According to the World Health Organization, young people between the ages of 10 and 19 years are often thought of as a healthy group. However, many do die prematurely due to illnesses that are either preventable or treatable. Maine tracks these issues through two performance measures: adolescent (ages 12-17) bullying; and unmet mental health needs of adolescents.

Despite increased attention to the need for prevention and intervention, bullying and harassment remain common experiences for children and adolescents. According to the 2019-2020 National Survey of Children’s Health (NSCH), 16% of adolescents, aged 12-17 years old bullied others and almost half (40.5%) were bullied in the previous 12 months. The percent of Maine children who have bullied others is about the same as the U.S. (13.7%). The percent of Maine adolescents who had been bullied is higher than the U.S. percentage of 35.2% and only 10 states had a higher percentage of parents reporting that their child had been bullied. However, the proportions of youth who have bullied others and who have been bullied have been declining over time.

Based on Maine Integrated Youth Health Survey (MIYHS) data, the percent of high school students reporting that they were bullied on school property and the percent who have been electronically bullied had been declining, but in 2019 both percentages increased slightly, but not significantly. We do not know yet whether school closures necessitated by COVID-19 had any impact on bullying behavior. The 2021 MIYHS was delayed from Fall 2021 to Spring 2022. Data should be available in Fall 2022. Schools and communities are increasingly recognizing the impact of bullying and harassment on students’ education success and mental and physical health. The Maine Department of Education (Maine DOE) provides ongoing training and technical assistance for school systems on implementation of required comprehensive model bullying and harassment prevention policies and procedures as well as trainings in other areas of best practice bullying prevention (http://maine.gov/doe/bullying). The Maine Center for Disease Control and Prevention’s (Maine CDC) Title V program funds Maine DOE staff to support best practices in addressing bullying and harassment behavior in school settings, including integration of restorative justice practices.

We know that some groups are disproportionately affected by bullying. About two out of three (66.1%) of children with special health care needs are bullied, picked on, or excluded by other children.[1] Students who are American Indian/Alaska Native (33%), Native Hawaiian/Pacific Islander (39%), or multiracial (29%) are more likely to be bullied than students who are white (23%).[2] Students who identify as gay, lesbian or bisexual have even higher rates of bullying and harassment with 37% of gay/lesbian youth and 37% of bisexual high school youth reporting being bullied at school in the past year.2 Almost half (44%) of high school youth who identify as transgender were bullied at school in the past year.2 It is also problematic that many youth report relatively low confidence in the ability of adults to respond supportively to bullying and harassment. Only 32% of high school students believe that adults in their school address conflict, negative language and bullying in positive ways to help students.2

Priority: Prevent Bullying and its consequences

Performance Measure: Percent of adolescents, ages 12 through 17 years, who are bullied or who bully others.

Strategy: Active engagement of health care professionals in bullying prevention to reduce the adverse health outcomes (physical and psychosocial) associated with bullying

During FY21 the strategy focusing on school health and other healthcare personnel was put on hold as school health personnel tended to COVID-19 pandemic matters. Maine DOE had planned to convene a multidisciplinary group of healthcare professionals in the fall of 2020 to identify unified ways to prevent, recognize, and support individuals that are impacted by bullying. COVID-19 dominated the workload of these professionals during FY21, and any activities not directly associated with the pandemic response were paused.

Although the working partnerships between Maine DOE and healthcare professionals, specifically athletic trainers, school physicians, and pediatricians has likely been strengthened during the ongoing pandemic response in schools, it was focused primarily on that. We hope to engage in this work in FY22 and FY23.

Strategy: Increase the number of schools providing students with instruction and practice in Trauma Informed strategies.

Maine DOE selected “the number of administrators, educators and support staff taking a new Social Emotional Learning (SEL) foundations training who have increased knowledge (70% increase in knowledge)” as an evidenced based strategy measure. Providing statewide SEL training to administrators, educators and support staff ensures knowledge and understanding of social emotional competencies as relative to reducing bullying incidence through a shift in school climate and culture to a trauma informed/compassionate/equitable environment. In FY21, Maine DOE planned to provide free and easily accessible trauma informed trainings for schools to increase supports to students. While the pandemic impacted in-person trainings a shift to virtual and asynchronous training led to the Maine DOE providing over 8,000 contact hours to educators focused on trauma informed content areas and over 3,500 educators completing trauma informed trainings. Using this technology, paired with an increase in new SEL trainings related to adult SEL development and the recently released SEL4ME program (described below), we expect meeting the target of a 70% increase in knowledge.

Trauma Informed Response and Readiness Workshops were postponed due to the pandemic and planning moved to develop a systemic, best practice, statewide approach. A taskforce planning team engaged cross-departmentally to assess existing trauma informed practice awareness and approaches as well as engaged other states that have existing statewide trauma informed approaches. This work will inform future Trauma Informed Response and Readiness Workshops.

Strategy: Provide professional learning (PL) to school personnel on inclusivity and systemic bullying prevention practices and program.

Maine DOE planned to develop and deliver professional development to school personnel on inclusivity and systemic bullying prevention practices during FY21. The pandemic changed the landscape for the 2020-21 school year with high demands on teachers and administrators making additional professional development a low priority. The activities within this strategy were postponed to FY22 and the 2021-22 school year. We are pleased to share that the Maine DOE created and filled a new position with a focus on diversity, equity, and inclusion. This individual will be a great resource for achieving activities related to this strategy.

The Maine DOE worked with Maine educators to develop asynchronous project-based modules to be used for remote learning. Included in the criteria was ensuring the modules were diverse and inclusive of populations and cultures so all students and families felt included, represented, and able to fully engage. It was also necessary for the modules to offer equal opportunity for access to all users. Other criteria included building in aspects of social emotional learning, movement breaks and brain boosters to support the health and well-being of the users. Teams of educators participated in training on best practices regarding diversity, equity and inclusion in curriculum materials and instruction that would assist the educators in developing modules that met this very important criteria. In addition, state leaders engaged in trainings to better understand best practices in diversity, equity and inclusion for adults and young people. This work will inform the trainings for educators in best practices around diversity, equity and inclusion in curriculum development and instruction planned for FY22.

The Maine DOE had planned to provide schools with assistance for assessing their current multi-tiered systems of supports (MTSS) and provide recommendations for improvements needed to strengthen tiered levels of support for bully prevention beginning in the fall of 2020. The pandemic changed educator priorities and objectives for the 2020-2021 school year and the efforts of the MTSS and bullying collaboration at Maine DOE. This work was postponed to FY22 and the 2021-2022 school year. Despite work plan delays, the Maine DOE worked briefly in collaboration with the Broward County School District in Florida and obtained a variety of materials that align with this strategy and will serve to inform work on it moving forward.

Strategy: Make available resources and technical assistance to support implementation of effective school-based strategies to reduce bullying behaviors and promote positive behaviors among youth ages 12 - 17.

With funding from the Fund for a Healthy Maine, the Maine DOE SEL team, consisting of experts and stakeholders from the field, Maine DOE and Maine Department of Health and Human Services purchased a unique to Maine comprehensive Collaborative for Academic, Social and Emotional Learning (CASEL) aligned and trauma informed, Pre-K through grade 12 SEL curriculum. This curriculum, named SEL4ME, is a free and readily accessible web based comprehensive SEL curriculum aligned with CASELs five foundational competencies to assist educators with tools to purposefully instruct students of all ages in the development of SEL skills. The curriculum is age and grade level appropriate and scaffolded in developmental sequences accordingly. Each module is accompanied with additional educator and student resources as well as parent engagement resources for generalization of learned materials. There are 450 SEL4ME learning modules in total Pre-k-12th grade with approximately 30-35 modules available at each grade level with the exception of Pre-k. These modules are readily available to support on-line or remote learning, easily embedded into everyday instruction and are free to all school districts, afterschool programs and others working directly with students in Maine. The goal of SEL4ME is for all school districts and community programs across the state to have equal access to resources aimed at the development of social-emotional competencies to create safe and supportive schools where all students can thrive, and know with certainty that they are safe, respected and valued regardless of race, sexual orientation or gender. SEL4ME provides districts with the most recent and up to date SEL materials and can be used by districts already utilizing other SEL resources including school counseling, health education or Second Step programs, as supplemental guidance.

Since its launch on October 27, 2020, SEL4ME has 5,528 registered users from 169 school districts, representing 137 schools. There have been over 70,000 lesson engagements with the content and 17,608 lessons completed.

Additionally, work with the Maine School Safety Center is on-going in partnership with the Maine Criminal Justice Academy in training School Resource Officers for understanding the key elements of school safety, emotional intelligence, brain-based systems of learning and trauma informed practices to reduce bullying prevention in Maine schools and increase safety.

The Maine DOE made marginal progress toward efforts of reviewing evidence-based bully prevention frameworks with the intent of creating a vetted clearing house of evidence-based practices for access by Maine schools. To date, Maine DOE reviewed one framework used in the state of Florida.

Other Efforts

The Adolescent Health and Injury Prevention (AHIP) Program partners with the Maine Youth Action Network (MYAN), an organization that strives to build young people’s leadership on issues of social justice, restorative practices, and public health. Through this partnership the MYAN promotes youth leadership and positive youth development, including youth-led initiatives focused on improving school climate and reducing bullying and harassment. Youth received training and engaged in assessing their schools and communities to identify opportunities for change, using the Youth Participatory Action Research model. Youth then developed and took action on projects with the support of adult advisors. All MYAN programming is based on the principles of social and emotional learning, which are protective in reducing bullying and harassment and enhancing resiliency for youth. During FY21, MYAN provided training to 1,830 youth, including ongoing engagement with 2,037 young people through groups working on local action projects. Maine exceeded our objective of 700 (number of youth receiving support from MYAN). The shift from in-person training during the pandemic allowed for greater virtual engagement as well as an increase in the statewide infrastructure around youth engagement.

Over the past five years, AHIP and the MYAN conducted significant outreach to increase engagement among youth who are often disproportionately at risk of experiencing bullying and harassment. During the COVID-19 pandemic, many lesbian, gay, bisexual, and transgender (LGBT) youth reported experiencing negative effects from isolation and lack of family support. MYAN partnered with OUT Maine, an organization serving LGBT youth in Mid-Coast Maine, to host regular virtual drop-in sessions and ongoing engagement, such as online gaming groups. These initiatives were planned and led by youth, building leadership skills while fostering connection and community support.

In addition to working with young people through the MYAN, the Adolescent Health and Injury Prevention Program invested in evidence-based interventions to teach social and emotional skills in school settings. The Maine Tobacco and Substance Use Prevention Program worked with 50 schools across the state to implement Second Step, a social and emotional learning curriculum for PreK-grade 8 students that has been demonstrated to reduce bullying and harassment as well as substance use behaviors. The AHIP Program began implementing Sources of Strength, a resiliency-building intervention demonstrated to increase connections with peers and supportive adults. During the 2020-2021 school year, six schools participated in Sources of Strength. Maines’ Safe Schools’ offered an online bullying prevention professional development course. The Creating Safe Maine Schools Resource Guide and other best practice resources are available through the Maine DOE bullying prevention webpage (https://www.maine.gov/doe/schools/safeschools/bullying).

Priority: Address Adolescent Unmet Mental Health Needs

Performance Measure (SPM): Percent of Maine high school students who report feeling so sad or hopeless (for 2 or more weeks) that they stopped doing regular activities (past 12 months)

Unmet mental health needs represent a significant burden on the wellbeing of adolescents in Maine. In 2019, 32.1% of Maine high school students reported feeling sad or hopeless for two or more weeks at least one time in the past 12 months, a significant increase from 2017. We do not yet have data from the 2021 MIYHS to determine how the pandemic impacted adolescent mental health. However, based on syndromic data from emergency departments in Maine, there was an increase in visits to the emergency room for suicidal ideation and attempts during COVID-19. This was especially the case for adolescent girls. To address these concerning trends, the Maine AHIP supports programs that increase access to high-quality behavioral health services and prevention initiatives that emphasize resiliency and connectedness.

Strategy: Maintain support for the School Based Health Center integrated medical and behavioral health care model

Maine’s 15 School Based Health Center (SBHC) clinics offer integrated medical and mental health services that are co-located at school sites. This model of service delivery allows students to easily access behavioral health care without losing instructional time and reduces barriers such as transportation and cost (SBHCs provide services to all students regardless of ability to pay). Additionally, students who present for medical concerns are screened for mental health needs (and vice versa), identifying youth who might not have otherwise received needed services. While COVID-19 related school closures and hybrid schedules impacted patient volume at SBHCs, all SBHCs continued to provide significant amounts of mental health care, both in-person and through telehealth. In addition, many SBHCs provided rapid COVID-19 testing for staff and adults, supported the school community and provided more opportunities for in-person learning. While the majority of SBHC operating costs are supported through private and public insurance reimbursement, the Adolescent Health and Injury Prevention (AHIP) Program provides funding to ensure all students can receive SBHC services regardless of insurance status. With many students under-insured for mental health (including those with high deductibles or co-pays), SBHCs are a critical access point for students in need of services.

During the 2020-2021 school year, AHIP finalized a competitive process for opening the SBHC program to new applicants and sites. As part of this process, the AHIP re-examined program data and revised the performance measures to bring them in line with national data reporting for SBHCs.

Strategy: Increase evidence-based primary prevention strategies to increase resiliency, promote social and emotional learning skills and reduce the risk of unmet mental health needs

The AHIP partners with MYAN to promote positive youth development and leadership across the state. MYAN Youth Policy Boards engage in youth-led participatory action research to address needs in their communities. MYAN also supports existing local youth groups and provides technical assistance and skill-building for adult advisors. Although COVID-19 presented significant challenges for working in-person with youth during FY21, MYAN successfully engaged youth through virtual platforms, such as a drop-in group for LGBT youth that served young people struggling with isolation during the pandemic. In 2021, MYAN engaged over 5,000 Maine youth, provided 3,300 hours of programming with young people, and implemented 96 youth-led projects using models like youth participatory action research. MYAN also provided support to schools implementing Sources of Strength, an evidence-based intervention focused on building resiliency and increasing connections to peers and supportive adults. In partnership with the National Alliance on Mental Health (NAMI) Maine and AHIP, five schools received virtual training and ongoing support with group activities. MYAN provided significant amounts of virtual training to staff from schools and youth-serving organizations on topics including social justice and equity in youth leadership, restorative practices, and the neuroscience of adolescent brain development.

In addition to work with MYAN, the AHIP provided support to the Maine Department of Education in their development and release of SEL4ME, an online platform for social and emotional learning curricula. SEL4ME provides developmentally staged SEL lessons for youth that can be led by classroom teachers or adapted for self-paced learning online. AHIP staff participate as part of the SEL4ME steering committee, and support SEL programs as an important primary prevention strategy for promoting mental health and wellbeing among youth.

Strategy: Increase the number of educators and youth-serving professionals who receive training in strategies to identify, intervene and assist youth at increased risk of suicide

The Maine Suicide Prevention Program (MSPP) continued to focus on preventing suicide among youth and young adults. The MSPP, in collaboration with our community training partner NAMI Maine, provided training and technical assistance in evidence-based practices to prevent suicide among youth and young adults. As a result of COVID-19, MSPP and NAMI Maine adapted many in-person trainings typically offered to school personnel and other professionals. Currently, we are providing Gatekeeper training, suicide risk assessment training, and “Coping with COVID” sessions in a virtual format. Maine’s Garrett Lee Smith Youth Suicide Prevention Grant is supporting Youth and Family Navigators to engage youth at risk of suicide before or after a crisis, to ensure young people are safe and connected to appropriate services.

Strategy: Increase access to high-quality behavioral health care for youth with unmet mental health needs

A Pediatric Mental Health Care Access Grant is in year three of implementation with a goal of increasing capacity among health care providers in identifying, intervening, and treating youth with unmet mental health needs.

The Maine Pediatric and Behavioral Health Partnership (MPBHP) is Maine’s Pediatric Mental Health Care Access (PMHCA) Program. This partnership provides training and support to child and adolescent primary care clinicians (PCCs) and other clinicians on the detection, assessment, treatment, and referral of behavioral health conditions within their practice.

The MPBHP mission is to educate, support, and empower child and adolescent primary care clinicians and their clinical team through training and ongoing web-based and telephonic patient care consultations with behavioral health providers.

The support provided is a component of a peer-to-peer, telehealth-based consultation model, where PCCs connect with off-site child/adolescent behavioral health professionals via phone, video call, or email/web-based portals for consultation.

The MPBHP is supported by a collaboration between Maine CDC, Northern Light Acadia Hospital, and MaineHealth where the teams work together to support child and adolescent PCCs in enhancing children’s behavioral health throughout Maine, particularly in rural and medically underserved areas.

In October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association joined together to declare a national state of emergency in children’s mental health caused by the effects of the COVID-19 pandemic.

Monthly webinars for community providers on several mental health topics and an Extension for Community Health Outcomes Learning Series with medical providers continued to be the mechanisms to disseminate information to providers and interested parties.

A sustainability group was formed to create strategies to weave Pediatric Mental Health Care Access into the standard of care. Maine has had discussions with other states to learn about their sustainability strategies. One option the Maine CDC is exploring, mirrors how vaccines for children are paid for in Maine. Insurance companies are billed a per patient fee to the State who, in turn, uses the funds for the program allowing everyone access “free of charge”.  Should Maine decide to move in this direction it would require legislative approval.

[1] National Survey of Children’s Health, 2019-2020.

[2] Maine Integrated Youth Health Survey, High school, 2019.