Finding Freedom in Appalachia: Evaluating a Mental Health Intervention in West Virginia.

Introduction: Rural areas have limited capacity to provide comprehensive mental health treatment and resources. This creates the need for interventions to ensure individuals with mental health concerns have access to resources to improve their mental health.

Purpose: The purpose of this mixed-methods evaluation was to assess the effectiveness and impact of Libera, a mental health program tailored for girls and women within the Appalachian region.

Methods: Quantitative surveys, including validated measures for depression, anxiety, and eating disorder symptoms, and life satisfaction, were collected pre- and post-Libera intervention for participants. Simultaneously, annual surveys were sent to Listeners in addition to qualitative semi-structured interviews. Data were collected from August 2019 - November 2021. All data were analyzed from December 2021 - March 2022 using SAS JMP 16 for quantitative data and NVivo 14 for qualitative.

Results: Participants showed significant improvements in depressive and anxiety symptoms, and life satisfaction following the Libera intervention. Disordered eating symptoms did not significantly improve. Similarly, Listeners showed changes from their training and experiences, with positive reactions, learning, behavior change, and effective results for them and their participants.

Implications: This study provides evidence for Libera's use among Appalachian women and girls. Participants experienced many improvements in mental health following completion of the Libera program. Additionally, Listeners leading groups experienced positive changes in learning and behavior. The results also indicate areas to continue strengthening the program with resources and training in specialized topics (such as eating disorders or Safe Zone training).