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.