Coast to Forest: Mental Health Promotion in Rural Oregon and Beyond

Description

Oregon State University (OSU) Extension Family and Community Health Program and the OSU Center for Health Innovation created the Coast to Forest program to improve mental health and prevent substance use disorders in rural Oregon and beyond. Coast to Forest delivers programming at the local, state, and regional levels.

OSU received funding from the U.S. Department of Agriculture (USDA) through the Rural Health and Safety Education (RHSE) program to implement Coast to Forest programming in rural Baker, Lincoln, Tillamook, and Union counties. This work was later expanded in 2022 through the same funding source to include Lake County, OR and delivery of culturally-specific programming in Lincoln County. This component of the project has since concluded though certain program elements, namely the delivery of Spanish Mental Health First Aid (MHFA), have been folded into other funding sources, outlined below.

OSU subsequently received funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) through the Rural Health and Safety Education (RHSE) program to implement Coast to Forest programming in all 36 Oregon counties. This work was expanded in 2022, in collaboration with Washington State University, through the formation of the Northwest Rural Opioid Technical Assistance Collaborative (NW ROTAC), which serves Oregon, Washington, Idaho, and Alaska.

Most recently, Coast to Forest received funding from SAMHSA through the Mental Health Awareness Training (MHAT) program to deliver tailored programming, including Mental Health First Aid and Question, Persuade, Refer (QPR) in three rural Oregon counties: Benton, Linn, and Lincoln.

Other program partners include the Northwest Portland Area Indian Health Board, Oregon Mental Health First Aid, Washington State University Cooperative Extension, local public health agencies and coordinated care organizations, community-based organizations, and community coalitions across all four states.

Services offered

• Adult, Youth, and Spanish Mental Health First Aid (MHFA) training for community members
• Question, Persuade, Refer (QPR) suicide prevention training for community members
• Delivery of an adapted version of SAMHSA's Community Conversations About Mental Health
• Capacity building and technical assistance for local partners, including:
  • A toolkit and trainings for others to replicate Coast to Forest's adapted version of Community Conversations about Mental Health
  • A free, self-paced Substance Use Disorders 101 online course
  • Coordination of train-the-trainer opportunities for MHFA and QPR
• Development and dissemination of local mental health and substance use disorder resource guides
• Development and dissemination of a graphic novel for youth that discusses mental health
• Development of a radio promotion toolkit containing interview guides, public service announcement scripts, and best practices for engaging with radio stations for community-based professionals across the Pacific Northwest
• Education about mental health and substance use disorders offered through statewide Extension networks and a free-to-access web library of tools and resources
• Media training to de-stigmatize mental health and substance use disorders, offered on-demand through the program's web library

Results

In its five years of operation, Coast to Forest has trained over 500 individuals in MHFA, including English Adult, Spanish Adult, and Youth MHFA. The majority of MHFA participants lived or worked in rural areas. Participants consistently increased their confidence in assisting a person experiencing a mental health or SUD-related challenge and increased their awareness of the common signs and symptoms of mental health and SUD-related challenges.

68% of SUDs 101 course participants who completed the pre- and post- quiz improved their knowledge, skills, and abilities related to SUDs and peer support fundamentals. In addition, those who completed the pre- and post-survey demonstrated increased confidence to perform helping behaviors.

The resulting action plans from the program's facilitation of Community Conversations in five rural Oregon counties have been used to prioritize funding, inform opioid settlement investments, guide Coordinated Care Organization (CCO) decision making, operationalize investments, and increase collaboration around prioritized action areas.

Finally, in collaboration with community partners, the Coast to Forest team has developed over 100 county-specific resource guides and counting as they expand across the region. The guides were each reviewed by local partners. Coast to Forest aired over 900 radio programs (including PSAs and interview-style content) focused on mental health and SUD resources.

During an unprecedented time, both with the COVID pandemic and persistent increase in deaths of despair across the region and nation, the study team and community partners have responded to emerging local needs by effectively connecting local partners to critical resources in a timely way.

Challenges

Delivering programming requires flexibility and responsiveness to ever-changing community needs and landscapes. For example, the COVID-19 pandemic, the post-pandemic recovery period, and behavioral health workforce shortages presented many challenges in the delivery of this program as the study team was committed to maintaining relationships with community partners and being considerate of the competing demands on their time and resources. Because of this, rollout of certain activities was slower than anticipated. Additionally, the implementation of MHFA requires more administrative oversight and coordination than originally anticipated.

In being responsive to community needs, the study team often adapted the original project goals to be more in line with on-the-ground needs. In rural Union County Oregon, the team had originally committed to airing 30-minute radio interviews on an ongoing basis describing the Coast to Forest project and available resources for mental health and substance use disorders. However, in collaborating with partners in Eastern Oregon, the study team learned that there was actually a higher need for short soundbites that educated the public on these topics and offered one specific resource they could access. Though it required additional resources, expertise, and partnerships to accomplish these goals, in the end the team was able to successfully develop nine radio PSAs that aired over 900 times in four rural Eastern Oregon counties. This is just one example of how the team creatively responded to emerging needs in ways that both honored grant commitments and responded to community needs.

Regional expansion of the program has also been tempered in states where Extension resources are focused on traditional Extension programs like agriculture and youth development. In line with this, becoming familiar with health systems and resources in rural and frontier regions has required special care and attention.

Finally, the time and effort required to implement new program activities when personnel and resources are scarce have presented ongoing challenges throughout this project and have required adaptability and a collaborative team approach to accomplishing project goals.

Replication

The Coast to Forest program is ongoing and recently completed its fifth year. Outlined below are key lessons for replication that the project team has learned.

• If planning to deliver MHFA for a large number of people on a consistent basis, dedicate concentrated staff time for developing procedures for course planning and delivery, recruiting participants, coordinating course facilitation, and tracking participation. The MHFA platform does allow for team members to serve in a dedicated coordinator role to support course delivery, if desired.
• If planning to deliver Spanish MHFA, trainers should carefully review the training material and its use of "Neutral Spanish" to determine if language and terms align with the Spanish typically used in their population of interest. Additionally, Spanish MHFA videos are Spanish subtitled, so they should also consider the Spanish literacy level of their intended population.
• Engage in community-based work with a lens of cultural humility and a focus on maintaining current and developing new and trusted relationships with community partners. This requires dedicated time and resources to do well. Community Conversations, for example, aimed to advance the work that was already being done in multiple counties by creating a space and structure for community leaders to share the strengths, gaps, and action areas of their local behavioral health system with one another to increase cohesion and collaboration.

Contact Information

Sandi Cleveland Phibbs, PhD, MPH, Project Director
Coast to Forest
Sandi.Cleveland@oregonstate.edu