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Rural minds initiative: navigating mental health wellness together at Gorham Middle/High School

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Rural minds initiative: navigating mental health wellness together at Gorham Middle/High School

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Content Running head: Rural Minds Initiative
Rural Minds Initiative: Navigating Mental Health Wellness
Together at Gorham Middle/High School
by
Sharon Lemire
A Capstone Project Presented to the
FACULTY OF THE USC SUZANNE DWORAK-PECK SCHOOL OF SOCIAL WORK
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
Doctor of Social Work
December 2024

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TABLE OF CONTENTS
I. Abstract .......................................................................................................... 3
II. Acknowledgements ...................................................................................... 4
III. Positionality Statement ............................................................................... 5
IV. Problem of Practice and Literature Review ............................................... 7
V. Conceptual/Theoretical Framework ............................................................ 14
VI. Methodology .............................................................................................. 16
VII. Project Description ................................................................................... 19
VIII. Implementation Plan ............................................................................... 28
IX. Evaluation Plan .......................................................................................... 25
X. Challenges/Limitations ................................................................................ 32
XI. Conclusions and Implications .................................................................... 33
XII. References ................................................................................................. 36
XIII. Appendix A: Logic Model ....................................................................... 40
XIV. Appendix B: Design Criteria ................................................................... 41
XV. Appendix C: Implementation/Action Plan ............................................... 42
XVI. Appendix D: Year One Budget ............................................................... 44
XVII. Appendix E: Stakeholder Map ............................................................... 45
XVIII. Appendix F: Program Components ...................................................... 46
XIX. Appendix G: High Fidelity Prototype ..................................................... 47

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Abstract
This capstone addresses the critical issue of inadequate mental health services available to rural
youth ages 14-17 at Gorham Middle/High School in Coös County, New Hampshire. The rural
area faces barriers such as limited access, transportation challenges, stigma, and financial
constraints, contributing to the lack of access and poor mental health outcomes. Aligned with the
Grand Challenges for Social Work, the project is grounded in the Grand Challenge of Ensuring
Healthy Development for all Youth. It highlights the preventable impact of childhood and
adolescent trauma and behavioral health problems. Over 5,000 rural New Hampshire youth face
increased risks of Adverse Childhood Experiences and isolation as a result of sparse population
density, compounding the issue (Board of Mental Health Practice, 2023). The proposed
intervention called the Rural Minds Initiative addresses the inadequate mental health care access
for rural youth aged 14-17 at Gorham Middle/High School by co-locating licensed therapists onsite to provide counseling sessions, mental health workshops, and other supports during and after
school hours. Additionally, a designated wellness room staffed by trained professionals within
the school premises will offer a safe space for students to seek support during challenging
situations. Mental health education workshops for students and families will increase awareness,
reduce stigma, and promote early intervention. Leveraging telehealth services and Medicaid
coverage through community and state providers will enhance accessibility and sustainability.
The project's uniqueness lies in its combination and enhancement of existing programs tailored
to address the needs of rural youth, fostering collaboration for positive social change. By
leveraging evidence-based models and community partnerships, the intervention aims to create a
supportive environment that addresses youth mental health needs.

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Acknowledgments
I would like to express my deepest gratitude to those who have supported and guided me
throughout the development of this capstone project. Firstly, I extend my sincere thanks to my
academic advisors, Ronald Manderscheid, Ph.D., and Cassandra Futoros, whose expertise and
mentorship were invaluable in shaping the direction of this research. I am also grateful to the
research participants and collaborators who provided essential insights and feedback: Amanda
Kovaliv, Chrissy Grant, and Patrick Tufts. Your contributions were critical to the success of this
project. Additionally, I would like to acknowledge the unwavering community support from
Gabrielle Flanders, Hayley Beroney, and Deborah Anderson. Your dedication to improving
mental health services in our community has been an inspiration, and this work would not have
been possible without your involvement. Thank you all for your encouragement, guidance, and
support.

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Positionality Statement
As a nonprofit professional with over a decade of experience in direct practice and
community-based work, my values are deeply rooted in a commitment to community-driven
solutions, particularly in my home state of New Hampshire. My identity as a middle-class
woman with progressive political beliefs significantly shapes my approach to social work and
design thinking. I hold a firm belief in the power of grassroots initiatives to address systemic
issues, which is a perspective that is integral to my Capstone Project. My personal and
professional experiences growing up in a low-income family in a rural community have given
me a unique understanding of the challenges similar communities face, making me acutely aware
of the nuances involved in addressing rural mental health needs. Growing up and working in
New Hampshire, a state characterized by its rural landscapes and tight-knit communities, I have
witnessed firsthand the disparities in access to mental health services. Additionally, moving to a
high-population density area like Los Angeles, California, has influenced my understanding of
the possibilities open to those who need assistance.
These experiences have informed my understanding of the importance of culturally and
contextually relevant interventions. My Capstone Project, the Rural Minds Initiative, is designed
through this lens, focusing on creating inclusive and sustainable solutions that resonate with the
identities and experiences of the end users. This initiative is not just a professional endeavor for
me; it is a personal commitment to improving the lives of those in my community.
I draw upon design justice principles in my design process, emphasizing the importance of
locating oneself within the broader design context. This includes a reflexive praxis where I
continuously assess how my cultural, social, and political positions influence the design and
implementation of solutions. My commitment to collaboration and the inclusion of marginalized

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voices is central to my work, ensuring that the solutions developed are innovative and grounded
in the realities of those they are meant to serve.
My work's theoretical perspectives are rooted in social justice and equity. I employ a
human-centered design approach, prioritizing the end users' needs and experiences, particularly
those from marginalized communities. This approach is complemented by understanding social
work theories emphasizing empowerment and systemic change. These frameworks enable me to
develop interventions that are responsive to immediate needs and capable of addressing systemic
issues contributing to mental health disparities in rural areas. As a result of my experiences, I
strive to create inclusive, sustainable interventions for rural youth.

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Rural Minds Initiative: Navigating Mental Health Wellness
Together at Gorham Middle/High School
The Rural Minds Initiative: Navigating Mental Health Wellness Together at Gorham
Middle High School is a proposed intervention addressing inadequate access to mental health
care access for rural youth aged 14-17 at Gorham Middle/High School (GMHS) in Gorham, New
Hampshire. The intervention includes co-locating licensed therapists on-site to provide
counseling sessions, mental health workshops, and an on-site wellness room for use during and
after school hours. Integrated interventions available to students and families will increase
awareness, reduce stigma, and promote early intervention. The project's uniqueness lies in its
combination and enhancement of existing programs tailored to address the needs of rural youth
while fostering collaboration for positive social change. Leveraging evidence-based models and
community partnerships, the Rural Minds Initiative aims to create a supportive environment that
increases access for youth to mental health services, decreasing stigma and mental health
concerns among the area's youth.
Problem of Practice and Literature Review
This collection and analysis of research explores inadequate mental health services
available to rural youth ages 14-17 at GMHS in New Hampshire and the need for enhanced
intervention to increase access and availability in the area. Research indicates that rural youth are
exposed to Adverse Childhood Experiences (ACEs) at higher rates than their urban counterparts,
which can result in youth behavioral concerns that continue to follow individuals over their
lifetime (Crouch et al., 2019). In addition to higher rates of exposure to traumatic experiences,
rural youth have limited access to services (Morales et al., 2020). The prevalence of mental
health challenges among rural youth in N.H., with over 20% experiencing such issues, highlights
a significant problem demanding attention (Warwick et al., 2021). The high prevalence of ACEs

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is compounded by the scarcity of mental health facilities specifically catering to youth in
nonmetropolitan areas (Morales et al., 2020). For instance, 92,510 people in New Hampshire live
in an area that does not have enough mental health professionals to meet the needs of the
community (NAMI, 2021). Consequently, rural youth, facing more severe mental health
concerns than their urban counterparts, encounter challenges in receiving adequate care,
exacerbating the persisting problem.
Inaccessible mental health care for those in remote communities contributes to the
increased risk of detrimental experiences for youth therein (Jenson & Hawkins, 2018).
Detrimental behaviors among youth include substance abuse, suicide, delinquency, school
dropouts, risky sexual behavior, violence, anxiety, and depression, to name a few. While mental
health concerns seem to be at the core of this problem, approaching the wicked problem through
a lens of inaccessibility and collaboration could provide a more holistic approach and bring much
needed treatment services to GMHS students.
Grand Challenge: Ensuring Healthy Development for All Youth
The Grand Challenges for Social Work (GCSW) identifies critical social issues requiring
innovative solutions. The challenge, Ensuring Healthy Development for All Youth, aims to
reduce preventable behavioral health problems by 20 percent over the next decade (Jenson &
Hawkins, 2018). This challenge emphasizes the importance of early intervention in addressing
youth behavioral health concerns (Jenson & Hawkins, 2018). GMHS students aged 14-17 face
these challenges at higher rates due to their exposure to potentially traumatic events and limited
access to essential services, all the while being unable to access the care they deserve (Morales et
al., 2020). The project's focus on destigmatizing mental health issues and providing tailored

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interventions for rural youth is critical to ensuring healthy development for all young people in
Gorham, New Hampshire.
Target Population
The population statistics of those in New Hampshire are essential to emphasize the need
for additional mental health resources. The U.S. Department of Agriculture defines rural as an
area with a population density of less than 500 individuals per square mile (Cromartie, 2019).
With a mere 17 people per square mile and a total population of 31,504 individuals in Coös
County, New Hampshire, the area falls well within the boundaries of a rural area (Board of
Mental Health Practice, 2023). Such sparse population density exacerbates the feeling of
isolation, which is linked with ongoing mental health issues. With 16% of Coös County's
population under 18, over 5,000 youth are at risk of ACEs and severe mental health concerns
(Board of Mental Health Practice, 2023). Sparse populations impact other resources. For
instance, 17% of New Hampshire individuals do not have broadband internet access, making
telehealth a challenge in the northernmost area of the state (2022). Despite being predominantly
White (93%), New Hampshire's rural areas also house Hispanic/Latino (4%), Asian (3%), and
Black (2%) populations (U.S. Census Bureau, 2021). The low ratios of people of color in the
area further exacerbate the issues they face.
The need for increased services for youth is evident; however, New Hampshire mental
health services are primarily supplied through only ten community mental health centers
(CMHCs) throughout the state (Kitch, 2019). Regional nonprofit CMHCs provide outpatient and
emergency services for 50,000 New Hampshire individuals, while over 90,000 remain without
care each year (Kitch, 2019). Intensifying an already unreachable demand, service requests rose
by 350% between 2016 and 2019 (Kitch, 2019). Across the entire state, 15,000 youth ages 14–17

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have depression, and over half (56.6%) of these individuals did not receive any care within the
past year (NAMI, 2021). In 2021, The Centers for Disease Control (CDC) reported that 42% of
high school students in Coös County felt sad or hopeless almost every day for at least two weeks,
negatively impacting their daily functioning. Continued CDC data shows that 21% of the
county's high school students reported seriously considering attempting suicide within the prior
twelve months, with 10% of all students attempting suicide (CDC, 2021). In the same 2021
report, the CDC noted that these statistics have increased drastically due to the COVID-19
pandemic. Further, over 20% of rural youth in the U.S. face mental health issues, with 36% of
New Hampshire youth reporting poor mental health, 7% above the national average (Warwick et
al., 2021; Lewis, 2023). Approximately 70,000 New Hampshire youth exhibit concerning
depression symptoms, and nearly 25% contemplate suicide (Lewis, 2023).
In addition to poor mental health, many young people are engaging in risky sexual
behaviors, with only 52% of sexually active high school students reporting using a condom
during their last sexual experience (CDC, 2021). Other studied high-risk behaviors, such as
substance use, found that 23% of high school students reported drinking alcohol, and 6%
reported misusing prescription opioids (CDC, 2021). While the above statistics include all
subgroups, it is essential to note that the percentage of students impacted by these issues is
increased for females, youth of color, and those in the LGBTQ+ communities.
High rates of ACEs impact childhood and adolescent mental health over their lifetime;
however, these challenges can be treated through early intervention and even prevented (Jenson
& Hawkins, 2018). If left untreated during the developmental years, youth mental health
concerns persist and escalate into adulthood, often resulting in exacerbated mental disorders,
physical health challenges, and decreased productivity (Douthit et al., 2015). The consequences

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of not addressing poor access to youth mental health needs place a significant financial burden
on communities, the healthcare system, and national budgets. Neglecting the mental health needs
of rural youth is costly. It puts unnecessary stress and financial burdens on individuals, families,
and communities, perpetuating the ongoing challenges of accessing mental health care.
Continued untreated mental health for youth will continue to grow and create negative impacts
on the local, state, and even national economies.
While the need for increased access to mental health services for youth in rural New
Hampshire is clear, barriers that prevent them from receiving care keep the problem from
improving. Too few mental health professionals, a lack of community resources, stigma, and
transportation challenges are some factors that cause those in rural areas to continue to go
without care (Douthit et al., 2015). Inaccessible mental health care for youth means inadequate
treatment for a population at risk for heightened exposure to ACEs. Nonmetropolitan youth are
isolated from the care they need. More often, these youth grow into adults with even more severe
mental health diagnoses, physical health challenges, and low earning levels (Douthit et al.,
2015). As a result of untreated challenges, youth are hindered from living the healthy and
financially stable lives they deserve.
Stakeholder Analysis
Ensuring healthy development for all youth impacts multiple stakeholders, including
families, schools, health systems, social service workers, legislative groups, funders, and
community members. A visual list of stakeholders and their definitions can be found in
Appendix H. Stakeholders across the youth mental health continuum provided insights into the
challenges of increasing access to mental health care for rural youth to inform the proposed
solution. To highlight state trends, interviews and surveys were conducted with GMHS high

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school students, low-income caregivers, teachers, nonprofit community leaders, and mental
health professionals in rural New Hampshire. Potential funders were interviewed to gain further
insight into the program's viability.
Several themes arose from stakeholder interviews and surveys, including accessibility of
mental health services, mental health prioritization, economic disparities, stigmatization, and
recommendations. A key theme identified by those interviewed was the lack of availability and
reach of mental health services in rural areas. Barriers include therapists not accepting new
patients, significant geographical distances to specialists, limited insurance acceptance, and
individuals needing to take time off work (G. Palmer, personal communication, September 12,
2023). Inadequate infrastructure, such as broadband for telehealth services and lack of public
transportation or accessible roads, further compounds these issues (P. Tufts, personal
communication, October 20, 2023). Youth specifically reported that beyond a school counselor,
they are unsure where to access mental health services in their community (M. Gorman, personal
communication, October 23, 2023). These compounded issues continue to restrict youth access
to mental health support.
Caretakers and community leaders noted financial challenges and a cultural hierarchy
that places mental health lower than physiological health and substance use treatment (J.
Dumont, personal communication, September 22, 2023). Youth reported that mental health is
rarely discussed despite experiencing stressors such as school, social and financial challenges,
and the common occurence of cyberbullying (M. Gorman, personal communication, October 23,
2023). This cultural inclination toward delayed mental health intervention can lead to long-term
socioeconomic consequences, such as increased dropout rates.

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Teachers observed that low-income students exhibit more behavioral problems,
supporting existing literature. Issues like truancy, disruptive behavior, teen pregnancy, and
dropout rates were noted among low-income students (D. Anderson, personal communication,
October 4, 2023). Youth do not typically link economic disparities with mental health, viewing
their struggles as individual problems, which could pose challenges in engaging this population
in mental health services (M. Gorman, personal communication, October 23, 2023). These
compounded challenges perpetuate poor mental health outcomes, further hindering
socioeconomic advancement.
Stigma emerged as one of the most substantial barriers to accessing mental health care,
according to all parties interviewed. The cultural stigma surrounding mental health, substance
use disorder, and homelessness often prevents individuals in rural New Hampshire from seeking
care. Individuals in the project footprint frequently adopt an individualistic attitude, preventing
them from seeking care (P. Tufts, personal communication, October 20, 2023). Additionally,
youth perceive that adults dismiss their mental health concerns as attention-seeking (M. Gorman,
personal communication, October 23, 2023), and rural caretakers expressed fear of being
criticized for seeking care (J. Dumont, personal communication, September 22, 2023).
Solution Landscape
Several initiatives are currently in place to address the mental health challenges faced by
individuals in the northernmost region of New Hampshire. One promising approach includes
recovery-friendly workplaces offering on-site services such as treatment, childcare, and
psychiatry. These services promote healthier environments for adults in students' lives and help
reduce the stigma associated with mental health care (P. Tufts, personal communication, October
20, 2023). Additionally, interventions like mobile crisis units and collaborations between law

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enforcement and healthcare providers have successfully delivered informed care to rural
communities. Hospitals are also stepping in to address substance use disorders in youth, which
can often intersect with mental health challenges (C. Gilbert, personal communication, October
19, 2023). Efforts to combat stigma have included peer-to-peer support for adults in recovery and
a targeted task force that provides ongoing care to a limited number of families. Cultural values
such as hard work and community support have been leveraged to encourage individuals to seek
mental health services, believing that care will enhance their ability to contribute at work and
within their communities (P. Tufts, personal communication, October 20, 2023). While current
efforts have proven to gain traction, they mainly support adults and have a limited geographical
and population footprint. Further intervention at a preventative level is needed to impact the area
and ensure healthy development for all youth.
Conceptual/Theoretical Framework
Systems Theory and a detailed logic model, found in Appendix A, guide the Rural Minds
Initiative. Systems Theory provides a framework for understanding how various interconnected
systems such as social, school, vocation, religion, socioeconomic standing, and ethnicity
collectively influence mental healthcare access in rural communities (Gulliver et al., 2012). This
perspective emphasizes the importance of considering the holistic environment when addressing
mental health, recognizing that changes in one part of the system can impact the entire system
(Aarons et al., 2014). Collaborative partnerships among stakeholders, including youth, school
professionals, healthcare providers, community organizations, government agencies, and
families, are essential for developing comprehensive and coordinated services (Proctor et al.,
2009). The theory also highlights the importance of adaptability and resilience in response to
changing circumstances, particularly in areas with limited resources (Bradshaw et al., 2019).

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Systems Theory is manifested for GMHS students through cultural and societal factors, such as
stigma and the intersectionality of poverty, race, and other social determinants of health, that
compound the challenges of mental health care access. Furthermore, stigma often perpetuates
misconceptions and hinders help-seeking behaviors, particularly among youth (Wzik, 2022).
High school students at GMHS experience these cultural norms, alongside economic
disadvantages, amplify mental health disparities among vulnerable populations. While these
students are more likely to need care, they are less likely to receive it (Hodgkinson et al., 2017;
Crouch et al., 2015).
Logic Model
The logic model aligns with the Systems Theory framework and outlines the project's
inputs, activities, outputs, and outcomes. It identifies critical connections, including program
partners, school counselors, and community partnerships, which are crucial for success.
Activities such as engaging community partners, conducting workshops, securing funding, and
providing services are designed to lead to significant outcomes, including increased access to
mental health care, improved mental health awareness, and reduced stigma.
Once implemented, the program aims to provide mental health services to 100 students
annually, with ten families participating in family therapeutic services. Expected outcomes
include increased mental health awareness, changes in attitudes around mental health, and
greater access to care for rural New Hampshire youth. The program also seeks to decrease
stigma, reduce mental health concerns, and create a sustainable model for improving mental
health outcomes among youth in rural New Hampshire.

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Methodology
The Rural Minds Initiative employs Design Thinking and Human-Centered Technology
approaches to address the limited access to mental health services for youth in GMHS. Design
Thinking, a problem-solving methodology, emphasizes understanding users, challenging
assumptions, and redefining problems to create innovative solutions tailored to the specific needs
of the population served. This project utilized Design Thinking to map and illuminate the
experiences of rural adolescents, revealing significant gaps in mental health service access. This
process was supplemented by an extensive literature review and expert insights, focusing on the
prevalence of depression, anxiety, and stress among rural youth and their lack of awareness and
access to tailored mental health services. Research was conducted through the University of
Southern California's library services, accessing relevant databases and journals. Interviews with
experts from the University of New Hampshire, Granite United Way, The Family Resource
Center, and community members further refined the understanding of these challenges. These
experts, identified by their roles and experience, provided critical feedback and suggested
additional information-gathering avenues, ensuring the program design was informed by
theoretical knowledge and practical insights relevant to the target population.
The next stage, driven by journey mapping and expert consultations, involved mind
mapping to synthesize the collected data and identify potential solutions to the challenges faced
by rural New Hampshire youth. This phase informed the development of tools for further
exploration, including focus group guides, observation protocols, and survey instruments,
capturing diverse perspectives from students, families, school and health systems, social service
workers, legislative groups, funders, and community members.
Human-Centered Design Approach

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In parallel with Design Thinking, the project employed a Human-Centered Technology
approach, which centers users in the development process to ensure solutions are tailored to their
needs (Landry, 2020). This approach was crucial in engaging stakeholders from various
institutions, ensuring that the voices of those directly impacted by the program were heard and
considered throughout the design process. The Human-Centered Design approach was mainly
utilized during the in-depth interviews and focus groups conducted with stakeholders. These
methods provided a platform for youth, their guardians, and other community members to share
their lived experiences and insights. Voices often underrepresented in the literature, such as those
of the youth and their caregivers, were deliberately targeted to ensure that the program's design
was inclusive and responsive to the community's needs.
Contribution of the Design Team Members
The design team for the Rural Minds Initiative was composed of a diverse group of
individuals, including students, parents, mental health professionals, school administrators,
counseling staff, community leaders, and potential funders. Each member of these stakeholder
groups brought unique expertise and perspectives to the table. For instance, students and their
families played a crucial role in shaping the design by participating in focus groups, surveys, and
interviews, providing firsthand insights into their challenges and expectations for mental health
services. Experts in mental health offered practical input on the feasibility and effectiveness of
proposed solutions, refining program components like therapy session structures and telehealth
platforms to ensure they were both practical and evidence-based. School staff contributed
insights on the logistical and administrative aspects of implementing the program within the
school environment, which is essential for seamlessly integrating the program into existing
school infrastructure. Community leaders guided in aligning the program with broader

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community goals and ensuring compliance with legal and regulatory requirements, particularly
concerning parental consent and privacy regulations. Engaging potential funders early in the
design process helped align the program with funding priorities and sustainability goals, shaping
the financial model and identifying key investment areas. This collaborative effort ensured that
the final design was both innovative and grounded in the realities of rural New Hampshire
communities, addressing immediate mental health needs and the long-term sustainability and
scalability of the initiative.
Design Justice Principles
Design Justice principles were central to the Rural Minds Initiative development by
prioritizing the voices and needs of marginalized communities, particularly the students and
families at GMHS and the broader Coös County region. The program was designed to address
stigma and resource scarcity barriers, focusing on equity and accessibility. Student input directly
informed components like telehealth services, student-led advisory boards, and the creation of a
wellness room at GMHS. At the same time, family involvement highlighted the need for familycentered therapeutic services. Partnerships with national, state, and local funders and
organizations ensured the program is affordable and accessible to all students, regardless of their
economic status. Applying Design Justice principles ensured the program was inclusive,
equitable, and community-driven, addressing the specific mental health challenges faced by
youth in Gorham, Coös County, and the broader North Country region. This approach meets the
community's immediate needs and empowers them to sustain and expand mental health services
in the future.
Market Analysis

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The market analysis for the Rural Minds Initiative at GMHS demonstrates a strong
demand for accessible, youth-centered mental health services at GMHS and in the greater Coös
County region. Research, including the Rural Youth Mental Health Needs and Services Survey,
adopted for each population was given to students, parents, and school counselors, indicating a
significant prevalence of mental health challenges among students, mainly related to relational,
financial, and educational pressures. These surveys revealed a critical gap in accessible, tailored
mental health services, underscoring a strong market need for the Rural Minds Initiative.
Additionally, focus groups and surveys conducted with GMHS students showed that students
and families were largely unaware of available mental health resources, further highlighting the
program's opportunity. The program's integration into the school setting at GMHS enhances
accessibility and acceptance within the community, addressing the stigma often associated with
seeking mental health services in rural areas. During initial and follow-up prototype testing, the
program received positive feedback from students, families, and community stakeholders,
indicating high market readiness and receptivity. Resounding support suggests that the Rural
Minds Initiative is well-positioned to meet the mental health needs of GMHS youth, with strong
potential for sustainability and replication across other communities.
Project Description
The proposed solution to inadequate access to mental health care for youth ages 14-17 at
GMHS in rural New Hampshire is an innovative, collaborative program that incorporates several
best practices interventions with community resources. These practices include co-locating
therapists on-site at the school for student and family support, creating a wellness room for
students during the school day, and offering in-person and telehealth mental health services and
education workshops for the community provided by partnering institutions. An integrative piece

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of this program will include a student advisory board to assist with student engagement and
messaging. This program draws upon evidence-based therapeutic models and leverages existing
community care services to ensure effectiveness and efficacy in addressing the mental health
needs of rural youth. Table 1 below shows a brief outline of the proposed solution.
Project Description and Overview
The Rural Minds Initiative addresses the mental health needs of students at Gorham
Middle High School (GMHS) in Coös County, New Hampshire, a region facing significant
barriers to care, including geographic isolation, transportation challenges, financial constraints,
and mental health stigma. Led by project manager Nanci Carney, Area Manager for North
Country at Granite United Way, with support from the University of New Hampshire Extension,
the initiative embeds trauma-informed care (TIC) and Integrated Behavioral Health (IBH)
models directly into the school environment to provide comprehensive and accessible mental
health services.
Key features include on-site licensed therapists available during and after school hours, a
designated wellness room to support students experiencing distress, and mental health education
workshops for students and their families. These interventions have proven to be useful in urban
communities and can be adapted to rural areas (Hoagwood et al., 2014, Kearney & Graczyk,
2022). To further expand access, the program integrates telehealth services with contracted
therapists, allowing students with transportation challenges or other limitations to receive care
remotely. By leveraging Medicaid funding to support telehealth services, the project ensures
long-term sustainability and affordability for the students and their families. This multifaceted
approach reduces financial, geographic, and social barriers to care while promoting early
intervention and holistic mental health support for rural youth.

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Alignment with Ensuring Healthy Development for All Youth
The Rural Minds Initiative directly contributes to the Grand Challenge for Social Work,
"Ensuring Healthy Development for All Youth," by addressing critical barriers to mental health
care in rural areas, such as accessibility, stigma, and limited resources. Integrating mental health
services within the school setting and offering both in-person and telehealth options promotes
early intervention, reducing the long-term impact of untreated mental health issues (Mahon,
2022). Embedding mental health services into the fabric of GMHS encourages open discussions
about mental health, helping to reduce stigma.
The program builds on established policies, programs, and models that place licensed therapists
directly in schools, ensuring immediate and easy access to mental health services—one of the
critical barriers rural youth face (Nielsen, 2014). Through this innovative approach, the Rural
Minds Initiative supports the broader GCSW goal of reducing preventable behavioral health
problems by increasing youth access to mental health care, normalizing help-seeking behavior,
and fostering a supportive school culture.
Design Criteria
The Rural Minds Initiative is guided by core design principles focused on accessibility,
cultural competence, sustainability, and adaptability. These criteria are crucial to addressing the
unique mental health challenges of rural youth while creating a scalable model that can be
implemented in other regions. Accessibility is prioritized by co-locating licensed therapists
within the scheduled and drop-in sessions during and after school, either voluntarily or by
referral of school staff. Telehealth services are also integrated, addressing transportation
challenges common in rural areas. By leveraging Medicaid funding, the program ensures
affordability for students and families. Cultural competence is central, with the program

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incorporating Trauma-Informed Care (TIC) to train school staff and mental health professionals
to understand the diverse needs of students. A trauma-informed wellness room offers a safe
space for emotional support tailored to individual backgrounds and experiences. Sustainability is
achieved through Medicaid reimbursements and local partnerships. By integrating mental health
education into the curriculum, the program fosters an ongoing dialogue around mental health,
ensuring long-term benefits. Adaptability allows the program to be replicated in other rural
schools. The combination of in-person and telehealth services offers flexibility to meet the
specific needs of different communities. A comprehensive guide, including partnership models
and budget frameworks, makes the program easily transferable to other rural areas. Focusing on
these core principles, the Rural Minds Initiative offers an effective, sustainable, and expandable
framework for addressing rural youth mental health, contributing to broader social change.
Prototype Description
The Rural Minds Initiative centers around a high-fidelity prototype designed to
comprehensively address the mental health needs of rural youth at GMHS. This prototype acts as
a complete guide for the development, planning, execution, and evaluation of the program,
ensuring effective and sustainable implementation at every phase. It offers schools and
communities a detailed blueprint to replicate the program, fostering a holistic mental health
support system for students.
The prototype begins with a step-by-step guide for conducting a thorough needs
assessment, which helps schools and communities understand the specific mental health
challenges rural youth face. By engaging stakeholders such as students, families, school staff,
and community leaders, the program is tailored to the community's needs. Tools like surveys and
focus group templates are included to gather critical data on mental health needs and resources.

RURAL MINDS INITIAVE
23
The prototype provides a comprehensive timeline covering all project stages in the
planning phase, from needs assessment to full-scale implementation. It includes budget templates
for the first and second years of operation, detailing costs for staffing, training, materials,
telehealth infrastructure, and on-site services. The prototype also identifies potential funding
sources such as grants, Medicaid reimbursements, and local sponsorships to support the
program's financial sustainability.
For execution, the prototype outlines an in-depth implementation plan, including the
setup of on-site mental health services, creating a trauma-informed wellness room, and launching
mental health education workshops for students and families. The wellness room will be staffed
by licensed therapists and trained professionals offering in-person and telehealth counseling,
ensuring students receive timely and effective mental health interventions.
Training modules are included to prepare school staff, counselors, and volunteers. Topics
such as Trauma-Informed Care (TIC), Integrated Behavioral Health (IBH), and Mental Health
First Aid (MHFA) equip participants with the skills needed for holistic care. Confidentiality
policies, consent forms, and data protection protocols are embedded to ensure student privacy
and compliance with legal and ethical standards.
A robust monitoring and evaluation framework is also part of the prototype, allowing for
the tracking of the program's effectiveness. Surveys, focus group guides, and progress-tracking
templates are designed to collect both quantitative and qualitative data, assessing metrics such as
student engagement, reduced mental health incidents, and increased access to services. Reporting
templates ensure transparency with stakeholders and funders.
Additionally, the prototype includes communication plans, marketing materials, and
community outreach strategies to build awareness and foster engagement. These materials are

RURAL MINDS INITIAVE
24
easily adaptable to fit the unique needs of different schools and regions, making the prototype
highly scalable. Strategies for securing local funding and leveraging community resources ensure
the program is sustainable and expandable to other rural schools across New Hampshire and
beyond. A visual description of the prototype is available in Appendix F.
Theory of Change
The proposed project is underpinned by Systems Theory, which serves as a guiding
framework for comprehending the multifaceted dynamics that contribute to inadequate access to
mental health services in rural communities. According to Systems Theory, various
interconnected systems, including social, school, vocation, religion, socioeconomic standing, and
ethnicity, collectively influence individuals' expectations, beliefs, and choices concerning mental
health care (Gulliver et al., 2012). This perspective sheds light on how rural youth
psychologically respond to social and socioeconomic factors, emphasizing the intricate interplay
between these systems.
Systems Theory offers valuable insights into increasing access to mental health care for
rural youth in Coös County, emphasizing the interconnectedness of various components within
the system and how changes in one part can impact the entire system (Aarons et al., 2014). This
approach encourages a holistic understanding of mental health care, considering individual
factors and environmental, social, and cultural influences (Lehmann et al., 2017). Collaborative
partnerships among stakeholders within the system, including schools, healthcare providers,
community organizations, government agencies, and families, are essential for developing
comprehensive and coordinated services (Proctor et al., 2009). Furthermore, Systems Theory
highlights the importance of adaptability and resilience in response to changing circumstances,
particularly in rural areas where resources may be limited and needs fluctuate (Bradshaw et al.,

RURAL MINDS INITIAVE
25
2019). By promoting equity and access to mental health care, Systems Theory helps identify and
address disparities among rural youth, ensuring that all individuals have the opportunity to
receive the support they need for the opportunity at a healthier future for generations to come
(Gulliver et al., 2012).
Revised Logic Model
The Rural Minds Initiative operates through a carefully structured logic model that
connects resources, activities, outputs, outcomes, and impact. The program's success relies on
several critical resources. These include diverse connections with program partners and potential
funders, ensuring the program's sustainability and growth. School counselors and community
partnerships are integral to embedding mental health services within the school and the broader
community. The initiative is supported by a solid research base, guiding its evidence-based
practices. Significant time investments from staff, counselors, and volunteers are essential for the
development and ongoing sustainability of the program. Additionally, the program leverages
telehealth infrastructure to provide remote mental health services, addressing geographic and
transportation barriers often limiting access in rural communities. A comprehensive program
prototype serves as a complete guide for developing, implementing, and evaluating the initiative.
The program also incorporates comprehensive needs assessments to identify the specific mental
health challenges rural youth face, allowing for informed adjustments to the initiative.
Furthermore, access to a counseling suite or in-school suspension rooms, which can be
transitioned into wellness rooms, provides dedicated student mental health support spaces.
Outputs from the initiative will include 100 students accessing regular mental health
services each school year, ten families participating in family-centered therapeutic services, and
the publication of easy-to-replicate curriculum materials on the school website. Additionally, the

RURAL MINDS INITIAVE
26
program will produce peer-led support activities, workshops, and a range of mental health
resources available to students and staff, both in-person and via telehealth.
The short-term outcomes of the Rural Minds Initiative will focus on increasing mental
health awareness and reducing the stigma surrounding mental health care among students,
families, and school staff. By improving mental health literacy and encouraging help-seeking
behavior, the initiative aims to increase the number of rural youth accessing both in-person and
telehealth services. Greater family involvement in youth mental health will further support these
efforts, creating a more inclusive approach to mental health care.
In the long term, the initiative expects a deeper integration of mental health awareness
into the school culture at GMHS, resulting in improved student well-being and greater capacity
among teachers and staff to recognize early signs of mental health concerns. Over time, students
will experience increased classroom engagement, reduced absenteeism, and better overall
academic and social outcomes.
The overall impact of the Rural Minds Initiative will be a significant reduction in mental
health stigma within rural communities and a decrease in the prevalence of mental health
challenges among youth in Coös County. The program will provide a scalable model that can be
replicated across other rural schools in New Hampshire and beyond, contributing to long-term
improvements in youth mental health on a broader scale.
Ethical Considerations
The Rural Minds Initiative is designed with a strong commitment to ethical principles,
prioritizing all participants' confidentiality, privacy, and autonomy. Confidentiality will be
strictly maintained in accordance with HIPAA regulations, and informed consent will be
obtained from all students and guardians before participation. The program is culturally sensitive

RURAL MINDS INITIAVE
27
and inclusive, ensuring that mental health services respect the diverse backgrounds of Coös
County residents. Efforts will be made to normalize mental health discussions within the school
environment, minimizing stigmatization. Participation in the program is voluntary, and steps will
be taken to prevent coercion or undue influence. Potential negative consequences, such as
reliance on school-based services without adequate transition plans, will be mitigated by
connecting students with external resources for continued care. Finally, the program will
implement ongoing monitoring and feedback mechanisms to address any ethical issues that may
arise, ensuring that the well-being of all participants remains the top priority.
Likelihood of Success
Insights gathered from stakeholders and academic resources emphasize the significant
role that schools can play in mitigating the limited access to mental health care for rural youth (P.
Tufts, personal communication, October 20, 2023). The proposed school-based interventions,
including mental health education, enhanced counseling services, wellness rooms, and online
resources, are designed to overcome challenges such as stigma, counselor capacity limitations,
and inadequate spaces for student expression. Success for this project looks like an increase in
students' access to mental health services, reduced stigma around mental health issues, and
improved overall well-being for youth in Coös County.
The project's sustainability is supported by integrating mental health education into
existing school curricula, which fosters ongoing discussions about mental health and normalizes
help-seeking behavior. Additionally, using online resources extends the reach of these services
beyond the school day, ensuring continued accessibility for students. To address counselor
shortages, the project includes strategies to secure long-term funding and leverage virtual

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28
counseling platforms, which can complement in-person services and enhance the program's
reach. The modular approach can be adapted to different school environments.
Implementation Plan
The proposed project to increase access to mental health services for youth in Coös
County, New Hampshire, is prepared for the initial stages of implementation. Developed to be
piloted at GMHS, the project will be ready for complete implementation once key collaborators
commit to the initiative, formalize partnership agreements, and secure funding from designated
sources. Key collaborators include Nanci Carney, Area Manager, North Country at Granite
United Way; Gabrielle Flanders, Director of Family Support Services at The Family Resource
Center in Gorham; Chrissy Grant, School Counselor at GMHS; and Patrick Tufts, CEO of
Granite United Way. These individuals will play essential roles in ensuring the program is
effectively integrated into the school's support structures and the broader community.
A detailed line-item budget has been developed to ensure transparency and effective
financial management throughout the project's lifecycle, which is available as Appendix C.
Major budget items include salaries for on-site therapists, the setup of a trauma-informed
wellness room, telehealth infrastructure, and costs for developing and delivering mental health
education workshops. Marketing and outreach efforts have also been accounted for, with a total
estimated budget of $683,200 for the first year. This budget is designed to cover all essential
aspects of the program, ensuring smooth and sustainable operation from the outset.
Fund Development Plan
While the implementation costs of the program are high, the fund development plan for
this project is comprehensive and diverse. It includes targeted grant applications to foundations
such as the Robert Wood Johnson Foundation and the Substance Abuse and Mental Health

RURAL MINDS INITIAVE
29
Services Administration (SAMHSA). Local community fundraising efforts, including schoolhosted events and online crowdfunding campaigns, will also be initiated. Partnerships with local
businesses and healthcare providers will be explored to secure additional funding and in-kind
support. A vital component of the financial strategy is the use of Medicaid reimbursements to
cover telehealth services and school-based counseling, ensuring a sustainable revenue stream for
ongoing operations.
Marketing Plan
In addition to a full funding plan, the developed robust marketing and branding strategy
builds awareness and foster engagement. Community engagement will include town hall
meetings, school assemblies, and parent-teacher conferences to introduce the program and gather
feedback. Social media campaigns will target students, parents, and community members with
information about the program's benefits. Collaborations with local media outlets will further
amplify the program's reach, with stories and interviews highlighting the initiative's goals and
impact. A consistent brand identity will be developed, including logos, taglines, and messaging
that reflect the program's mission to reduce stigma and improve access to mental health services
for rural youth.
Evaluation Plan
The evaluation plan for the project to enhance access to mental health services for GMHS
students is designed to rigorously assess the program's impact, effectiveness, and sustainability.
The project's primary objectives include improving accessibility, affordability, and sustainability
of mental health services for high school students at GMHS. The plan focuses on measuring the
reduction in mental health stigma, increasing youth engagement in their own care, and
leveraging the strengths of the community to improve access to mental health services. The

RURAL MINDS INITIAVE
30
evaluation plan includes both formative and summative components. Formative evaluation will
focus on ongoing monitoring and assessment during the implementation phase, providing realtime feedback for adjustments and improvements. This will involve analyzing data collected
through surveys, focus groups, and interviews to ensure the program is meeting its objectives and
addressing the needs of the students and community effectively.
Summative evaluation will occur at the end of the first semester after the pilot has been
implemented. It will consist of a comprehensive review of all collected data to assess the
project's success. Success will be determined by the extent to which the program has met its
goals, including reducing mental health stigma, increased accessibility and utilization of services,
and improved mental health outcomes for students at GMHS. The summative evaluation will
also consider any changes and improvements that need to be made to the program for the second
school semester. Once updates have been made, further evaluation will address the sustainability
and replicability of the program, assessing whether the initiative can be maintained and expanded
to other schools in Coös County and similar rural areas. Through this detailed evaluation plan,
the project team will ensure that the Capstone Project achieves its immediate objectives and
provides valuable insights for continuous enhancement and long-term impact on rural youth
mental health services.
Measuring Social Change/Impact
A combination of quantitative and qualitative methods will be employed to
comprehensively evaluate the social change and impact generated by the program. Quantitative
metrics will be used to track changes in mental health knowledge, attitudes toward seeking care,
and the frequency of service utilization. These metrics will be gathered through pre- and postintervention surveys administered to students and staff at GMHS. The surveys will assess

RURAL MINDS INITIAVE
31
improvements in mental health literacy, the reduction of stigma, and the effectiveness of the
services provided, such as the usage rates of co-located therapists, wellness rooms, and telehealth
options. Additionally, participation in mental health advocacy groups and peer support networks
will be monitored to gauge the program's broader impact on student engagement. Qualitative
feedback will be collected through focus groups and interviews with students, parents, teachers,
and mental health professionals. This feedback will provide deeper insights into the personal
growth, awareness, positive changes experienced by participants, and shifts in the school
environment. Continuous stakeholder input will be sought to ensure the program remains
responsive to the community's needs and identify ongoing improvement areas.
Data Collection Plan
The data collection plan will involve systematic and ongoing quantitative and qualitative
data collection. Surveys will be administered at multiple points throughout the program to
measure progress and impact over time, starting with a baseline assessment before the program's
implementation. Follow-up surveys will be conducted at regular intervals to monitor changes and
outcomes. Qualitative data from focus groups, interviews, and direct observations within the
school environment will complement data from these surveys.
The collected data will be analyzed to monitor the program's effectiveness as it evolves,
with particular attention to identifying trends and patterns that indicate success or areas needing
adjustment. This iterative process will allow the project team to make data-driven decisions to
refine and enhance the program's design and implementation. Additionally, longitudinal data will
be analyzed to assess the program's long-term impact on students' mental health outcomes.
Communication Plan for Reporting Results

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32
A comprehensive communication plan will be implemented to report the project's results
and impact to stakeholders, including students, parents, school staff, community partners, and
funders. Regular updates will be shared through multiple channels, including school newsletters,
community meetings, social media, and formal reports. These communications will highlight key
findings, successes, and lessons learned, ensuring transparency and ongoing community
engagement. Final evaluation reports will be prepared at the end of each school year,
summarizing the program's outcomes, including quantitative metrics and qualitative feedback.
These reports will be disseminated to all stakeholders to inform discussions on the program's
future direction, potential expansion, and opportunities for replication in other rural
communities.
Challenges and Limitations
Implementing mental health services in rural areas like Northern New Hampshire
presents several challenges that require adaptive strategies. One major obstacle is the limited
access to telehealth services due to poor broadband infrastructure and a lack of necessary
technology. To address this, the project will advocate for improved infrastructure and partner
with technology providers to supply internet hotspot equipment to families in need. The stigma
surrounding mental health, especially among youth, poses another significant barrier, impeding
engagement with available services. The project plans to implement destigmatization campaigns
through community events and educational workshops. Should these efforts prove insufficient,
alternative strategies, such as peer-led initiatives or collaborations with local influencers, will be
explored. Additionally, recruiting and retaining qualified mental health professionals is a
persistent challenge in rural areas due to professional isolation, lower salaries, and limited access
to career development. To mitigate this, the project will offer incentives such as salaries

RURAL MINDS INITIAVE
33
competitive with urban rates, loan repayment programs, and professional growth opportunities.
paraprofessionals or telehealth support from urban practitioners. Finally, the success of rural
mental health initiatives relies heavily on continuous legislative support. Although legislative
efforts are underway in New Hampshire, inadequate funding or poor implementation could
hinder progress. The project will actively engage policymakers to secure sustained investment in
rural mental health care.
Challenges in implementing the Rural Minds Initiative will be addressed through a series
of proactive strategies and contingency plans. If telehealth remains unfeasible, the focus will
shift to expanding in-person services. Alternative models such as volunteer-based or peermentoring programs will be explored if staffing shortages persist. To ensure financial
sustainability, the project will pursue long-term grants, partnerships, and Medicaid
reimbursements while also offering professional development and peer support for mental health
staff. If legislative support falls short, the project will seek alternative funding from private
foundations or community fundraising efforts. These mitigation strategies are designed to ensure
that rural youth in New Hampshire continue to receive essential mental health services despite
potential challenges.
Conclusion and Implications
The collaborative problem-solving and design thinking process employed throughout this
project offered invaluable insights into addressing the unique mental health challenges students
at GMHS face. One of the most significant lessons learned is the importance of engaging
stakeholders at every stage of the project. Involving students, educators, mental health
professionals, and community leaders in the design and implementation process ensured that the
program was tailored to meet the community's specific needs. This collaborative approach also

RURAL MINDS INITIAVE
34
fostered a sense of ownership among stakeholders, which is critical for the program's
sustainability. Additionally, the iterative nature of the design thinking process allowed for
continuous refinement of the program based on feedback and testing. This adaptability is crucial
when addressing complex social issues, ensuring that the solutions remain relevant and effective
over time. The process also highlighted the need for flexibility in program delivery,
acknowledging that the rural context may require alternative methods for reaching and engaging
youth.
Implications for Practice and Future Use
This project has significant implications for practice, particularly in the field of rural
mental health services. Demonstrating the feasibility of a school-based mental health program
tailored to the needs of rural youth illustrates a model that can be adapted and replicated in other
rural communities. The use of design thinking and stakeholder collaboration in the development
of the program also serves as a best practice for other social work initiatives, emphasizing the
importance of user-centered design in creating effective interventions. Additionally, the
program's focus on integrating mental health services within the school environment also has
broader implications for rural education and healthcare ecosystems. By embedding mental health
support directly within the school system, the project addresses barriers to access, often
insurmountable in rural areas, such as transportation and stigma. This integrated approach could
serve as a blueprint for future initiatives to improve the overall well-being of rural populations.
Action Plan
Further steps must be taken to advance the project and ensure its successful
implementation. First, a team of project managers, including community partners and school
staff, must be officially created. Securing funding to support the full-scale implementation of the

RURAL MINDS INITIAVE
35
program is a second major step in program implementation. This includes applying for grants,
engaging with potential donors, and exploring partnerships with local organizations and
government agencies. Next, the pilot program must be implemented. Building on the prototype
of the project, the next step is to implement a full-scale pilot program at GMHS. This will
involve recruiting and training staff, designing and furnishing the school-based wellness room,
forming a student advisory board, and launching the program's initial phase. Continuous
evaluation and adaptation will then be essential to measure its effectiveness and identify areas for
improvement. This will include collecting data on student outcomes, gathering participant
feedback, and adjusting the program as needed. Once the program has proven successful, it will
be expanded to include middle school students and other schools in Coös County. The program
is a scalable model that can be adapted to expand into to other rural areas across New Hampshire
and even the country. Finally, the Rural Minds Initiative's long-term sustainability involves
advocating for policy changes at the state level to provide permanent funding for school-based
mental health programs in rural areas.
In conclusion, this project is innovative in addressing rural youth mental health and has
the potential to create a lasting positive social impact. By leveraging design thinking and
collaborative problem-solving, the project has developed a practical and adaptable solution,
offering a new pathway for improving mental health services in rural communities. While the
Rural Minds Initiative has yet to be piloted, the prototype serves as a comprehensive guide that
can be implemented in a school setting.

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36
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Appendix A
Logic Model
• Diverse
connections,
including
program
partners and
potential
funders
• School
counselor and
community
partnerships
• Research base
• Time
investments
• Telehealth
infrastructure
• Full program
prototype
• Comprehensive
needs
assessments
• Counseling
suite or inschool
suspension
rooms
available to
transition into
wellness room
• Engage
community
partners in
program
implementation
• Form youth
and student
advisory
boards
• Conduct
workshops and
meetings
• Secure funding
for
programming
on-site
• Secure funding
for additional
mental health
professionals
• Conduct
services with
target
audiences
• Marketing and
communication
with
stakeholders
• 100 students
will have
access to
regular mental
health care
each school
year
• Ten families
participate in
family
therapeutic
services
• Easy-toreplicate
curriculum
materials are
published on
the school
website
• Increase
mental health
awareness
and knowledge
among
students
• Change
attitudes
among youth
around mental
health
• Increase in
rural N.H.
youth
accessing care
• Increase in
family
engagement in
youth mental
health
• Mental health
awareness
becomes a part
of school
culture
• Increase the
amount of time
students are in
class
• Increase in
knowledge of
mental health
behavioral
signs for
teachers and
administration
• Decrease in
stigma around
mental health
and seeking
care for mental
health in the
community
• Reduction in
mental health
concerns
among youth
in COÖS
county
• The program
is replicated
across other
rural N.H.
schools
Long-Term
Outcomes Inputs Activities Outputs Short-Term
Outcomes
Mid-Term
Outcomes
Long-Term
Outcomes

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41
Appendix B
Design Criteria
Criteria Wider Opportunity Space
• Be accessible
• Reduce stigma
• Include collaboration
• Be culturally
sensitive
• Have data-driven
assessment
• Prioritize interventions that enhance accessibility to mental health services,
including low-cost options, telehealth, and outreach to remote areas.
• Develop campaigns aimed at destigmatizing mental health challenges
among rural youth and the general population.
• Create a connected network of support involving schools, community
leaders, government agencies, and nonprofits to provide a holistic solution.
• Ensure that solutions are culturally inclusive and tailored to specific
communities.
• Establish mechanisms for continuous data collection, analysis, and impact
assessment to adapt and refine interventions over time.
• Identify co-located or school-located interventions that could be sustainable
and accessible and treat stigma.
• Include education and
awareness
• Mental health training
• Be sustainable
• Provide multiple avenues for youth to access support through schools,
community centers, digital platforms, telehealth services, and more.
• Develop training programs for educators, community members, and peers to
recognize signs of mental health issues and offer initial support.
• Explore sustainable funding models, including public-private partnerships,
corporate sponsorships, and community-driven support to ensure long-term
program viability.
• Identify culture-friendly workshop supports for caretakers
• Have multiple
avenues for youth to
seek help
• Include online
resources
• Peer-to-peer supports
• Utilize online platforms, apps, and virtual support communities specifically
designed for youth in rural areas.
• Promote initiatives that foster peer support, allowing youth to connect, share
experiences, and help each other navigate mental health challenges.
• Increase online broadband access and online supplemental services
• Include short-term
fixes
• Exacerbate stigma
• Assume one approach
will work for all
communities
• Ignore the role of
family and
community
• Assume that a single solution will fit the diverse needs of all rural youth.
• Overlook the importance of involving families and local communities in the
mental health support system. Isolation can be counterproductive.
• Create solutions that reinforce or intensify the stigma surrounding mental
health.

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42
Appendix C
Implementation/Action Plan
Objective Action Justification Impacted
Stakeholder
Deadline
Engage
community
partners
Collaborate with local
community organizations,
mental health agencies, and
educational institutions to
involve them in developing and
implementing the mental health
program.
Community
involvement ensures
diverse perspectives,
resources, and
support, fostering a
community-tailored
initiative.
Community
partners, mental
health
professionals,
educators,
youth and their
families
MarchAugust
2025
Secure space
for wellness
room
Work with school partners to
identify and secure a dedicated
space for the wellness room
within the school premises,
considering future expansion
needs.
A designated space
provides a safe and
accessible
environment for
wellness and
therapeutic support,
which is essential to
the program's
success.
GMHS
administrators,
facilities
management,
mental health
professionals,
students
July -
August
2025
Conduct
workshops and
meetings
Organize workshops and
meetings to educate school
staff, parents, and community
members about mental health,
the program's goals, and the
role of stakeholders. Include
feedback sessions to gather
input for continuous
improvement.
Building awareness
fosters a supportive
environment, reduces
stigma, and ensures
informed engagement
in the program.
Feedback provides
the program is
responsive to the
community's needs.
School staff,
parents,
community
members,
mental health
professionals
August -
September
2025
Secure funding
for on-site
programming
Identify and engage funders to
garner financial support and
resources to fund on-site mental
health programming, including
therapy sessions, workshops,
and awareness campaigns.
Adequate funding is
essential for program
sustainability,
covering operational
costs and ensuring
the availability of
vital services.
Granting
organizations,
potential
funders, school
administrators,
financial
officers
May -
September
2025
Secure funding
for additional
mental health
professionals
Identify and obtain funding to
hire licensed mental health
professionals to provide on-site
counseling and support.
Sufficient staffing is
crucial for meeting
the mental health
needs of the target
youth population and
ensuring the
program's
effectiveness.
Granting
organizations,
potential
funders, school
administrators,
mental health
professionals
October
2025

RURAL MINDS INITIAVE
43
Implement
Services with
Target
Audiences
Roll out mental health services
targeting the identified youth
population, including therapy
sessions, support groups, and
educational programs.
Directly addressing
the mental health
needs of the target
audience is the core
objective of the
program.
Mental health
professionals,
students,
parents, school
staff
September -
November
2025
Marketing and
Communication
with
Stakeholders
Develop and execute a
comprehensive marketing and
communication strategy to
inform and engage stakeholders
about the program. Emphasize
the program's importance and
expected outcomes.
Effective
communication
builds awareness,
trust, and support,
fostering a
collaborative and
informed community.
School
administrators,
parents,
community
members,
mental health
professionals,
local media
December
2025
Launch Pilot
Program
Begin a pilot program in
selected schools to implement
the developed mental health
services on a smaller scale.
Gather data and feedback to
assess the program's
effectiveness.
The pilot program
allows for testing and
refinement of the
initiative before fullscale implementation,
ensuring it meets the
needs of the students
and community.
School
administrators,
mental health
professionals,
students,
parents,
community
members
January -
June 2026
Review and
Revise the Pilot
Program
Conduct a thorough review of
the pilot program's outcomes,
including effectiveness,
challenges, and stakeholder
feedback. Implement necessary
revisions to improve the
program.
Continuous
improvement based
on real-world
application is
essential for refining
the program to serve
the target population
better.
School
administrators,
mental health
professionals,
students,
parents,
community
members
July -
August
2026
Develop a Full
Implementation
Plan
Finalize the program based on
revisions and prepare for fullscale implementation in the
2025/2026 school year. Secure
additional resources as needed
for expansion.
Ensures the program
is fully optimized and
ready for broad
application,
addressing the mental
health needs of
students across the
school district.
School
administrators,
mental health
professionals,
students,
parents,
community
members
September
2026
Full
Implementation
of Program
Roll out the fully developed
mental health program across
all intended schools, providing
ongoing support, services, and
evaluations to ensure continued
success.
The program's broad
implementation aims
to meet the mental
health needs of all
students, promoting
long-term well-being
and academic
success.
School
administrators,
mental health
professionals,
students,
parents,
community
members
September
2026 - June
2027

RURAL MINDS INITIAVE
44
Appendix D
Year One Budget
Category Item Cost
Personnel Costs Program Director $165,000
Licensed Therapists (2) at $85,000 each $170,000
Support Staff (2) at $65,000 each $130,000
Training and Professional Development $5,000
Fringe Benefits at 30% $141,000
Total Personnel Costs $611,000
Program Implementation Costs De-escalation/ Wellness Room Setup $20,000
Workshop Materials and Supplies $5,000
Telehealth Technology and Maintenance $10,000
Total Program Implementation
Costs
$35,000
Marketing and Outreach Website Development and Maintenance $15,000
Social Media and Online Advertising $2,000
Print Materials and Local Advertising $5,000
Radio Advertisements (Once weekly at $100
each)
$5,200
Total Marketing and Outreach
Costs
$27,200
Administrative Costs Office Supplies $3,000
Insurance (Liability and Health) $2,000
Miscellaneous Administrative Costs $5,000
Total Administrative Costs $10,000
Total First-Year Budget $683,200

RURAL MINDS INITIAVE
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Appendix E
Stakeholder Map
Appendix E

RURAL MINDS INITIAVE
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Appendix F
Program Components
Component Description Availability Impact
Co-located
Therapists
Licensed therapists
stationed at GMHS for
on-site therapy sessions
During and
after school
hours
Increased accessibility to
therapy services, personalized
support for students
Wellness
Room
Designated space for
students to seek coping
skills and support during
challenging behaviors
During school
hours
Safe environment for deescalation, reducing
disruptions, and promoting
emotional regulation
Mental Health
Education
Workshops and sessions
to increase mental health
literacy among students
During school
hours
Enhanced understanding of
mental health, recognition of
symptoms, awareness of
available resources
Peer Support
Groups
Groups aimed at
reducing mental health
stigma and fostering
youth engagement
After school
hours
Encouragement of open
dialogue, peer support
network formation, and
normalization of mental
health topics
Family
Therapeutic
Services
Therapy sessions
available for families to
address mental health
concerns
After school
hours
Strengthening familial support
networks, addressing family
dynamics and communication
patterns

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Appendix G
High Fidelity Prototype

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Abstract (if available)

Abstract This capstone addresses the critical issue of inadequate mental health services available to rural youth ages 14-17 at Gorham Middle/High School in Coös County, New Hampshire. The rural area faces barriers such as limited access, transportation challenges, stigma, and financial constraints, contributing to the lack of access and poor mental health outcomes. Aligned with the Grand Challenges for Social Work, the project is grounded in the Grand Challenge of Ensuring Healthy Development for all Youth. It highlights the preventable impact of childhood and adolescent trauma and behavioral health problems. Over 5,000 rural New Hampshire youth face increased risks of Adverse Childhood Experiences and isolation as a result of sparse population density, compounding the issue (Board of Mental Health Practice, 2023). The proposed intervention called the Rural Minds Initiative addresses the inadequate mental health care access for rural youth aged 14-17 at Gorham Middle/High School by co-locating licensed therapists on-site to provide counseling sessions, mental health workshops, and other supports during and after school hours. Additionally, a designated wellness room staffed by trained professionals within the school premises will offer a safe space for students to seek support during challenging situations. Mental health education workshops for students and families will increase awareness, reduce stigma, and promote early intervention. Leveraging telehealth services and Medicaid coverage through community and state providers will enhance accessibility and sustainability. The project's uniqueness lies in its combination and enhancement of existing programs tailored to address the needs of rural youth, fostering collaboration for positive social change. By leveraging evidence-based models and community partnerships, the intervention aims to create a supportive environment that addresses youth mental health needs.

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Asset Metadata

Creator Lemire, Sharon (author)

Core Title Rural minds initiative: navigating mental health wellness together at Gorham Middle/High School

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Degree Conferral Date 2024-12

Publication Date 11/12/2024

Defense Date 11/08/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag adolescent mental health support,Adverse Childhood Experiences (ACEs),community mental health empowerment,community partnerships for mental health,culturally sensitive mental health care,holistic mental health framework,human-centered design in mental health,mental health,mental health access in rural areas,mental health collaboration,mental health disparities,OAI-PMH Harvest,peer support programs,Prevention,rural mental health,school wellness room,school-based mental health,stigma reduction in mental health,systems theory,trauma-informed care telehealth for adolescents,youth mental health interventions

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Manderscheid, Ronald (committee chair), Flanders, Gabrielle (committee member), Futouros, Cassandra (committee member)

Creator Email slemire@usc.edu

Unique identifier UC11399DI6F

Identifier etd-LemireShar-13625.pdf (filename)

Legacy Identifier etd-LemireShar-13625

Document Type Capstone project

Format theses (aat)

Rights Lemire, Sharon

Internet Media Type application/pdf

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