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.

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

Objective: Engage stakeholders, increase awareness and use of best practices in bullying prevention and support DOE in providing technical assistance on bullying policies in schools.

Current Status: Despite increased attention to the need for prevention and intervention, bullying and harassment remain common experiences for children and adolescents. According to the 2018 National Survey of Children’s Health (NSCH), 20% of adolescents, aged 12-17 years old bullied others and 51% were bullied in the previous 12 months. The percent of Maine children who have bullied others is about the same as the U.S. (15.3%). The percent of Maine adolescents who had been bullied is significantly higher than the U.S. percentage of 39% and only six states had a higher percentage of parents reporting that their child had been bullied.

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. 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 (DOE) provides ongoing training and technical assistance for school systems on implementation of required comprehensive model bullying and harassment prevention policies and procedures (http://maine.gov/doe/bullying). The Maine Center for Disease Control and Prevention (Maine CDC) supports 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. More than half (57.3%) 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

The Adolescent Health and Injury Prevention (AHIP) Program is focusing on primary prevention of bullying and harassment through interventions that engage youth in creating a positive school climate. The AHIP Program partners with the Maine Youth Action Network (MYAN) to promote youth leadership and positive youth development. Youth receive training and are engaged in assessing their schools and communities to identify opportunities for change. Youth then develop and take action on projects with the support of adult advisors. All MYAN programming is focused on developing social and emotional learning skills, which are protective in reducing bullying and harassment and enhancing resiliency for youth.

Throughout the year, MYAN District Youth Coordinators support Youth Policy Boards and other youth groups across Maine’s nine public health districts. Many of the Youth Policy Boards and youth groups focus on supporting youth who disproportionately experience harassment. In the Downeast District, youth from RSU 24 (Sumner) developed a policy proposal for increasing inclusivity for transgender youth within the district. The group presented the project to both the RSU 24 School Board and the District Coordinating Council and worked with the school to implement the recommendations. MYAN District Youth Coordinators also significantly support and provide leadership development to many school-based Gay/Straight/Trans Alliances (GSTAs) and Civil Rights Teams across the state.

In addition to working with youth, MYAN provided training and technical assistance to school staff, adult advisors, and youth-serving organizations on social and emotional learning, principles of youth engagement, and strategies for reducing bullying and harassment. In FY19, AHIP supported MYAN in work with 698 youth and 750 adults.

The AHIP program identified youth engaged by the Maine Youth Action Network as our ESM recognizing that social and emotional learning skills and connections with caring adults are primary factors in preventing bullying and harassment and promoting resiliency. While Maine CDC can provide data on youth directly impacted by MYAN programming, it is difficult to truly capture the impact on school climate and support. For these reasons, Maine CDC closely monitors data from the MIYHS on protective factors such as support from teachers, safety at school, and connections to caring adults.

Maine Department of Education (Maine DOE) continued to explore innovative strategies to address bullying prevention. The research collaboration examining the effects of bullying prevention policy implementation was ongoing and analysis of survey responses were completed. 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).

Current Efforts

The AHIP Program continues the statewide partnership with the MYAN to engage youth in strategies to reduce bullying and harassment. This includes expanding networking among youth groups focused on improving school climate and increasing technical assistance to youth-serving adults on strategies to address bias and conflict among young people. This year MYAN is developing new programming to build the use of restorative practices within school systems. The restorative practice model focuses on building strong relationships that foster connections between and among students and adults and provides a way to address conflict and harm before it escalates. This model enhances existing school climate and primary prevention activities and provides additional support to students at risk of bullying and harassment. MYAN will begin training a cohort of schools through a pilot and expand to additional systems in the next school year.

Maine CDC is continuing to emphasize primary prevention of bullying and harassment through evidence-based interventions to build children’s social and emotional learning skills. The Maine CDC Tobacco and Substance Use Prevention Program is working with 50 schools across the state to implement Second Step, a social and emotional learning curriculum for Pre K-grade 8 students that has been demonstrated to reduce bullying and harassment as well as substance use behaviors. In addition, the AHIP Program is working with 14 Maine High Schools to implement Sources of Strength, a peer-based program that emphasizes building resiliency and enhancing relationships with trusted adults in the school setting with plans to add additional school systems in the next academic year.

Performance Measure (State): Percent of adolescents, ages 12 through 17, with unmet mental health needs

Objective: Maintain support for School-based Health Centers (SBHC), increase partnerships between schools and community clinics, increase the number of primary care providers screening for mental health and increase evidence informed/based training for youth-serving organizations on mental health topics.

Current Status: While efforts targeting adolescents often focus on their physical health, unmet mental health needs among teens has a significant impact on their current well-being, and a lasting effect on their future. According to the 2017-2018 NSCH, about 8% of Maine adolescents aged 12-17 years currently have depression; this is slightly more than the national average of 6.3%. About 18% have problems with anxiety (compared to 11% nationally), and 7.7% have behavioral or conduct problems (vs. 6.4% nationally).

Unrecognized or unmet mental health needs can affect all aspects of adolescents’ wellbeing and may put them at higher risk for academic failure, substance use, and suicide. Even if youth and families recognize the need for mental health services, youth face additional barriers to care. Maine is a rural state, and a lack of transportation or long wait times make it difficult to access the behavioral health providers specializing in care for adolescents. About 18% of Maine children received treatment or counseling from a mental health professional in the previous 12 months. Among Maine high school students, 1 in 3 (32%) reported feelings of sadness or hopelessness that lasted two or more weeks, yet only 25% of those students ever sought help from an adult.[3]

To increase access to care, the AHIP Program supported 15 School Based Health Centers (SBHCs) that offer co-located medical and behavioral health services, including mental health counseling that is accessible to youth during the school day. School Based Health Center providers conduct health risk assessments with young people that include screening for depression and other behavioral health conditions. In FY19, 90% of youth identified as needing mental health services ultimately received that care through the SBHC. Following a gap in funding during the 2017/18 school year, support for services was restored in FY19. In total, the SBHCs provided ongoing mental health care to over 400 students.

In addition to youth engagement activities for bullying and harassment prevention, the Maine Youth Action Network (MYAN) supported multiple Youth Policy Boards and local youth action groups focused on mental health awareness and stigma reduction. Several groups chose to focus on increasing awareness of mental health services available in their local schools and communities. Regardless of the focus of the work, MYAN promotes a positive youth development framework focused on enhancing social and emotional learning among all participants, with an emphasis on building resiliency and strengthening protective factors that contribute to positive mental health.

In FY19, MYAN worked with multiple youth groups that were engaged in the Yellow Tulip Project at their schools. The Yellow Tulip Project is a youth-led organization that began after the suicide deaths of several young people in the Portland area; the organization encourages youth to break down stigma around mental illness. Several MYAN-supported youth groups participated in activities such as planting school Hope Gardens – beds of yellow tulips that are an opportunity to bring students together to talk about mental health and resources for recovery. Other youth leadership groups focused on changes to school policies and practices. The MYAN Statewide Youth Policy Board used the framework of Youth Participatory Action Research to gather data from fellow students about awareness of mental health resources in their schools. Based on the results, group members identified that students were often unaware of the availability of staff in their schools who had advanced training in supporting students at risk of suicide. The Statewide Youth Policy Board is developing recommendations for increasing visibility of trained staff and educating students on strategies for accessing support.

Reducing suicide deaths and serious attempts among youth is a longstanding priority for the Maine CDC. Suicide is the second leading cause of death among Maine youth aged 10-19 years. Maine’s youth suicide rate in 2016-2018 was 16.1 deaths per 100,000 youth aged 15-19 years, which was the highest youth suicide rate in New England, and is in the top quartile of state youth suicide rates. Youth suicide rates in Maine have been increasing over the past 10 years. According to data from the MIYHS, the number of high school students who seriously considered attempting suicide in the past year increased significantly between 2009 and 2019 (12.5% in 2009 to 16.4% in 2017). The reasons for Maine’s relatively high youth suicide rate are multiple and complex; as in many rural states, Maine’s youth face barriers to receiving mental health care, and few providers in Maine specialize in treating adolescents. Maine CDC is committed to improving early identification of youth at risk of suicide and reducing barriers to care.

In FY19, AHIP continued to provide statewide trainings in evidence-based suicide prevention practices, including skill building for educators, youth service providers and community members on strategies for identifying and supporting adolescents in need of mental health services. The AHIP Program worked with training partner NAMI Maine to enhance professional development offerings, including developing an Advanced Gatekeeper training focused on skill building for school staff renewing their required suicide prevention credentials. Additional professional development for educators and youth-serving providers included trainings on suicide risk assessment, safety planning, and addressing non-suicidal self-injury. The Maine Suicide Prevention Training Program reached over 800 school staff and community providers.

As part of the National Strategy for Suicide Prevention Implementation Grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), the AHIP program offered additional training and capacity building resources related to suicide prevention and addressing unmet mental health needs among youth and adults. The program continued working with three large community behavioral health agencies to implement the Zero Suicide model and improve suicide prevention services for clients in their care. One of the organizations, Aroostook Mental Health Center, modified their Electronic Health Record to require staff to assess all clients for suicidality at every visit. All partners continued promoting the web-based Suicide Safer Care Training Portal (https://sweetser.academy.reliaslearning.com/) to provide access to online training in evidence-based suicide prevention, screening, intervention and follow-up care.

Maine DOE Health Education and Physical Education Consultants worked with the AHIP Program and NAMI Maine to finalize revisions to the middle school stress management and suicide prevention curriculum lessons and partnered with NAMI Maine to deliver suicide prevention curriculum lessons for middle and high school educators. The Maine DOE Health Education Consultant was responsible for the rulemaking process to amend the current state law requiring all school personnel to receive suicide awareness and prevention training every five years, as well as designating trained gatekeepers in all school districts. The new amendment requires that all Maine schools develop protocols for suicide prevention, intervention and postvention. The protocols are to be in place for the 2019-2020 school year. Maine DOE secured additional funding to allow NAMI Maine to deliver an additional eight protocols development trainings across the State reaching each of the nine-school superintendent regions.

Current Efforts

In July 2019, The AHIP Program began implementing the Garrett Lee Smith (GLS) Youth Suicide Prevention Grant. Major objectives for this initiative include enhancing professional development and prevention policies within schools; increasing screening, early intervention, and access to care; and building social connections and peer-to-peer supports for youth. In partnership with NAMI Maine and the Maine Youth Action Network, AHIP is working with 13 schools across the state to implement Sources of Strength (https://sourcesofstrength.org/), an evidence-based program that has been demonstrated to increase resiliency, help-seeking and connections to caring adults. As part of the GLS grant, AHIP is developing a network of Youth and Family Navigators who will work with young people at risk of suicide or with unmet mental health needs to connect them to appropriate care and ongoing support. Activities under the GLS grant are supported by ongoing professional development for educators and youth-serving providers through the Statewide Suicide Prevention Training Program.

In partnership with the Maine CDC Tobacco and Substance Use Prevention and Control Program, AHIP was able to provide additional funding to SBHCs to increase access to mental health services. These funds will allow SBHCs to serve more youth and provide greater access for uninsured or underinsured students. Additionally, SBHCs will receive training and support to implement Screening, Behavioral Intervention, and Referral to Treatment (SBIRT) to intervene with students who struggle with substance use.

The Maine Youth Action Network is continuing to engage young people around issues related to youth mental health. MYAN youth leaders provided input into the MCH Strengths and Needs Assessment, and identified issues related to mental health as a top priority in promoting wellbeing for young people in Maine.

Maine DOE Health Education and Physical Education Consultants continue to work with the AHIP Program and NAMI Maine to deliver at least three regional trainings for the combined stress management and suicide prevention curriculum lessons and high school Lifelines Suicide Prevention lessons for middle and high school educators. The state law requiring all school personnel to receive suicide awareness and prevention training every five years, as well as designating trained gatekeepers in all school districts, requires ongoing training provided by NAMI Maine. The law was amended to require all Maine schools to put locally developed protocols for suicide prevention, intervention and postvention in place for the 2019-2020 school year. NAMI Maine is continuing to offer protocol development training to support all Maine schools in reaching this requirement by the end of the 2019-2020 school year.

The 2007 Health Education and Physical Education standards within the Maine Learning Results commenced a revision process in the fall of 2019. The steering committee comprised of a variety of stakeholders is meeting through June 2020. The process will incorporate newly enacted laws on mental health, child sexual abuse prevention and affirmative consent. The committee will recruit teachers to be a part of the writing team.

Members of the Maine DOE Office of School and Student Supports participated on the Governor’s Opioid Prevention and Intervention Task Force as well as the sub-committee for identifying education resources for substance-use prevention efforts. The recommendations from the sub-committee included more qualified instructors for PreK – diploma health education, so that more students receive quality skills-based instruction that includes substance use prevention, mental health and components of social emotional learning, as well as a requirement for social emotional learning for all adult educators.

[1] National Survey of Children’s Health, 2017-2018.

[2] Maine Integrated Youth Health Survey, High school, 2017.

[3] Maine Integrated Youth Health Survey, High school, 2017.