Poster #103 - Moving Rural Mental Health Forward: From Collaboration to Program Evaluation

• In Event: Poster Session 14

Abstract

Introduction: At large, the country is facing a mental health crisis. A growing rate of youth have major depression, and of those with major depression, 60% do not receive mental health treatment (Mental Health America, 2022). Fontanella et al. (2015) found that suicide rates for adolescents are higher in rural than in urban communities. Reasons for rural-urban mental health disparities can be due to a lack of mental health providers, distance to mental health providers, and poor infrastructure for telehealth. For instance, when comparing the ratio of mental health providers per population, statistics show that there is only one mental health provider for every 1,520 people in Montgomery County (Robert Wood Johnson Foundation, 2019). Community-based participatory processes, such as those in Communities That Care (Hawkins et al., 2008) or Evidence2Success, have been forward-thinking models to create sustainable solutions to improve youth health and development. However, in rural areas where individuals have to already serve multiple roles in the community, they might not have the time to understand evidence-based practices, and in these cases, it may be better to form partnerships where skilled partners can focus on the data and the community to drive decision making. The current study leverages the Communities That Care and Evidence2Success frameworks, and modifies them in a way to work with rural communities through forming partnerships between critical access hospitals and grade schools.

Methods: A seven-step framework was developed which integrates a Community-Based Research Participatory approach to transform the mental health of adolescents in the community. A community board of nine members was created. An assessment was administered, which used a risk and protective factor approach (Fitzpatrick, 1997) to help explain the difference between different risk levels for suicide and depressive symptomology. Data was collected community-wide from youth in grades 6-12 (n=736). After priority selection and program implementation, a one-year evaluation was conducted to test whether risk and protective factors improved.

Results: Mental health outcome data suggested that one in five youth considered suicide in the past six months, and one in four youth had abnormal levels of anxiety and depression. A series of stepwise regressions revealed that the three biggest risk factors explaining poor mental health outcomes were (a) Low Commitment to School (r2adj = .23, β =.34), (b) Family Conflict (r2adj =.14, β =.28 ), and (c) Bullying (r2adj =.08, β =.28). The most important protective factors in mitigating daily challenges were Family Attachment (r2adj =.27, β = -.30), Rewards for Prosocial Involvement in School (r2adj =.04, β = -.20), and Opportunities for Prosocial Involvement with Family (r2adj =.02, β = -.24). The community selected Sources of Strength to target these issues. Results from the pre-test to post-test school year evaluation of Sources of Strength revealed significant improvements in some of the most important risk factors and protective factors such as mother-child relationships and prosocial behaviors.

Conclusion: This partnership continues to be successful three and a half years later. Since the initial implementation of this service delivery framework, three new communities have started a similar process.

Group Authors

Hillsboro Area Hospital

Authors

• Nicole Marie Summers-Gabr, Southern Illinois University School of Medicine
  Presenting Author

• Jessica Cantrall, Southern Illinois University School of Medicine