U.S. Cooperative Extension's response to substance misuse: A scoping review

Abstract

BackgroundThe U.S. has experienced exponential growth in overdose fatalities over the past four decades and more than 22 million people are currently living with a substance use disorder (SUD). While great strides have been made in advancing the science of SUD prevention and treatment, proven programs and interventions are not commonly disseminated at scale in impacted communities. The U.S. Cooperative Extension System (Extension) has been recognized as a valued partner in addressing SUD in communities. Federal funding supporting Extension's response to the opioid epidemic reached $35 million in 2021 primarily through two grant programs: the United States Department of Agriculture's (USDA) Rural Health and Safety Education program; and the Substance Abuse and Mental Health Services Administration (SAMHSA) Rural Opioid Technical Assistance (ROTA) grants. The primary objective of this scoping review was to identify the range of Extension activities aimed at mediating substance misuse.MethodsAuthors utilized the PRISMA-SCR model to complete this scoping review. Due to the nature of Extension work and the expectation that few activities would be cited in the peer-reviewed literature, the scoping review included a search of peer-reviewed databases, Extension websites for each state and U.S. territory, and the utilization of a web search engine. Upon initial analysis of records returned, authors noted a discrepancy between results returned and the number of states receiving ROTA grants. Thus, authors supplemented the PRISMA-SCR review protocol with a systematic procedure for investigating ROTA funded activities not readily apparent in the peer-reviewed or grey literature.ResultsA total of 87 records met inclusion criteria. Findings included seven peer-reviewed articles and 80 results from the grey literature. An additional 11 ROTA grantees responded to requests for information regarding state level activities.ConclusionsNationwide, Extension has scaled multiple efforts to address SUD operating through a loose confederation of organizations connected to the land-grant system. Most activities are funded by federal grants and focus on state-sponsored training and resource sharing. The volume of effort is significant, however, implementation at the community-level has been slow. Significant opportunities exist for local adoption of evidence-based practices aimed at mitigating SUD.

The Role of Cooperative Extension in Delivering Training and Technical Assistance to Support Evidence-Based Behavioral Health Practices in Rural Communities

“…We echo the conclusions of Smith et al (2016) and Hagaman et al (2023) who acknowledge that to most effectively promote health within rural communities, we need to involve a range of community partners holding complementary roles, and to better coordinate federal funders’ dissemination strategies that impact the local level. Federal funding entities supporting TTA work, like SAMSHA, influence factors such as application of TTA theories, models, and frameworks (e.g., ISF), intensity and variety of TTA provided, and constructs targeted in TTA evaluation (Scott et al, 2022).…”

“…A recent scoping review of behavioral health programming delivered in Extension found that 29% of programs, activities, and strategies delivered were considered evidence-based and another 14% were evidence- or research-informed (Hagaman et al, 2023). The remainder were categorized as activities (16%; e.g., distribution of Naloxone kits), initiatives (5%; e.g., Recovery Friendly Workplace), trainings (31%; e.g., training to administer Naloxone), or resources (17%; e.g., fact sheets).…”

Understanding the Role of Extension Professionals in Public Health and One Health in Kansas

“…It aims to improve the health outcomes and livelihoods of the communities [ 7 ]. The CES houses a team of campus-based subject matter specialists and support county-level EPs whose activities are driven by the needs and priorities of the local communities, including the available resources from the sponsoring LGUs [ 8 , 9 ].…”