2019 AgrAbility NTW Lincoln, NE Wednesday, March 27, 2019 10:10-10:55 am & 11:05-11:50 am

1. 2019 AgrAbility NTW Lincoln, NEWednesday, March 27, 201910:10-10:55 am & 11:05-11:50 am By Robert J. Fetsch, Colorado State University Extension, Hamida Jinnah & Paige Tidwell, University of Georgia, &NAP Evaluation Committee AANTWMcGillQOL3.2719 (Rev. 3.0419)

2. To “AgrAbility Quality of LifePsychological Well-Being Improved” +28% vs. -4%”

3. AgrAbility Quality of LifePsychological Well-Being Improved +28% vs. -4%By Robert J. Fetsch (CSU) Robert Aherin & Chip Petrea (UIL),Hannah Barthels, Vicki Janisch, & Abigail Jensen (UW), Sheila Simmons & Kerri Ebert (KU), Candiss Leathers & Danielle Jackman (CSU/Goodwill Denver), Nancy Frecks & Sharon Nielsen (UN), Linda Fetzer (PSU), Karen Funkenbusch (UMO), Rick Peterson (TAMU), Linda Jaco, Jan Johnston, & Diana Sargent (OSU), Toby Woodson (UAR),Richard Brzozowski & Leilani Carlson (UME), Inetta Fluharty (WVU), Kirk Ballin (ESVA), Betty Rodriguez, Michele Proctor & Madeline McCauley (ECU)& Hamida Jinnah & Paige Tidwell (UGA).

4. How many matched pre-post surveys did each SRAP provide? (AA Treatment = 273; Comparison = 100)

5. Our AgrAbility Vision “The vision of AgrAbility is to enhance the quality of life for farmers, ranchers, and other agricultural workers with disabilities, so that they, their families, and their communities continue to succeed in rural America.” Source: Retrieved from www.agrability.org/about/program/#mission

6. What’s Our Agenda Today? Introduction. QOL Behavioral Health Results Why Are These Results Important—Especially Now? What Can We Learn from Those Who Improved the Most or the Least? What did they and their SRAPs do differently?

7. What’s Our Agenda Today? Introduction.

8. Who Is an AgrAbility Client? An AgrAbility client is an individual with a disability engaged in production agriculture as an owner/operator, family member, or employee who has received professional services from AgrAbility project staff during an on-site visit.

9. Measures Used in 14-State Study McGill Quality of Life (QOL) Survey AgrAbility Independent Living & Working Survey (ILW) Thank you, Carla Wilhite! NAP Demographic Data

10. What’s Our Agenda Today? 2. QOL Behavioral Health Results.

11. History of NAPEC Fourteen SRAPs conducted an 11-year* AgrAbility treatment versus non-AgrAbility treatment comparison, pretest-posttest study to answer three questions: Do AgrAbility participants’ overall QOL and ILW levels improve? Do AgrAbility participants’ behavioral health levels improve? Does a group of AgrAbility participants’ behavioral health levels improve more than those of a group of non-AgrAbility participants? * 2/20/2007-10/20/2017

12. Chip Petrea Worked Diligently with the No-Treatment Group. Chip provided us with 100 matched pretests and posttests. None of the No-Treatment Comparison Group participants ever received AgrAbility services currently or in the past. Thank you, Chip!

13. How many matched pre-post surveys did 14 SRAPs provide? (AA Treatment = 273; Comparison = 100)

14. What Was the Average Length of Time with AgrAbility? The amount of time spent by AgrAbility treatment group participants with AgrAbility ranged from 1 month to 106 months or 8.83 years (M = 15.74; SD = 12.96; N = 273). The amount of time spent by non-AgrAbility group participants ranged from 12 to 19 months (M = 13.76; SD = 0.98; N = 100).

15. How Do We Measure Quality of Life (QOL) Levels? The McGill QOL scale is a 17-item scale (0-10) with five subscales… Physical well-being. Physical symptoms. Psychological well-being. Existential well-being. Support.

16. Quality of Life The group of AgrAbility participants’ average overall QOL level improved 26%, while the non-AgrAbility group’s average overall QOL level fell 4%. Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

17. McGill QOL Pretest-Posttest Total Score Changes for AgrAbility Treatment & Non-AgrAbility Comparison Groups • Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

18. What Has AgrAbility Achieved?What Can We Show for It? In an 11-year AgrAbility treatment versus no-treatment comparison group study we found that a group of AgrAbility participants (N = 240) reported statistically significantly pretest-posttest improvements in QOL levels (p < .001), while a group of non-AgrAbility participants (N = 99) reported no change in QOL levels. Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

19. How Do We MeasureIndependent Living & Working (ILW) Levels? I am able to… Complete chores on my farm/ranch. Operate machinery. Manage my farm/ranch. Access workspaces on my farm/ranch. Live in my home on the farm/ranch Change or modify my machinery in order to accommodate my needs.

20. Independent Living and Working The group of AgrAbility participants’ average ILW level improved 28%, while the non-AgrAbility group’s ILW level improved 8%. Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

21. ILW Pretest-Posttest Total Score Changes for AgrAbility Treatment and Non-AgrAbility Comparison Groups • Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

22. Mental/Behavioral Health The McGill Quality of Life Survey is a 17-item scale (0-10) with five subscales: Physical Well Being Physical Symptoms Psychological Well Being Existential/Experiential Well Being Support Source: Cohen, S. R., Mount, B. M., Bruera, E., Provost, M., Rowe, J., & Tong, K. (1997). Validity of the McGill Quality of Life questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine, 11, 3-20.

23. Mental/Behavioral Health Three of five subscales focus on mental/behavioral health: Psychological Well Being Existential/Experiential Well Being Support Source: Cohen, S. R., Mount, B. M., Bruera, E., Provost, M., Rowe, J., & Tong, K. (1997). Validity of the McGill Quality of Life questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine, 11, 3-20.

24. Psychological Well-Being The psychological well-being subscale has 4 items—Over the past two (2) days: I have been depressed (not at all…extremely). I have been nervous or worried (not at all…extremely). how much of the time did you feel sad (never…always). when I thought of the future, I was (not afraid…terrified). Source: Cohen, S. R., Mount, B. M., Bruera, E., Provost, M., Rowe, J., & Tong, K. (1997). Validity of the McGill Quality of Life questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine, 11, 3-20.

25. Psychological Well Being The group of AgrAbility participants’ psychological well being levels improved 28%, while the non-AgrAbility group’s psychological well being fell 4%. Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

26. Psychological WB Pretest-Posttest Changes for AgrAbility Treatment & Non-AgrAbility Comparison Groups • Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

27. Existential/Experiential Well Being The Existential/Experiential well-being subscale has 6 items—Over the past two (2) days: my life has been (utterly meaningless and without purpose…very purposeful and meaningful). when I thought about my whole life, I felt that in achieving life goals I have (made no progress whatsoever…progressed to complete fulfillment). when I thought about my life, I felt that my life to this point has been (completely worthless…very worthwhile). I have felt that I have (no control over my life…complete control over my life). I felt good about myself as a person (completely disagree…completely agree). To me, the past two days were (a burden…a gift). Source: Cohen, S. R., Mount, B. M., Bruera, E., Provost, M., Rowe, J., & Tong, K. (1997). Validity of the McGill Quality of Life questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine, 11, 3-20.

28. Existential Well Being The group of AgrAbility participants’ existential well being level improved 21%, while the non-AgrAbility group’s existential well being level fell 2%. Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

29. Existential WB Pretest-Posttest Changes for AgrAbility Treatment & Non-AgrAbility Comparison Groups • Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

30. Support The Support subscale has 2 items—Over the past two (2) days: the world has been (an impersonal unfeeling place…caring and responsive to my needs). I have felt supported (not at all…completely). Source: Cohen, S. R., Mount, B. M., Bruera, E., Provost, M., Rowe, J., & Tong, K. (1997). Validity of the McGill Quality of Life questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine, 11, 3-20.

31. Support The group of AgrAbility participants’ support level improved 20%, while the non-AgrAbility group’s support level fell 5%. Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

32. Support Pretest-Posttest Changes for AgrAbility Treatment & Non-AgrAbility Comparison Groups • Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

33. Results from 14 States Found that on Average… 240 AgrAbility intervention group participants’… QOL levels increased 26% (p < .001). ILW levels increased 28% (p < .001). 99-100 non-AgrAbility comparison group participants’… QOL levels declined 4% (N.S.) ILW levels increased 8% (p < .05). Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

34. Results from 14 States Found that on Average… 269-271 AgrAbility intervention group participants’… Psychological WB levels increased 28% (p < .001). Existential WB levels increased 21% (p < .001). Support levels increased 20% (p < .001). 99-100 non-AgrAbility comparison group participants’… Psychological WB levels fell 4% (N.S.) Existential WB levels fell 2% (N.S.) Support levels fell 5% (N.S.) Source: Fetsch, R. J., & Collins, C. L. (2018). The effects of AgrAbility on the mental/behavioral health of farmers and ranchers with functional limitations: A comparison study. Medical Research Archives, 6(2). http://www.journals.ke-i.org/index.php/mra/article/view/1691/1762

35. “Good News” These matched pretest-posttest results suggest that 14 AgrAbility Projects may be more effective than a non-AgrAbility comparison group at increasing behavioral health levels (AR, CO, GA, KS, ME, MO, NC, NE, OK, PA, TX, VA, WI, & WV).

36. “Good News” We now have data from a non-AgrAbility participant comparison group. We now have empirical evidence that suggests that the increases in behavioral health levels may be due to AgrAbility in 14 states/SRAPs.

37. “Caveat” The results reported here (Fetsch & Collins, 2018) apply to the 14 SRAPs that provided data and participated in this study. What about in the non-participating SRAPs? Who knows? More SRAP involvement is needed to report with confidence that these positive effects apply to other currently funded SRAPs.

38. How Do We Explain These Significant Results? Most of us are not counselors/therapists. We refer folks with behavioral issues to professionals. We provide mostly physical modifications. We focus mostly on physical symptoms.

39. How Do We Explain These Significant Results?

40. How Do We Explain These Significant Results? We provide on-site visits. We address mostly physical conditions with physical modifications. Few of us are trained therapists. We do not provide counseling or behavioral health therapy—we refer.

41. How Do We Explain These Significant Results? 14 SRAPs connect well with clients. We accept them as they are. We “normalize” all functional limitations. We use a family systems approach. We listen well for individual and family goals. We do not counsel/do therapy—we refer.

42. How Do We Explain These Significant Results? 14 SRAPs ask clients to complete QOL surveys prior to our on-site visit. We create a plan. We partner with DVR et al. to address AgrAbility clients’ needs and goals. Later we close out the case and request that they complete a posttest.

43. What’s Our Agenda Today? 3. Why Are These Results Important—Especially Now?

44. We’ve seen progress in physical, but what about in behavioral health? We’ve seen progress in reduced numbers of physical fatalities and injuries in agriculture, thanks to the efforts of OSHA and Extension Farm Safety programs. But we’ve not seen progress in reducing behavioral health issues like suicide, especially among older white men. Source: M. Rosmann (personal communication, June 4, 2010.)

45. Comparison U.S. Workplace Suicides with Non-Workplace Suicides (Per million)

46. Factors that may contribute to this risk of suicide for farmers & ranchers include: Potential for financial loss Chronic physical illness Social isolation Work-home imbalance Barriers & unwillingness to seek behavioral health treatment Source: Tiesman, H. M., Konda, S., Hartley, D., Menéndez, C. C., Ridenour, M., & Hendricks, S. (2015). Suicide in U.S. workplaces, 2003-2010: A comparison with non-workplace suicides. American Journal of Preventive Medicine, 48(6), 674-682.

47. Factors that may contribute to this risk of suicide for farmers & ranchers include: Depression due to chronic pesticide exposure Increased access to lethal means Firearms & hanging are the two leading methods of suicide for farmers. Access to mental health services can be limited in rural locations. Finding time to leave the farm to receive medical care can be challenging. Source: Tiesman et al., 2015.

48. Why do farmers/ranchers commit suicide at higher rates? It’s not increased levels of mental health issues. It may have to do with: Demands of family farms Culture of farming communities Shortage of health care professionals in rural farming communities High accessibility to firearms Occupational stress Financial difficulties Family problems Retirement is a trying transition for farmers.

49. Masculine “Scripts” (David & Brannon (1976) No sissy-stuff - men are expected to distance themselves from anything feminine. Big wheel - men should be occupationally or financially successful. Sturdy oak - men should be confident and self-reliant. Give ‘em hell -men should do what is necessary to “make it.” “When you’re hurting, be a man—keep it inside and tell no one!” (Fetsch, 2009.)

50. HANDOUT: Farm and Ranch Family Stress and Depression: A Checklist and Guide for Making Referrals