curricula, and 20 community members will be trained to deliver evidence-based curricula to parents and caregivers in a variety of community settings to reach diverse audiences. The anticipated number of students to be served over the two-year project is 18,425 (5,360 in year one and 12,885 in year two). Approximately 4,500 parents and caregivers will receive the evidence-based parent program. Linkages with SAMHSA State Opioid Response (SOR) providers and State Targeted Response TA teams will be accomplished through collaboration between Virginia Cooperative Extension and the Department of Behavioral Health and Developmental Services Office of Behavioral Health Wellness and local community services boards (CSBs). DBHDS will facilitate implementation of the Youth Mental Health First Aid program in target communities to reach approximately 1,500 adults across Virginia. DBHDS will also provide in-service training on Adverse Childhood Experiences for VCE faculty and staff. Collaboration with the Virginia Department of Education (VDOE) Office of Student Services through the Virginia Tiered Systems Supports (VTSS) will provide integrated support for schools served by both programs. VCE will develop a website to facilitate bi-directional sharing of resources and training opportunities among VCE, DBHDS, VTSS, and community coalitions across the project service area.

The New Hampshire Opioid Prevention Project (NH OPP) brings together stakeholders that not only recognize but prioritize the call to action to prevent drug use before it starts to build strong and healthy communities. Our partnership will strengthen our response to identified needs and gaps in the prevention of opioid misuse in NH. The goal of the NH OPP is to bolster opioid prevention efforts in NH by implementing a multi-pronged approach to training and technical assistance that will reach varied audiences at the consumer level. Thus, older adults, parents, teens, community coalitions, and healthcare providers will be served with the programs, on demand information such as print resources and videos, and training and skill building opportunities made available with project resources. The NH OPP consists of three components to educate and inform the NH community in the prevention of opioid misuse. First, the project will reach over four hundred rural adults and older adults, 18 years or older, suffering from chronic pain with the evidence-based Chronic Pain Self-Management Program, building self-efficacy and confidence in one's ability to overcome symptoms of chronic pain and depression. We will measure staff and community partners trained to be Chronic Pain Self-Management Program leaders as well as participants reached with online and in person workshops across NH. We will deliver pre- and post-surveys to program participants, assessing impact, satisfaction, and engagement of the program. We will achieve wide reach with information about this program by activating partnerships such as the NH State Opioid Response team, regional public health networks, and healthcare provider practices. Second, we will partner with the NH State Opioid Response team and the Bureau of Drug and Alcohol Services to develop short informational videos and virtual learning modules to be hosted on the Partnership for Drug Free NH website for the NH community to educate about and destigmatize opioid misuse. Third, our Project Extension for Community Healthcare Outcomes, or ECHO, will provide a deep dive into chronic pain management strategies for fifteen NH provider practices and will feature an in-depth educational component about the benefits of the Chronic Pain Self-Management Program as a frontline strategy for reducing opioid prescriptions. We will assess healthcare providers knowledge and competence before and after engagement in the ECHO. Taken together, this project will 1.) increase capacity of adults with chronic pain to implement self-management strategies in effort to reduce opioid use; 2.) increase capacity of the workforce in rural communities to offer low risk pain management opportunities and prevent opioid misuse; and 3.) provide the NH public with interactive, educational virtual content to decrease stigma about opioids and prevent opioid misuse.

Preventing Opioid Misuse In the SouthEast: PROMISE Initiative 3.0 In effort to reduce the misuse of prescription opioids, the Mississippi State University Extension Service-based Preventing Opioid Misuse In the SouthEast: PROMISE 3.0 project builds upon current United States Department of Agriculture Rural Health and Safety Education and SAMHSA Rural Opioid Technical Assistance-supported work, the PROMISE Initiative, which seeks to promote resiliency among rural communities with focused efforts to reach the agricultural sector. PROMISE 3.0 proposes an upstream approach to opioid misuse prevention through promoting resiliency among these agricultural producers and other adults in rural communities. Prescription opioid misuse continues to be a major problem in the United State, especially among rural populations; 128 Americans are dying every single day from an opioid overdose. Although the opioid epidemic affects individuals all across the United States, the opioid epidemic is disproportionately affecting rural populations. In addition to higher rates of opioid-related overdose deaths being reported in rural areas, there are also higher prescribing rates of opioids in rural areas than other areas. significant portion of these rural communities and economies are driven by the agricultural sector. Three in four farmers and farm workers report being directly impacted by opioid misuse. Resiliency is “the manifestation of positive adaptation despite significant life adversity.” Effective coping skills can enhance resiliency of individuals to deal with stressors and potentially turn away negative coping strategies, such as opioid misuse. We have also noticed a significant need for financial stress and farm management. Many of the stressors in rural communities include financial factors, such as low employment rates and low commodity prices for agricultural producers. Our formative assessment from previous work in this area suggests that community members, including the agricultural sector, are eager to do something about this crisis. The following objectives will be designed, implemented, and evaluated through PROMISE 3.0: (1) Increase the number of rural gatekeepers who are able to identify and refer a community member at risk of opioid misuse or mental health crisis. (2) Increase the number of rural adults, including agricultural producers, who are able to recognize and implement prescription opioid misuse strategies and resources through communication efforts (i.e., targeted message campaign). (3) Increase stress, coping, and farm management skills of rural Mississippians, including agricultural producers, through publicly available trainings, such as direct consultations, web-based trainings, and local or state meetings. (4) Data collection, evaluation, and dissemination of findings from this work.

The Opioids/Stimulant Misuse Training and Education Outreach Project will implement strategies including evidence-based training, in-person technical assistance and education, and virtual/web-based education to address opioid use disorder and/or stimulant use disorder for communities in need, especially those designed as rural. The project anticipates reaching nearly 3,000 individuals, families, and employers in Indiana during the project. The project is led by Purdue Extension and includes strong collaboration with the Indiana Recovery Network. The goal of the project is to educate on prevention, treatment, and recovery related to opioid and stimulant misuse. The populations served will include primarily adults who live and/or work in rural communities, the majority being Caucasian. Some community sectors specifically served in this project include farm industry, peer recovery coaches, employers, individuals, and families. Some project activities, such as use of online education, will lend themselves to reaching individuals and professionals across the country. The measurable objectives during the funding period include: 1) delivery of up to 48 evidence-based trainings (Mental Health First Aid) that address OUD prevention, treatment, and recovery; 2) offer up to 48 training and technical assistance events regarding recovery support services and recovery community organizations (RCOs), including peer recovery coach training and support to existing RCOs; 3) expand the existing on-demand, virtual (online) opioid series to include 3 videos to teach individuals, families, communities, and providers about stimulant misuse; 4) develop and implement a curriculum about mental health and substance misuse (including opioids) specifically tailored to workplaces; and 5) provide easily understandable and accessible information about opioid/stimulant misuse prevention, treatment and recovery to all 92 counties in Indiana. The project’s strategies and interventions combine into the following major categories: evidence-based training; hosting training and technical assistance for education and professional development on various aspects of OUD; and development of virtual/web-based modules for educating about OUD/stimulant misuse. Collectively among these strategies and interventions, the project anticipates reaching an estimated 1,300 individuals in year 1 and 1,640 in year 2 through events and activities that conclusively measure attendance—for a total of 2,940 individuals across the lifetime of the project. The project anticipates reaching countless more individuals through website interactions and educational material dissemination.

Together with the UW Madison School of Medicine and Public Health and the Center for Health Enhancement Systems Studies (CHESS), Division of Extension aims to address opioid and stimulant use disorders by working through community coalitions and/or providing direct education youth and adults to provide tools to combat substance use disorders in a proposed project called Wisconsin Rural Opioid and Stimulant Engagement (WiROSE). We will use a three-part approach to address substance use disorders in rural Wisconsin. These three approaches may be used singularly or in combination with each other. WiROSE will strengthen the capacity for health coalitions to identify needs and address opioid and stimulant prevention/treatment/recovery in their communities through assistance in strategic planning and technical assistance, Strategic planning for coalitions has been a need that the Wisconsin Department of Health Services has identified. Extension educators will work with 8 community coalitions to select from the menu of evidence-based programs and schedule what appear to be the best interventions based on community priorities and assets. In addition, with the support of the Center of Addiction Medicine at the UW-Madison and CHESS, we will provide periodic technical assistance and expertise support meetings. WiROSE will provide Adult and Youth Mental Health First Aid training to communities to better equip adults to help those in their community who may be experiencing a mental health crisis or substance use disorder. Mental Health First Aid aims to reduce stigma and increase the ability for community members to intervene when youth and adults need help. We propose to expand the availability of Youth and Adult Mental Health First Aid training to more rural communities. We anticipate approximately 2000 participants to be trained through the grant period, approximately 1000 each year. WiROSE will provide Adults and Youth with coping skills to combat stress with youth mindfulness (Learning to Breathe) and adult positive emotion interventions (IRISS). In Wisconsin, thirty percent of the population lives in a county designated as a Mental Health Professional Shortage Area. In many counties of Wisconsin, it can take weeks or months to obtain appropriate mental health services. Within our counties, the gap in professional services available makes it imperative that we deploy programming to support skills in socioemotional education and management, especially in rural communities where resources are particularly limited. We anticipate approximately 800 youth and 800 adults to be trained in coping skills each year.

The University of Missouri Extension Building Capacity for Recovery-Friendly Communities project will engage rural communities disproportionately impacted by SUD/OUD, by providing evidence-based technical assistance, training and education options to strengthen recovery capital and build sustainable Recovery-Friendly Communities. The University of Missouri Extension Community Health Engagement and Outreach Program will partner with Rural Communities Opioid Response Program grantees and stakeholders using a multi-prong approach to address identified gaps along the addiction continuum and interrelated social determinants that compound the SUD/OUD challenges. This project proposes to serve more than 34,960 constituents within various populations across Missouri. This two year project will build capacity among Extension professionals and create linkages to RCORP/STR/SOR grantees for collaboration, create bi-directional dissemination of available resources, and expand evidence-based training on opioid/stimulant prevention, treatment, and recovery to the public. The Building Capacity for Recovery-Friendly Communities project has four goals that will address specific technical assistance/training needs and gaps for rural communities across Missouri. These goals are designed to achieve the targeted outcomes described below: Goal 1: Provide evidence-based technical assistance to Rural Communities Opioid Response Program Grantees located in 8 regions across Missouri. Objective 1.1: By August 2022, provide eight (8) technical assistance trainings to RCORP/STR/SOR communities. Obj. 1.2: By August 31, 2022 increase knowledge within RCORP grantees of Extension programs, services and resources. Goal 2: To provide training and technical assistance to regional Extension faculty to build capacity for effective and efficient collaboration and implementation of evidence-based public health interventions targeting opioid/stimulant abuse. Obj. 2.1: By August 31, 2022, increase capacity of Extension faculty to collaborate with grantees on evidence-based prevention. Objective 2.2: By December 31, 2021 identify at least five (5) PROSPER-ready communities in Missouri. Goal 3: Develop a framework and guidelines for training and technical assistance to businesses and labor organizations to be recognized as Recovery-Friendly Workplaces (RFW). Obj. 3.1: By December 31, 2020 conduct economic analysis and literature review to disseminate across Extension (8) regions. Obj 3.2: By August 31, 2022 provide eight (8) technical assistance trainings to employers, businesses & communities. Obj 3.3: By August 31, 2022 develop curriculum & guidelines for Recovery-Friendly Workplaces Goal 4: To provide training/technical assistance on opioid/stimulant use to a network of mobility managers and volunteers, educating Extension and RCORP/STR/SOR grantee communities on linkages to rural mobility management resources for individuals, families, and communities with members in recovery. Obj. 4.1: By August 31, 2022 develop opioid/stimulant specific educational content and resources for mobility management network. Obj. 4.2: By August 31, 2022 disseminate educational resources within Extension, RCORP grantees, mobility management network, and Recovery-Friendly workplaces

This project is focused on the scale-up of evidence based substance misuse prevention practices targeting young adolescents and their families. It extends prior work on EBP dissemination by continuing to build and coordinate state-level networks for substance misuse prevention and treatment, converting EBP materials for on-line use, and developing additional resources for grandparents raising children due to family substance misuse issues. Project Goals & Objectives: The goals of this project will include: (1) ongoing dissemination and scale-up of evidence based prevention programs and practices; (2) ongoing networking with other substance use prevention and treatment initiatives in Pennsylvania, across the continuum of care; (3) work with Extension and EBP developers to create on-line resources for families in the wake of COVID-19; and (4) development of additional supports for grandparents raising children due to substance abuse problems of the middle generation. Project strategies will include ongoing, high-quality delivery of EBPs for youth and families in targeted communities by Penn State Extension educators; continued engagement of drug take back (DTB) stakeholders and promotion of DTB in communities by PROSPER teams; continued development of the upgraded PROSPER website, which will serve as a clearinghouse for information on effective prevention and implementation science for families, service providers and community members; collaboration with Extension and EBP developers to make materials available to families in an on-line format; the development of 3 online support modules for grandparents raising young adolescents; social networking and ongoing collaboration and coordination with other key, state-level substance misuse stakeholders, including the Pennsylvania Department of Drug & Alcohol programs (DDAP), the PA National Guard, the DEA, and the University of Pittsburgh. The project evaluation will include tracking of youth substance use patterns using the Pennsylvania Youth Survey, tracking the utilization of DTB events and boxes in communities where this is actively promoted by PROSPER teams, monitoring the implementation quality of programs, and tracking the use, feasibility and desirability of the web-based prevention and intervention resources developed for families and youth as a result of the COVID-19 pandemic. Population to Be Served: This project focuses on primary substance use prevention for youth ages 10-14 and their families. PROSPER teams work in 4 rural & small-town communities in southwestern Pennsylvania. The demographics of these communities are approximately 50% female, 94% Caucasian, 4% African-American, and 1% Latinx. Youth under age 18 make up about 20% of the population and about 15% of the population lives below the poverty line. On-line resources for youth and families will be available statewide through the PROSPER website. We expect to serve about 80 youth and families per year with the family program, about 1,200 youth per year with the school based program, and possibly thousands with the online resources.

The Adapting To Change: A Collaborative Approach To Substance Use Prevention, Intervention, And Recovery For Minnesota Rural And Tribal Communities project engages rural Minnesota counties and tribal communities that suffer a disproportionate burden from opioid and stimulant misuse. The proposed project will create a regional-based coalition that supports a menu of in-person and on-line evidence-based technical assistance and training options that are specific to the unique needs of communities to help build local positive recovery capital. This project will collaborate with current State Opioid Response (SOR) grantees to assure a bi-directional flow of information and dissemination of resources and products that can be used to support each other’s programs in the area of opioid and stimulant use disorder prevention, treatment, and recovery. The proposed project strategies: (1) Develop a strong, regionally-based network of partners (tribal communities, SAMHSA SOR grantees, county public and health and human services, University of Minnesota Extension, and College of Pharmacy, Duluth) that support each other's work and promote a bi-directional flow of information and resource sharing to collectively prevent opioid and stimulant use disorders and support those in recovery in rural and tribal communities; (2) Provide easily accessible, up-to-date online and in-person resources and information for individuals, families, communities, and practitioners in rural and tribal communities to increase awareness and reduce stigma of opioid and stimulant use disorders; and (3) Build rural and tribal communities' capacity to meet the unique needs of their communities to address opioid and stimulant use disorders through the ongoing development of sustainable and culturally relevant training and technical assistance for professionals and community members. Project Goals and Measurable Objectives: Goal: Participants will increase their knowledge and confidence about opioid and stimulate use prevention/recovery support strategies. This will increase the capacity of local community professionals and stakeholders to apply OUD and SUD harm reduction strategies. Objective: By the end of year 2 of the project up to 960 local community members and professionals will be trained in opioid and stimulant use harm reduction strategies. Goal: Participants will 1) gain knowledge about OUD and SUD and 2) gain knowledge about local resources available for people to prevent OUD and SUD and support for those in recovery. This will increase the capacity of participants across the grant-funded region to prevent OUD and SUD and support people in recovery. Objective: By the end of year 2 of the project, up to 2000 participants will engage in online opioid use and stimulant use prevention and recovery support education.

This project addresses a critical need in Ohio’s opioid mitigation strategy by creating a sustainable opioid prevention framework that compliments existing treatment and recovery efforts in the state. The Ohio Prevention Partnership (OPP) is a collaboration between The Ohio State University and local community partners to develop sustainable community teams who deliver coordinated implementation of quality evidence-based and evidence-informed opioid prevention programs in high-need communities. Our project will leverage OPP’s experience creating community prevention frameworks and use SAMHSA’s Strategic Prevention Framework (SPF) to assess local community partners’ technical capacity to plan and implement successful community-forward programs. Once communities are assessed, OPP will help communities form multi-disciplinary teams committed to a shared interest in opioid prevention programming. OPP will then guide the community in selecting evidence-based and/or evidence-informed opioid prevention programs from the broad categories of family-based parent/child relationship skill building, school-based youth resilience training, youth and adult mental health crisis identification and response training, and prescription opioid safety. This project will serve some of the highest need rural communities in Ohio, a state that has led the nation in overdose deaths for six consecutive years.