The Cooperative Extension Service (CES) infrastructure and subject matter expertise are well suited for harnessing the self-sufficiency commonly found in rural communities to create healthier people and environments through policy, systems, and environmental (PSE) approaches. Similar to public health professionals, CES agents, specifically Family and Consumer Sciences (FCS) agents and program assistants, are accustomed to providing direct education activities for individuals, families, and organizations related to healthy eating and active living. However, the capacity to deliver effective direct education programs differs from the skills, support, and resources required to successfully implement PSE strategies. 

FCS Extension heavily utilizes the train-the-trainer model for program delivery to maximize program offerings and clientele reached, due to the limited number of Extension Specialists serving in FCS. Traditionally, these trainings have been program specific. In response to the need for new, diverse skillsets required for PSE work, Extension Specialists have been offering trainings that focus on capacity-building for PSE work to increase healthy eating and active living in rural communities. Since 2019, five trainings have been offered to FCS agents with 60 agents receiving training on PSE work and the role it can play in existing FCS Extension programming. 

With more FCS agents receiving training on the topic, efforts are being made statewide to make local communities healthier through PSE work. Extension Specialists have worked with Extension Administrators to provide mechanisms for agents to report their time and effort integrating PSE work into community level activities. From 2021-2022, FCS Agents reported 41 policies, systems, and/or environmental changes that promote healthy eating and active living in their community. These range from instituting meeting policies that build in activity breaks to large building projects for community common spaces and playgrounds. These PSE changes were implemented by 28 different organizations. Finally, PSE work requires groups to effectively work together to implement and this is largely driven by local coalition work. Extension agents reported participating in 37 different coalitions/organizations with the goal of implementing PSE strategies to promote healthy eating and active living. 

At the state and national level, UK Extension Specialists have contributed to 4 published journal articles that share PSE training models for agents, tools/resources, and agent experiences related to PSE work within FCS Extension. In addition, one Extension publication cowritten by University of Tennessee Knoxville and the University of Kentucky focused on PSE strategies has been published. Multi-state partnerships are ongoing, and UK Extension is often looked to nationally to share on PSE work within Extension as a novel mechanism to promote health at the county level. Future work within this space includes developing additional tools and resources to support agent-led PSE work as well as integrate PSE components into comprehensive FCS programs.