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INVESTIGATOR: Farrell, B. P.; Tutor Marcom, RO, .; Hatcher, BR, .

PERFORMING INSTITUTION:
Rollins Animal Disease Diagnostic Laboratory
2101 Blue Ridge Road
Raleigh, NORTH CAROLINA 27607

FARMER AND RANCHER STRESS ASSISTANCE NETWORK - NORTH CAROLINA (FRSAN-NC)

NON-TECHNICAL SUMMARY: North Carolina is home to 46,200 farms, 85% of which are family owned and operated as defined by the USDA-NASS 2017 Census of Agriculture. Farms have been plagued with numerous stressors including catastrophic weather, nuisance law suits, land loss, COVID-19, labor issues and more. NC has been working to better understand and respond to the issue of farm stress resulting in a network of researchers, Extension professionals, behavioral health providers, agricultural organizations, funders, policy makers, and farmers/ranchers. Outcomes of collaboration serve as underpinnings for successful development of the Farm and Ranch Stress Assistance Network-NC (FRSAN-NC). FRSAN-NC will be overseen by NC Department of Agriculture & Consumer Services in collaboration with the NC Agromedicine Institute, NC State and NC A&T Cooperative Extension and CareNet Counseling, Inc. New and existing partners will be involved at to strengthen FRSAN-NC's work,, especially in relation to farmers of color and veterans. This will include coordinating with the Southern Region-FRSAN to ensure that work is completed with minimal repetition and maximum sharing.FRSAN-NC will set up and implement a statewide farm crisis and resource line, develop and implement an agricultural specific curriculum for the recognition/management of farm stress-related conditions and emotion regulation, and increase access to counseling and support systems needed to reduce the burden of farm stress. Opportunities will be made for farmers, ranchers, their family members, and staff of agencies supporting farmers (e.g., Cooperative Extension, Farm Services Agency, Farm Credit, etc.) to take advantage of other stress-related trainings such as Mental Health First Aid.

OBJECTIVES: FRSAN-NC will be overseen by NC Department of Agriculture & Consumer Services in collaboration with the NC Agromedicine Institute, NC State and NC A&T Cooperative Extension and CareNet Counseling, Inc. New and existing partners will be involved to strengthen FRSAN-NC's work, especially in relation to farmers of color and veterans. This will include coordinating with the Southern Region-FRSAN to ensure that work is completed with minimal repetition and maximum sharing.FRSAN-NC will set up and implement a statewide farm crisis and resource line, develop and implement an agricultural specific curriculum for the recognition/management of farm stress-related conditions and emotion regulation, and increase access to counseling and support systems needed to reduce the burden of farm stress. Opportunities will be made for farmers, ranchers, their family members, and staff of agencies supporting farmers (e.g., Cooperative Extension, Farm Services Agency, Farm Credit, etc.) to take advantage of other stress-related trainings such as Mental Health First Aid.

APPROACH: Methods for implementing the FRSAN-NC are outlined below; surveys will be conducted at events and trainings where appropriate. Number of participants will be shared for those activities that are confidential based on type of service provided to these individuals.1. Develop and implement farm specific curriculum on recognition/management of farm stress related conditions and emotional regulation for farmers, ranchers, and their communities. A total of 25 workshops will be conducted, reaching a total of 200 individuals across the state. (lead: CareNet, Inc.)2. Provide access to Mental Health First Aid and other behavioral health training, as appropriate. Support will be provided for tuition reimbursement, supplies, travel, and subsistence for individuals to access/conduct Mental Health First Aid or other behavioral health trainings, as appropriate. (lead: NC Agromedicine Institute)3. Partnering to care for NC's Diverse Farm Community. Twoworkshops will be conducted across the state reaching a total 120 individuals with continuing education credit for CareNet staff.(lead: NC Cooperative Extension/ CareNet, Inc.)4. Increase access to behavioral health (BH) and Farmer to Farmer peer support services for farmers of color, veterans, farmworkers, and their families.Identify BH providers of color and/or with military services from a farm background.Provide training for providers of color and/or with military service not from a farm background.Provide farm stress awareness training and resources for farmers of color and veterans.Work with consultant to coordinate training & resources for farmworkers. (lead:NC A&T State University/NC Agromedicine Institute)5. Establish care circle model for farms in crisis.Partners will come together with other farm-related organizations (e.g., Farm Credit, USDA -Farm Services Agency, etc.) to develop a model for agencies to collectively support farms in crisis. Care circles will be coordinated by six Community Connector staff (lead: CareNet, Inc.)6. Set up & activate Farm Crisis & Resource Line.Six staff will be trained on use of farm crisis & resource line software; crisis and resource line will be promoted and activated. (lead: NC Agromedicine Institute)7. Establish counseling internship /pilot counseling services in Cooperative Extension offices. A pilot counseling program will be established in Cooperative Extension Offices with the goal being to reduce stigma associated with accessing services in a clinical setting. Program will be developed as a special project for a master's level counseling student in their final program semester.(lead: NC Agromedicine Institute/NC Cooperative Extension)8. Support cost of behavioral health services for farmers, ranchers, and their families. Funds will be made available to support up to 6 counseling sessions/100 individuals. (lead: CareNet, Inc.)9. Coordinate activities with Southern Region - Farm & Ranch Stress Assistance Network (SR-FRSAN). Participate in SR-FRSAN meetings; monitor activities of SR-FRSAN & other state partners; participate in SR-FRSAN SWOT analysis and other activities/workgroups; share learned experiences and provide technical assistance to other states, as appropriate; promote SR-FRSAN activities across NC. (lead:NC Agromedicine Institute)

PROGRESS: 2022/09 TO 2023/08
Target Audience:Target Audience Farmers, ranchers, farm family members, farmworkers, and agencies/organizations providing support to farming and ranching populations in North Carolina. Changes/Problems:What do you plan to do during the next reporting period to accomplish the goals? Subcontracts with the NC Agromedicine Institute-East Carolina University and CareNet, Inc - Wake Forest Health will be maintained. Work will continue on each of the state work plan goals discussed earlier in this report. Staff will continue to collaborate with community partners across NC and the southeastern US to close any gaps that exist relative to access to services, support services and training. Efforts will also be made to ensure that project activities and outcomes are evaluated and documented. What opportunities for training and professional development has the project provided?What opportunities for training and professional development has the project provided? The FRSAN-NC Coordinator and Outreach Specialist were both certified as adult Mental Health First Aid trainers. The Outreach Specialist has also completed rural, first responder and military modules. The FRSAN-NC Resource Specialist has been certified as a youth Mental Health First Aid (MHFA) and QPR trainer. All three, along with five other Institute staff, the Executive Director (ret.US Marine Corp) and a student (ret. US Army) from The Veteran's Farm of North Carolina have completed Farmer to Farmer (peer support) training. Thirty-three (33) health profession students (Master of Public Health, Master of Environmental Health, Master of Nursing Science, and Doctor of Nursing Practice) completed a module on psychosocial conditions in agriculture as part of the Institute's Fundamentals of Agromedicine course. The Institute also maintained its online Agriculture Behavioral Healthcare for Family Farm Systems and Agricultural Behavioral Health Care for Family Farm Systems - The Farmworkers courses https://www.piedmontahec.org/courses-and-events/68461/ashce-agricultural-behavi oral-healthcar-for-family-farm-systems and https://www.piedmontahec.org/courses-and-events/68462/ashce-agricultural-behavi oral-healthcare-for-family-farm-systems---the-farmworkers Dr. Tutor Marcom shared an overview on the development, implementation and future plans for FRSAN-NC with ~75 participants at a national Family Consumer Sciences meeting held in Raleigh, NC. Similarities and differences in state and regional FRSAN programming and reporting were discussed. Tips for working with local Cooperative Extension agents and state level leaders were also shared. The Institute sponsored a session on Cultivating Health Farmers: How Family Medicine Can Keep NC Farms Growing on December 3rd at the 2022 Winter Family Physicians Weekend coordinated by the NC Academy of Family Physicians. Dr. Dawn Caviness led the session along with farmer and Stanly County family physician, Dr. Holly Stegall. Two hundred fifty five (255) physicians were in attendance. A physician that grew up on a farm provided the following feedback: "I grew up on a farm, my dad was a farmer, my grandad was a farmer, and I helped farm until leaving home. Farming and the beauty and stress of it was my normal. It was so helpful to hear y'all's stories to help me find language to describe it and understand it better for myself and for what it was like for my parents. Even growing up in it, without hearing it, it's hard to understand the water we swim in until someone describes it and then I'm like, yeah! That's it! So, thanks for putting to words what it's like and helping others understand it better (farmers themselves and those caring for them)." Dr. Dawn Caviness - Atrium Health, Dr. Roberta Bellamy-Medical and Family Therapy Consulting, Mr. Elliott-Veterans Farm of NC, and Reverend Brian Davis-CareNet attended the 2023 International Society for Agricultural Safety and Health meeting in Tampa, Florida with support from the Institute. Each of gave oral presentations about their work with the Institute in addressing the health or behavioral health needs of North Carolina's farmers including military veteran farmers, women and farmworkers. They were also given the opportunity to attend professional development sessions and to network with others from around the world doing work in the area of farm stress. Dr. Tutor Marcom continues to serve on the dissertation committee for a health sciences student from Radford University Carilion who is surveying healthcare providers in NC's top ten agriculture producing counties to determine what they know about and how they respond to patients presenting with farm stress. How have the results been disseminated to communities of interest?How have the results been disseminated to communities of interest? Results have been disseminated through in-person and virtual events, social media, websites, popular media and word of mouth. The project has a dedicated website www.ncfarmstress.org and Facebook page @Farm and Ranch Stress Assistance Network. Additional information about dissemination efforts can be found under Goal 2 above and under Products and Other Products sections below. Bobby Thompson, a farmer and Farm Health Connector from Pitt County spoke about farm stress leading to suicide at NC Senator Don Davis's May 5th listening session for the 2023 Farm Bill. Bobby's comments were broadcasted on WNCT Channel 9 News. https://www.wnct.com/news/politics/congressman-don-davis-hosts-listening-sessio n-in-pitt-county-regarding-2023-farm-bill/ What do you plan to do during the next reporting period to accomplish the goals?What do you plan to do during the next reporting period to accomplish the goals? Subcontracts with the NC Agromedicine Institute-East Carolina University and CareNet, Inc - Wake Forest Health will be maintained. Work will continue on each of the state work plan goals discussed earlier in this report. Staff will continue to collaborate with community partners across NC and the southeastern US to close any gaps that exist relative to access to services, support services and training. Efforts will also be made to ensure that project activities and outcomes are evaluated and documented.

IMPACT: 2022/09 TO 2023/08
What was accomplished under these goals? ?What was accomplished under these goals? Curriculum Development Project staff continue to work with CareNet, Inc, Cooperative Extension, Eastern Area Health Education Center, American Foundation for Suicide Prevention - NC Chapter and other community partners to develop and/or identify curriculum. Training topics are chosen based on requests from members of the community and on qualitative and quantitative research findings. To continue to legitimize the farm stress conversation by using voices from the farming and ranching community, three additional panels have been conducted. Two at the NC Association of County Agricultural Agents annual conference, one at an event with Carolina Farm Stewardship, one during a NC Choices and SAgE webinar, and one at a Farm Connector training. Revisions to the Institute's Farmer to Farmer curriculum have been completed. . Access to MHFA and other behavioral health training MHFA and QPR training are made available to farm community members across the state at no cost. To date, 33 individuals have completed adult MHFA, 11 have completed youth MHFA and 10 have completed QPR. A total of 60 training sessions have been conducted with other topics including recognition and management of farm stress and FRSAN-NC resources. At least 2530 individuals have been reached through these activities. Partner to care for NC's Diverse Farm Community Initial plans for this goal were to conduct two workshops for CareNet providers and Cooperative Extension agents. Those were completed in Spring 2022 and reported on in the previous year's annual report. In addition to training for CareNet providers, staff have collaborated with CareNet staff to facilitate training for Farm Health Connectors, Faith Health Connectors and Faith Health nurses. The Institute and CareNet partnered with the American Foundation for Suicide Prevention to provide SafeTalk training for twenty-nine Farm Health Connectors and FaithHealth Connectors. Training on agromedicine and farm stress was also provided for Faith Health Connectors from Atrium Health Wake Forest Baptist (FaithHealth - Community Partnerships for Better Health). This population consists of trusted members of the faith community who work to provide referrals to resources that can assist with decreasing stress/burdens that are not remedied by behavioral health appointments (i.e., handicap ramp for wheelchairs, assistance with food, caring for an aging parent, etc.). Two trainings on agricultural safety and health and farm stress were conducted with Atrium Wake Forest Baptist's Faith Health Nurses and Faith Community Health Workers. A total of forty-one individuals from six counties participated. Increase access to behavioral health and Farmer to Farmer peer support services for farmers of color, veterans, farmworkers and their families. Work continues with The Veteran's Farm of North Carolina to develop curriculum for teaching veterans transitioning into farming about the signs/symptoms of stress and how to manage it effectively. This work is being done through a partnership with Dr. Roberta Bellamy, LMFT, facilitated by the Institute and funded by the NC Farm Bureau. A model for prevention of veteran suicide has also been developed and is undergoing evaluation. NC Farmworker Health Program, growers and migrant outreach programs continue to be made aware of the availability of assistance with behavioral health services for migrant/seasonal farmworkers. The NC Growers Association continues to cover cost of travel for LMFT to visit farms whenever a request is received for assistance with a farm worker behavioral health issue. D FRSAN-NC Coordinator and Institute AgriSafe-NC Nurse participated with the NC Baptist Medical bus to conduct health services for farm workers in Wilson and Nash counties. Services included a behavioral health screening and referral coordination, if indicated. Establish a care circle model for farms in crisis. Connectors are individuals of high trust in the community who serve as the bridge between a member of the farming community and additional needs he/she may have beyond counseling. The expectation is that CareNet counselors may identify needs, beyond counseling, that a farmer, farm family member of farm worker may possess. When this happens, the counselor will refer the person to the Connector who will work with other community partners to find resources to meet this additional need. For example, a farmer may share that an additional point of stress in their life is related to a specific health need of an aging parent. The counselor will refer the farmer to the Connector, who will then collaborate with other community resources to address these specific needs of the parent. Connectors have served twenty-one (21) individuals. Thirteen (13) farmers, two (2) farm family members, one (1) logger/forester, one (1) nurseryman, one (1) beginning farmer, one (1) farmworker, and one (1) farmer who rents land. Farm Health Connectors are also working with community partners to increase awareness around farm stress and FRSAN-NC resources. Set up and activate farm crisis line. The NC Farm Help Line is available 24/7 and continues to be promoted to the farm and ranch community on the FRSAN-NC website, during partner meetings and outreach/education events. To extend promotional reach, a portion of additional funds received in November 2022 was used to conduct a 6-week radio broadcast campaign on the Southern Farm Network. Establish counseling internship/pilot counseling services in NC Cooperative Extension offices. The intern who planned to pilot counseling services in Cooperative Extension offices was unable to do so due to IT security and HIPPA concerns expressed by NC State University. Unfortunately, concerns were not applicable as the platform used to conduct telehealth services meets security and privacy requirements. CareNet, Inc. plans to establish an internship in Fall 2023 that will pilot service provision in a local Cooperative Extension office. Salary support for the intern will be provided by the Institute. Support cost of behavioral health services for farmers, ranchers, their workers and their families. A portion of CareNet's subcontract is to provide services at no cost to farmers, farm family members and farm workers. To date, CareNet has reported 135 sessions. Coordinate activities with Southern Region - Farm and Ranch Stress Assistance Network (SAgE) Dr. Robin Tutor Marcom serves as Principal Investigator (PI) on the subcontract with the University of Tennessee (UT). UT serves as the lead institution for SAgE. The Institute's primary scope of work isto serve as the lead for farmer/rancher support networks in the southern region and to develop a behavioral health provider support network. The intent of the network will be for providers to have a place where they can share best practices, discuss service delivery issues, receive training, and gain support for self-care. Additional funds have been requested from SAgE to provide training and technical assistance to community liaisons for diverse populations including military veteran and Lumbee farmers. Courtney Moore, FRSAN-NC Coordinator, provides logistical and technical assistance for support activities in other states and periodically serves as SAgE's representative at conferences such as the South Carolina Black Farmers Coalition and the 2023 International Society for Agricultural Safety and Health meeting. Staff participate in SAgE office hours and action team meetings, as appropriate and scheduled permitting.

PUBLICATIONS (not previously reported): 2022/09 TO 2023/08
No publications reported this period.