Caldwell County CES

County Emphasis:

Health and Wellbeing

Concentration 1:

Health and Wellbeing

Concentration 2:

Substance Use Prevention and Recovery

Concentration 3:

Mental Health and Well-Being

Situation:

Health & Well-Being 

The opportunities and resources available to support the health and well-being of adults and families in Kentucky vary widely. Disparities in health-promoting knowledge, resources, and infrastructure contribute to higher rates of chronic health conditions and lower quality of life. Prevention, early detection, and care are essential to maintain and/or improve quality of life. Yet, this burden is often placed on individuals to navigate the healthcare system and traditional public health entities. Additionally, for decades, little attention has been given to the external factors that undoubtedly affect health such as access to care, education, nutritious foods, and safe physical spaces. These same issues and concerns were echoed throughout the 2023 UK Cooperative Extension Community Assessment. Within the top 15 priority issues identified by Kentuckians, “ensuring individuals and families have access to affordable nutritious foods” was #4 and “reducing youth obesity through nutrition education and/or exercise” was #8. Guided by the Cooperative Extension’s National Framework for Health Equity and Well-being, UK Extension aims to become a critical public health partner for addressing disparities in health-promoting knowledge, resources, and infrastructure through comprehensive health, nutrition, and wellness programming that supports adult physical health and well-being. 

Youth Focus 

Thriving youth are healthy, productive, and engaged (Arnold, 2024). According to Kentucky Kids Count Database (AECF, 2023) 41% of Kentucky teenagers are obese or overweight. Youth are also experiencing alarming levels of negativity about themselves, their confidence in the future, and their ability to find contentment in life (McKinsey & Company, 2022). 30% of youth are chronically absent (United States Department of Education, 2024). The University of Kentucky Cooperative Extension Service Needs Assessment (2024) identified key priorities issues related to health and wellbeing as need for improved access to mental health and wellbeing resources, reducing youth obesity through nutrition education and/or exercise, minimizing bullying and/or school violence. To address these issues, Kentucky 4-H creates opportunities for youth in the five domains of physical, emotional, social, spiritual, and intellectual health and well-being. 

Substance Use Prevention and Recovery

Though substance use and substance use disorder have been pressing social problems for decades, the public health burden and consequence associated with substance use has rapidly worsened in recent years. Drug overdoses have surpassed car accidents as the leading cause of accidental death and overdoses have contributed to a reduction in average life expectancy in the US. Much of the substance use-related morbidity and mortality is a result of a persistent treatment gap. Each year, about 90% of people who need treatment for SUD in Kentucky do not receive it. To address this gap in service provision, more community-level programming is required to meet the complex needs of Kentuckians who use drugs. Cooperative Extension is uniquely positioned, both with deep connections to each Kentucky county and with its transdisciplinary team of specialists, to address the holistic needs of Kentuckians who use drugs including mental health, fair housing, second-chance employment, nutrition and physical health, and much more. 

Youth Focus 

Substance use and substance use disorder are persistent public health problems in Kentucky. Kentucky youth fare worse than their US counterparts in terms of numerous indicators of drug use and drug-related harm including cigarette and smokeless tobacco use, vaping, alcohol use, and illicit drug use such as opioid and methamphetamine use. Accordingly, the recent University of Kentucky Cooperative Extension Service Needs Assessment (2023) indicated substance use prevention is the primary concern among most Kentucky counties. Nevertheless, few Kentucky communities support prevention efforts that are informed by research. Cooperative Extension is well-positioned with deep collaborative community ties to support evidence-based prevention programming. Such programs may target substance use directly or indirectly by focusing on pertinent risk and protective factors and promoting overall well-being for Kentucky youth. 

 

Mental Health and Wellbeing: 

More than ever before, people are feeling the burden of stress on their wellbeing. More than 1 in 5 adults in the United States lives with a mental illness; in Kentucky, 43% of adults report signs or symptoms of anxiety or depression across their lifespan. At the same time, suicide is a leading cause of preventable death in Kentucky for individuals aged 10-34, and those over the age of 59. 

Concern over the state of mental health and access to care was echoed in the Cooperative Extension Community Needs Assessment, where respondents listed “improved access to mental health and wellbeing resources” as one of the top 6 priority issues. Kentuckians are aware of their need for knowledge and skills to recognize and respond to a mental health challenge, whether it be their own or to help someone else, and the ability to advocate for more mental health resources in all areas of the state. 

Cooperative Extension is poised with the research and evidence-based resources needed to serve as a beacon of hope in times of distress through our ability to help overcome stigma, connect people to care, and amplify the voices of many to advocate for better quality of life for all. 

Youth Focus 

Kentucky’s youth population deserves safe and nurturing environments that foster their growth and wellbeing. Unfortunately, mental health challenges affect a significant portion of our youth, with 17% of those aged 6-17 experiencing mental health disorders, according to the National Alliance on Mental Illness (2023), and only 50% receiving treatment. The impact is profound, with one person in the U.S. dying by suicide every 11 minutes, and in Kentucky alone, 800 lives were lost to suicide in 2022. Recognizing the urgency, the Kentucky Cooperative Extension Service’s 2019 and 2023 statewide programming issue surveys highlighted mental health and wellbeing as priority areas. Nationally, 45% of 4-H participants reported high stress in a 2023 survey by 4-H.org. The University of Kentucky Community Needs Assessment (2023) indicates priorities of improve access to mental 

health and wellbeing resources, minimizing bullying and/or school violence, stronger parenting and relationship-building skills, and social, emotional, and/or behavioral education for adults working with youth. To address these concerns, the 4-H Program provides evidence-based educational programs focused on positive mental health and self-care, aiming to empower youth with decision-making and critical thinking skills, fostering resilience and overall wellbeing. By emphasizing mental health and offering targeted educational initiatives, we can create a brighter future for Kentucky’s youth. 

County Situation:

The 2023 University of Kentucky Community Needs Assessment revealed several health and well-being priorities identified by Caldwell County respondents. Youth-focused needs included minimizing youth substance use, strengthening youth-adult relationships through mentorship, reducing youth obesity through targeted nutrition education and exercise programs, and developing coping strategies to support overall youth well-being. Respondents also highlighted the importance of substance use addiction prevention and recovery, along with improving access to mental health and well-being resources for individuals across all ages. Community-wide priorities included addressing food insecurity and combating diet-related chronic diseases by promoting "food as health" initiatives. Additionally, support programs for senior citizens were recognized as essential for fostering a healthier and more resilient community. Collectively, these identified needs demonstrate a commitment to the physical, mental, and emotional health of residents at every stage of life. 

Long-Term Outcomes:

• Routinely meeting guidelines and recommendations for health behaviors that promote wellness and quality of life 

• Improved quality of life 

• Reduced stigma related to adult substance use 

• Increased recovery capital 

• Reduced adult substance use 

• Reduced adult substance use disorder 

• Reduced adult overdose fatalities 

• Youth will increase contributions to their communities through applying critical thinking, problem-solving, and effective communication learning in the 4-H Health and Well-Being Core Content Area. 

• Kentucky 4-H members report decreased obesity.   

Intermediate Outcomes:

• Increased health-promoting behaviors that support family, community, and occupational health and safety 

• Increased availability and accessibility of evidence-based recovery capital-building programs 

• Enhanced community partnerships that target recovery from substance use disorder 

• Increased knowledge about addiction as a chronic disorder 

• Increased awareness of community resources to support prevention and recovery 

• Increased confidence making decisions related to substance use (i.e. substance use refusal skills) 

• Increased confidence and motivation to use destigmatized language 

• Increased intentions to employ health-promoting behaviors (e.g., exercise, healthy nutrition, positive coping, etc.). 

• 4-H members will practice general wellness habits.   

• 4-H members will increase physical activity. 

Initial Outcomes:

• Increased knowledge about health-promoting behaviors. 

• Increased awareness of community resources to support health-promoting behaviors. 

• Increased confidence in making decisions related to health-promoting behaviors. 

• Improved skills related to health-promoting behaviors 

• Increased knowledge and awareness of healthy habits and practices among 4-Hers.   

• Improved attitudes and beliefs towards healthy habits and practices among 4-Hers.   

• Increased knowledge of general wellness practices 

Evaluation:

Initial Outcome: Increased knowledge about health-promoting behaviors (e.g., how to prepare nutritious foods, benefits of routine vaccinations/screenings) 

Indicator: Number of participants who reported/demonstrates improved knowledge, skills, opinions, or confidence regarding a health-promoting behavior as a result of a participating in a health and well-being program  

Method: Observation by Agent or self-reported surveys  

Timeline:  Post-program/curricula survey administration  

Initial Outcome: Increased confidence and motivation to engage in health-promoting behaviors (e.g. add physical activity, consume more nutritious foods, receive vaccination or screen) 

Indicator: Number of participants who reported/demonstrates improved knowledge, skills, opinions, or confidence regarding a health-promoting behavior as a result of a participating in a health and well-being program  

Method: Self-reported surveys  

Timeline: Post-program/curricula survey administration or follow up evaluation  

Initial Outcome: Increased intentions to employ health-promoting behaviors (e.g. vaccinations, screenings, preparation/consumption of nutritious foods, active living, pest prevention) 

Indicator: Number of participants who reported intentions to implement a behavior learned from a health and well-being program  

Method: Demonstration or self-reported surveys  

Timeline: Post-program/curricula survey administration   

Initial Outcome: Increased knowledge about addiction as a chronic disorder 

Indicator: Number of participants who reported an increased knowledge of substance use prevention, addiction, and/or recovery (or related subject matter)  

Method: Self-reported surveys  

Timeline: Post-program/curricula survey administration  

Initial Outcome: Short Term  

Indicator: 

-Number of youth who reported that they have identified an interest in health or wellbeing initiatives in their community.  

-Number of youth who reported that they understand the importance of habits or choices that promote health and wellbeing.   

-Number of youth who reported that they learned ways to be physically active   

-Number of youth who reported that they learned how physical activity contributes to overall health  

-Number of youth who reported that they learned how food impacts their overall health.  

-Number of youth who reported that they have identified at least one job/career in health and wellbeing that fits their interest.    

Method: Standard Evaluation for 4-H Health and Wellbeing: Survey  

Timeline: Immediately after program or event  

Initial/Intermediate Outcome: Increased awareness of community resources to support prevention and recovery 

Indicator: Number of partnerships with community organizations, institutions, agencies, or individuals to address substance use/recovery in the community  

Method: Program metrics agents will track, and report based on their activities and partnerships related to substance use prevention, addiction, and/or recovery)  

Timeline: Post-program/curricula survey administration (ST) and follow-up survey (BC).  

Initial/Intermediate Outcome: Increased confidence making decisions related to substance use (i.e. substance use refusal skills) 

Indicator: Number of participants who reported intended behavior change as a result of participation in substance use prevention and/or recovery programming; Number of participants who reported that they intend to use self-care strategies to improve their recovery and/or substance refusal skills. 

Method: Self-reported surveys  

Timeline: Post-program/curricula survey administration (ST) and follow-up survey (BC).  

Initial/Intermediate Outcome: Increased intentions to employ health-promoting behaviors (e.g., exercise, healthy nutrition, positive coping, etc.). 

Indicator: Number of participants who reported that they intend to use self-care strategies to improve their recovery and/or substance refusal skills (ST) ;  Number of participants who used self-care strategies to improve their recovery and/or substance refusal skills. 

Method: Self-reported surveys  

Timeline: Post-program/curricula survey administration (ST) and follow-up survey (BC)  

Intermediate Outcome: Increased health-promoting behaviors that support family and community health (e.g., physical activity, consuming nutritious foods, routine vaccinations and screenings) 

Indicator: Number of physical activity minutes recorded by a participant; Number of participants who reported consuming more nutritious foods and/or beverages; Number of participants who reported a change in a health-promoting behavior as a result of participating in a health and well-being program 

Method: Self-reported surveys  

Timeline: Repeated self-reported surveys and/or follow-up evaluations to capture change over time  

Intermediate Outcome: Increased confidence and motivation to use destigmatized language  

Indicator: Number of participants who reported an increased ability to use destigmatized language  

Method: Self-reported surveys  

Timeline: Repeated self-reported surveys and/or follow-up evaluations to capture behavior change over time  

Intermediate Outcome: Medium term  

Indicator:  

-Number of youth who reported that they have used knowledge and/or skills learned in health and wellbeing programs to complete a project.    

-Number of youth who reported that they have used nutrition as a way to improve their overall health.   

-Number of youth who reported that they have taken steps to pursue gaining more knowledge for a job in health and wellbeing based on their interests. 

Method: Standard Evaluation for 4-H Health and Wellbeing: Survey 

Timeline: End of club/program year  

Long-term Outcome: Long Term  

Indicator: Long-term evaluation will be conducted using the National 4-H Index Study  

Method: Standard Evaluation for 4-H Health and Wellbeing: Survey  

Timeline: 1 or more years after completion of the program  

Learning Opportunities:

Audience: Families and Individuals  

Project or Activity: Family & Community Health  

Content or Curriculum:  Publications, presentations, trainings, demonstrations, Health Bulletins, Pathways to Wellness, resources for early care and education settings, Health Literacy for the Win, Health Family Guides, Healthy Homemakers, chronic disease prevention programs and materials, health fairs, hygiene education  

Inputs:  Programmatic materials, paid staff, volunteers, community partners, healthcare providers, health departments, non-profits, faith-based organizations, schools, company health & wellness, community centers, etc.   

Date: Ongoing  

Audience: Families & Individuals  

Project or Activity: Physical Activity  

Content or Curriculum: Publications, Faithful Families, Story Walks, Health and wellness Ambassadors, Shared Space Agreements, Health Coalitions, WIN, Health Partners, Bingocize, Walk Your Way, Families on the Move, County Walking Challenges, Mindfulness Trails, Fit Tips, Hiking for Health  

Inputs: Programmatic materials, paid staff, volunteers, community partners, facilities, healthcare providers, health department, non-profits, schools, company health & wellness, faith-based organizations, Homemakers, community centers, etc.   

Date: Ongoing/seasonal  

Audience: Families & Individuals  

Project or Activity: Nutrition Education  

Content or Curriculum: Nutrition Education Program, SNAP-Ed toolkit, Publications, Faithful Families, Cook Together Eat Together, Savor the Flavor, Dining with Diabetes, Plate it up! Kentucky Proud, Cook Wild Ky, Food as Health Toolkit, Recovery Garden Toolkit, Family Mealtime, maternal and child health program materials,  

Inputs: Programmatic materials, paid staff, community partners, volunteers, faith-based organization, healthcare Providers and local clinics, health department, non-profits, schools, company health and wellness, Homemakers, farmers’ markets, local farms/growers/producers, commodity groups, community centers, etc.   

Date: Ongoing  

Audience: Families and Individuals  

Project or Activity: Addiction Education  

Content or Curriculum: Publications, Addiction 101, Harm Reduction 101  

Inputs: Programmatic materials, community partners, healthcare providers, clergy, and healthcare providers  

Date: Ongoing  

Audience: Families and Individuals  

Project or Activity: Stigma Reduction  

Content or Curriculum: Publications, Language Matters, Addiction 101 Engaging People with Lived Experience (Testimonies), Mind Art Recovery Kentucky  

Inputs: Programmatic materials, community partners,  detention centers, healthcare providers, law enforcement, and clergy  

Date: Ongoing  

Audience: Families and Individuals  

Project or Activity: Recovery Capital Building  

Content or Curriculum: Healthy Choices for Your Recovering Body (HCYRB), Recovering Your Finances (RYF), Recovery Gardens, Positive Employability, Question. Persuade. Refer (QPR), Mind Art Recovery Kentucky  

Inputs: Programmatic materials, community partners, detention centers, healthcare providers, law enforcement, and clergy  

Date: Ongoing  

Audience: Communities  

Project or Activity: Policy, Systems, and Environmental (PSE) Approaches  

Content or Curriculum: Addiction 101, Recovering Your Finances (RYF), PROFIT, Building Recovery Ready Communities (e.g. presenting to coalitions), Resources for Family Members and Concerned Others, Parenting in Recovery  

Inputs: Programmatic materials, community partners, grant funding, elected officials, health coalitions, and other key stakeholders  

Date: Ongoing  

Audience: Youth  

Project or Activity: Nutrition and Food Preparation    

Content or Curriculum: Jump Into Food and Fitness 

Inputs: 

-4-H Family and Consumer Sciences programs in which youth experience a sense of belonging, and developmental relationships, explore their spark, and actively engage in meaningful opportunities.   

-Accredited and certified volunteers in 4-H FCS projects.  

-Kentucky Extension Homemakers Association   

-Four residential camping facilities.   

-Cooperative Extension Educational facilities.   

-Utilization of approved research-based curriculum.  

-Outreach of the Cooperative Extension Land-Grant System.   

-Funding from the Kentucky 4-H Foundation, Inc.   

-Funding from local, state, and federal sources.   

-Engagement of youth and volunteers in program delivery.  

-Engaging communities in identifying and implementing programming based on local needs 

Date: September 1 – August 30    

Audience: Youth  

Project or Activity: Health Rocks  

Content or Curriculum: 4-H Health Rocks Curriculum,  Healthy Bodies: Teaching Kids What They Need to Know, mental Health Services Administration  

Inputs: 

-4-H Family and Consumer Sciences programs in which youth experience a sense of belonging, and developmental relationships, explore their spark, and actively engage in meaningful opportunities.   

-Accredited and certified volunteers in 4-H FCS projects.  

-Kentucky Extension Homemakers Association   

-Four residential camping facilities.   

-Cooperative Extension Educational facilities.   

-Utilization of approved research-based curriculum.  

-Outreach of the Cooperative Extension Land-Grant System.   

-Funding from the Kentucky 4-H Foundation, Inc.   

-Funding from local, state, and federal sources.   

-Engagement of youth and volunteers in program delivery.  

-Engaging communities in identifying and implementing programming based on local needs 

Date: Programming year  

Evaluation:

Initial Outcome: Increased knowledge about health-promoting behaviors (e.g., how to prepare nutritious foods, benefits of routine vaccinations/screenings) 

Indicator: Number of participants who reported/demonstrates improved knowledge, skills, opinions, or confidence regarding a health-promoting behavior as a result of a participating in a health and well-being program  

Method: Observation by Agent or self-reported surveys  

Timeline:  Post-program/curricula survey administration  

Initial Outcome: Increased confidence and motivation to engage in health-promoting behaviors (e.g. add physical activity, consume more nutritious foods, receive vaccination or screen) 

Indicator: Number of participants who reported/demonstrates improved knowledge, skills, opinions, or confidence regarding a health-promoting behavior as a result of a participating in a health and well-being program  

Method: Self-reported surveys  

Timeline: Post-program/curricula survey administration or follow up evaluation  

Initial Outcome: Increased intentions to employ health-promoting behaviors (e.g. vaccinations, screenings, preparation/consumption of nutritious foods, active living, pest prevention) 

Indicator: Number of participants who reported intentions to implement a behavior learned from a health and well-being program  

Method: Demonstration or self-reported surveys  

Timeline: Post-program/curricula survey administration   

Initial Outcome: Increased knowledge about addiction as a chronic disorder 

Indicator: Number of participants who reported an increased knowledge of substance use prevention, addiction, and/or recovery (or related subject matter)  

Method: Self-reported surveys  

Timeline: Post-program/curricula survey administration  

Initial Outcome: Short Term  

Indicator: 

-Number of youth who reported that they have identified an interest in health or wellbeing initiatives in their community.  

-Number of youth who reported that they understand the importance of habits or choices that promote health and wellbeing.   

-Number of youth who reported that they learned ways to be physically active   

-Number of youth who reported that they learned how physical activity contributes to overall health  

-Number of youth who reported that they learned how food impacts their overall health.  

-Number of youth who reported that they have identified at least one job/career in health and wellbeing that fits their interest.    

Method: Standard Evaluation for 4-H Health and Wellbeing: Survey  

Timeline: Immediately after program or event  

Initial/Intermediate Outcome: Increased awareness of community resources to support prevention and recovery 

Indicator: Number of partnerships with community organizations, institutions, agencies, or individuals to address substance use/recovery in the community  

Method: Program metrics agents will track, and report based on their activities and partnerships related to substance use prevention, addiction, and/or recovery)  

Timeline: Post-program/curricula survey administration (ST) and follow-up survey (BC).  

Initial/Intermediate Outcome: Increased confidence making decisions related to substance use (i.e. substance use refusal skills) 

Indicator: Number of participants who reported intended behavior change as a result of participation in substance use prevention and/or recovery programming; Number of participants who reported that they intend to use self-care strategies to improve their recovery and/or substance refusal skills. 

Method: Self-reported surveys  

Timeline: Post-program/curricula survey administration (ST) and follow-up survey (BC).  

Initial/Intermediate Outcome: Increased intentions to employ health-promoting behaviors (e.g., exercise, healthy nutrition, positive coping, etc.). 

Indicator: Number of participants who reported that they intend to use self-care strategies to improve their recovery and/or substance refusal skills (ST) ;  Number of participants who used self-care strategies to improve their recovery and/or substance refusal skills. 

Method: Self-reported surveys  

Timeline: Post-program/curricula survey administration (ST) and follow-up survey (BC)  

Intermediate Outcome: Increased health-promoting behaviors that support family and community health (e.g., physical activity, consuming nutritious foods, routine vaccinations and screenings) 

Indicator: Number of physical activity minutes recorded by a participant; Number of participants who reported consuming more nutritious foods and/or beverages; Number of participants who reported a change in a health-promoting behavior as a result of participating in a health and well-being program 

Method: Self-reported surveys  

Timeline: Repeated self-reported surveys and/or follow-up evaluations to capture change over time  

Intermediate Outcome: Increased confidence and motivation to use destigmatized language  

Indicator: Number of participants who reported an increased ability to use destigmatized language  

Method: Self-reported surveys  

Timeline: Repeated self-reported surveys and/or follow-up evaluations to capture behavior change over time  

Intermediate Outcome: Medium term  

Indicator:  

-Number of youth who reported that they have used knowledge and/or skills learned in health and wellbeing programs to complete a project.    

-Number of youth who reported that they have used nutrition as a way to improve their overall health.   

-Number of youth who reported that they have taken steps to pursue gaining more knowledge for a job in health and wellbeing based on their interests. 

Method: Standard Evaluation for 4-H Health and Wellbeing: Survey 

Timeline: End of club/program year  

Long-term Outcome: Long Term  

Indicator: Long-term evaluation will be conducted using the National 4-H Index Study  

Method: Standard Evaluation for 4-H Health and Wellbeing: Survey  

Timeline: 1 or more years after completion of the program