Closing the mental health treatment gap for rural adolescents: An evidence-based collaboration in a public high school

Background: Mental health disorders represent the most common disease in childhood and adolescence in the United States, with anxiety disorders showing the highest prevalence. Adolescents in rural areas face unique socioeconomic and cultural challenges, elevating their risk for anxiety and depression. Of note, less than 1/3 of youth with mental health disorders receive evidence-based treatment. Methods: The primary objective of this evidence-based practice project was to enhance mental health screening in a local rural high school and to increase access to mental health care through the implementation of Creating Opportunities for Personal Empowerment (COPE). Students (485) in a public high school received evidence-based mental health screening materials, which 39.8% (193) returned. Students were recruited to participate in COPE through a convenience sampling method. The 7-session COPE program was co-led by a primary care pediatric nurse practitioner and the director of school counseling. Findings: Participants completed mental health screening forms, including the PHQ-9 and GAD-7, prior to intervention, after the 4th COPE session, and again after the intervention. Participants also completed a qualitative evaluation. Results indicate clinically significant improvements in anxiety, with depression symptoms remaining at baseline. Conclusion: The delivery of COPE in a rural public school setting has the potential to meet a great need for increased access to mental health care. The project is cost-effective and is well accepted by school administrators, students, and parents.