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: http://www.maine.gov/suicide
National Alliance on Mental Illness (NAMI) of Maine: www.namimaine.org
National Suicide Prevention Resource Center: www.sprc.org
American Association of Suicideology (AAS): www.suicideology.org
Center for Suicide Prevention: www.suicideinfo.ca

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

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.

Summertime brings a spike in underage drinking

There's plenty to celebrate with the coming of summer. For kids, there's the extra free time to relax, go to the beach, spend more time with friends. There also tends to be a spike in underage drinking when school lets out.

According to the Community Anti-Drug Coalitions of America (CADCA), More teens start drinking  in June and July than in any other months. On an average day in June and July, more than 11,000 teens ages 12 to 17 use alcohol for the first time – December is the only other month with comparable levels. Throughout the rest of the year, the daily average for first-time alcohol use ranges from 5,000 to 8,000 adolescents.

The evidence is clear: more free time and less adult supervision increases the likelihood of exposure to the dangers of underage drinking.

Below are some tips to keep your kids safe this summer:

• Approach your teenager with honest and direct communication. Learning how to express your concerns without making your teenager feel guarded is critical to effective dialogue. Let him/her know the dangers of underage drinking, which include behavioral changes and increased likelihood of vehicular accidents.
• Keep your alcohol usage under control. Teenagers watch their parents for guidance so setting a negative example can make teenagers justify their own negative behavior.
• Secure your personal supply of alcohol. Teenagers may be tempted to drink alcohol while you're away, so keeping it inaccessible can help prevent these dangerous situations.
• Monitor your teenager's friends and whereabouts. Knowing who your teenager is hanging out with can alert you to possible problems. Avoid letting your teenager attend unsupervised parties. Follow up with other parents to ensure your child is being truthful about his friends and his social activities.

For more prevention tips and information on alcohol laws in Maine, visit:

Preventing underage drinking in your kids

Kay Stephens: Cyberbullying is not ‘sticks and stones.’ It’s psychological warfare

Previously run in the Penobscot Bay Pilot.

I’ve been following this Orono cyberbullying case very closely since it broke on the statewide scene. The Bangor Daily News reports: Teen cyberbully pleads guilty to terrorizing former Orono schoolmate. Every day, I receive stories all over the world like this: kids getting defamed, libeled, psychologically tortured by other kids through digital devices. This 16-year-old girl, Lexi Henkel, was incredibly brave to take her story public as her 17-year-old tormentor terrorized Lexi and her family to the point of vacating their home, moving schools and pushing Lexi to the brink of suicide.

So often, it seems as though adults aren’t truly waking up to the potential destruction of cyberbullying until a teenager is on the brink of suicide.

I’m not glad this happened; but I’m glad it became public. In Maine, I don’t think adults are fully comprehending how destructive cyberbullying can be. Since September, I’ve visited and spoken to parents and educators from at least 40 Maine schools to provide some perspective around the motivations behind certain types of cyberbullying and how to prevent it.  Most adults leave with a better understanding that there's not a “one-size-fits-all” solution; that each incident needs to be thoroughly understood before it can be strategically dealt with. But I’ve actually had a few teachers tell me: “We don’t have cyberbullying at our school.”

They are not seeing it, because they’re not part of the kids’ digital networks, but it’s there.  At its highest extreme, it becomes known to the principal and a news story. At its lowest to medium level, it’s being done covertly, through texting, email, Instagram, Facebook and Twitter. But it’s there.
But let me go back to this Orono story for a moment, because worse than the “cyberbullying doesn’t exist” mindset is the “suck it up” mindset.

Take for example this anonymous poster “Hussar” who wrote a comment in response to this Orono story:
What ever happened to "sticks and stones may break my bones, but names will never hurt me?" It appears that we are raising a generation of over emotional crybabies, scared of their own shadows, that need the nanny state to protect their feelings from being hurt. I am sorry, for Ms. Henkel's pubescence angst, but this is classic case of taking ourselves and perceived dangers to our children way too seriously.

He read the same story as everyone else. He saw that these weren’t some mild, adolescent outbursts. The posts threatened the girl’s life and safety. Here’s an example of a few of them:
 • “Ready for tomorrow night? I’d learn to sleep with your eyes open if I were you. I’m dulling my knife right now so when I stab you in the face, gut and legs it’ll be painful as possible.”
• “You know how all these environmental friendly groups say that waste should be properly disposed of? Well, come on Lexi, do the world a favor, and properly dispose of your [expletive deleted] self!”
• “Your face is like a baby seal. Fat, furry and just asking to be clubbed to death.”

Law 101: A "criminal threat" is when you threaten to kill or physically harm someone either in person or electronically. These are not “sticks and stones” comments. But unfortunately, I’ve seen this mindset appear in multiple comments to hundreds of cyberbullying stories I’ve read through.  It’s not about “protecting their feelings about being hurt” it’s about protecting vulnerable young people from being threatened, defamed, libeled and psychologically tortured—you know, the very types of behavior that will land an adult in court. Just because they’re minors doesn’t mean they don’t have the same legal rights and protections as adults.

Yet, in several Maine schools I’ve visited, students have come up to me after a presentation and told me in confidence that “adults don’t know how to deal with cyberbullying” and that “all this talk that they were going to stop it” has basically been seen as lip-service.
So what happens is: when influential people like “Hussar” reiterate this specious “suck it up” mindset; teens who are being badly cyberbullied feel completely unprotected. Like hunted animals, they feel they will never escape the torment, never find peace or a normal life again—and sometimes they look to the extreme choices.

As Lexi’s mother Judy Henkel wrote in response to “Hussar”:
Know your facts before you write an opinion such as you did. You haven't read the emails Lexi recieved, you haven't heard your daughter say that taking her own life would be easier then having to go through all this. Having your daughter tell you she is thinking of taking her life so it would all stop is just like having a knife plundged (sic) into your heart.

Thankfully, with the staunch support of Lexi’s parents, her community and the police, Lexi has been able to tell her story. I don’t know if she will ever feel safe again as she does her best to resume a normal life, but she has given voice to a deep-seated problem that hides in the very insular walls of social media and electronic communication that we adults don’t often get a chance to see. This is probably one of the biggest cyberbullying wake up calls Maine has seen. . and these kids need your protection.

Kay Stephens is the co-author of Cyberslammed: Understand, Prevent, Combat and Transform the Most Common Cyberbullying Tactics, published this year and sponsored by Time Warner Cable. She has been doing presentations to Maine schools on specific cyberbullying threats and how to understand, prevent, combat and transform them. She is also the editor of FTCTC's monthly teen-focused feature, Sound Off, designed to increase the number of youth who have one of the protective factors that helps keep kids out of trouble—recognition for pro-social involvement. To see more posts oncyberbullying, visit Kay Stephens on The Pen Bay Pilot.

Alcohol consumption and sexual assault

Our thanks to Michelle Harris, Outreach Advocate for Sexual Assault Support Services of Maine, for submitting the  following blog post. 

Research presented at the latest Five Town CTC Coalition meeting highlighted the fact that underage alcohol consumption is a major concern to our communities. It is important to bring to light some of the not so obvious and yet related risks to this data that may affect our children in dangerous and potentially long-lasting ways.

The issue of sexual assault and alcohol consumption may appear to be worlds apart, when in fact there is evidence that shows a relationship between the two. Some of these relationships may be obvious common sense, while others may be new and just as alarming. Extensive information on this relationship can be found at http://www.vawnet.org

Let’s look at the first possibility of an offender providing and encouraging alcohol consumption in an effort to reduce an intended target’s resistance and inhibitions. The influence of alcohol can impair the judgment of a person, who can then find him or herself in a dangerous situation, potentially being faced with a person who will not take no for an answer. Furthermore, if enough alcohol is consumed, a person may entirely lose the ability to give consent at all, which to an offender who has preplanned this event, is exactly the opportunity he or she was trying to create.

 A person may also use alcohol as a way to reduce his or her own inhibitions relating to respecting another person’s boundaries and right to say no. This can be used as a convenient excuse after things have gone too far, after a victim has said no, but whose wishes have gone unheard and are ignored.

There are emotional repercussions after a sexual assault, particularly one in which alcohol consumption was a factor. If a survivor had been drinking and was sexually assaulted, there can be feelings of guilt and self-blame, in spite of the fact that the person committing acts of sexual aggression is entirely responsible for his or her actions.

A person who has been drinking and was sexually assaulted can be apt to minimize the event, again taking on deep feelings of guilt and of shame. When a survivor reports a crime such as this to the police, a crime in which one or both parties were consuming alcohol, the case can become that much more complex. If a survivor’s blood alcohol level is found to be high enough to suggest that he or she was not in physical condition to provide consent, this can serve as evidence of that person being incapacitated.

There is another perspective to the relationship between alcohol consumption and sexual assault. That is the fact that if a person is also a survivor of child sexual assault, alcohol consumption can be used as a coping mechanism. This increases the risk of being sexually assaulted once again, perhaps by “lowering the ability to perceive risk as the intoxication level increases.” (Norris, J., 2008, December).

Underage drinking is something that we as parents and community members are rightfully concerned about. It is important to not only look at the issue on the surface, but also to examine the hidden risks involved, if we are to make effective and lasting changes.

Finally, and most importantly, there is absolutely no circumstance or excuse that ever gives a person the right to sexually assault another person. Sexual assault is a serious crime that should be taken seriously and at no time is a victim at fault.

There are some great tips for parents of teens located at http://www.maineparents.net.

References:

Norris, J. (2008, December).

The Relationship Between Alcohol Consumption and Sexual Violence. Harrisburg, PA: VAWnet,
a project of the National Resource Center on Domestic Violence/Pennsylvania Coalition
Against Domestic Violence. Retrieved February 28, 2013 from:

http://www.vawnet.org

Resource: 

Sexual Assault Support Services of Midcoast Maine

24 hour support line:  1-800-822-5999

www.sassmm.org

The Science of not believing in Science

Cruising around the internet this week, I ran across an interesting article that focused on why people often are unconvinced by scientific evidence.  The article appeared in Mother Jones in 2011 and has a liberal slant, but it contained information that I think applies to a variety of human enterprises...including the prevention of problem adolescent behaviors like substance abuse and suicide.

Chris Mooney's piece (The Science of Why We Don't Believe Science) explains that even when we are at our most "logical," our prior knowledge, emotions, and biases deeply color the way we process information.  One of the ways that this plays out is in the way we determine who is credible.  It turns out that we are not very quick to accept those who contradict our deeply held beliefs or values as expert...

This makes considerable sense when you think about it.  If people have developed a belief system over many years, and have organized their actions around it, it would be somewhat irrational to think that they might throw their beliefs out based on a piece of "evidence."  (Even if it was very sound evidence, from a logical standpoint.)  People gravitate toward information that confirms what they believe, and they select the sources that deliver it. No real surprise here.

This leaves those of us trying to infuse science-based practice into our community prevention work in a bit of a pickle.  How do we deliver information in a way that can be heard and processed so that it neither overstates or understates the credibility of the person or organization delivering the message, nor leads to the backlash of even more entrenched views that sometimes results from being confronted with information that contradicts what you currently believe?

For example, if I were to tell you that marijuana use can cause addiction, what is your reaction?  Do you first weigh the statement against your own knowledge and experience (perhaps your friends used it and they aren't addicts?)?  Or do you first consider whether I am likely to be an expert in this area of information?  What would lead you to be likely to read and objectively consider studies that support this fact?

As a real science geek, this is fascinating.  As a preventionist with a real sense of urgency around correcting some common misconceptions, it is terrifying.

I would love to hear your thoughts about it!

Mental health stigma: changing minds and outcomes

Last month’s tragedy in Connecticut thrust our country into a painful moment of collective reflection. The debate on how to prevent such a tragedy from happening again touches upon many subjects: gun control, school security measures, and the possible effects of video game violence on young brains, among them.

And then there is the question of the mental illness. Consider a simple fact: Mental, emotional, or behavioral health problems affect one in five children and adolescents. Put another way: a child is as likely to suffer one of these disorders as s/he is to break a bone. Mental health affects everyone regardless of race, class, gender, sexual orientation or socioeconomic status.

Consider another fact: Mental illness is preventable. Unfortunately, many people who suffer mental illness do not seek the treatment they need because of real or perceived barriers. Among these are:

·      Attitude: Believing that mental illness will resolve on its own or believing that psychiatric care would not be beneficial

·      Financial concerns: Lack of health insurance coverage, or coverage that leaves a large amount owed by the patient.

·      Poor self-perception: Unlike with physical illnesses, people suffering from a mental illness often do not realize that they are ill.

·      Poor access:  Some Americans have poor access to mental health care services because they live in a rural environment. Others lack transportation options or are overwhelmed by work and home responsibilities.

·      Stigma: Many patients believe a stigma exists regarding the mentally ill. They feel that negative stereotypes could damage their careers or relationships. Embarrassed and fearful of what others may think, they do not seek the services they need.

Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net

Getting help at the earliest possible time is key to feeling better and possibly to preventing mental illness altogether. Early identification and intervention improve outcomes for children, before these conditions become far more serious, more costly and difficult to treat. Some facts on children and mental illness from Mental Health America reveal the scope of the problem:

·      13% of youth aged 8-15 live with mental illness severe enough to cause significant impairment in their day-to-day lives. This figure jumps to 21 percent in youth aged 13-18.

·      Half of all lifetime cases of mental illness begin by age 14 and three quarters by age 24.

·      Despite the availability of effective treatment, there are average delays of 8 to 10 years between the onset of symptoms and intervention—critical developmental years in the life of a child. In our nation, only about 20% of youth with mental illness receive treatment.

·      Unidentified and untreated mental illness is associated with serious consequences for children, families and communities:

o   Approximately 50% of students aged 14 and older with mental illness drop out of high school—the highest dropout rate of any disability group.

o   90% of those who die by suicide have a mental illness. Suicide is the third leading cause of death for youth aged 15-24; more youth and young adults die from suicide than from all natural causes combined.

o   70% of youth in state and local juvenile justice systems have mental illness, with at least 20% experiencing severe symptoms. At the same time, juvenile facilities fail to adequately address the mental health needs of youth in their custody.

(For more information, see Children's mental health fact sheet: Mental Health America.)

We know HOW to prevent many forms of mental illness through appropriate, timely interventions. If we are to capitalize on our proven ability to shape healthier lives, however, we must rethink our negative attitudes. The answer to our mental health crisis lies in education and the correction of common misperceptions. Shine a light on the problem and the barriers facing those in need of help will begin to fall.