Project Upstream: Prevention and Community Navigation

A Prevention-First, Relationship-Driven Model for Resilient Communities

Greater Manchester Region, New Hampshire | Makin' It Happen Coalition for Resilient Youth
NEW HAMPSHIRE Urban Suburban Rural Pop. 180k Launched 2023
The Manchester, New Hampshire skyline seen across the Merrimack River, with a steel railroad bridge spanning the water in the foreground.
Lead Agency
Makin' It Happen Coalition for Resilient Youth, Inc. (dba Makin' It Happen)
Location
Hillsborough County, Manchester, and the Greater Manchester region, New Hampshire
Year Launched
FY24 (July 2023–June 2025); renewed for a second two-year term (July 2025–2027)
Opioid Settlement
75% of an approximate $325,000 annual budget, awarded through New Hampshire's state opioid settlement process
People Served
~180,000 residents reached indirectly and ~500 reached directly per year
Service Type
Planning & Coordination, Care Navigation, Prevention/Education
8
COMMUNITIES SERVED
across the Greater Manchester region
75%
OPIOID SETTLEMENT FUNDED
of an approximate $325K annual budget
500+
RESIDENTS REACHED
directly each year through outreach, training, and community engagement

Makin' It Happen built a regional prevention model that connects eight urban, suburban, and rural communities across Greater Manchester to existing state and local services, serving as a trusted navigator who helps residents learn what help is available and how to reach it before a crisis arises.


The Challenge They Were Addressing

Outlying communities around Manchester had a recurring experience: residents who needed help were directed into the city, which strained an already busy system and left smaller towns feeling that they had no local support. Suburban and rural residents told the coalition that they either could not access services or did not understand how to do so, and many felt the regional and state systems were not built with their towns in mind.

New Hampshire has spent years building strong statewide resources, and most of them are free. The state built a regional public health network, a Doorway hub-and-spoke system for people seeking help with substance use, the 988 line, a rapid-response mobile crisis system, the Recovery Friendly Workplace initiative, and the Strong as Granite anti-stigma campaign. The gap was not a missing service. The gap was awareness. As the coalition put it, the people who set up these systems all know about them, but most of the residents they aim to serve do not.

The need built up in layers rather than from a single event. New Hampshire was already in an overdose crisis in 2018 and 2019. The pandemic followed, mental health concerns rose as communities came out of it, and more recent shifts in national funding left local programs uncertain about what would continue. Prevention had long been treated as part of the work, funded only if money was left over. Project Upstream was built on the opposite premise: that helping families and communities know their resources before a crisis is the steady, year-round work that keeps the whole system from being overwhelmed.


"We've got to get upstream, start younger, and get the parents involved in prevention."
Mary Forsythe-Taber, Executive Director, Makin' It Happen

What They Built

Makin' It Happen operates as a connector agency, similar to the hub in a hub-and-spoke model. National, state, and local service providers are the spokes; the coalition is the connector that links residents to them. The team describes itself as navigators. They get to know each community by attending its meetings and events or by being invited to deliver a training or workshop, and then grow the relationship from there. In partnership with the Manchester Health Department, Makin' It Happen is the lead prevention agency for the Greater Manchester Regional Public Health Network.

The work does not follow a single script. The coalition learned this early. Its first instinct was to hold listening and learning sessions and tell each community about all the state resources it might not know about. The first session in a suburban community was too much: a lot of the coalition talking to people who did not yet know who the coalition was. The team backtracked and changed its approach, showing up repeatedly at community events, learning each town, and letting residents see them more than once before asking anything of them.

Because the region spans urban, suburban, and rural towns with different needs and different capacities, the model is built to flex. What happens in Manchester looks different from what happens in Auburn. In Auburn, the coalition trained school district staff in suicide prevention, which led to work with the police department on a neighborhood event, which in turn led to scheduling sessions with the school nurse and police on additional strategies. Each community starts where it is ready.

Marketing and communications carry the model as much as in-person outreach. Many families in the region work second and third shifts. They may not be able to attend a school or library event, so the coalition uses social media, a resource hub website, and a podcast series to reach them on their own time. The team also built a resource connection map of services across the area, including mental health, food assistance, homelessness, and treatment and recovery supports, which was distributed to outreach workers, urgent care sites, and schools.

Key Program Components

Community navigation hub
Makin' It Happen acts as a connector agency, linking residents to the free state and local services they qualify for and walking them through how and when to use each one.
Relationship-based outreach
A three-person Community Impact team makes first contact, attends local meetings and events, and returns repeatedly so that towns come to know the coalition before any program is proposed.
Listening and learning sessions
Structured community conversations that assess what each town needs, what is already happening locally, and which partners should be brought in, replacing a one-size-fits-all rollout.
Trainings and custom workshops
A two-person training team delivers sessions such as mental health first aid, QPR suicide prevention, and inhalant and medicine safety, tailored to each community and offered at no cost.
Resource hub and connection map
A website resource hub and a printed regional map of mental health, food, housing, treatment and recovery supports, distributed to outreach workers, urgent care sites, and schools.
Marketing and digital reach
A dedicated marketing and communications role manages social media, the website, and two podcast series, reaching second- and third-shift families who cannot attend in-person events.
Youth leadership program
A youth-led, adult-supported initiative in which trained high schoolers visit middle schoolers to talk about vaping and medicine safety, modeling the community ownership the coalition is building toward.

Who You Need at the Table

Required Partners
Role
Manchester Health Department
Co-leads the regional prevention work; Makin' It Happen is the lead prevention agency in partnership with the department for the Regional Public Health Network.
Six core community sectors (government, health, education, business, safety/law enforcement, community/family)
Provide the local relationships, meeting access, and reach that make community navigation possible across all eight towns.
Prevention, mental health, treatment, and recovery providers
Serve as the spokes residents are connected to, including the Doorway system, 988, rapid-response crisis services, and 2-1-1.
Hope Recovery (local recovery center)
Connects people in recovery back into prevention so they can teach their own families; the center's leadership keeps that loop open.
Helpful Partners
Role
NH Recovery Friendly Workplace initiative
Opens a path for for-profit employers, helping the coalition reach working families and reduce stigma through workplace trainings.
Civic organizations, community centers, and libraries
Serve as community meeting places and trusted venues, proving more essential to reach than first expected.
Schools, including private and charter schools
Host youth leadership and prevention programming; relationships are strong in some districts and still developing in others.

What made a willing partner essential vs. optional?

The partner that makes this model possible is a community willing to be in a real relationship rather than a transactional one. The six core sectors and the regional providers are required because they supply the local trust and the actual services residents are connected to. Without them, a navigator has nowhere to navigate. The coalition found that some partnerships it first labeled helpful, such as libraries, community centers, and civic groups, turned out to be essential, because those are the places where residents already gather and feel safe.

Some relationships take patience to build. Rural, private, and charter schools often start by sending us some information; we will call you. Some for-profit employers are slow to engage. The coalition has found openings through existing statewide doors, drawing on the Recovery Friendly Workplace initiative to reach businesses it could not reach directly. The pattern holds across sectors: a partner becomes essential the moment it is willing to let the coalition show up more than once and learn the community together.


Budget Breakdown

$325K
Annual Project Budget
approximately per year
75%
Opioid Settlement Funded
awarded through New Hampshire's state opioid settlement process
80%
Personnel/Staffing
community impact, training, communications, and leadership staff
Primary Funding Source
New Hampshire state opioid settlement funds
Additional Funding
Braided with other grants, including a separate SAMHSA training grant, plus in-kind community support
Budget Category
Amount
Notes
Personnel/Staffing
About 80%
Three-person Community Impact team, a two-person training team, a marketing and communications role, and partial time from focus-area directors.
Treatment/Clinical Services
N/A
Direct treatment is delivered by partner providers, not by the coalition; Project Upstream is prevention and navigation.
Peer Support/Recovery Coaches
Included in partner network
Recovery connection runs through partners such as Hope Recovery rather than through grant-funded coaching positions.
Technology/Data Systems
About 10% (with services)
Resource hub website, social media, and the two-podcast series that reach families working second and third shifts.
Training & Capacity Building
Recurring
T3 training on new evidence-based programs, professional development, and Certified Prevention Specialist credentials.
Supplies/Equipment
Small allocation
Printed resources such as connection maps, 988/Rapid Response materials, Narcan kits, and medicine disposal bags distributed across the region.
Contracts
Minimal
Most work is delivered by coalition staff and volunteer partners rather than outside contractors.
Admin/Indirect
About 10%
Standard administrative allocation, including travel across eight communities, where fuel is a real recurring cost.

What is the minimum viable budget to replicate this?

A smaller county could start with two full-time staff plus committed partner and volunteer time, braiding a modest grant with free state resources and donated community capacity. The coalition is clear that $75,000 alone would need to be combined with other funding or social capital, such as partnering with volunteers, to work. With limited dollars, the advice is to run an asset and gap analysis first, identify the strengths that already exist in a community, and match those strengths to stated needs rather than building new programs from scratch. What cannot be cut is the core function: identifying support resources and connecting residents to them.


What Worked and Why

Specific decisions or design features that drove success

Slowing down and building trust before delivering content was the decision that turned the model around. The first listening-and-learning session showed limited engagement because the coalition arrived as strangers, talking to residents. Showing up at town events, handing out water, joining National Night Out and DEA Take Back days, and letting people see the same faces repeatedly eventually led communities to start calling the coalition on their own.

Using the language of resilience rather than addiction made the work approachable. When the team leads with “we do drug prevention”, doors close. When it leads with “what we want is to help build resilient youth, families, and communities”, people lean in and ask to hear more. It is the same work described in a way that invites the community in rather than putting it on the defensive.

Investing in marketing and communications reached the families that in-person events miss. Many households in the region work two or three jobs across second and third shifts and will never make it to a school or library meeting, but they will see a positive, health-focused message online while winding down from a shift. Social media also lets the coalition send timely alerts about emerging risks to parents, schools, and providers simultaneously.

Staffing the team with at least one person who has lived experience gave the outreach empathy and credibility. That staff member can speak openly about what helped her family and what she wished she had known earlier, which lands differently than information delivered by someone who learned it from a binder.

Anchoring the project in the coalition's existing mission and staying fluid, flexible, and willing to adapt is what the team identifies as the single most important factor. Because community building was already the organization's purpose, Project Upstream extended what Makin' It Happen does rather than asking it to become something new.

"People need human connection. They don't want to be sent to a website."
Mary Forsythe-Taber, Executive Director, Makin' It Happen

Early outcomes and data

  • Steady year-over-year growth in requests for training, workshops, and support materials from the eight communities.

  • Rising social media engagement as the coalition shares what services exist and how to reach them.

  • Positive pre-survey and post-survey results from trainings and workshops.

  • Local reports of eased pressure on emergency rooms and shelters as residents learn alternatives such as calling 988 or visiting a Doorway.

  • Rural police departments equipped with Narcan kits, medicine disposal bags, and 988 information are now carried in cruisers.

  • An anti-stigma training, delivered with a national policy partner, that shifted how partner agencies think about their work.

  • A mobile My Recovery Gallery of community recovery stories, hosted at roughly a half dozen sites and expanding into billboards.


Replication Guide
How to Replicate This Model
Minimum viable version
The smallest version that still works is two outreach staff who know the available services, are approachable, and act as connectors rather than salespeople, supported by partner and volunteer time. Much of prevention is relationship work: building enough trust that residents will have the harder conversations. A replicating county should braid a small grant with the free resources its state already offers and with the time, training, and goodwill of its community sectors. Beyond that, the model flexes. A team does not need to attend every meeting or event, which is impossible for any agency; it should evaluate and be selective. A region can start with one focus, such as a single training offering or a resource map, and grow from there.
First three steps
1
Find a mentor and a prevention champion agency The coalition's own answer to who a county should call first is us. A replicating county needs a designated prevention champion to anchor the work and an experienced mentor to learn from, so it is not starting from scratch.
2
Conduct an asset and gaps analysis before spending a dollar Map the services, partners, and strengths a community already has against what residents say they need. This groundwork prevents wasted effort and is the step the coalition says it would have done earlier if starting over.
3
Build relationships before programming Show up at community events, learn each town, and let residents see you more than once before proposing anything. This is steady, ongoing development, not a quick setup, and skipping it is the most common mistake.
Common Pitfalls
Treating it as a quick setup is a mistake This relationship-building model depends on steady, long-term development. Counties that expect to set it up and walk away will not see it take hold.
Leading with listening sessions before residents know you Arriving as strangers to tell a community about services often overwhelms people. Build familiarity first, then bring the content.
Skipping the asset and gaps analysis Standing up new programs without first mapping local strengths and needs wastes limited dollars and duplicates services that already exist.
Bringing community partner agencies in too late Rural and suburban communities want to meet the people behind the agencies; involving partner organizations early builds the trust that the model runs on.
Planning around short-term funding Two-year grants drive staff turnover and disrupt the residents being served. Plan for sustainable, long-term funding wherever possible, because trust and systems take time to build.

Lessons Learned

  • Build trust before you build programs. The first listening session showed that residents may not engage with an organization they do not know. Showing up repeatedly, learning each town, and letting people see the same faces is the foundation on which everything else rests.

  • Run the asset and gaps analysis earlier. The team would map its community continuum-of-care partners sooner. Knowing each town's strengths and needs from the start would have focused the work faster.

  • Bring community partners into the work sooner. Rural and suburban towns want to meet the people behind the agencies. Involving partner organizations earlier would have built relationships ahead of need rather than during it.

  • Speak the community's language. Framing the work as building resilience rather than fighting addiction opens doors that clinical language closes, even when the underlying work is identical.

  • Plan and advocate for sustainable funding. Short-term grants create turnover and disrupt the people being served. Prevention deserves stable, long-term support, and replicators should plan to braid funding and advocate for it from day one.


"It doesn't cost much to go and be consistent, listening and connecting with people."
Mary Forsythe-Taber, Executive Director, Makin' It Happen

Primary Contact
Mary Forsythe-Taber
Executive Director, Makin' It Happen Coalition for Resilient Youth, Inc.
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