Colorado State University Extension, 2019 AgrAbility NTW Lincoln, NE Wednesday, March 27, 2019 10:10-10:55 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) Pass out 40 copies of .ppt @ 6 slides per page.
To “AgrAbility Quality of Life Psychological Well-Being Improved” +28% vs. -4%”
AgrAbility Quality of Life Psychological Well-Being Improved +28% vs AgrAbility Quality of Life Psychological 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). Would all the members of the NAPEC please stand and be recognized?... Thank you! Thanks to each of you for your contributions of treatment group data to this program evaluation study. And special thanks to Chip Petrea for your contributions of no-treatment group data to this program evaluation study. This study would not have been possible without the ongoing dedication and good work of our colleagues—Sheila Simmons, Bob Meyer, Vicki Janisch, Vince Luke, Rick Peterson, Toby Woodson, Kirk Ballin, Bob Aherin, Inetta Fluharty, Sharry Nielsen, Diana Sargent, and Tina Little. Could we have a hand of appreciation for them? Several years ago during the previous administration, President Bush asked all the Secretaries, including the Secretary of Agriculture (who is Brad Rein’s and our Superior), to assess their success at increasing Quality of Life Levels. In 2007? we told Brad Rein that we could help him assess AgrAbility’s success at increasing new clients’ QOL levels. He asked us to provide him with recommendations (by 8/1/09). We formed the National AA Evaluation Committee. Would Committee members present please wave? We looked at 100 QOL tools and picked 2—SF-36 and the McGill QOL. We pilot tested the McGill QOL over the past four years as a pre- and post-survey in 9 states to see if it works with farmers and ranchers and to see if we observe increases in QOL levels. Currently, President Obama is asking, “What works?” as he decides which programs to fund and which to cut. We in AR, CO, KS, ME, MN, MO, NC, NE, OH, OK, TX, UT, VA, WI, and WV are working as a team to answer two questions for Brad:
How many matched pre-post surveys did each SRAP provide How many matched pre-post surveys did each SRAP provide? (AA Treatment = 273; Comparison = 100) 5/16/18 Chip Petrea 100 WI 90 KS 86 CO 29 NE 13 PA 12 MO 10 TX 9 OK 6 AR 4 ME 4 WV 4 VA 3 NC 2 GA 1 Total AA Treatment Group 273 Total Non-AA Comparison Group 100
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 5
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? 6
What’s Our Agenda Today? Introduction. 7
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.
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
What’s Our Agenda Today? 2. QOL Behavioral Health Results. 10
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 2/20/2007-1/20/2016 include the first entrya and the last exitb for the 225 included in the QOLTreNoT [QOLTrtCom] study. Note: According to QOLMss6.1813, 6.5 years = 1/26/2007-6/18/2013. QOLILWMss., pp. 8.5, 10.2 N = 476/788 (QOLILWMss., p. 10.2).
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! 12
How many matched pre-post surveys did 14 SRAPs provide How many matched pre-post surveys did 14 SRAPs provide? (AA Treatment = 273; Comparison = 100) 5/16/18 Chip Petrea 100 WI 90 KS 86 CO 29 NE 13 PA 12 MO 10 TX 9 OK 6 AR 4 ME 4 WV 4 VA 3 NC 2 GA 1 Total AA Treatment Group 273 Total Non-AA Comparison Group 100
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).
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.
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 Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 16
& Non-AgrAbility Comparison Groups 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 5/16/18 AA Treatment Group QOL Pretest (M = 5.53, SD = 1.65, N = 240) AA Treatment Group QOL Posttest (M = 6.98, SD = 1.75, N = 240, p < .001) Non-AA Comparison Group QOL Pretest (M = 5.09, SD = 0.74, N = 99) Non-AA Comparison Group QOL Posttest (M = 4.90, SD = 0.70, N = 99, N.S.) The group of AgrAbility participants’ average overall QOL level improved 26.22%, while the group of non-AgrAbility participants’ average overall QOL level fell 3.7%. Life-threatening experience—How many of us have experienced it either directly or via someone we care deeply about? In my experience and in the experience of many of my farm/ranch friends, when we face our own mortality, we raise deep questions about who we are and what life is all about. How many of us have experienced this too? Existential ~ Experiential. 4/27/15 Support (N=188)*** M=6.197.60 As of 4/27/15, the effect size was .72 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Existential/Experiential Well-Being (N=190)*** M=6.117.47 As of 4/27/15, the effect size was .74 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Psychological Well-Being (N=187)*** M=5.787.27 As of 4/27/15, the effect size was .66 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Note again—AgrAbility participants’ Quality of Life subscale scores rose from Pre-Survey to Post-Survey at a statistically significant amount. These results are real and are due to chance < 1 time out of 1,000. Experiential, existential, i.e. derived from experience or the experience of existence. Synonyms: experiential, existential Antonyms: theoretic, theoretical Retrieved September 4, 2011 from http://www.synonyms.net/synonym/existential 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
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 Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 18
How Do We Measure Independent 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. Here I wish to acknowledge Carla Wilhite and express NAP’s Evaluation Committee’s gratitude to Carla. 8 years ago Carla and others insisted to the other 20 or so of us on the Evaluation Committee that we need to ask our clients about their abilities to complete chores, modify machinery, live in their homes on the ranch/farm both before and after they receive AgrAbility information, education, and service. Thank you, Carla!
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 Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 20
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 5/16/18 AA Treatment Group ILW Pretest (M = 17.41, SD = 5.38, N = 239) AA Treatment Group ILW Posttest (M = 22.25, SD = 5.70, N = 239, p < .001) Non-AA Comparison Group ILW Pretest (M = 19.42, SD = 5.96, N = 100) Non-AA Comparison Group ILW Posttest (M = 21.02, SD = 5.14, N = 100, p < .05) The group of AgrAbility participants’ average ILW level increased 27.8%, while the group of non-AgrAbility participants’ average ILW level improved 8.2%. 6/9/16 ILW AA Treatment Group Pretest (M = 16.91, SD = 5.26, N = 197) or 7/27/17 (M = 2.86; SD = 0.91; N = 217) ILW AA Treatment Group Posttest (M = 22.21, SD = 5.75, N = 197, p < .001) or (M = 3.71; SD = 0.95; N = 201) ILW Comparison Group Pretest (M = 19.42, SD = 5.96, N = 100) or (M = 3.24; SD = 0.99; N = 100) ILW Comparison Group Posttest (M = 21.02, SD = 5.14, N = 100, p < .05) or (M = 3.50; SD = 0.86; N = 100) 4/27/15 ILW Total Score (N=168)*** M=16.9521.80 As of 4/27/15, the effect size is .84 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Finally, on the ILW Total Score, AgrAbility participants’ QOL total score rose from Pre-Survey to Post Survey. These results are statistically significant. They are real, worthy of note. Note that if any of the items are missing for a case, SPSS will not compute a total score. These results are real, not by chance. They are statistically significant. They need to be taken seriously. For those of you who are interested in more detail, there’s a language, a way of thinking, a set of conventions that researchers use that I can go into more detail later with those who are interested. P < .05 means that these results are real, are statistically significant, and are due to chance < 5 times out of 100. *indicates p <.05. P < .01 means that these results are statistically significant and are due to chance < 1 time out of 100. ** indicates p < .01. P < .001 means that these results are statistically significant and are due to chance < 1 time out of 1,000. *** indicates p < .001. (R.K. Yang, personal communication, September 15, 2009). 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
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. Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 22
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. Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 23
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. Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 24
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 Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 25
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 5/16/18 AA Treatment Group Psychological WB Pretest (M = 5.71, SD = 2.40, N = 270) AA Treatment Group Psychological WB Posttest (M = 7.30, SD = 2.18, N = 270, p < .001) Non-AA Comparison Group Psychological WB Pretest (M = 5.20, SD = 1.31, N = 100) Non-AA Comparison Group Psychological WB Posttest (M = 4.98, SD = 1.37, N = 100, N.S.) The group of AgrAbility participants’ psychological WB level improved 27.8%, while the group of non-AgrAbility participants’ psychological WB level fell 0.042%. Source: QOLTrtCom, p. 29, Table 2 7/27/17 QOL AA Treatment Group Pretest (M = 5.56, SD = 1.65, N = 216) QOL AA Treatment Group Posttest (M = 7.13, SD = 1.67, N = 207, p < .001) QOL Comparison Group Pretest (M = 5.10, SD = 0.75, N = 100) QOL Comparison Group Posttest (M = 4.91, SD = 0.70, N = 97, N.S.) Life-threatening experience—How many of us have experienced it either directly or via someone we care deeply about? In my experience and in the experience of many of my farm/ranch friends, when we face our own mortality, we raise deep questions about who we are and what life is all about. How many of us have experienced this too? Existential ~ Experiential. 4/27/15 Support (N=188)*** M=6.197.60 As of 4/27/15, the effect size was .72 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Existential/Experiential Well-Being (N=190)*** M=6.117.47 As of 4/27/15, the effect size was .74 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Psychological Well-Being (N=187)*** M=5.787.27 As of 4/27/15, the effect size was .66 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Note again—AgrAbility participants’ Quality of Life subscale scores rose from Pre-Survey to Post-Survey at a statistically significant amount. These results are real and are due to chance < 1 time out of 1,000. Experiential, existential, i.e. derived from experience or the experience of existence. Synonyms: experiential, existential Antonyms: theoretic, theoretical Retrieved September 4, 2011 from http://www.synonyms.net/synonym/existential 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
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. Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 27
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 Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 28
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 5/16/18 AA Treatment Group Existential WB Pretest (M = 6.13, SD = 2.00, N = 271) AA Treatment Group Existential WB Posttest (M = 7.40, SD = 1.76, N = 271, p < .001) Non-AA Comparison Group Existential WB Pretest (M = 5.00, SD = 1.18, N = 100) Non-AA Comparison Group Existential WB Posttest (M = 4.91, SD = 1.11, N = 100, N.S.) The group of AgrAbility participants’ existential WB level improved 20.7%, while the group of non-AgrAbility participants’ existential WB level fell 0.018%. Source: QOLTrtCom, p. 29, Table 2 7/27/17 QOL AA Treatment Group Pretest (M = 5.56, SD = 1.65, N = 216) QOL AA Treatment Group Posttest (M = 7.13, SD = 1.67, N = 207, p < .001) QOL Comparison Group Pretest (M = 5.10, SD = 0.75, N = 100) QOL Comparison Group Posttest (M = 4.91, SD = 0.70, N = 97, N.S.) Life-threatening experience—How many of us have experienced it either directly or via someone we care deeply about? In my experience and in the experience of many of my farm/ranch friends, when we face our own mortality, we raise deep questions about who we are and what life is all about. How many of us have experienced this too? Existential ~ Experiential. 4/27/15 Support (N=188)*** M=6.197.60 As of 4/27/15, the effect size was .72 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Existential/Experiential Well-Being (N=190)*** M=6.117.47 As of 4/27/15, the effect size was .74 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Psychological Well-Being (N=187)*** M=5.787.27 As of 4/27/15, the effect size was .66 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Note again—AgrAbility participants’ Quality of Life subscale scores rose from Pre-Survey to Post-Survey at a statistically significant amount. These results are real and are due to chance < 1 time out of 1,000. Experiential, existential, i.e. derived from experience or the experience of existence. Synonyms: experiential, existential Antonyms: theoretic, theoretical Retrieved September 4, 2011 from http://www.synonyms.net/synonym/existential 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
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. Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 30
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 Source: Fetsch, R. J., & Turk, P. (2017, July 27). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review 31
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 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 5/16/18 AA Treatment Group Support Pretest (M = 6.20, SD = 2.20, N = 269) AA Treatment Group Support Posttest (M = 7.46, SD = 2.01, N = 269, p < .001) Non-AA Comparison Group Support Pretest (M = 5.09, SD = 2.36, N = 99) Non-AA Comparison Group Support Posttest (M = 4.85, SD = 1.89, N = 99, N.S.) The group of AgrAbility participants’ support level improved 20.3%, while the group of non-AgrAbility participants’ support levels fell 0.047%. Source: QOLTrtCom, p. 29, Table 2 7/27/17 QOL AA Treatment Group Pretest (M = 5.56, SD = 1.65, N = 216) QOL AA Treatment Group Posttest (M = 7.13, SD = 1.67, N = 207, p < .001) QOL Comparison Group Pretest (M = 5.10, SD = 0.75, N = 100) QOL Comparison Group Posttest (M = 4.91, SD = 0.70, N = 97, N.S.) Life-threatening experience—How many of us have experienced it either directly or via someone we care deeply about? In my experience and in the experience of many of my farm/ranch friends, when we face our own mortality, we raise deep questions about who we are and what life is all about. How many of us have experienced this too? Existential ~ Experiential. 4/27/15 Support (N=188)*** M=6.197.60 As of 4/27/15, the effect size was .72 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Existential/Experiential Well-Being (N=190)*** M=6.117.47 As of 4/27/15, the effect size was .74 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Psychological Well-Being (N=187)*** M=5.787.27 As of 4/27/15, the effect size was .66 which is large or larger than typical (Cohen, 1988; Morgan et al., 2004, p. 91; Morgan et al., 2011, p. 101.3) Note again—AgrAbility participants’ Quality of Life subscale scores rose from Pre-Survey to Post-Survey at a statistically significant amount. These results are real and are due to chance < 1 time out of 1,000. Experiential, existential, i.e. derived from experience or the experience of existence. Synonyms: experiential, existential Antonyms: theoretic, theoretical Retrieved September 4, 2011 from http://www.synonyms.net/synonym/existential 32
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 33
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 34
“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). 35
We now have data from a non-AgrAbility participant comparison group. “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. 36
“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. 37
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. 38
How Do We Explain These Significant Results? 39
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. 40
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. 41
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. 42
What’s Our Agenda Today? 3. Why Are These Results Important—Especially Now? 43
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.)
Comparison U.S. Workplace Suicides with Non-Workplace Suicides (Per million) 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. Am J Prev Med 2015;48(6):674-682 -National Average overall rate of workplace suicide between 2003 and 2010 in the U.S. was 1.5 per million workers (p. 675B.9/678.9) -Men 2.7 per million (p. 678.2) -Workers 65-74 2.4 per million (p. 678.5) -Protective Service Occupations 5.3 per million (p. 676A.7) 3.5 times greater than the overall U.S. worker rate. 84% of suicides involved firearms. -Farming, Fishing & Forestry 5.1 per million (p. 676B.2) 3.4 times greater than the overall U.S. worker rate. 50% of suicides involved a firearm and 50% were due to other causes, primarily strangulation by hanging. -Installation, Maintenance, & Repair Occupations 3.3 per million (p. 676B.2) 2.2 times greater than the overall U.S. worker rate. -Farmers & Ranchers 10.0 per million (p. 679.7) 6.67 times greater than the overall U.S. worker rate. -Farmers & ranchers’ suicide rates are almost 7 times higher (6.67) than suicide rates for workers in all other private industries.
Potential for financial loss Chronic physical illness Social isolation 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. 46
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. 47
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. 48
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.) I wonder if there could be a #5. When you’re hurting, don’t tell anyone. What do you think? In CO, where ¾ suicides are committed by men, we think the problem has to do with Masculine “Scripts.” Do you think this might be true for men and/or women in your state too? If so, what do we do to address this issue?
HANDOUT: Farm and Ranch Family Stress and Depression: A Checklist and Guide for Making Referrals
What Works to Address This Problem? FRSAN Each of seven upper Midwestern states (IA, KS, MN, NE, ND, SD, and WI) had a farmer-friendly telephone hotline and website. They offered free, confidential telephone counseling 24/7 to callers and emailers, as well as up to five prepaid counseling sessions from licensed behavioral healthcare professionals with a farm background/experience working with farmers. Source: Rosmann, Mike. (2016, August 15). Employee assistance programs reduce workplace stress and improve agriculture. [News Release]. Available from author. 51
What Works to Address This Problem? FRSAN Between September, 2005 and October 2007 hotline telephone responders referred 10,647 individuals, couples, or families involved in agriculture in the seven states for professional behavioral health services. The rate of farmer suicide did not increase in the seven states, despite a difficult economic era. Source: Rosmann, Mike. (2016, August 15). Employee assistance programs reduce workplace stress and improve agriculture. [News Release]. Available from author. 52
What Works to Address This Problem? FRSAN 93% reported that their services were helpful and they would recommend that people involved in agriculture obtain similar services if needed. Many stressed farm and ranch people could benefit from an EAP like the Farm and Ranch Stress Assistance Network. Source: Rosmann, Mike. (2016, August 15). Employee assistance programs reduce workplace stress and improve agriculture. [News Release]. Available from author. 53
What Works to Address This Problem? FRSAN (Farm and Ranch Stress Assistance Network) could help distressed farmers and their families and save lives if it was available. Source: Rosmann, Mike. (2016, August 15). Employee assistance programs reduce workplace stress and improve agriculture. [News Release]. Available from author. 54
What Works to Address This Problem? AgrAbility: In 14 states, a group of 269 AgrAbility participants’ mental/behavioral health levels improved significantly (p < .001) as compared with no change in a no-treatment comparison group (n = 99). 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 55
AgrAbility Works: Both the Quality of Life (QOL) and the Independent Living and Working (ILW) levels of AgrAbility participants in 10 states improved (p < .001) (cf. Fetsch, Jackman, & Collins, 2018). The QOL levels of a group of 225 AgrAbility participants in 12 states improved significantly as compared with a group of non-AgrAbility participants whose QOL levels did not change (cf. Fetsch & Turk, 2018). 56
AgrAbility Works: In 12 states, a group of 196 AgrAbility participants' QOL levels increased 28% as compared with a group of 97 non-AgrAbility participants' QOL levels that decreased 4% (cf. Fetsch & Turk, 2018). A group of 196 AgrAbility participants' ILW levels increased 30% in 12 states as compared with a group of 97 non-AgrAbility participants whose ILW levels increased 8% (cf. Fetsch & Turk, 2018). In 14 states, a group of 269 AgrAbility participants' mental/behavioral health levels improved significantly (p < .001) as compared with no change in a no-treatment comparison group (n = 99) (cf. Fetsch & Collins, 2018). 57
We are building a road to Evidence-Based AgrAbility Programming over the next three years—Together!
Our Steps Toward Evidence-Based AgrAbility Programming QOL SEM (In preparation) AgrAbility Demographics (In preparation) Who Gains the Most/Least? (In preparation) Behavioral Health with 14 SRAPs (N =273), (Fetsch & Collins, 2018) Treatment-Comparison with 12 SRAPs (N = 225), (Fetsch & Turk, 2018) Pretest-Posttest Changes from 10 SRAPs (N = 191), (Fetsch, Jackman & Collins, 2017) Pretests from 11 SRAPs (N = 398), (Jackman, Fetsch, & Collins, 2016)
Questions? & Answers
What’s Our Agenda Today? 4. What Can We Learn from Those Who Improved the Most or the Least? What did they and their SRAPs do differently? 61
NAP Qualitative Evaluation Study Jinnah, Hamida; Ph.D., University of Georgia Fetsch, Robert J.; Ph.D., Colorado State University Tidwell, Paige; Ed.S., University of Georgia
Key Research Question What are the key factors (programmatic or personal) that contributed to significant changes in quantitative pre-post scores in Quality of Life (QOL) levels and Independent Living and Working (ILW) levels for clients with disabilities who were part of the AgrAbility project. Questions revolved around: Service quality Program Process factors - communication Project impact on farmers’ quality of life Project Improvements
Methodology Phone interviews were conducted with farmers having disabilities from 17 states across the U.S. Farmers who showed the greatest or least pre-post changes in QOL and ILW scores were selected. IRB approval was obtained from University of Georgia Human Subjects. Semi-structured interview guide with imbedded probes was utilized during the interview. Staff completed an online survey about each case in Qualtrics. Nine interviews were completed.
Analysis Using grounded theory approach as described by Glaser and Strauss (1967), data were collected and analyzed simultaneously using the constant comparative method until it reached a point of saturation. Preliminary themes emerging from the data are presented here.
Sample Deceased – 11 Hospice – 1 No response, unreachable – 12 Refused – 3 No response from state – 28+ Completed - 9
Key Programmatic Factors Farmers appreciated: Comprehensive farm assessments and recommendations Total value ($) of equipment, modifications, services received from AgrAbility project or Vocational Rehabilitation. Could not distinguish between who provided it. Ongoing and trusting relationship with project staff Quality of referrals or in-house staff expertise (assistive technology, occupational therapy)
Key Program Impacts Participation in the project led to: Increased ability to continue farming Increased farm productivity (depended on their retirement goal and health status) Improved financial status (depended on their retirement goal and health status) Improved health status (less stress, less pain, prevention of secondary injuries)
Ball drops – things that can be improved Gaps farmers identified: Gaps in assessments, stopping at recommendations without implementation or follow up Gaps in assistive technology recommendations, services, referrals Inadequate funding to buy equipment, implement recommendations Lack of regular communication from the staff
Questions? & Answers
Further Research Is Needed to Answer… What can we learn from AgrAbility demographics? What can we learn from those who improved the most or the least? What did they and their SRAPs do differently? How can we get more matched pretest-posttest QOL data? 71
To Answer These Questions… More SRAPs are encouraged to join us especially new SRAPs (OH & TN). All SRAPs are encouraged to collect more matched pre-test and post-test data. 72
Please Join Us! Treatment Group SRAPs Currently unfunded Com- parison Group SRAPs 3/5/18 To answer more sophisticated AgrAbility questions about what works best on the road to evidence-based programming, we need larger samples of QOL data from additional SRAPs to join us. 2/14/2017 20 SRAPS/20 States are currently funded (CA, CO, GA, IL, IN, KS, KY, ME, MI, MO, NC, NE, OH, PA, TN, TX, VA, UT, WI, and WV).?? Of these 20, 15 (75%) are using the QOL and ILW (CO, GA, IL, KS, ME, MO, NC, NE, OH, PA, TX, UT, VA, WI, & WV) plus 2 previously funded SRAPS (AR & OK) = 17 SRAPS are using QOL & ILW. (AgrAbility Green) 17 Treatment Group States (AR, CO, GA, IL, KS, ME, MO, NC, NE, OH, OK, PA, TX, UT, VA, WI, & WV (17 SRAPS). (Purple) 16 No-Treatment Group States + NAP (AL, AR, AZ, CA, FL, IA, IL, MN, MO, MT, MS, NAP, NY, OR, TX, WA, WY) 6 currently funded SRAPs are not yet with us using the QOL & ILW (Red)—Won’t You Join Us? (CA, IL, IN, KY, MI, & TN). [BOB, CHANGE IL (WEST OF IN) FROM AA GREEN TO RED.] 7 SRAPs are formerly funded SRAPs (Blue) (IA, LA, MN, MS, NH, VT, & WY). 2 of the 17 SRAPs are formerly funded (OK & ___??) 2 SRAPs are newly funded as of 10/14/15 (IL & MI). 3 SRAPs are newly funded as of 12/1/17 (OH, PA, TN). -Click on the State to change. -To change IL from red to AA green, Right click on IL Format Shape. -FillSolid FillColor -Go to Recent Color at bottom left and click on AA green OK??. -Olive Green, Accent 3? To change color to AgrAbility Green, use More Colors, Color Model RGB, Red = 118, Green = 202, Blue = 94, Transparency = 0%. -Close -Blue is in Standard Colors, 3rd from the right. -Purple is in Standard Colors, 1st from the right. -Red is in Standard Colors, 2nd from the left. -Yellow is in Standard Colors, 4th from the left. Please Join Us! Treatment Group SRAPs
Why Join Us? Document your project’s effectiveness at increasing clients’ ILW and QOL levels. Enhance your chances of receiving funding next time with empirical evidence of your SRAP’s quality and effectiveness. (Cf. FY 2018 RFA, pp. 17, 18, and 25.) Increase your chances for outside funding by demonstrating your accountability. Contribute to AgrAbility’s Vision.
Won’t You Join Us? Here’s How: Send an email to robert.fetsch@colostate.edu. Seek IRB approval from your Land-Grant University. Study and use the same protocol. Adapt CO to __ on pp. 1-2 & mail. Enter your data into an Excel file that we will provide, proof perfectly & email to me.
Thank you very much! Now let’s go back to the Major Results of this study. Slide #21 McGill Total Score Changes Improve from 5.65 to 7.12***. Slide #27 AAILW Total Score Changes Improve from 16.95 to 21.80***. Now I want to hear from you. Let’s brainstorm implications and practical steps that AgrAbility teams can take.
National AgrAbility Project Evaluation Committee (NAPEC) Produced Results Published 7 refereed journal articles, & 2 are in preparation. Christen, C. T., & Fetsch, R. J. (2008). Colorado AgrAbility: Enhancing the effectiveness of outreach efforts targeting farmers and ranchers with disabilities. Journal of Applied Communication, 92(1&2), 57-73. 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
National AgrAbility Project Evaluation Committee (NAPEC) Produced Results Published 7 refereed journal articles & 2 are in preparation. Fetsch, R. J., & Jackman, D. M. (2015, December). Colorado’s AgrAbility Project’s effects on KASA and practice changes with agricultural producers and professionals. Journal of Extension, 53(6), Article # 6FEA6. Available from http://www.joe.org/joe/2015december/a6.php
NAPEC Produced Results Published 7 refereed journal articles & 2 are in preparation. Fetsch, R. J., Jackman, D. M., & Collins, C. L. (2018). Assessing changes in quality of life and independent living and working levels among AgrAbility farmers and ranchers with disabilities. Disability and Health Journal, 11(2), 230-236. doi: https://doi.org/10.1016/j.dhjo.2017.08.001 Fetsch, R. J. & Turk, P. (2018). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Disability and Health Journal, 11(2), 249-255. doi: https://doi.org/10.1016/j.dhjo.2017.10.004
NAPEC Produced Results Published 7 refereed journal articles & 2 are in preparation. Jackman, D. M., Fetsch, R. J., & Collins, C. L. (2016). Quality of life and independent living and working levels of farmers and ranchers with disabilities. Disability and Health Journal, 9, 226-233. doi: http://dx.doi.org/10.1016/j.dhjo.2015.09.002 Meyer, R. H. & Fetsch, R. J. (2006). National AgrAbility Project impact on farmers and ranchers with disabilities. Journal of Agricultural Safety and Health, 12(4), 275-291.
NAPEC Produced Results Published 7 refereed journal articles & 2 are in preparation. Fetsch, R. J., Petrea, R. E., Field, W. E., Jones, P. J., & Aherin, R. A. (2017, August 26). A 25-year overview of AgrAbility demographics. Manuscript in preparation. Jinnah, H. A., & Fetsch, R. J. (2018, in preparation). What can we learn from those USDA AgrAbility clients who improved the most and least? Manuscript in preparation.
How Reliable Are the Subscales? A common measure of reliability is Cronbach’s alpha. Subscale (N = 325) Pre Post Physical Symptoms .50 .73 Psychological WB .82 .87 Existential WB .86 .90 Support .76 .74 MQOL Total .70 .84 ILW Total .74 .74 Updated as of 4/17/15. “Alphas should be positive and usually greater than .70 to provide good support for internal consistency reliability.” (Morgan, G. A., Leech, N. L., Gloeckner, G. W., & Barrett, K. C. (2004). SPSS for introductory statistics: Use and interpretation (2nd ed.). Mahwah, NY: Lawrence Erlbaum Associates. (p. 122.7). Sometimes 3-item subscales have lower Cronbach’s alphas. Ours is .59 which is marginal because it is (slightly) less than .70 (Morgan, Leech, Gloeckner, & Barrett, 2004, p. 124.2). The three-item physical symptoms subscale has at times had low Cronbach alphas in other studies ranging from .62 (Cohen et al., 1997) to .70 (Cohen, Mount, Strobel & Bui, 1995). The other 9 Cronbach alphas are .79-.93 which are quite acceptable because they are >.70. Cohen, R. S., 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. Cohen, R. S., Mount, B. M., Strobel, M. G., & Bui, F. (1995). The McGill Quality of Life Questionnaire: A measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliative Medicine, 9, 207-219.
Aida Balsano & Brad Rein Asked Us to Help Respond. So far 16 SRAP’s are working to collect data from AgrAbility clients with an on-site visit (AR, CO, GA, KS, ME, MO, NC, NE, OH, OK, PA, TX, UT, VA, WI, & WV). AR, CO, GA, KS, ME, MO, NC, NE, OH, OK, PA, TX, UT, VA, WI, & WV ME = Maine MI = Michigan MN = Minnesota We invite you to join us, CA, IN, KY, MI, TN, & VT. 83
How Do We Define QOL? QOL is a multidimensional construct of a person’s overall physical, emotional, social, financial, and spiritual well-being. Sources: Bogue P, Phelan J. Exploring the quality of life of farm families in Ireland: implications for extension. J Int Agri Ext Educ. 2005;12(1):79-90. Cummins RA. Assessing quality of life for people with disabilities. In: Brown RJ., ed. Quality of Life for Handicapped People. Cheltenham, UK: Stanley Thomas, 1997:116-150. Fetsch, R. J., & Turk, P. (2016, December 13). A quantitative assessment of the effectiveness of USDA’s AgrAbility Project. Manuscript in review. Hagerty MA, Cummins RA, Ferriss AL. et al. Quality of life indexes for national policy: review and agenda for research. Soc Indic Res. 2001;55(1):1-96.
From 25 years of Demographic Data We Learned that: Counting both new and repeat clients, AgrAbility served 27,201 clients over 24 years (1992-2015) which on average was 1,133 clients served each year. Source: Fetsch, R. J., Petrea, R. E., Field, W. E., Jones, P. J., & Aherin, R. A. (2017, September 14). A 25-Year Overview of AgrAbility Demographics. Manuscript in preparation. 86
What Has AgrAbility Achieved? What Can We Show for It? So far 15/20 currently funded SRAPs are working to collect data from AgrAbility clients with an on-site visit. 17 SRAPs used the same measures to assess QOL changes from before AgrAbility to after AgrAbility. 14 SRAPs collaborated to assess treatment versus no-treatment comparison group differences. 14 SRAPs collaborated to assess behavioral health improvements. “What Has AgrAbility Achieved? What Can We Show for It?” –Aida Balsano, 1/30/2017 But there are still 5 SRAPS who have not yet joined us in using our QOL surveys—please do! We welcome you! (CA, IL??[CHECK NAPEC]??, IN, KY, MI, & TN) 87
What Are Our Newest Directions? How do we get more matched pretest-posttest QOL data? What are we learning about who gains the most from AgrAbility in our qualitative case studies project? Source: Fetsch, R. J., Petrea, R. E., Field, W. E., Jones, P. J., & Aherin, R. A. (2017, September 14). A 25-Year Overview of AgrAbility Demographics. Manuscript in preparation. 88
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 2/20/2007-1/20/2016 include the first entrya and the last exitb for the 225 included in the QOLTreNoT [QOLTrtCom] study. Note: According to QOLMss6.1813, 6.5 years = 1/26/2007-6/18/2013. QOLILWMss., pp. 8.5, 10.2 N = 476/788 (QOLILWMss., p. 10.2).
History of NAPEC Fourteen SRAPs conducted an 11-year AgrAbility treatment versus non-AgrAbility treatment comparison, pretest-posttest study. c. 2005 President George W. Bush asked, “What difference are the tax dollars you receive making in the Quality of Life (QOL) of the people you serve?” c. 2006 at NTW, Brad Rein asked, “What difference are the tax dollars we receive making in the QOL of the clients we serve?” Fetsch immediately afterwards went to tell Brad, “We can help you find out!” Fetsch invited all SRAPs to meet and find QOL instruments that are practical, valid, and reliable. * 2/20/2007-10/20/2017 2/20/2007-1/20/2016 include the first entrya and the last exitb for the 225 included in the QOLTreNoT [QOLTrtCom] study. Note: According to QOLMss6.1813, 6.5 years = 1/26/2007-6/18/2013. QOLILWMss., pp. 8.5, 10.2 N = 476/788 (QOLILWMss., p. 10.2).
History of NAPEC Fourteen SRAPs conducted an 11-year AgrAbility treatment versus non-AgrAbility treatment comparison, pretest-posttest study. 2006-2007 c. 20 of us met, reviewed, and discussed > 100 QOL instruments and narrowed it to the PF-36 and the McGill QOL. 2007 Carl Wilhite challenged us also to measure Independent Living and Working levels, so we wrote and pilot tested 6 items. We obtained permission from Robin Cohen to use QOL pretests, posttests, cover letters. We created QOL pretests and posttests with cover letters. We obtained IRB approval. We worked with NAP to add demographic items (income level, veterans, ?, ? * 2/20/2007-10/20/2017 2/20/2007-1/20/2016 include the first entrya and the last exitb for the 225 included in the QOLTreNoT [QOLTrtCom] study. Note: According to QOLMss6.1813, 6.5 years = 1/26/2007-6/18/2013. QOLILWMss., pp. 8.5, 10.2 N = 476/788 (QOLILWMss., p. 10.2).
History of NAPEC Fourteen SRAPs conducted an 11-year AgrAbility treatment versus non-AgrAbility treatment comparison, pretest-posttest study. 2006 We published Meyer & Fetsch. 2008 We published Christen & Fetsch. 2015 We published Fetsch & Jackman. 2016 We published Jackman, Fetsch, & Collins. 2018 We published Fetsch & Collins; Fetsch, Jackman & Collins; and Fetsch & Turk. 2018 We have two additional manuscripts in preparation. * 2/20/2007-10/20/2017 2/20/2007-1/20/2016 include the first entrya and the last exitb for the 225 included in the QOLTreNoT [QOLTrtCom] study. Note: According to QOLMss6.1813, 6.5 years = 1/26/2007-6/18/2013. QOLILWMss., pp. 8.5, 10.2 N = 476/788 (QOLILWMss., p. 10.2).
How Many SRAPs Are Collecting ILW and QOL data?
1) Suicide 2) Animals 3) Tractors What do you think the leading external causes of death on Colorado ranches/farms have been? 1) Suicide 2) Animals 3) Tractors
Farm/Ranch Depression Leads to Suicides People working in farming, fishing, and forestry in 17 states* had a controversial suicide rate more than five times the U.S. suicide rate in 2012: 84.5/100,000 vs. 16.1/100,000. *AK, CO, GA, KY, MD, MA, NJ, NM, NC, OH, OK, OR, RI, SC, UT, VA, and WI. Source: McIntosh, W. L., Spies, E., Stone, D. M., Lokey, C. N., Trudeau, A. T., & Bartholow, B. (2016). Suicide rates by occupational group — 17 States, 2012. Morbidity and Mortality Weekly Report, 65, 641–645. 95
Rates of Suicide per 100,000 17 States (McIntosh et al., 2016) Source: McIntosh, W. L., Spies, E., Stone, D. M., Lokey, C. N., Trudeau, A. T., & Bartholow, B. (2016). Suicide rates by occupational group — 17 States, 2012. Morbidity and Mortality Weekly Report, 65, 641–645.
So What? Why Are These Results Important Now? Recent controversial research found that farmers’ and ranchers’ suicide rates are 5 times the normal U.S. average.* Recent research found that ranchers’ and farmers’ suicide rates are almost 3 times that of army veterans.** *** The 2018 Farm Bill is up for renewal. Source: * McIntosh et al. (2016); **Zoroya (2016a); *** Zoroya (2016b). 97