Coping Power -- Rural: Iterative Adaptation of an Evidence-Based Preventive Intervention for Rural Upper Elementary and Middle Schools

Background: Educators in rural schools are uniquely situated to address youth mental health disparities, yet often face challenges in delivering mental health supports. This paper describes the process of adapting the evidence-based Coping Power program, a small group prevention program for youth with aggressive behavior problems, to be a two-tiered (Tier 1 and Tier 2), transdiagnostic intervention to improve fit and feasibility for rural upper-elementary and middle schools. Method: Identified challenges with the Coping Power program for rural areas included program length, substantial staffing and resource requirements, lack of universal programming, low caregiver engagement, and co-occurring problems. Initial adaptations included a classroom and small group format implemented by school staff, teacher consultations integrated into coaching and co-facilitation, and a technology-supported caregiver component. Implementer feedback forms, coaching notes, and individual interviews informed the iterative development and feasibility testing process. Results: Between 2019-2023, thirteen schools across six rural districts implemented the program. Student curriculum revisions included order and relative emphasis of content, classroom and small group overlap, necessary simplification of concepts, improved contextualization to the rural setting, and the addition of student workbooks. Supports for implementers included fully developed lesson plans and slides, a comprehensive implementation manual, video lesson overviews, action-focused training, and a 3-session coaching model to support implementer preparation and sustain motivation. Teacher and caregiver infographic text "nudges" were improved to promote generalization of concepts across settings. Discussion: By partnering with school-based implementers, the adapted program holds promise to be more feasible and appealing for rural schools than the original model. This fully developed program is now ready for larger-scale testing in rural schools. [This paper was published in "School Mental Health."]