The North Central Regional Center for Rural Development hosted a webinar recently to address what rural health experts are calling a “perfect storm” of opioid dependence and related behavioral health problems encroaching on rural communities across the country in the wake of COVID-19.

Behavioral health and prevention services are sparse to non-existent in 85 percent of rural counties, according to recent surveys, despite those health conditions continuing to increase. COVID-19 has intensified the situation’s trajectory toward a perfect storm, evidenced by a recent survey conducted by the National 4-H Council which polled 1,500 youth. 

“What they found was really interesting and honestly a bit scary,” said presenter Greg Pliler, a program specialist at the Partnerships in Prevention Science Institute (PPSI) at Iowa State University. 

According to the survey, 7 in 10 teens are struggling with mental health, defined by feelings of anxiety, stress and depression. In particular, 55 percent reported experiencing anxiety, 45 percent experienced excessive stress and 43 percent experienced depression. 

Adults are not faring better. Since stay-at-home orders were issued on March 19, the location of substance abuse-related overdose clusters have shifted from centralized, urban locations to rural and suburban locations.

“COVID-19 opens up the door to offer a new vision for the future of health care in this country, and mental health should be central to that vision,” Pliler said, citing a study by the Wellbeing Trust that estimated between 27,000 and 154,000 additional deaths over despair from COVID-related loss of jobs.

In addition, half of adults in rural areas are directly affected by opioid abuse. This was found via a study that compared a sample of five states chosen for their consistency in overdose statistics in the past, to the duration of the COVID-19 related stay-at-home orders and shutdowns. 

To combat the so-called perfect storm of behavioral and substance abuse problems brewing in rural areas, some believe a broader dissemination state programs could help. Building up the rural infrastructure of behavioral health networking is a necessary step in getting the right kind of proven programs to the people in need of them, according to Richard Spoth, director of PPSI. 

“We need to be taking advantage of the existing infrastructures that are there in rural counties in one way or another,” Spoth said. “So, of course Extension is in nearly all counties, the public school system, health services are in all counties—the idea is to build out of these structures to strengthen what can be done by way of prevention of opioid misuse and some of the related issues like depression, anxiety and so forth. One of the ways to do this is to form partnerships with community teams, the way county Extension does so well.”

Experts in the health and ag community believe an Extension-related program called PROSPER could be a powerful tool to combat rural behavioral health challenges. Having evolved over 25 years, PROSPER is a proven, state-based, science-driven program focused on training, technical assistance and program delivery. It is designed to support sustained implementation of universal, evidence-based prevention programs. PROSPER benefits from careful consideration and buy-in across multiple levels within Extension and partnering schools, according to Program Coordinator at the PPSI, Cassandra Knutson.

“What makes PROSPER different from other programming efforts, is the emphasis it places on local teams moving through a series of developmental phases and long-term sustainability efforts.”

A community that has implemented PROSPER can expect support from the program’s team at Iowa State University, made up of technical assistance personnel, evaluation specialists, researchers and prevention scientists. Through virtual resilience trainings and technical assistance, this team works to address COVID-related school and community needs.  Resilience is cultivated in the program through cognitive behavioral therapy, stress management science and resiliency intervention science. Additionally, PROSPER will provide