The Agricultural Cooperative Extension Service model offers academic health centers methodologies for community engagement that can address the social determinants of disease. The University of New Mexico Health Sciences Center developed Health Extension Rural Offi ces (HEROs) as a vehicle for its model of health extension. Health extension agents are located in rural communities across the state and are supported by regional coordinators and the Offi ce of the Vice President for Community Health at the Health Sciences Center. The role of agents is to work with different sectors of the community in identifying high-priority health needs and linking those needs with university resources in education, clinical service and research. Community needs, interventions, and outcomes are monitored by county health report cards. The Health Sciences Center is a large and varied resource, the breadth and accessibility of which are mostly unknown to communities. Community health needs vary, and agents are able to tap into an array of existing health center resources to address those needs. Agents serve a broader purpose beyond immediate, strictly medical needs by addressing underlying social determinants of disease, such as school retention, food insecurity, and local economic development. Developing local capacity to address local needs has become an overriding concern. Communitybased health extension agents can effectively bridge those needs with academic health center resources and extend those resources to address the underlying social determinants of disease.

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Aid (MHFA) has the potential to addresses health disparities, especially within rural communities that are underserved with respect to behavioral health services, through increasing mental health literacy among key community members. Because MHFA instructors play a key role in the dissemination of MHFA, their views on the challenges in delivering the MHFA course are important. The purpose of this study was to identify the type and extent of challenges that MHFA instructors have experienced, or expect to experience, when disseminating MHFA in New Mexico. An online survey on challenges encountered, or expected to be encountered, in the dissemination of MHFA was completed by 31 MHFA instructors. Challenges were classified into costs associated with the training, MHFA-specific issues, community-related issues, and implementation issues. Among 22 potential challenges, those related to costs were the challenges most likely to be identified by instructors. These costs include MHFA books for those being trained, snacks for the training, and instructor-related travel expenses. An understanding of the challenges will help increase the dissemination of MHFA in New Mexico as well as in other states. Further exploration of the value of instructor support (e.g., administrative, organizational, and financial) and importance of prerequisite skills (e.g., mental health expertise and training experience) in the dissemination process is warranted.