- March 25, 2026
- By John Tucker
Noah Triplett grew up in the one-stoplight town of Tyro, N.C., where cows seemed to outnumber people and the hot teen hangout was Walmart. He’s lost several childhood acquaintances to the opioid epidemic that hit small-town America hard, and understands how isolation and poverty can threaten mental health.
His background helps Triplett, a child psychologist and assistant professor of behavioral and community health in the University of Maryland’s School of Public Health, connect with his current patients: students from rural Caroline County, Md., struggling with substance use and other acute psychological disorders.
Across the state, Caroline County claims the fifth-highest poverty rate and fifth-highest rate of students—3.1%—who say they’ve used heroin. Students as young as 14 have overdosed, yet the nearest hospital is in neighboring Talbot County and the closest inpatient children’s clinic is in Delaware. Students who use drugs often struggle with other mental health conditions.
Caroline County Public Schools employs just one mental health counselor, but for the past academic year it has partnered with Triplett to offer teletherapy to middle- and high-schoolers struggling with substance use and at least one co-occurring mental health problem. Sometimes he’ll teach an anxious teen mindfulness techniques; on another occasion he’ll nudge a depressed student to stroll outside.
In addition to his pro-bono clinical work, Triplett is conducting a community-engaged needs assessment in Caroline County through a Center for Addiction Research Education, and Service grant from the University of Maryland, Baltimore (UMB) School of Social Work. It addresses an often-overlooked community and helps fill a gap in psychological research. “During my academic training I had no exposure to rural mental health at all until I sought it out on my own,” Triplett explained.
In a recently published study in the Journal of Rural Mental Health, Triplett interviewed several mental health clinicians in rural Washington State, who told him that youths often can’t access treatment because of staff shortages, clinician burnout and transportation barriers. Some staffers reported offering parents to pay for bus fare to cover a child’s two-hour trip to the clinic and acknowledged a lack of substance use-specific services.
Triplett’s youth-focused work builds off a Caroline County Health Department program featuring a van that travels the county offering treatment for adults battling opioid addictions, conducted in partnership with UMD’s Center for Substance Use, Addiction and Health Research (CESAR) and UMB’s School of Medicine. Several staffers in that program are individuals in recovery-turned-peer advisers, and after one recounted his story of using heroin in his high school bathroom, county school officials in 2023 launched its public school program.
As staff worked to normalize mental health problems and trained teachers to ask the right questions, students who in years past might have been labeled only as anxious or depressed were suddenly acknowledging they used drugs and alcohol, too. Because the school district’s contracted clinicians lacked specialized training in substance use and co-occurring disorders, partnering with Triplett, a CESAR faculty affiliate, made sense, said Cara Calloway, the district’s behavioral health services coordinator.
What’s more, with so many students “coming out of the woodwork,” Calloway said, waitlists for therapy could run more than a month. “Now we can fast-track them to Noah, and he can engage with them in a week or two.”
CESAR Director and UMD Associate Professor of clinical psychology Jessica Magidson, who conducts research on Caroline County’s adult mobile van program, said the youth services may also help address addiction in the long run. “If we address mental health concerns with early intervention in schools, it may be less likely that my team will see severe cases years later in the adult unit,” she said.
After evaluating his project later this year, Triplett aims to replicate it in other parts of rural Maryland, where there is also need. As of 2022, Maryland was one of eight states where drug overdose death rates are higher in rural counties than urban ones, according to federal data.
In the meantime, Triplett is relying on his own experience to empathize with the stigma surrounding mental health that small-town gossip mills can send into overdrive.
“Everybody knows everybody, and everybody knows everybody’s business,” he said.
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