Nicholas County CES

County Emphasis:

Equipping Nicholas County Citizens with Knowledge and Skills Surrounding Health and Safety

Concentration 1:

Substance Use Prevention and Recovery

Concentration 2:

Mental Health and Well-Being

Situation:

Though substance use and substance use disorder have been pressing social problems for decades, the public health burden and consequences associated with substance use have 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.

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.

More than ever before, people are feeling the burden of stress on their well-being. 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 a better quality of life for all.

Kentucky’s youth population deserves safe and nurturing environments that foster their growth and well-being. 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 well-being 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 improving access to mental

health and well-being 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 well-being. By emphasizing mental health and offering targeted educational initiatives, we can create a brighter future for Kentucky’s youth.

 

County Situation:

Substance use continues to be a significant concern in Nicholas County, affecting individuals, families, and the community as a whole. While substance use disorders can impact anyone, Nicholas County faces particular challenges related to opioid use, alcohol misuse, and other substances, which contribute to public health issues and place strain on community resources. According to the Community Assessment survey conducted in 2024, respondents' top priorities identified were minimizing youth substance abuse and the need for support for substance use addiction prevention/recovery. Additionally, Nicholas Countians identified the need for improved access to mental health and well-being resources as a top priority for Nicholas County. 

Residents across the county experience the effects of substance use, from its toll on physical and mental health to its broader impact on families, schools, and workplaces. Access to prevention and treatment services remains a barrier for many, often due to stigma or limited awareness of available resources.

Through education, awareness-building, and support for prevention, treatment, and recovery efforts, Nicholas County Cooperative Extension plays a vital role in assisting individuals and families affected by substance use in both mental and physical well-being. 

Long-Term Outcomes:

Adult:

Reduced stigma related to adult substance use

Reduced adult substance use

Increased access to mental health care and resources for all

Youth:

Improved social and emotional competency

Reduced youth substance use

Increased number of 4-Hers who pursue mental health & well-being employment.  

Intermediate Outcomes:

Adult:

Enhanced community partnerships that target recovery from substance use disorder 

Increased use of self-care and other coping strategies

Increased advocacy for mental health and wellbeing resources

Increased partnerships (number or strength) to address mental health and wellbeing issues within the community

Youth:

Increased availability and accessibility of evidence-based prevention programs

Increased self-reflection and exploration of personal values and beliefs related to mental health and wellbeing among 4-Hers.

Initial Outcomes:

Adult:

Increased awareness of community resources to support prevention and recovery

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

Increased ability to recognize and respond to a mental health concern

Youth:

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

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

Increased knowledge of positive mental health practices  

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

Evaluation:

INITIAL

Outcome: Increased awareness of community resources to support prevention and recovery (initial)

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).

 

Outcome: Increased confidence making decisions related to substance use (i.e. substance use refusal skills) (Short-term, ST, and Intermediate, BC).

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).

 

Outcome: Increased intentions to employ health-promoting behaviors (e.g., exercise, healthy nutrition, positive coping, etc.). (Short-term, ST, and Intermediate, BC).

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) 

 

Outcome: Increased ability to recognize and respond to a mental health concern

Indicator: Number of participants who reported an increased knowledge of how to respond to mental health concerns.

Method: Post-participation survey/evaluation results

Timeline: On-going; Surveys should be administered immediately after a program 

 

Outcome: Short Term 

Indicator: 

• Number of partnerships with community organizations, institutions, agencies, or individuals to address mental health and wellbeing for youth in the community.
• Number of youth who reported an increased knowledge of how to respond to mental health concerns.
• Number of youth who intend to adopt self-care strategies to improve their own mental health and wellbeing.
• Number of youth who intend to adopt strategies to support or promote mental health and wellbeing in their community.
• Number of youth who reported intended behavior change as a result of participation in mental health and wellbeing programming.

Method: Survey 

Timeline: Immediately post-program

 

Intermediate Outcome:

Outcome: Increased confidence in making decisions related to substance use (i.e. substance use refusal skills) (Short-term, ST, and Intermediate, BC).

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).

 

Outcome: Medium Term 

Indicator: 

• Number of youth who adopted self-care strategies to improve their own mental health and wellbeing.
• Number of youth who adopted strategies to support or promote mental health and well-being in their community.
• Number of youth who reported behavior change as a result of participation in mental health and wellbeing programming.

Method: Survey 

Timeline: 3-6 Months post-program 

 

Long-term Outcome:

Outcome: Increased confidence and motivation to use destigmatized language (intermediate)

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 

 

Outcome: Increased advocacy for mental health and wellbeing resources

Indicator: Number of participants who adopted strategies to support or promote mental health and well-being in their community.

Method: Follow-up survey/evaluation results

Timeline: On-going; Surveys should be administered at least 3-6 months after a program

 

Outcome: Long Term 

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

Method: Survey or Interview 

Timeline: 1+ years 

Learning Opportunities:

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: TBD

 

Audience: Families and Individuals

Project or Activity: Substance Use Prevention Programming

Content or Curriculum: Botvin Lifeskills, Strengthening Families, 4-H Health Rocks, Engaging People with Lived Experience (testimonies),

Inputs: Programmatic materials, paid staff, volunteers, community partners, health coalitions, schools, and school staff

Date: 2025-2029

 

Audience: Communities

Project or Activity: Mental Health Access and Advocacy  

Content or Curriculum: BARN (Bringing Awareness Right Now) Farm Dinner Theater, Pathways to Wellness, Building and Maintaining Health Coalitions

Inputs: Programmatic materials, state specialist support, staff training, facilities, community partners (health coalitions, schools, local non-profits, etc.), UK Healthcare mental health resources, 988 community resources.

Date: Ongoing; 2025-2029

 

Audience: 4-Hers, Extension Professionals, Clientele

Project or Activity: Mental Health First Aid 

Content or Curriculum: Mental Health First Aid (Youth). Additional resources include Healthy Bodies: Teaching Kids What They Need to Know, and National Alliance on Mental Illness

Inputs: These programs are supported by the research base of the Cooperative Extension Land-grant system, funding from the Kentucky 4-H Foundation, Inc., local, state, and federal sources, grants, and the engagement of volunteers, youth, communities, and external stakeholders such as civic groups. Focus is on Adults working with youth. 

Date: TBD

Evaluation:

INITIAL

Outcome: Increased awareness of community resources to support prevention and recovery (initial)

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).

 

Outcome: Increased confidence making decisions related to substance use (i.e. substance use refusal skills) (Short-term, ST, and Intermediate, BC).

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).

 

Outcome: Increased intentions to employ health-promoting behaviors (e.g., exercise, healthy nutrition, positive coping, etc.). (Short-term, ST, and Intermediate, BC).

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) 

 

Outcome: Increased ability to recognize and respond to a mental health concern

Indicator: Number of participants who reported an increased knowledge of how to respond to mental health concerns.

Method: Post-participation survey/evaluation results

Timeline: On-going; Surveys should be administered immediately after a program 

 

Outcome: Short Term 

Indicator: 

• Number of partnerships with community organizations, institutions, agencies, or individuals to address mental health and wellbeing for youth in the community.
• Number of youth who reported an increased knowledge of how to respond to mental health concerns.
• Number of youth who intend to adopt self-care strategies to improve their own mental health and wellbeing.
• Number of youth who intend to adopt strategies to support or promote mental health and wellbeing in their community.
• Number of youth who reported intended behavior change as a result of participation in mental health and wellbeing programming.

Method: Survey 

Timeline: Immediately post-program

 

Intermediate Outcome:

Outcome: Increased confidence in making decisions related to substance use (i.e. substance use refusal skills) (Short-term, ST, and Intermediate, BC).

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).

 

Outcome: Medium Term 

Indicator: 

• Number of youth who adopted self-care strategies to improve their own mental health and wellbeing.
• Number of youth who adopted strategies to support or promote mental health and well-being in their community.
• Number of youth who reported behavior change as a result of participation in mental health and wellbeing programming.

Method: Survey 

Timeline: 3-6 Months post-program 

 

Long-term Outcome:

Outcome: Increased confidence and motivation to use destigmatized language (intermediate)

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 

 

Outcome: Increased advocacy for mental health and wellbeing resources

Indicator: Number of participants who adopted strategies to support or promote mental health and well-being in their community.

Method: Follow-up survey/evaluation results

Timeline: On-going; Surveys should be administered at least 3-6 months after a program

 

Outcome: Long Term 

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

Method: Survey or Interview 

Timeline: 1+ years