Friday, April 11, 2014

Behavior change: taking the long view

Rome… Built in a day? Nope. The mangosteen tree, native to Southeast Asia, grows for 8 to 15 years before bearing its exquisitely tasty fruit. Construction of the basilica la Sagrada Familia in Barcelona has been under construction since 1882. The current estimate for its completion is 2028.
La Sagrada Familia: see you for the
completion ceremony in 2028!

Good things take time, but these days it’s easy to fall prey to the instant-gratification, results-now trap. The ever-increasing pace of technology, the 24-hour news cycle, pizza delivered in 30 minutes or less—we come to expect results/answers/satisfaction NOW. 

Contrast our restlessness with the patience of magicicada, the cicada that lurks for 17 years deep in the dark earth sucking on tree roots before finally emerging to mate.  

Nature has its own timetable, human nature included. Behavioral change, like that we create through the Communities That Care prevention system, is a slow, steady process that builds over years. There are no shortcuts.

If we want a senior in high school to make the choice not to drink, smoke, steal, or commit an act of violence, we must begin that journey of prevention early in his or her life. Efforts in behavior change that work must get ahead of the curve, and they must change the entire landscape of the community, shifting the culture for the better, for now and into the future. 

The Communities That Care prevention system engages not just the individual, but also his or her family, peer group, school, church, clubs, and so on. The whole community must get on board, as seen in the creation of our 2013-14 Community Action Plan, which involved the active participation of >100 individuals from >57 organizations.

If we want to create lasting change so that our culture is one that promotes healthy youth development, we cannot take shortcuts and we must work together. The payoff, if we’re patient, is priceless… and right now we can proceed with the satisfaction that we are creating something great.

Friday, March 28, 2014

Reaping the health benefits of volunteering

This week's blog was contributed by Mariah Smith, Five Town CTC's Community Coordinator.

So, a couple of weeks ago I got approached by an organization to do a presentation at a conference outlining the health benefits of volunteerism. As the community coordinator of an organization that is run almost entirely off the work of dedicated volunteers, I’m a big proponent of volunteerism in any capacity. However, engaging an active volunteer base has also been one of those things that I’ve been beating my head against a wall trying to figure out since I took on this role. All of you out there who work in the nonprofit world know what I’m talking about!

People today are so incredibly overbooked. It’s a tough time right now for everyone and budget cuts have caused new duties to be tacked onto every job description. Even kids today have two or three things to do after school in a given week, so how can we expect families to volunteer their time?

What if getting out there and volunteering some time to a cause was actually healthy? Once I did some delving on the inter webs, I found that there is quite a lot of research supporting this idea that volunteerism, at any age, is really good for you. In a 2003 study by Morrow-Howell, Hinterlong, Rozario, and Tang, the team tested the influence of volunteering on the health of older adults. The team looked at information gathered from the Americans’ Changing Lives Study that included several wellbeing and lifestyle measures. The results suggested that older adults who volunteer a lot actually report higher levels of wellbeing (Morrow-Howell, Hinterlong, Rozario, & Tang, 2003)!

While the research surrounding the health benefits of volunteerism have mainly focused on an older age group, prevention science has shown the benefits of volunteerism for youth. In the world of prevention science we often talk in terms of risk and protective factors. Just like with diseases such as diabetes, problem adolescent behaviors like substance use, suicide, school drop out, teen pregnancy, and delinquency have risk and protective factors that change the likelihood that youth will in engage in these types of behaviors in adolescence. Protective factors represent the equivalent of clothing kids in bubble wrap—no matter how many pointy objects there are in the environment, the child will still be protected. Risk factors represent the pointy objects, the factors that increase the chances a child will engage in problem behaviors. Research has shown that prosocial involvement, or becoming involved in the community in positive ways (i.e. volunteering!), is a HUGE protective factor for kids! Volunteering in the community, in any way, decreases the chances that kids will drink, use drugs, develop depression, drop out of school, become pregnant, or engage in some delinquent act during adolescence. In my mind, avoiding these kinds of issues is definitely an indication of increased wellbeing.

Prevention science even yields an incentive for parents to get out there and start volunteering. The Social Development Strategy is a cornerstone of prevention science that helps organize various protective factors in a community to reach prevention goals. Ultimately the goal of prevention is healthy behaviors for all of our kids. Achieving this goal starts with setting healthy beliefs and clear standards by modeling these prosocial behaviors. Gone are the days of “Do as I say, not as I do.” Now research says if we’re going to “talk the talk” we also really need to “walk the walk.” The best way to get our kids to engage in some of the protective behaviors, like volunteering, is to do it ourselves.

Even though we’re all busy, I urge you to volunteer for a cause you’re passionate about. Volunteerism really is healthy for our community AND for our community members. In the words of Elizabeth Andrew, “Volunteers do not necessarily have the time; they just have the heart,” and I know that our community has so much heart to share.

Friday, March 21, 2014

Some thoughts on Gatekeeper Training

This week's blog contributor is Joel White, STAR Program Coordinator at Five Town Communities That Care

This week, I participated in the Suicide Prevention Gatekeeper Training hosted by the National Alliance on Mental Health (NAMI). This training is being provided throughout Maine to school staff in accordance with LD 609, passed into law on April 25, 2013. LD 609 required each school district to have at least two staff trained as suicide prevention Gatekeepers. High schools in Maine must have this in place by the start of the 2014-15 school year, while Maine Middle schools must comply the following year.

There is a lot of information out there on this, and I am not going to go into the details of the training, but there was one specific exercise that stood out to me which I thought would be good to share. This particular exercise is a Values Clarification exercise that helps individuals get a better idea of where they stand on the difficult topic of suicide. There is no right or wrong answer and, as we found in the class, a lot of shades of gray.

For each set of values, use a 1-5 scale, 1 being absolutely the first of the two values and 5 being absolutely the second of the two values in the pair.

1. Suicide should be prevented no matter what. (1 2 3 4 5) People have the right to decide whether to live or die.

2. If I had made a suicide attempt in the past I’d do all I could to keep it a secret now. (1 2 3 4 5 ) It really doesn’t matter if people know about my suicide attempt.

3. When there is a suicide in the community it is best to cover it up. (1 2 3 4 5) When there is a suicide death in the community everyone has a right to know.

4. People who are suicidal can only be helped by mental health professionals. (1 2 3 4 5) People who are suicidal can be helped by any concerned person.

5. I would never pursue a friendship with someone who had attempted suicide. (1 2 3 4 5) I would have no problem developing a friendship with someone who had attempted suicide.

6. I feel that suicide should be talked about openly. (1 2 3 4 5) Talking openly about suicide is dangerous.

7. I feel comfortable talking about suicide with anyone. (1 2 3 4 5) I feel uncomfortable talking about suicide.

This list of questions is an excellent way to begin to identify your own feelings on this complex issue of suicide. After spending some time with it, I would recommend parents take a moment and consider these questions with regards to their children. For example, number 5 might be a really good way to open a dialogue with your teen or pre-teen about the issue of suicide. Having these open conversations with your child may not only allow your child to feel supported if there were a time in their life when they were struggling, but also allow your child to be a support to a struggling peer.

Having over 10 years of experience working with middle school and high school teens, I have seen many examples of times where a teen that is struggling reaches out, not to mental health professionals, teachers, or even parents, but to their peers.

These peer relationships can be a significant lifeline for a struggling child, but also a source of anxiety for the peer that is being relied on. It is important that parents have conversations with their children and teens about what to do in these situations. Having a child or teen that knows upfront what to do, and when to seek help will not only attach a struggling peer with professional help in a timely way, but also allow your child or teen to feel confident that they know what to do and say in a very difficult and stressful situation.

Maybe as a parent you are unsure what resources are available to you. If so, here are some excellent contacts for further information:

Maine Suicide Prevention Program:
National Alliance on Mental Illness (NAMI) of Maine:
National Suicide Prevention Resource Center:
American Association of Suicideology (AAS):
Center for Suicide Prevention:

There are many more local supports and programs, but the ones listed above are a great place to start.

Monday, March 17, 2014

Binge Drinking: Prevention Paradox

This entry was contributed by Five Town CTC Mentor Coordinator, Marti Wolfe

Binge drinking among high school students in our Five Town Community is real, not just a problem that happens in “other” places.  We know that 18.5 % of tenth grade students reported binge drinking, consuming five or more alcoholic drinks in a row on the 2012 Communities That Care Youth Survey. Thirty-six percent (35.9) of the seniors surveyed in 2012 also reported binge drinking.  How do we prevent this injurious behavior and arm our youth with information and skills to make healthful decisions?

Prevention efforts come in all shapes and sizes.  Some are designed to address the general population, Universal Prevention, while others focus on those with greatest risk, Selective Prevention. When faced with the challenge of significantly reducing a problem behavior such as binge drinking, is it best to focus on those with greatest risk or the general population?

Researchers know that risk factors are important predictors of binge drinking. So, why not identify those individuals exposed to a high number of risk factors and target prevention efforts to this selected group? Naturally, this would reduce the incidence of binge drinking among our young people. It seems pretty simple, but the Prevention Paradox proves otherwise.

A recent University of Washington, Seattle Social Development Research Group (SDRG) Study illustrates the Prevention Paradox. Researchers followed 808 diverse Seattle public school youth since they were 10 years old, over an eight-year period.  Researchers categorized this sample population into two groups based on their exposure to risk factors as reported on annual surveys. It turned out that 87.2% of this population had a low-risk for binge drinking, and 12.8% had a high-risk for binge drinking.

When it came to measuring the binge-drinking behavior of this sample group at age 18, it became crystal clear that risk factors matter!  In the low-risk group, only 21% reported binge drinking while in the high-risk group about half reported binge drinking. So far it seems like a selective approach to reducing binge drinking is the ticket to reducing this dangerous behavior. But there is more to consider.

In total, 25% of the 18 year olds in the SDRG Sample reported binge drinking.  But, only 6.4% were from the high-risk group, about 50 students, three-quarters of those reporting binge drinking were from the low-risk group, about 152 students.  The low-risk individuals in this sample contributed the most cases of binge drinking by virtue of their being in the majority. Roses’s Theorem explains this Prevention Paradox. “A large number of people exposed to a small risk may generate many more cases than a small number exposed to high-risk” (Rose 1994:24).

The Prevention Paradox gives us a solid, science-based lens with which to see the need for Universal prevention efforts. It is important to address the most widespread risks of binge drinking community wide. These risks affect both low-risk and high-risk individuals. If we want to significantly reduce binge drinking in our community, let’s inoculate all of our young people with Universal, tested-effective prevention programming.