Wellness in Tough Times

Rushville Community Garden; photo credit: Julien Hoffman

Wellness in Tough Times Toolkit

By Soni Cochran, Kerry Elsen, Susan Harris, Kayla Hinrichs, Julien Hoffman, Michelle Krehbiel, Brandy VanDeWalle; funded by: Nebraska Extension, Peter Kiewit Foundation, Center for Disaster Philanthropy Midwest Early Recovery Fund, Extension Foundation

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A T T R I B U T I ON

Wellness in Tough Times Toolkit Copyright © Cochran S., Elsen, K., Harris, S., Hinrichs, K., Hoffman, J., Krehbiel, M., and VanDeWalle, B. 2021, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). Published by Extension Foundation.

e-pub: 978-1-955687-07-2

Publish Date: November 4, 2021

Citations for this publication may be made using the following: Cochran S., Elsen, K., Harris, S. Hinrichs, K., Hoffman, J., Krehbiel, M., and VanDeWalle, B. (2021). Wellness in Tough Times Toolkit eFieldbook (1 st ed). Kansas City: Extension Foundation. ISBN: number Producer: Ashley S. Griffin Peer Review Coordinator: Rose Hayden-Smith Editorial Assistant: Heather Martin Technical Implementer: Heather Martin and Rose Hayden-Smith Welcome to the Wellness in Tough Times Toolkit eFieldbook, a resource created for the Cooperative Extension Service and published by the Extension Foundation. We welcome feedback and suggested resources for this publication, which could be included in any subsequent versions. This work is supported by New Technologies for Agriculture Extension grant no. 2020-41595-30123 from the USDA National Institute of Food and Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the U.S. Department of Agriculture. For more information please contact: Extension Foundation c/o Bryan Cave LLP One Kansas City Place

1200 Main Street, Suite 3800 Kansas City, MO 64105-2122 https://impact.extension.org/

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T A B L E O F CO N T E N T S

ATTRIBUTION....................................................................................................................................... 2 MEET THE TEAM .................................................................................................................................. 5 Acknowledgements ............................................................................................................................. 7 INTRODUCTION ................................................................................................................................... 8 Outreach Highlights .................................................................................................................................................................................9 Part One: Collaborating With Communities ........................................................................... 13 Choosing Pilot Locations for the Wellness in Tough Times Project ......................................................................................13 Community Advocates Are the Key to Success ............................................................................................................................14 Part Two: Needs Assessment and Evaluation......................................................................... 15 Husker Harvest Days Survey ...............................................................................................................................................................15 Community-Informed Research for Improving the Delivery of Virtual Resources Promoting Wellness and Stress Management .............................................................17 Extension Foundation Health and Wellness Survey ...................................................................................................................20 Assessing Mental and Physical Health-Related Quality of Life Issues in Rural Communities Following a Natural Disaster .............................................................................................................21 Internal Assessment—Nebraska Extension ..................................................................................................................................26 Connect Extension Chat .......................................................................................................................................................................27 Part Three: Programming ...................................................................................................... 29 “Communicating With Farmers Under Stress” ............................................................................................................................29 Neighbor-to-Neighbor Initiative ........................................................................................................................................................31 Wellness in Tough Times Inspires Outreach Projects in Australia ........................................................................................35 Part Four: Community Projects .............................................................................................. 42 Community-led Projects Supported by Wellness in Tough Times ........................................................................................42 Read for Resilience: Books for Young Children ............................................................................................................................44 Little Free Libraries for Communities ..............................................................................................................................................44 “Start the Conversation” Bingo .........................................................................................................................................................45 Neighbor-to-Neighbor Quarterly Newsletter ...............................................................................................................................52 Part Five: Media and Storytelling .......................................................................................... 53 “Start the Conversation” Bulletins ...................................................................................................................................................53 “Nebraska Extension Cares” Resource Cards ...............................................................................................................................54 Public Service Announcements .........................................................................................................................................................56 Podcasts .....................................................................................................................................................................................................57 Videos .........................................................................................................................................................................................................58

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Press Releases .........................................................................................................................................................................................59 The Importance of Storytelling ..........................................................................................................................................................59 Part Six: Conclusion ............................................................................................................... 60 Part Seven: Wellness in Tough Times Project Rationale Statement........................................ 63

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M E E T T H E T E AM

Susan Harris

Soni Cochran

Susan is the Rural Health, Wellness, and Safety Educator for Nebraska Extension with a 15-year history of education, liaison, and administrative work in health promotion. She leads the Rural Family Stress and Wellness Collaborative Group and offers programs for all ages, promoting optimal mental and physical quality of life. Susan Harris, MLS, Team Lead go.unl.edu/s-harris

Soni is a Community Engagement and Wellness Extension Associate for Nebraska Extension. Soni is a member of the leadership team for the Nebraska Extension Disaster Education Network (EDEN) and Heartland EDEN representing Missouri, Iowa, Nebraska, and Kansas. Her work focuses on disaster education and rural family stress and wellness programming, including suicide awareness and prevention. Soni Cochran, MS, NTAE Project Fellow go.unl.edu/s-cochran

Kerry Elsen

Kayla Hinrichs

Kerry is a 4-H, Youth Development Educator, with a focus on Agricultural Literacy Education. She is also involved in her family’s cattle operation, making rural wellness an additional focus area. Kerry Elsen, go.unl.edu/k-elsen

Kayla is a Food Nutrition and Health Extension Educator for Nebraska Extension. Her main office is in Ord, Nebraska. Kayla Hinrichs, go.unl.edu/k-hinrichs

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Julien Hoffman

Michelle Krehbiel, Ph.D.

Julien is the Disaster Education Community Engagement and Wellness AmeriCorps VISTA with Nebraska Extension. During her service term in Nebraska, she is handling writing and media for the “Wellness in Tough Times” project in a variety of capacities. She is documenting the progress of each community through photography and interviews, while writing promotional materials. Julien Hoffman, AmeriCorps VISTA

Michelle is a youth development specialist and associate professor at the University of Nebraska- Lincoln Extension 4-H Youth Development. Her work focuses on creating positive youth development environments and youth mental health. She provides professional development training to 4-H Youth Development professionals, after-school workers, and 4-H volunteers throughout Nebraska and the nation. Michelle Krehbiel, Ph.D., CFLE go.unl.edu/m-krehbiel

Brandy VanDeWalle

Brandy is a Nebraska Extension Educator who focuses on 4-H and Youth Development. She works to engage youth in agriculture-related areas in addition to working with Nebraska farmers and ranchers. Brandy VanDeWalle, go.unl.edu/b-vandewalle

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A C K NOWL E D G E M E N T S

Holly Hatton-Bowers, Ph.D., Assistant Professor and Early Childhood Extension Specialist, Nebraska Extension Lisa Franzen-Castle, Ph.D., Associate Dean, College of Education and Human Sciences, University of Nebraska-Lincoln

Megan Hanefeldt, Extension Educator, 4-H Youth Development, Nebraska

Chandra Plate, Extension Educator, 4-H Youth Development, Nebraska

Ashley Mueller, Extension Educator, Disaster Education Coordinator, Nebraska Extension

Jason Weigle, Extension Educator, Rural Prosperity Nebraska, Nebraska Extension

Robert Tigner, Extension Educator (Retired), Agricultural Systems Economist, Nebraska Extension

Jessie Reed, Graduate Student, University of Nebraska-Lincoln

Stephanie Cole, Business Manager, Nebraska Extension

Pat Neben, Finance/Grants Specialist, Nebraska Extension

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I N T ROD U C T I O N

By Soni Cochran

Welcome to “Wellness in Tough Times Toolkit.” Join us in “Starting the Conversation” around mental well-being! This eFieldbook is a toolkit of resources, stories, and lessons learned as our team and partners navigated the Wellness in Tough Times (WTT) project supporting Nebraskans affected by multiple stressors: The continuing downturn in the agricultural economy, a year of record-breaking disasters that impacted Nebraskans from border-to-border, and a global pandemic created challenges that took us all into uncharted waters as we worked to achieve project outcomes.

Throughout this project, we tapped into creative thinkers, we adjusted, and we used the assessments and community survey data to re-imagine critical outreach efforts. In collaboration with the community advocates in our WTT pilot locations, and with the generosity of and commitment from project funders, colleagues, and partner agencies, we were able to meet rural residents where they live even during periods when we could not be face to face. We have highlighted a few of these efforts in this eFieldbook. The stigma associated with asking for help in rural areas and the lack of access to mental health resources

“Worried!” by photoloni is licensed under CC BY 2.0 .

compounded all the challenges Nebraskans have been facing from disaster impacts and pandemic isolation. The WTT project strives to empower and strengthen the resiliency of individuals and families in communities by promoting opportunities to “Start the Conversation” around mental well-being. Project outcomes include: 1. increased mental health awareness

2. decreased behavioral health stigma

3. increased use and/or awareness of behavioral health support resources

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In 2019, suicide was listed as the ninth leading cause of death in Nebraska. Nationwide in 2019, suicide is listed as the tenth leading cause of death.

—C enters for Disease Control

When this project began, we understood that rural Nebraskans are a tough bunch and may not reach out for help if they are struggling. However, for even the toughest individuals, the strain on mental well-being can be overwhelming with the potential for devastating consequences, including suicide. Nebraska Extension and the WTT team continue

to provide educational programs for the agricultural industry and rural residents— programs like “Communicating with Farmers Under Stress” and “Question–Persuade–Refer.” These programs have taken place virtually and in person, depending on directed health measures from local health departments in Nebraska.

Wellness in Tough Times presentation Rural Family Stress and Wellness

RESOURCES

Whether you are a university Extension professional, a health care provider, a member of a non- governmental organization, or an advocate in your own community, we want this toolkit to inspire you to create those opportunities to start the conversation around mental well-being in rural communities during blue skies. We love this example:

An Australian team working with rural locations devastated by brush fires were inspired by the “Neighbor-to-Neighbor” project and “Nebraska Extension Cares” resource cards. The team used this information to start “Tailgates4Mates” and adapted the wallet-sized resource cards so they could be shared at events in Australia. Read about their experiences.

On behalf of the WTT Team, thank you for helping us continue the conversations around mental well- being!

Outreach Highl ights By Susan Harris and Soni Cochran

Here are just a few of the ways we shared the “Start the Conversation” message around mental well- being and overall wellness. Some of these outreach efforts took place prior to the global pandemic:  Promoted awareness of the WTT project and distributed material to people at the following events:

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• Nebraska Community Foundation Annual Banquet (650 attendees) • Annual Nebraska Extension Fall Conference (350 attendees) • West Central Cattlemen’s Association events in Nebraska communities of Ogallala, Culbertson, Loup City, Tryon, Alma (220 attendees)

• Soil Health Conference in Hickman (400 attendees)

 Created a pesticide education module for over 9,000 farmers, featuring the WTT video of three rural Nebraska families faced with challenges, including the 2019 disasters, a fire, and the stress of farm life on individuals and in relationships  Presented “Communicating with Farmers Under Stress” to over 700 agribusiness professionals, with 28 workshops in communities and online  Presented programs about stress and/or sleep to the following:

Ag-Ceptional Women’s Conference in Norfolk

Women in Ag Conference in Kearney

• Nebraska Cattlemen membership online webinar • Nebraska USDA FSA employees in all seven regions

• Nebraska Extension’s Front Door Forum

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Sharing wellness information and resources at the 2019 Nebraska Community Foundation Annual Banquet in York, Nebraska. (l to r): Jason Weigle, Emily Freudenburg, Soni Cochran, Susan Harris, Brandy VanDeWalle

 “Neighbor-to-Neighbor” hosted a free social gathering event in four rural communities affected by the 2019 bomb cyclone. These communities were in the WTT pilot locations. The event included a free meal provided by local businesses. The featured speaker focused on “bringing humor into rural communities during stressful times.” The program, “Momma Told Me There’d Be Days Like This,” was funded in part by WTT.  In Bassett, Nebraska, students in grades seven through 12 learned how to write and rewrite their own powerful narratives as they developed mental well-being. A motivational speaker presented “Flip the Script,” inspiring students to continue those conversations supporting mental well-being.

 A media campaign was developed to bring attention to the following:

• One-year anniversary of the bomb cyclone Winter Storm Ulmer (The media campaign began in March 2019 and included radio spots, public service announcements [PSAs], videos, newspaper and newsletter articles, social media posts, and website resources.) • Mental Health Awareness Month in May (The campaign included radio spots, PSAs, videos, newspaper and newsletter articles, social media posts, and website resources.)

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 Initiated the “Start the Conversation” campaign, focusing on high school youth participating in the annual Future Farmers of America Convention in Lincoln, with green bandanas to symbolize Mental Health Awareness Month in May (Over 9,000 members and guests attend the event, which was postponed to 2020 due to the global pandemic.)

 The multidisciplinary Rural Family Stress and Wellness Collaborative created a website.

 Developed a 12-page bulletin that was mailed to over 7,000 rural residents in WTT project locations, which were further isolated due to the pandemic (The “Start the Conversation” bulletin featured helpful resources, websites, and positive messages to help people connect

during isolation. Issues were published and mailed in May and October 2020.)

 Dr. Christine Chasek, LIMHP, LADC, was a featured speaker at the 2019 Nebraska Extension Fall Conference. A rural resident herself, Dr. Chasek shared stories and inspiration focused on self-care during tough times. The WTT team worked with Dr. Chasek to develop videos and podcasts with messages to improve the well-being of rural

residents and reduce stress during challenging times.

Dr. Christine Chasek at the 2019 Nebraska Extension Fall Conference; photo credit: Susan Harris

Lessons Learned The multi-faceted impacts of the COVID-19 pandemic overshadowed efforts to highlight challenges Nebraskans were facing, including the one-year anniversary of the bomb cyclone. With travel restrictions, protocols that prevented face-to-face programming with the public, and mandates for remote work only, it was critical to find alternate methods and supportive resources to connect with rural residents. Some of the resources we used are described in this eFieldbook, including making connections virtually, using direct mail to reach rural residents, and increasing media outreach. Said H. Maricle, Nebraska Extension Engagement Zone Coordinator, “I love to see the success and global impact. It may not be next door, but it is great to see that the work this team does has an impact on peoples’ lives and success.”

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Part One: Collaborating with Communities

Choosing Pi lot Locations for the Wel lness in Tough Times Project By Julien Hoffman

WTT Team strategizing the selection of pilot community locations; photo credit: Susan Harris

To select the pilot locations for the WTT project, the team collaborated with Rural Prosperity Nebraska Extension professionals and used data provided by the Federal Emergency Management Agency (FEMA) following the bomb cyclone in 2019. The team used a rubric created by FEMA that scored combined capacity and vulnerability to determine, through metrics, what affected communities would need to recover. The project funders also requested that the team identify communities that were not featured in the media when disaster struck their area, which naturally left them with less outside assistance than similar areas that received more attention. Taking into consideration all the parameters, the team selected seven locations that spanned the state of Nebraska. The pilot locations include the rural communities of Bassett, Dannebrog, Gibbon, Gordon-Rushville-Hay Springs area, Lynch, Niobrara, and Peru.

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Lessons Learned  The WTT team did not necessarily work or live in the locations selected for the pilot project. It was important to identify local Extension professionals who were trusted resources and were willing to serve as liaisons between community advocates and the project team.  Some of the WTT locations selected for the project were in frontier areas of Nebraska. Instead of selecting one small village in these locations, the team focused on a multi-county area that included several small rural communities.  Due to the nature of this work, it was also important to engage with Extension professionals focused on rural community development.

Lynch, Nebraska (population 206) was one of the villages affected by the 2019 flooding. Photo credit: Lynch Volunteer Fire Department

Community Advocates Are the Key to Success By Julien Hoffman

Selecting community advocates involved more personal connections than metrics. The WTT team relied on local Extension professionals and community leaders to suggest strong candidates to be the advocates for their communities’ needs and liaisons for the WTT project. The communities were represented by individuals with leadership skills, a sense of responsibility to their community, and a high level of trust with other locals. These qualities allowed each chosen community advocate to act as a representative comfortably and confidently in their community and champion their selected community projects. Lessons Learned  When communities already have a stable leadership structure and a network of community advocates, a new project is more likely to be welcomed and have follow-through.  Community advocates have good intentions but may find they have limited capacities and access to resources. In our project communities, advocates were also affected personally by the 2019 disasters. While they wanted to help their communities, they also had to help themselves.

 Relationship building with communities and community advocates is key to project success.

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Part Two: Needs Assessment and Evaluation

Husker Harvest Days Survey By Soni Cochran

In 2019, the Nebraska Extension Rural Family Stress and Wellness Working Group hosted a WTT booth at Husker Harvest Days. HHD is the “World’s Largest Totally Irrigated Farm Show.” It drew 100,000 visitors from around the world. The WTT team distributed thousands of wallet-sized resource cards for the agricultural community. These resource cards, termed “Nebraska Extension Cares” cards,

2019 Husker Harvest Days booth; photo credit: Susan Harris

2019 Husker Harvest booth children’s activity; photo credit: Susan Harris

Kayla Hinrichs and Melissa Bartels at 2021 Husker Harvest Days; photo credit: Susan Harris

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shared numbers for the Rural Response Hotline, the National Suicide Prevention Lifeline, and the Negotiations Hotline. The cards also conveyed messages of hope and support.

At HHD, the team also provided information and resources related to suicide awareness. A short video played on a continuous loop and provided opportunities to engage in conversations with people who stopped by to watch it. Considering the stigma surrounding mental well-being and suicide, the WTT team members were surprised that in this environment, people openly shared stories and their concerns for loved ones or themselves and their mental well-being. Many also opened up about their own struggles and the need to address mental well-being. Many HHD attendees stopped to thank the team for the suicide awareness messages and for bringing this important topic to the forefront. As another way to identify the stress and wellness needs of rural communities, the team conducted an informal survey of HHD attendees who stopped by the WTT booth. Three kiosks were set up for people to easily give their responses, using iPads. The team gained valuable knowledge from 471 participants on how to best communicate with residents in rural communities to provide information and resources on mental well-being. Some of the items participants selected as preferred ways to receive information included listening to radio programs or podcasts, Engaging with 2021 Husker Harvest Days attendees at the booth; photo credit: Susan Harris

attending programs in person, emails, and getting information from their church group. Many of the participants who completed the survey (68%) agreed they were experiencing stress and, 57% identified the need for more information and educational programs to support rural communities learn how to cope with stress in healthy ways. Another stress and wellness needs assessment survey is planned for the 2021 HHD event.

2021 Husker Harvest Days Survey

SURVEY

In 2020, due to the COVID-19 pandemic, the WTT team was not able to participate in HHD but still identified a way to hear from a few selected rural counties. In partnership with the Extension Foundation and the Farm Journal “Trust in Food” (TIF) initiative, a survey was developed, adapted from the stress and wellness needs assessment survey given at the 2019 HHD. The results from the 2020 survey were consistent with the results of the 2019 HHD survey, with many reporting stresses and the need for resources and information to support well-being in rural communities. The WTT team provided another informal survey for the 2021 HHD, receiving 486 usable responses from those 19 and older. This survey snapshot showed that about 20% are “very or extremely bothered” by stress, and work continues to cause stress while also giving relief as a coping mechanism. Again, responses provided insight into how our constituents prefer to receive information. After “radio and podcasts” ranked high in 2019, we decided to separate those to compare value placed on each. They ranked very closely.

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Lessons Learned  Prior to the 2019 HHD stress and wellness needs assessment survey, we assumed more females would participate in the surveys than males. Instead, we discovered approximately half of the people taking the survey reported being males. We were surprised at the number of men who not only were willing to take the survey but also spent time openly talking with WTT team members about their challenges and the effects stress had on their mental well-being.  Each survey gives us another opportunity to obtain specific information about how people in rural areas want to receive information and educational resources to support their stress management and wellness. Experiences during the global pandemic may also influence survey responses. Community- Informed Research for Improving the Del ivery of Virtual Resources Promoting Wel lness and Stress Management By Soni Cochran In late 2020, the WTT team partnered with the Extension Foundation and a team of assessment specialists from Trust in Food (TIF). The collaborative team sought to gain insights that could help improve programmatic capacity for Nebraska Extension. The result of this effort supports the delivery of impactful events, programming, and outreach in a virtual learning environment (TIF, 2020).

The primary goals of the project were:

 gain insight into the audience’s information consumption trends

 assess community perspectives of wellness and awareness of available materials

 identify stigmas related to wellness

 conduct a needs assessment to improve the delivery of events, courses, and resources

The collaborative team developed a survey instrument that was sent to Farm Journal ’s email database of rural residents and agribusinesses in the WTT pilot locations. Those in the database voluntarily opt in to receive email notifications and information from Farm Journal . Using the HHD survey as a model for the types of questions asked, the TIF survey was designed to capture qualitative and quantitative data points that provide insights into the target audience’s needs and preferences related to consuming information related to wellness and stress (TIF, 2020). The release of the emailed survey was timed to coincide with when most harvest efforts would be wrapping up and following the Thanksgiving holiday. The Extension Foundation provided gift card incentives for those completing the survey. The TIF team compiled the results of the survey and provided insights, action steps, and recommendations. The final report was shared with the WTT team and the Extension Foundation.

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The following insights, actions, and recommendations were based on the survey responses and were shared with the collaborative team:

Insights  Less than half of the respondents said they believed they have the resources available to help them cope with stress.  Work ranked highest on the list of stressors for people. Work was also the top way people coped with their stress.  More than half of respondents shared that they do not have the resources to help them cope with stress. Actions: Nebraska Extension should consider launching a high-touch messaging campaign that highlights the resources available to Nebraskans, how to access them, and the difference those resources could make in the lives of those who engage with them. The TIF report (2020) also suggested that Nebraska Extension has experts who can share practical strategies for managing stress and the capacity to start conversations around how people manage stress. Encourage conversations in programs to encourage the audience to take action. Example of a prompt in a media message: “X% of Nebraskans surveyed do not manage their stress well. Do you manage your stress well? Hear from Nebraska Extension experts about practical strategies for how to manage stress.” Insight  Nebraskans generally seem uncertain that stress and mental health are related. Action: To address this uncertainty, Nebraska Extension can play a central role in better defining the relationship between the two, leading to improved mental and physical health for Nebraskans. Insight  These findings suggest that many things—like financial management, time management, and lack of entertainment—cause stress. Actions: Nebraska Extension can develop a speaker/event series that addresses the need for entertainment, dives deeper into various stressors, and shares resources and activities that can improve quality of life through strategies for stress management, coping, and overall wellness. Nebraska Extension can also promote a more holistic understanding of wellness that could help Nebraskans better manage stress. Insight  To meet Nebraskans’ desire to learn through experience, consider developing resources, events, and courses that incorporate hands-on learning in a virtual environment. If the workshop will be virtual, consider sending “preparation kits” before the workshop with tools, instructions, or materials for people to use while they learn.

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Actions: Nebraskans would consider using free resources to help them manage stress and promote wellness. When developing messages about mental health and stress-related resources, be sure to highlight the direct benefits individuals can expect by engaging with stress-management and related resources that promote wellness. Also consider broadening the placement of resources to include such locations as the local hospital, pediatricians’ offices, and pharmacies. Nebraska Extension should continue to diversify its outreach and engagement approaches to include email, direct mail, text messages, and social media posts for the communications they share with the target audience. Insights  Half of those surveyed said they were unaware that stress management resources are available. Yet most of the respondents said they would use such free resources.

 Email, direct mail, and newsletters are the most preferred methods for receiving information.

The TIF team shared the following recommendations based on the survey responses:

 Consider launching a campaign to amplify communications around the stress and wellness- related resources that Nebraska Extension has available. In the deployment of this campaign, vary the methods of communication to include email, direct mail, newsletters, social media, and texts. In addition, consider collaborating with local health-related organizations (e.g. hospitals, clinics, pediatricians, pharmacies, etc.) to strategically place messages in settings where Nebraskans are predisposed to think about their health. Use findings from this research to develop messages that resonate with the target audience (TIF, 2020)  Work never stops for farmers. There are no eight-to-five office hours; agricultural commodities do not recognize holidays; and many farmers are the sole proprietors of their farm business. It is obvious that such a never-ending cycle of work and worry does not promote wellness. Because Nebraska Extension has specialties in health and farm business, there are opportunities to help farmers understand the connection between mental and physical health. Nebraska Extension can work with farmers to identify ways they can prioritize self-care.  When developing messages about resources, events, or workshops, ensure that the personal benefits of participation are at the forefront. Use boldface, larger typeface or a list to call out these benefits clearly. This survey shows many Nebraskans already feel they do not have enough time in the day to get things done. To improve engagement with Nebraska Extension materials and event attendance, make sure people know what they can expect to gain—or what they risk losing—if they do not engage or attend. Reference Trust in Food: A Farm Journal Initiative (2020). Community-informed research for improving the delivery of virtual resources promoting wellness and stress management [Unpublished]

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Lessons Learned  Very few rural residents responded to the email survey. Gift card incentives were offered by the Extension Foundation, but even after those were promoted, few survey responses were received. Future surveys could use additional methods for gaining information, including following up on emails with phone calls.  The information gained from the TIF survey reaffirmed the results from the needs assessment shared at HHD 2019.  A comment was shared with our team that one of the respondents to the TIF survey felt our “Start the Conversation” bulletin was too feminine. This was something we had not encountered before but will take into consideration when creating future resources.

Extension Foundation Health and Wel lness Survey By Soni Cochran

To gain more responses for the TIF survey, “Community-Informed Research for Improving the Delivery of Virtual Resources Promoting Wellness and Stress Management,” the Extension Foundation offered to send the same survey to another email database of a small group of farmers in the WTT pilot locations.  Twenty-one email addresses on the Extension Foundation database matched the WTT pilot locations.

 The survey was delivered to the database email addresses four times.

 Eight responses were received. Fifteen people who received the email opened it and read it. Six people did not open any of the emails. Although a formal comparison of the results between the Extension Foundation survey and the TIF survey were not completed, similarities were noted between the two assessments. This information was shared informally with the collaborative team working on the assessments. Lessons Learned  The TIF and Extension Foundation survey results reaffirmed the 2019 HHD survey results.  It would be interesting to see what the reasons are for low email survey response rates. Is it the subject of the survey and challenges due to stigma, timing, or mode of delivery to rural residents?

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Assessing Mental and Physical Health-Related Qual i ty of Life Issues in Rural Communi ties Fol lowing a Natural Disaster By Michelle Krehbiel Need Nebraska Extension responded to local physical and mental health needs following a bomb cyclone— which caused major flooding—by providing educational materials, making connections to various resources, and engaging in community organizing. In addition to responding to the various immediate needs, Extension also helped with recovery efforts. Helping communities evaluate and assess their readiness to assist community members’ physical and mental health-related quality-of-life issues was a determined need. Social determinants of health (HHS, n.d.) and health related quality of life (CDC, 2018) were used as the theoretical concepts guiding the study. The goal of the study was to assess and investigate key community leaders’ beliefs and perceptions about community attitudes, culture, and resources to address physical and mental health-related quality-of-life issues after experiencing a major disaster. Research The “Health-Related Quality of Life” (HRQoL) community readiness assessment was used in 2020 with five communities to research the mental and physical quality of life. The assessment consisted of demographic, closed-ended, and open-ended questions. Closed- and open-ended questions spanned six dimensions: leadership energy, issue awareness, participation, inclusivity, resources, and entrepreneurial activities. Key community members completed a survey and then participated in a follow-up interview. Data Analysis and Results Quantitative data were analyzed using SPSS, Version 19, and the in-depth interview transcripts were analyzed by two researchers following qualitative research methods to categorize themes and subthemes. Seventeen individuals representing five communities completed interviews. Out of those interviewed, 14 completed the survey assessment instrument. Demographics of Participants Survey respondents (n=14) represented education (11.5%), community-based organizations (15.4%), health care systems (15.4%), businesses (19.2%), government (19.2%), non-profit organizations (11.5%), and other (7.7%). Ages of survey respondents ranged from 25-64 years old, and time lived in communities ranged from zero to three years to 16-plus years, with almost half reporting 16-plus years in their respective communities (46%). Household income level ranged from $35,000 to $149,999. Survey Results The average total readiness score across all communities assessed fell into the “moderately ready” category regarding readiness to address mental and physical health-related quality of life issues. Leadership energy and entrepreneurial activities were ranked highest in terms of readiness by

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participants. In the participation, inclusivity, and resources sub-score sections, the majority of questions had an average mean response of approximately 3 (slightly), indicating there is a perception that their communities could make improvements in these areas to increase readiness for future interventions and programming. Respondents were able to identify at least two resources available to promote mental and physical health-related quality of life in the community. Examples of responses included: Extension, gyms, food pantries, local businesses, churches, public schools, proximity to larger communities, libraries, and senior centers. Interview Results The in-depth interviews revealed six different themes: leadership, community culture, organization efforts/engagement, community participation, community events, and resources available. Specifically, the community culture of not asking for help and not dwelling on the situation impacted individuals’ willingness to seek professional help for mental health issues. Community cultural values of neighbors helping neighbors and the community taking care of one another served as ways that community members informally offered their friendship to improve quality of life. Leadership and organizational efforts also contributed to quality of life. Recommendations Results from the study revealed that while small rural communities are moderately ready to address mental and physical-related quality-of-life issues after a natural disaster, there is more work to be done. Using community values of neighbors helping one another is one way to engage community members in addressing quality-of-life issues; however, education about basic mental health issues needs to be shared with community members to improve quality of life. Schools, businesses, and faith communities are key community resources that must be engaged to improve quality-of-life issues after a major disaster.

From Survey Participants “I think the city teams and most of the leadership in town are willing to talk about it [mental health]. I just don’t know if there’s the resources to make a cohesive plan or really guide people to the right place.” (Community Readiness/Response)

“People are really proud, and they’re private.” (Culture)

“There are some places where they just have a coffee group that sits down and just is willing to listen, you know.” (Social Supports) “I know the church communities do a good job at touching base with their congregations.” (Social Supports) “So, there is not a lot of health- and mental health-related activities here, but I know that the high school tries a lot.” (Social Supports)

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Table 1. Closed-ended Survey Responses

Questions by Dimension

n (%)

Leadership Energy Sub-score (sub-score range from 3 to 15 points) (mean ± SD)

11.4 ± 2.8

Are community leaders (formal and informal) willing to address mental and physical health-related quality-of- life issues? (mean ± SD)

3.9 ± 0.86

Don’t know

0 (0%)

Not at all

1 (7.69%)

Slightly

2 (15.38%)

Moderately

7 (53.85%)

Greatly

3 (23.08%)

Issue Awareness Sub-score (sub-score range from 4 to 20 points) (mean ± SD)

12.2 ± 3.31

Do people in your organization see mental and physical health-related quality of life as an issue? (mean ± SD)

3.7 ± 0.94

Don’t know

1 (7.69%)

Not at all

0 (0%)

Slightly

2 (15.38%)

Moderately

9 (69.23%)

Greatly

1 (7.69%)

Participation Sub-score (sub-score range from 3 to 15 points) (mean ± SD) Are community organizations engaged in efforts to promote mental and physical health-related quality of life? (mean ± SD)

9.2 ± 2.48

3.0 ± 1.11

Don’t know

1 (7.14%)

Not at all

4 (28.57%)

Slightly

4 (28.57%)

Moderately

4 (28.57%)

Greatly

1 (7.14%)

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Table 1 (continued). Closed-ended Survey Responses

Questions by Dimension

n (%)

Inclusivity Sub-score (sub-score range from 4 to 20 points) (mean ± SD)

12.1 ± 4.68

Is diversity (age, culture, interests) within the community represented in mental and physical health- related quality-of-life activities? (mean ± SD)

2.78 ± 1.18

Don’t know

3 (21.43%)

Not at all

2 (14.29%)

Slightly

4 (28.57%)

Moderately

5 (35.71%)

Greatly

0 (0%)

Resources Sub-score (sub-score range from 3 to 15 points) (mean ± SD)

8.4 ± 2.92

Is there an institutional support (government, local businesses, schools, health care) in the community for efforts to promote mental and physical health-related quality of life? (mean ± SD)

3.0 ± 1.3

Don’t know

3 (21.43%)

Not at all

1 (7.14%)

Slightly

4 (28.57%)

Moderately

5 (35.71%)

Greatly

1 (7.14%)

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Table 2. Interview Themes

Themes

Sub-themes

 Community decision making  Communication

Leadership

 Small town community values (both positive and negative traits)  Neighbors helping neighbors  Individual community members unwilling to ask for help  Forge ahead; keep moving forward  Value community needs over individual needs

Community culture

 Local government  Faith-based organizations  Public schools

Organizational efforts/engagement

 Physical action translated into positive coping strategies

Community participation

 Community members wear multiple roles that cross over into personal and professional lives.

 Points of celebration/community gatherings

Community events

 Increase morale

 Communication outlets (social media, newspaper, word of mouth)

 Community institutions (schools, churches, libraries, businesses, social clubs, non-profits [internal and external to community])

Resources available

 Physical activity resources (gyms, trails, etc.)

 External support; donations and volunteers

References Creswell, J. W. (2014). Research design: qualitative, quantitative, and mixed methods approaches. 4th ed. Thousand Oaks, California: SAGE Publications. Healthy People 2030 (n.d.). U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved March 8, 2021 from https://health.gov/healthypeople/objectives-and-data/social- determinants-health

HRQOL concepts. (2018, October 31). Retrieved March 8, 2021, from https://www.cdc.gov/hrqol/concept.htm

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Schmader, B., 2020. Healthy Lifestyles Community Readiness Assessment: Co-Creating I Initiatives with Communities and Examining Differences in Sectors and Demographic Characteristics across Dimensions. Undergraduate Honors Thesis. University of Nebraska-Lincoln.

Internal Assessment—Nebraska Extension By Soni Cochran

At the start of the WTT project, the team surveyed Nebraska Extension colleagues to find out who was interested in supporting mental well-being and wellness program initiatives. The WTT team also wanted to know what programs were currently being delivered in Nebraska or were being developed. The results from the 2019 survey provided additional opportunities for collaboration and focused programming. Survey Findings  Over half of the 103 Nebraska Extension colleagues responding to the survey said they were interested in working in mental well-being and wellness initiatives.  Some of our colleagues were already involved in mental well-being and wellness initiatives. Examples shared included the following:

developing new programs

• creating media campaigns to help reduce the stigma of asking for help

• being proactive and supporting youth mental well-being

• leading county officials in development courses

• helping at events like Husker Harvest Days (HHD)

 Specific programs that were already in place included the following:

• “Communicating with Farmers Under Stress”

“Sleepless in Nebraska”

• “Our Stress and Communicating with Those Who Are Stressing”

“Food in the Field”

“Neighbor-to-Neighbor”

• “Cultivating Healthy Intentional Mindful Educators (CHIME)”

• “Connect the Dots” (debt management)

“Managing Farm Bill Stress”

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“Overcoming Harvest Stress”

“Wellness in Tough Times”

 Current mental well-being and wellness program needs in counties (ranked):

1. stress management

2. resilience building for children and youth

3. financial management education

4. connecting individuals and families with mental health resources

5. community capacity building

6. suicide prevention

Lessons Learned  In March 2020, the global pandemic completely shifted the capacity of our colleagues and our programs to provide outreach. All of our Nebraska Extension colleagues had to readjust their priorities and program delivery.  It would be interesting to see if the global pandemic has changed the needs for mental well- being and wellness programs now as compared to the 2019 list of needs.

Connect Extension Chat By Julien Hoffman

One unique form of gathering information that the WTT team members were not aware of before beginning the New Technologies in Agricultural Extension (NTAE) project was hosting a Connect Extension Chat. This is an hour-long live virtual chat room where the host posts several prompts to participating Extension faculty and other professionals from across the country that are interested in the theme or subject matter. This question and answer format allows for exploratory discussions on the topic at hand and a way to easily brainstorm and share resources with other professionals who may be working on a similar project or looking for ideas. The process of solidifying a theme, drafting questions, and then facilitating the discussion in real time seemed overwhelming for the team initially, but once they began preparations it was a simple and enjoyable experience. The amount of preparation beforehand was manageable and well worth it, with the valuable information and advice that we received.

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Across the country, disasters affect individuals, communities, and the capacity of the Extension system to provide resources supporting disaster recovery and promoting resilience. These incidents and threats affect livelihoods, well-being, and the prosperity of communities—places we live, work, and volunteer. Furthermore, since these incidents and threats are complex and multifaceted, they affect many areas of our lives: healthy lifestyles, child development, families, businesses, agricultural systems, and local economies. WTT Connection Extension Chat (May 19, 2021)

”Exploring Extension’s Role in Disaster Response and Mental Health & Wellness” In this chat, we explored Extension’s role in facilitating conversations around mental health and wellness. We also discussed the challenges faced and the lessons learned by Extension professionals working with communities impacted by disaster.

Compounding disaster-related stress with other variables like economic security and COVID-19 isolation leads to a need for mental health services. We are mindful that just as disasters are local, every community’s needs are unique so we cannot use a cookie- cutter approach to each

CHAT

WTT Connection Extension Chat Blog Post

community’s conversation about mental health and wellness. Instead, we serve as facilitators and providers of education and resources to support the communities as they take their own lead to support the resiliency of their residents. Lessons Learned  The most difficult part of hosting the Connect Extension Chat was writing questions that were open-ended enough to start a conversation. The drafts initially had many “yes or no” questions that later had to be changed so people would respond with more detailed information, personal stories, and opinions about the project.

 Once our team learned more about Connect Extension Chat and went through a live session ourselves, we enjoyed the experience and would do it again!

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