Youth-designed “blue-green” spaces boost resilience and mental wellness for Appalachian adolescents

WASHINGTON (June 15, 2026) — Adolescents in rural Appalachian communities face disproportionate mental health risks and geographic isolation, but new research from Georgetown University’s Berkley School of Nursing suggests that youth-led environmental design can foster a unique form of “Situated Strength.”

The study, preprint published June 14, 2026 in the journal Progress in Community Health Partnerships, found that co-developing "blue-green" spaces, outdoor environments incorporating water and vegetation, significantly supports emotional regulation, resilience, and a sense of belonging among high school students.

Emerging from an ongoing partnership with Clay County, West Virginia, and the Appalachian Community Engagement (ACE) project, this initiative highlights youth-led, community-engaged innovation in rural health. Clay County reflects structural vulnerabilities common across Central Appalachia, including high rates of foster and kinship care associated with parental substance use. To address these needs, Georgetown faculty and graduate nursing students collaborated with local high schoolers through a Community Engagement Council to transform an unused concrete pad into a multifunctional wellness space.

“Clay County is one of the most remote, rural, and under-resourced areas in the state of West Virginia,” said lead author Melody Wilkinson, DNP, APRN, FNP, FAANP, FAAN,  a native West Virginian and professor at Georgetown’s Berkley School of Nursing. “It was actually at the request of the high school students, who came forward and said they wanted a blue and green space to exist where this barren concrete pad sat that allowed us to pursue the project.”

The research team utilized Photovoice, a participatory method where students captured images and stories to document their experiences. The analysis revealed two core concepts: Situated Strength (researcher-identified) and Healing and Restoring (student-identified). Together, these themes illustrate how the natural environment functions as a psychological refuge for rural youth.

Key findings from the study include:

• Emotional Regulation: Students associated the sound of flowing water and the presence of greenery with "cognitive decompression," providing a necessary shift from the "performance pressure" of the classroom.
• Rooted Resilience: Participants frequently compared the new space to "home" or "family porches," suggesting these environments help bridge the gap between school and the comfort of personal identity.
• Growth Through "Risk": Rather than physical danger, students framed "risk" in these spaces as the freedom to explore and experiment, which they described as essential to feeling "alive".
• Symbol of Voice: Beyond the physical features, students interpreted the space as evidence that adults valued their perspectives, strengthening their sense of agency.

“The high school students were incredibly  insightful about the needs of their community,” Wilkinson noted. “As a clinician, it challenges us to recognize that some of the most meaningful impacts on health may happen outside the clinic – through connection, environment, and experiences as simple as building something together.”

Researchers say that modest investments in youth-designed outdoor infrastructure can serve as a sustainable, contextually grounded strategy for promoting wellness in rural, economically distressed settings.

“This work is an expression of cura communitas—care for the whole community, by the community,” says Debora Dole, PhD, CNM, FACNM, Vice Dean for the nursing school. “By positioning adolescents as co-designers, we aren't just creating a space; we are fostering agency and ownership of health-promoting environments.”

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In addition to Wilkinson and Dole, authors include Vera Barton-Maxwell and Jill Ogg-Gress of Georgetown University; Angela Brown of the Clay County Health Department; Stephanie Wayne of Clay County Schools/Project Aware; and Walter Hatfield, Adam Landers, and Travis Tatalovich of CMI2.

The project was supported by GUMC DISCOVER, RADIANCE grants, and the Burton Family Endowed Nursing Experiential Fund.