Best Practices and Cautionary Lessons from a Behavioral Health Program for Rural Southern Youth: The Case of “I Got U” in Central Mississippi

Health Affairs is requesting abstracts for its theme issue on behavioral health, which will present work pertaining to policies involved in the delivery of mental health and substance abuse services.  The issue will include 15-20 peer reviewed articles.


Youth who live in rural Southern locales face a wide range of economic, educational, and social disadvantages. Moreover, schools in these communities are under intense pressure to meet academic standards and are therefore reluctant to divert student attention from core courses. This project delineates best practices and cautionary lessons that emerged from the implementation of a three-year youth supports program delivered to eighth and tenth grade rural Mississippi students from fall 2012 through spring 2015. I Got U (IGU) coupled a daylong intensive immersion in youth risk prevention and mental health promotion with school-based information dissemination related to alcohol and drugs, self-injury, suicide, mental health, and bullying. The Health Resources and Services Administration (HRSA) funded IGU. This article provides detailed descriptions of strategies enlisted to implement IGU, as well as the statistical results of key evaluation outcomes.


IGU served many central Mississippi students during its funding cycle (total evaluation N = 5807). Participating schools were located in disadvantaged communities, thereby providing a stringent test of the program’s effectiveness. Assessment data on the pretest survey indicated that the program’s objectives aligned well with student needs. Common student deficits included stress associated with academic performance, peer pressure, and low self-esteem. A diverse slate of speakers was enlisted to deliver modules during each daylong IGU event. During the first two program years, IGU intentionally kept the number of student attendees at each event capped at approximately 200 and restricted its focus to participants from rural schools. During year three, speaker availability limitations led to two significant changes in the program’s implementation: (1) program expansion, with larger venues used to serve over twice the typical number of students per event, and (2) attendee diversification, such that students from semi-urban areas were also served. Program content did not change. Unmatched pre-event, post-event, and three-month follow-up evaluation surveys with proprietary validated measures were used to gauge the program’s impact. Due to resource and logistical constraints, a conventional control group was not utilized.


Evaluation results were robust during the first and second project years, with significant salutary changes observed from pretest to post-test in eleven out of fifteen outcome measures during year one. Increases in self-esteem, drug disapproval, and bullying awareness were observed, as were decreases in adverse characteristics such as mental illness stigma. Many desirable changes persisted at follow-up, particularly for students who self-identified as confirmed IGU participants when compared with their counterparts who did not attend or could not recall doing so (same-school quasi-control). However, program expansion and attendee diversification during year three largely undermined IGU’s effectiveness. During year three, very few desirable outcomes were observed from pretest to post-test and several significant findings indicated increases in adverse attitudes and dispositions. No salutary outcomes were observed at follow-up during year three. Overall, the implementation and evaluation of IGU illustrates the need for small scale, narrowly focused youth supports programming in rural areas such as those found in central Mississippi.

Publication Type: 
Journal Article
John Bartkowski
Xiaohe Xu
Jerri Avery
Debbie Ferguson
Frankie Johnson
Year of Publication: 
Journal, Book, Magazine or Other Publication Title: 
Health Affairs
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