An Extension 4-H Program Helps Prevent Opioid Misuse

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To say that the opioid crisis is a dire health emergency might be an understatement. Opioids are a factor in 72% of the nearly 97,000 deaths from drug overdoses each year. Opioid-involved overdose deaths rose from 21,089 in 2010 to 80,411 in 2021.

North Carolina is not immune from the epidemic. More than 28,000 North Carolinians have lost their lives to drug overdose since 2000. Those numbers don’t begin to measure the damage that addiction inflicts on families and communities across the state.

Niki Maness doesn’t need to read the statistics to know the devastating consequences of drug addiction. She’s seen it first-hand.

“Substance misuse has a long history on both sides of my family — alcohol on my dad’s side, and any altering substance available on my mom’s side,” she said. “Not long before I moved back home, I lost a great uncle due to an opioid overdose of Oxycontin and fentanyl. Two of his three sons followed in his footsteps by misusing opiates. I have a close cousin whose life is over because he’s facing several prison sentences — all drug-related in one way or another. I’ve seen how the choices have an effect on the family and how the pattern of misuse is so easily recreated if the cycle isn’t broken.”

Home is Yancey County, where she grew up. She returned late in 2017 to become a program assistant for NC State Extension’s Empowering Youth and Families Program (EYFP).

EYFP is a family leadership program administered by NC State Extension 4-H with a primary focus on opioid prevention education for youth and their caregivers in rural North Carolina. The goals are to improve parenting skills to equip young people to make healthy choices,  improve family relationships, and  empower families to lead community change. Achieving those goals is key to reducing youth substance use.

“Extension has a role to play. Our role is prevention through education,” said Amy Chilcote, the program’s first director. “People may say why is 4-H doing this. The fourth clover is health. We are over 100 years old, and we have always done our best to meet young people where they are when society needs us to move in that direction. If we don’t do it, we are doing children a misjustice. They’re our next generation.”

NC State Extension 4-H empowering youth and families opioid prevention

Adults and youth say they are equipped to talk about difficult situations after completing the Empowering Youth and Families Program.

EYFP began in 2017 when a Rural Health and Safety Education grant from the USDA’s National Institute of Food and Agriculture program allowed for curriculum development. It was implemented in three counties the following year, and has since been taught in 12 counties. Yancey was one of the inaugural counties, and Maness was one of the first program assistants. 

Like NC State Extension agents and experts around the state, Maness is motivated by a deep desire to help her neighbors and fellow community members.

“Once I moved back home, every other time an arrest report came out, I was seeing someone from high school or someone I knew personally on the list for drug charges,” said Maness, now an Extension Family and Consumer Sciences agent. “I wanted to make a difference in the community where I was raised. All of this is why I wanted to work with EYFP and why I continue to work with the program.”

The primary purpose of the program is not stated in the title. That is by design.

“That was the biggest barrier when I started,” Maness said. “You would say, ‘I’ve got this great program. It’s an opioid prevention program.’ You would see people’s faces go blank. ‘We don’t have this problem. It’s not happening in my family. We don’t need it.’”

Instead the emphasis is on equipping families with skills to prepare adolescents to navigate the difficult path to adulthood.

“We don’t advertise opioid prevention to our participants and families up front,” said Extension associate Autumn Cano-Guin, who co-developed the program and became director when Chilcote retired. “We talk about learning how to be a stronger family and helping youth set goals, things that are attractive to parents.”

NC State Extension 4-H empowering youth and families opioid prevention

Caregivers and youth learn vital communication skills during the 10-week Empowering Youth and Families Program.

One of the distinctives of EYFP is the involvement of dads, moms and caregivers. They attend along with their kids, participating in 10 weekly sessions where together they learn perhaps the most important skill — communication. 

“If your family is together and talking a lot, your kids are not going to be out doing stuff you don’t know about,” Maness said. “That in itself is a form of prevention.”

Studies show that if children feel free to talk about anything, and if parents attentively listen to their concerns, problems like substance misuse can be stopped before they start.

“A couple of the parents had used opiates in the past,” Maness said. “After going through the program, they say it is easy to talk about it with their kids. They know how to communicate regarding some of these bigger things like peer pressure, knowing what substances are, and don’t take pills that are not yours.”

The weekly sessions begin with family meal time, move to break-out discussion groups, and end with a time to plan action steps.

“Everybody sits down to do a meal together,” Maness said. “We give them conversation starter cards and ideas of what to talk about beyond ‘How was your day?’ ‘Fine.’ Then they have an hour of individual time with the adults in one room and the kids in another. There’s an activity the parents love where we talk about having five positive engagements for every one negative. Then they come together and talk about what they have learned. We ask them to come up with a family motto, what represents your family in a couple of words. Many of them have never talked about what their family values are.”

NC State Extension 4-H empowering youth and families opioid prevention

A community event in Yancey County helps spread the word about the dangers of opioid abuse.

At the end of the program, families are encouraged to hold community outreach events to spread the word about what they have learned, expanding the reach of the program. 

“That’s our change mechanism, creating advocates who can then educate the community,” Cano-Guin said. “Hopefully they will stay involved to pass on what they now know to young people, to older people, to everybody. The big win is when we’re able to have people become advocates.”

The outreach events are supported by EYFP associates, other Extension agents, and community groups and representatives.

“This is a place where we were able to bring together the best of Extension,” Cano-Guin said. “We have Family and Consumer Sciences agents, we have County Extension Directors, we have 4-H agents. We have community partners, all helping with the youth and families. That’s one of the things that most excites me about the work, bringing together all of those parts of Extension to do something. This is a labor of love for us.”

While EYFP facilitators are available to provide input, access Extension resources and help implement the outreach, it is the families who collaboratively brainstorm and plan the events.

“It’s their time to come up with something to create awareness or education around substance misuse,” Maness said. “We’ve done Halloween events, where along with candy we give out information about spending time as a family. We did a really big three-day event where we partnered with at least 20 different agencies in Yancey and Mitchell counties. We did a county-wide education day where we provided trauma-informed care and resources. We’ve done training to help the police department and county agencies become better informed about dealing with people who have had a rough past.”

NC State Extension 4-H empowering youth and families opioid prevention

Participants in a recovery walk during the last day of a three-day community event planned by EYFP graduates in Yancey County to raise awareness about the dangers of opioid addiction.

The families are equipped to be advocates after going through a curriculum that is based on science and research.

“We looked at the best of the best research behind parenting, behind youth identity,” Cano-Guin said. “We are very heavily focused on the work around adverse childhood experiences, social determinants of health, and the science of learning and positive youth development. The idea is to have parents who understand youth development, and distinctions between what is positive discipline versus what is punishment. Things like emotion regulation and delay of gratification are important.”

Delayed gratification is a vital component of the curriculum. Research shows the harmful effects of substance abuse — whether opioids, alcohol, marijuana or tobacco — before the brain has fully matured.

“Brain science tells us the brain is not fully developed until age 25,” Cano-Guin said. “If you misuse substances earlier in that trajectory you are actually changing the composition in the way the brain works in a way that can be devastating.”

One of the tools youth learn is the importance of goal setting, and concrete ways to put it into practice.

“It’s understanding the ‘how’ of goal setting,” Cano-Guin said. “It’s not good enough to say I want to be a doctor. You have to get good grades, and in order to get good grades you might have to study instead of going outside to play basketball. Giving them those concrete skills helps them to delay gratification. That’s the big picture piece that helps youth to be successful and to delay onset.”

NC State Extension 4-H empowering youth and families opioid prevention

Extension agent Niki Maness (rear) at Millstone 4-H Camp with a family that participated in the Empowering Youth and Families Program.

Data published in the EYFP impact report provides evidence that the program is having a positive impact. More than 90% of caregivers who participated in 2022 either agreed or strongly agreed that they had confidence in their ability to identify warning behaviors for substance misuse. Among 2022 youth participants, 73.9% agreed or strongly agreed that they were better able to discuss difficult situations with their caregivers following EYFP. 

There are scores of anecdotes about the difference EYFP is making in the lives of families. Maness tells the tale of a couple who learned how to turn their disparate backgrounds into a strength.

“They met in the military,” she said. “The husband was from Yancey County and the wife was from California. She said he was raised really strict and she and her brothers kind of raised themselves because her mom was an active user and her dad was an alcoholic. She said this helped them figure out mutual ways to parent that combined both styles. Just enough freedom for the boys without being overprotective.”

Success stories are always encouraging. Extension agents are invested in their communities, and come to work every day hoping to make a difference.

“I just want to make a better place for my kids to grow up in,” Maness said.