Project Profile: Teen Speak-Out

PROJECT: Engaging rural teenagers to develop community-driven interventions to address stress.

• Convened five community Teen Speak-Out dinners with prompting questions, discussions, and brainstorming to identify perceptions of approaches to address stress
• Recruited 35 teens (including two youth leaders) aged 13-19 from the Woodsville (NH), Blue Mountain Union (VT), and Oxbow (VT) school systems, with some teens attending multiple sessions
• Formed a Teen Advisory Board that included at least two teens from
from each school system; also invited community stakeholders to attend dinners
• Used questionnaires to do pre- and post- testing of teen well-being and to determine: acceptance, perceived relevance and usefulness, and intention to use interventions in the future; and to develop strategies for broad dissemination

“Teen Speak-Out gives youth in our community an opportunity to voice how they feel about their experience growing up in rural Vermont and New Hampshire. Students have a chance to guide a group discussion about identifying what the barriers are and how to develop strategies to overcome them. The program has been a powerful away for students to see how big of an influence they have on their community and how their mobilization can change the way their community evolves over time…

“Giving youth a chance to develop leadership skills and realize their influence on their community establishes a sense of worth and belonging, which initiates a ripple effect of positive change.”

– Ashleen Buchanan, Program Coordinator, Little Rivers Health Care

• Identify individual and social factors associated with stress among teens living in rural communities along the Connecticut River
• Targeted catchment area included underserved communities in and around Haverhill (NH), and Wells River and Bradford/Newbury (VT)
• Design and evaluate the feasibility and acceptability of at least one measurable intervention to address stress among teens that could be reproduced

• Researched mobile apps rated for teens (through partnership with the Dartmouth Center for Technology and Behavioral Health); Pacifica stress and anxiety app chosen by Teen Advisory Board
• Compelling and heart-breaking stories shared by teens documented by the research group and shared with community stakeholders
• Little Rivers Health Care leveraged HRSA funding to enable the expansion of its behavioral health program and thus provide clinical social workers at 2 area high schools to provide counseling services to any teen in need of these services
• After 6-week trial period, teens reported that the Pacifica app was very helpful in dealing with stressors and saw it as a valuable support tool for future use that could easily be disseminated to other students
• Students found in-school counselors/therapists to be very beneficial, and community stakeholders offered significant support for expanding these positions to more school systems through FQHC funding
• Some research activities (such as school events and calendars) were limited by lack of school buy-in

TEENAGERS’ PERSPECTIVES: The teens identified a number of key sources of stress—among the most prevalent were: bullying (especially cyber bullying), schoolwork, time, parents, money, and drama.

They communicated a desire for: a safe space for discussing their stressors, better coordination of school schedules (to help avoid exam “overload”), more adult guidance, counseling/therapy available at school, a school mechanism for dealing with bullying, and a “Life 101” course (to learn practical skills like budgeting and grocery shopping).

The above schematic, created by the research team, illustrates the many sources of stress identified by the teens—the larger and bolder the stressor, the more frequently it was reported.

The teens suggested a number of interventions to help deal with their stress. These included: mindfulness apps or programs; counseling/therapy available at school; free yoga, dance or Zumba classes at school; discussion groups like Teen Speak-Out, schoolwide on-line and coordinated schedules, and a project for sharing stories, such as those found on the “Humans of New York” and Tumblr sites.

“I really enjoyed Teen Speak-Out. I got to meet other kids from the area. I was able to talk about stressors in my life, both at home and at school, and learned about different ways to deal with them.”

-Jessica Riley, Student Participant, Freshman at Woodsville High School

“As a result of our involvement in this project, Little Rivers Health Care was made aware of an unmet need for behavioral health resources for this population. Further discussion in our Community Collaborative and with our area schools has now resulted in placing social workers at 3 area schools, and we are recruiting an additional social worker to provide these services at 2 other schools who have requested them…

“We have continued to receive reports from the schools about what an enormous help this has been to them and were specifically cited by the Vermont Board of Education for developing a model they would like to see replicated across the state. This project has demonstrated in no uncertain terms how powerful it is to actually listen to teens!”

-Gail Auclair, Chief Executive Officer, Little Rivers Health Care

FUNDING: Dartmouth Clinical and Translational Science Institute (aka SYNERGY), AIMS (Access Increases in Mental Health and Substance Abuse Services) grant.

“The advantage of introducing an intervention like the Pacifica app is that it’s a low-risk technology solution that teenagers can easily embrace—if you have a teen, you know that their phone is like an appendage to their bodies! We found that it was easy for them to use, and they seemed to like it…

“By continuing with this research, we hope to further develop and evaluate both technology- and non-technology-based intervention solutions that can make a real difference in helping teens to manage stress and life challenges.”

-Maureen Boardman, Principal Investigator

RESEARCH TEAM: Maureen Boardman, APRN (PI), Little Rivers Health Care, Bradford, VT; Deborah Johnson, MHA, Executive Director of the Dartmouth Primary Care Cooperative Research Network; Sarah Lord, PhD, Director of the Dissemination and Implementation Core of the Dartmouth Center for Technology and Behavioral Health; Ardis Olson, MD, Professor of Pediatrics and of Community and Family Medicine at Geisel School of Medicine.

COLLABORATORS: Woodsville High School, Haverhill Middle School, Oxbow High School and Middle School, Blue Mountain Union School, Riverbend Career and Technical Center, Little Rivers Health Care, Newbury Health Clinic, Clara Martin Center, Vermont Blueprint for Health.


The strong relationship that exists between stress and teen health has been well-documented. High stress and anxiety are associated with teen risk behaviors such as substance misuse, mental health difficulties, academic problems, poor decision-making, and diminished physical well-being.

The most recent annual teen risk behavior assessments of high school students in Vermont indicate that those living in rural, underserved areas where poverty is prevalent—such as those targeted in this study—are among the highest risk statewide.


The project team is applying for additional funding to study the teen-identified intervention approaches more broadly. They are considering doing an intervention targeting teens with pre-existing anxiety/mental health diagnoses.


Project Profile: Patient Decision Aid for Depression

PROJECT: Guide the development of an encounter-based decision aid for depression that can be seamlessly embedded into primary care clinics. The tool will facilitate routine depression screening while linking real-time decision support to patients who screen positive for depression.


  • Four focus groups (6-12 people each) including individuals with depression, members of the general public, and clinicians to inform the decision aid’s scope and identify facilitators and barriers to implementation
  • Participants recruited from Dartmouth-Hitchcock Nashua, Dartmouth-Hitchcock Medical Center (Lebanon), and Mental Health America
  • Usability testing of an on-line prototype of the tool to identify refinements for the decision aid development
  • A caregiver partner and consumer partner who contribute to study design, analysis, and sharing of the research findings

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Project Profile: Connecting Patients and Researchers in Patient-Centered Vascular Disease Research

Ms. Joan Baillargeon (center) is a Patient Advisor that helped with the Patient Advisors course. source: Patient Advisors Course in Vascular Medicine

Patients with vascular disease want to share their personal experiences, connect with other patients, and more actively participate in research to help others. Clinicians and researchers in vascular care have been largely unable to connect with patients with vascular disease and engage in patient-centered outcomes research. To create a network between researchers, clinicians, and patients trained in patient-centered outcomes research (PCOR), Dr. Adrienne “Addi” Faerber’s team has created an online course to teach patients with vascular disease in PCOR, along with sessions held at the 2017 Vascular Annual Meeting of the Society for Vascular Surgery. These sessions included a patient panel discussion that explored questions about how to improve the care of patients with vascular disease, and a patient-researcher networking reception, along with opportunities to learn more about PCOR in vascular disease research.

Goals: Bring together patients with vascular disease, researchers, and clinicians.
Create a network between researchers, clinicians and patients trained in patient-centered outcomes research (PCOR).
Build an infrastructure to permit patient-centered outcomes research in the field of vascular disease.

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Project Profile: Standing Strong

A community-led initiative to improve care for our aging population

Community Connection
Why Quail Hollow?
Desired Outcomes
Contact Info

Part of an ongoing effort to improve care coordination between community services and health systems, by creating a communication process between Emergency Medical Services and Primary Care Physicians that will reduce unnecessary Emergency Department visits, this pilot project is aimed at preventing falls-related injuries and death in people over age 65 in our communities and reducing falls related 911 calls.  

Funding Source(s):

  • DH-Population Health
  • Endowment for Health Grant
  • Public Health Council of the Upper Valley (PHC)
  • Lake Sunapee Regional Visiting Nurses Association (LSRVNA)
  • Dartmouth Center for Health & Aging (ACL Grant)

Goals of the intervention:

  • Increase # of Home Safety Visits made by LSRVNA
  • Increase # of seniors connecting with DCHA to participate in falls prevention programs.
  • Reduce # of falls-related 911 calls
  • Reduce # of ED visits or hospitalizations due to falls

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Project Profile: Mental Health at the Margins

What was Discovered
Next Steps

Mental Health at the Margins uses qualitative and participatory research methods to learn about the perspectives and experiences of low-income rural populations. This information will be used to recommend strategies for designing culturally-appropriate mental health supports with the longer-term goal of reducing rural mental health disparities.

Funding: Dartmouth Synergy Grant

Goals for the intervention:

  • Identify concrete strategies for improving mental health services
  • Create an infrastructure that promotes systematic learning from community members, direct services providers, and other mental health stakeholders


  • Conduct qualitative interviews with Haven service users
  • Establish and sustain a Project Advisory Board
  • Hold community forum discussions with Haven service users and staff
  • Create brief, multi- media stories with Haven service users and staff
  • Evaluate feasibility and acceptability of community-engaged research strategies

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Project Profile: Healthy Families Mobile Phone Pilot

The Aim of the Healthy Families workgroup:
Ensure healthy lives and well being for people of all ages. Allow all families to thrive by eliminating all barriers to safe housing, employment, education and nutritious food. Some identified barriers include limited transportation, unintended pregnancy, limited communication, poverty, and lack of affordable, quality child and elder care.

The Plan:
First initiative: Pilot project for expanding communication infrastructure for socially vulnerable families.

The TLC Family Resource Center serves families in Claremont and reports difficulty engaging and retaining families in evidence-based early childhood home visiting programs. One challenge is that some families in transition do not have a stable phone number or internet access. This makes communication difficult. This project distributed mobile phones with internet access and phone cards to improve communication, retention and service delivery to socially vulnerable families.

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Project Profile: MySafePlan


MySafePlan- a Mobile App
Background Data 
Next Steps
More Information / Contact

PROJECT: MySafePlan mobile app

GOAL: Engage women in developing a digital technology to provide easily accessible resources needed for self care, recovery, and parenting and to support compliance with the federal mandate for a plan of safe care for babies born exposed to opiates during pregnancy.

COMMUNITY PARTNERS: Habit OPCO, a national network of substance use treatment centers that provide methadone and buprenorphine treatment to individuals with opioid use disorder; Groups (formerly Recover Together), a locally-started and nationally growing network of centers that provide medication-assisted treatment and group psychosocial support to individuals with opioid use disorder.

RESEARCH TEAM: Sarah Lord, PhD; Daisy Goodman, CNM, DNP, MPH; Jennifer Williams, LPN; Mary Kay Jankowski PhD


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Project Profile: NH Falls Prevention Network Hub

“Tai Ji Quan: Moving for Better Balance®” class at Dartmouth Hitchcock Medical Center (DHMC). Photo by Lora Gerand.

Background Data
More Information / Contact

PROJECT: NH Falls Prevention Network Hub

GOALS: (1) Establish FPN-Hub and workflows to coordinate Falls Prevention efforts across NH.

(2) Enroll at least 600 participants in NH evidence-based community programs (Tai Ji Quan: Moving for Better Balance® and Matter of Balance) falls prevention programs in each year of the grant (3 years).

(3) Collaborate with health care and insurance organizations to demonstrate the cost effectiveness of enrolling members, at risk for falls, in falls prevention programs in NH.

TEAM: Ellen Flaherty (PI), Dawna Pidgeon (Lead Trainer, Implementation Specialist), Lora Gerard (Project Manager), Timothy Hesselton (Project Coordinator), Renee Pepin (Implementation Specialist)

FUNDING:  2017 Administration for Community Living Evidence-Based Falls Prevention Program Grant (awarded to Dartmouth Centers for Health and Aging)

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