Q&A: Why Rural Youth Deserve Our Investment in Mental Health Supports

Too often the challenges facing rural adolescents are overlooked. The Curry School is changing that by launching a series of new initiatives to address issues related to mental and behavioral health in rural schools.

Audrey Breen

Educators and community organizers have long been committed to addressing many of the challenges facing young people. From eliminating ineffective zero-tolerance policies and replacing them with positive behavior supports and social-emotional learning strategies, research-based solutions are finding their ways into schools and communities where they are making a difference, according to Catherine Bradshaw, professor in the Curry School of Education & Human Development.

“Unfortunately, many of these efforts have been slow to find their way into rural communities and schools,” Bradshaw said. “Rural communities are unique and the students in these communities deserve more of our attention.”

While opioid addiction is a growing community health concern that is ravaging many rural communities, especially in the Appalachian areas of West Virginia, Virginia and North Carolina, Bradshaw believes there are many layers of challenges facing rural youth.

We sat down with Bradshaw and her colleague Amanda Nguyen, assistant professor at the Curry School, both of whom are leading a series of new initiatives to support mental and behavioral health in rural schools to hear more about why this work is critical.

Q: What are some of the larger, external trends that have had a significant impact on rural areas in recent years?

More rural areas are facing a number of factors that have a significant impact. These areas are seeing elevated levels of unemployment and poverty, many having persistently had high poverty rates spanning decades. The well-reported opioid crisis is another. The levels of opioid addiction impact children through increases in family disruption such as being placed in a more distant relative’s care or in non-relative care. Additionally, there is a lack of access to behavioral and mental health services. Together, these contribute to the multiple forms of disadvantage that are concentrated in rural areas.

Specifically related to education, the schools in these areas are typically quite under-resourced and as such often result in low educational attainment for residents. Across the United States, 79% of “low education” counties, those where 20% or more of adults do not have a high school diploma or equivalent, are rural.

One thing to note here is that in spite of these challenges, educational attainment is rising in rural communities. But the pace of that growth is slower than in urban settings, resulting in a widening gap in educational attainment between urban and rural settings.  Some of this might be due to fewer people in rural communities seeking higher education, but also because of the phenomenon called “brain drain,” where residents with higher levels of education seek employment in urban communities.

Q: Your work focuses in part on mental health. What kinds of mental health challenges exist particularly in rural communities?

Many of the same ones that affect urban communities also occur in rural settings, and some are even exacerbated in rural communities.  A big focus as of late has been on the opioid crisis, and the disproportionate impact in rural communities, and growing concerns about cancer and obesity.  But there is also other research that suggests rural youth are disproportionately impacted by suicide and other mental health problems as well, particularly internalizing problems like anxiety and depression.

Q: A significant tool-box of programs and interventions exist already for many of these challenges. What are the challenges to using those to improve services for rural communities?

We don’t yet know if and how programs are transferable from more urban and suburban settings into more rural communities. We are trying to better understand which evidence-based programs work in rural schools and communities by adapting them for these settings and testing them to determine their impact. Researchers are often located in urban and suburban areas where school districts are larger and closer together. In these settings, researchers have easier access to large populations of classrooms and students for their research. As a result, there has been considerably less research on school-based programs in rural settings as compared to urban or suburban communities.

In addition, we are increasingly leveraging technology to reach schools and families in rural and remote areas.  A lot of these challenges are surmountable, but the research needs to be done, guidelines developed, and specialists trained to support these communities effectively while recognizing the full range of cultural and contextual realities. 

Q: Why is research conducted in other settings difficult to transfer to more rural settings?

Some of the challenges relate to issues of accessibility, acceptability, and appropriateness of evidence-based programs.  With regard to accessibility, there are real barriers that children and families in rural settings face in accessing a range of services to address behavioral and mental health concerns.  This is due, in part, to challenges like a lack of specialty providers in rural communities. Therefore, children and families who need services end up having to travel a long distance to get care and help.  There is also a lack of public transportation, no taxis, Uber, etc. So how do people with mobility issues get the care they need? 

There are also issues of acceptability.  For example, there is often higher mental health stigma in rural communities, which could impact ability to access care.  With smaller, close-knit communities, anonymity is also less guaranteed – everyone knows each other, people take on multiple roles (e.g. the same people providing family services may also work at the local diner, etc.), etc. Whereas in urban settings if a particular provider is not a good fit, you find a different one – that may not be an option in rural communities.

And then there is appropriateness.  We know, for example, that young people in rural communities are less likely to have access to mental health care, but even when they do get it, it is less likely to be “youth friendly”; providers may not have particular training in child mental health. When it comes to program content, some aspects of programs just may not be culturally or contextually relevant to rural settings, and some of the program content or examples that are written into many social/behavioral programs just don’t fit in the rural context.  For example, in one program may be designed with a component on “neighborhood problems.”  Many rural people don’t live in traditional “neighborhoods” in a way that this would even transfer.

Q: Most of this work seems to reach beyond schools. How does this work matter for schools and education specifically?

There is a growing body of research showing that mental and behavioral health issues co-occur with poor academic functioning and low school connectedness, which in turn predicts school failure and dropout and subsequent occupational and life adjustment challenges.  This is why prevention is so important – early identification and support for kids who are struggling can significantly help them thrive at school, at home, and in their communities.

Additionally, in many rural towns, schools--the high school especially--serve as a real hub of the community. For many residents, there is great pride in being a graduate of the local high school and its events are popular. In some cases, the schools are the easiest place to connect to Wi-Fi and residence often gather in the parking lot to get work done. The schools also serve as a consistent point of health care, too.

With this in mind, the school-based programs have the potential to make an even greater impact in these areas than in other communities.

Q.  What are your plans going forward?

Our team has been working with a number of evidence-based programs that have been shown to be effective in supporting students’ mental health and improving their social and behavioral well-being. What we need to know is how these models can be best integrated into rural schools and what impact they have on rural youth.

We have recently launched several new federal grants funded by the U.S. Department of Education that are helping us to advance this line of work. For example, we are part of a 10 million dollar federally funded center focused on rural school mental health, called the National Center for Rural School Mental Health. This center supports the formation of a partnership between researchers, clinicians, and rural schools across Missouri, Montana, and Virginia.

Over the next five years, we will be working to adapt many of our research-based prevention and early intervention programs and models to better fit the needs of rural schools. We will also create a number of training and support resources for these programs, which are available through a user-friendly online delivery system. This system will include supports for screening and identifying students in need, and training in data-driven decision-making and specific evidence-based programs. 

A second, related initiative is a new 4-year partnership with colleagues at Appalachian State University to adapt one particular research-based intervention, Coping Power, to better fit the needs of rural elementary and middle school students, their teachers, and parents.  We will also provide coaching for teachers, and a parent-engagement strategy that will better fit the needs and lifestyles of busy rural parents.  We expect these changes to improve the scope of intervention impact in schools that don’t have the resources to offer multiple different types of prevention programming, with a better fit for families facing barriers to traditional support services. 

We look forward to continuing to build our partnerships with rural Virginia schools through these initiatives over the next five years. We are excited about the opportunities and resources that we’ll be able to offer to help improve student outcomes in rural schools.

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Audrey Breen