Making Sure Maine Youth Matter

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson.

On this episode: reducing suicide and overdose in Maine with a plan to let young people know they matter.

SHEILA NELSON:
You know, young people who report mattering in their community are much less likely to be experiencing some of the potential risk factors around substance use and poor mental health. Specifically, you know, they're less likely to report depressive symptoms, they're less likely to report some of those early substance use behaviors that we know can potentially really increase you know, again, person's likelihood of struggling with substance use disorder later in their life.

KINI-ANA TINKHAM:
We have not heard directly from youth around suicide ideation or use of substances. But they certainly have reported that they feel like their voice and their presence does not matter to adults, that people don't look to them for ideas or listen to their solutions.

JOHNSON:
Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials. With each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories.

Today, we look at a program in Maine that wants every young person to know they matter with the goal of reducing overdose and suicide rates. It's called the Cultivating Mattering for Maine Youth Initiative, and those directly involved in the work are hopeful it can not only save lives but give the next generation of adults a new lease on life.

Kini Tinkham is executive director of the Maine Resilience Building Network, a statewide nonprofit that works to address adverse childhood experiences and help people build resilience. She's along shortly to talk about her goals for the initiative.

But first, we hear from Sheila Nelson, a program manager for adolescent health and injury prevention at the Maine Center for Disease Control and Prevention. She talks about the partnership with Tinkham's group and the impact of youth data on the solution.

NELSON:
The Maine Resilience Building Network is really driving a lot of the sort of community conversations around what it means to have young people be connected to community. So, not just to individual folks, but to feel like they are important in their school, you know, geographic, family, you know, friend group, communities. And we know that that's a really critical factor.

So, you know, our community partners, Maine Resilience Building Network have really sort of done a great job of kicking off that conversation with many of our organizations and networks across the state. And then, we've been really working with them in two ways.

One is to support them with some robust data that we're able to collect from young people that looks at how mattering affects other health risks. And, you know, the other thing is to really start thinking about how do we kind of embed this primary prevention, connectedness mindset in all of the public health programming that we do, you know, around both substance use disorder prevention, suicide prevention, but also many of the other public health issues that we're looking at when we work with young people.

JOHNSON:
How much does connect in this have to do with reducing suicide or even the thought of it, overdose or the thought of it?

NELSON:
Yeah, I mean, one of the things that we see in that Maine Integrated Youth Health Survey data—which is one of our most robust data sources, it's Maine's statewide youth risk survey—we ask about a bunch of health risk behaviors, but also some really good protective factors. And, you know, young people who report mattering in their community are much less likely to be experiencing some of the potential risk factors around substance use and poor mental health. Specifically, you know, they're less likely to report depressive symptoms, they're less likely to report some of those early substance use behaviors that we know can potentially really increase, you know, a young person's likelihood of struggling with substance use disorder later in their life. So, there's a really direct impact on well-being as we see it, you know.

But we also just know that, you know, that some of those secondary benefits, right? Like, young people who feel like they matter to communities are more likely to, you know, stay in an educational environment that they feel like supports them. And they're more likely to go on to, you know, remain in some of our rural communities across the state where we know we really need young people to sort of stay as the beating heart of some of those smaller communities, and that's always been a challenge in Maine. And we're hoping that increasing those community relationships will help address some of that as well.

JOHNSON:
You touched on the importance of data, but I'd like you to talk about that a little bit more. You have a statewide survey that you administer and now you're tapping it for this initiative.

NELSON:
Yeah, we're really fortunate. Maine collaborates with our department of education and some of our other statewide partners to administer the Maine Integrated Youth Health Survey. Some folks may have heard of the Youth Risk Behavior Survey; that's one of the national youth behavior surveys that's administered in schools. Maine's sort of took that as our platform, but then added a whole bunch more content to it. And we also, you know, try to recruit every school in the state, every middle and high school in the state, to participate.

So, we're fortunate to have a real depth of data on our student population every two years. And that's been a gold mine, both, first sort of tracking what young people experienced as health behaviors, but also to sort of look at how they feel and perceive the ways that adults do or don't support them in their lives. And that, you know, we find is really equally important as a protective factor.

JOHNSON:
Some states may not have a statewide survey of their younger people. They may not have a mattering initiative. Are there other approaches that you've considered that they might want to hear about as well?

NELSON:
Yeah, absolutely. Again, one of the things I think has been great about this project and some of the collaborative work that we've done is that, you know, it's really helped us articulate that importance of early primary prevention interventions. And one of the things that we've sort of talked about is that primary prevention work, while really important, often doesn't really mean that much to folks outside of the community, you know. As a public health community, we know what we mean, but your average person on, you know, a community street probably doesn't know what we mean when we say that.

So, we've talked a lot about how do we shift that narrative to talk more about how do we help young people thrive. So, not just keeping bad things from happening to them, which is important, but certainly that's not all we want for young people. You know, we want them to be successful. We want them to be connected to people who care about them and giving back to their communities over the long run. And so, we've sort of kind of tried to up that narrative because I think it's hard to argue against the idea that we want our young people to be as, you know, happy and successful as they can be. And that's a universal message that we can share with communities in lots of different ways. So, you know, I think data helps, but also finding the right message and the right messengers help.

We've also got a really robust statewide youth engagement and youth leadership building process. And we know that young people who are engaged in youth leadership activities also report feeling more connected to their community and feeling like they have more connections to adults who care about them. And both of those are really key to helping young people thrive over the long run and keep them kind of buffered, again, against some of those early risk behaviors that may have longer term health implications for them.

JOHNSON:
Thinking about your mattering initiative, is this an idea that you hope could someday take the nation by storm?

NELSON:
I would love it if focusing on protective factors did take the nation by storm. You know, I think—especially during COVID and even in other times when you're talking about really serious health issues like overdose prevention or suicide prevention, right—it's really understandable to want to kind of focus on, you know, that end of the prevention spectrum where we're identifying folks and saving their lives in a crisis.

And that is absolutely important, I'd be the last person to say that it wasn't. But when we really think about our goal is to not have folks get to that point where we're trying to pull them out of the river before they go over the waterfall, right. Like, you know, that old analogy, wouldn't it be better if they didn't end up in the water in the first place?

And so, again, Maine is a pretty small public health infrastructure, but I think one of the things that I would say for states like us is that, you know, to really think hard about what our greatest impact could be. And for us, we really made that decision that our greatest impact is on building protective factors for young people, again, before they fall in that river.

We want them to have really strong social and emotional skills, and we want them to have deep connections to adults who care about them. Because we know those young people are the most likely to make their way into adulthood with the skills and resources that they need, to be able to balance and to be able to manage everything that life throws at them.

JOHNSON:
You have immediate challenges trying to bring those numbers down and save lives, but this also hints at attempting, anyway, to make generational change.

NELSON:
Yeah, absolutely. And to again, you know, shift our focus a little bit from just focusing on what's wrong—again, very important to acknowledge the realities of folks struggling—but to also put into that conversation: what do we want our communities to be for young people? What are the positive things that adults—any adult, frankly—can offer to young people in their lives? And how can every individual, right, be contributing to a community that provides adequate support and, you know, a really strong foundation for young people to build on as they go forth in their lives?

I think we can do both. We just know that, you know, it can be easy to sort of have that upstream prevention stuff feel a little drowned out when things are hard and heavy. And, you know, part of what I think our program has tried to do is just to make sure that that's a voice in the room, no matter what conversation we're having, that prevention matters and it saves folks' lives in the long run. But it also really contributes to well-being, and well-being is what we want to see.

JOHNSON:
Kini Tinkham leads the Maine Resilience Building Network. Like Nelson, she too is thinking about how to use data to guide a project that will generate a roadmap anyone can use to help youth grapple with the factors that can lead to overdose and suicide.

Can you tell us how the issues of suicide and overdose are addressed in this work?

TINKHAM:
Yes. We have data from the Maine Integrated Youth Health Survey that speaks to 41% of middle schoolers and 44% of high schoolers stating that they do not feel like they matter in their community, so they're lacking a protective factor that could lower their risk for diseases of despair. And again, look at suicide and early onset use of substances as an example.

So, we also have a significant drop between data in 2017 and 2019, 15 points, by youth stating that they don't have support by an adult other than their parents outside of the home. So, looking at this data along with feelings of sadness and hopelessness, low scores in Maine were mattering as closely linked to this important issue of social connectedness, which we know is seriously impacted by the pandemic.

JOHNSON:
Based on your experience working in these communities, how do those scores translate to young people being willing to either consider substance misuse or, even worse, thinking about suicide?

TINKHAM:
Yeah, so, the data really speaks to this youth mental health issue that's happening across our state and across the country. We know that mattering is really a sense of being seen, heard, valued, as this protective factor that we've talked about. Within communities, we believe that when you feel connected to where they live and where they go to school and community, it's really a protective factor that will address use of substances early. And again, when they're feeling disconnected and that just relates to sadness and hopelessness, which may end up with suicide ideation or even suicide. So, really this community-driven solution with youth part of the solution is what we're advocating.

JOHNSON:
With students at the table, with young people at the table, do you hear them talking about considering drug use or suicide, having those thoughts or ideas?

TINKHAM:
In the work that we have done on this initiative, we have not heard directly from youth around suicide ideation or use of substances. But they certainly have reported that they feel like their voice and their presence does not matter to adults, that people don't look to them for ideas or listen to their solutions. So again, they're feeling more isolated and disconnected; which, again, we recognize social connectedness as a really important social determinant, you know, where people live and work. And so, youth mattering is really critical for their well-being long-term.

JOHNSON:
And you've used that word mattering a lot. The Mattering for Maine Youth Initiative is part of what you're talking about. Can you explain how your organization fits into that and what you're doing to support it?

TINKHAM:
So, we have been working in Maine for the last 15 months to understand youth mattering. And youth mattering is, again, being seen, heard, or valued; or more importantly, when you're absent, you're missed. And the research tells us there are three domains of mattering: school, home, and community.

So, we have this compelling data in Maine that speaks to almost 50% of youth feeling like they don't matter in community. So, we have gone out and worked statewide through our public health districts to understand adults' perception of mattering in their communities. And then we brought together these youth-serving organizations, diverse groups—again, listening to both youth and the adults from those organizations to understand mattering. And we're currently developing messaging from youth that we will give back to communities to support initiatives in the communities, along with this main youth thriving guide, which is a guide for community action, bringing youth as part of the solution.

So again, we have data every two years on youth mattering, and we believe when community members really understand mattering—including businesses—they recognize their role in changing the landscape and the perception by youth that they feel connected to their community. This primary protective factor will impact long-term suicide in the state of Maine.

JOHNSON:
Is this mostly a challenge of getting people to pay more attention, to be more aware of what young people are feeling?

TINKHAM:
I think it's a combination of first understanding the data and being educated. So awareness, I think, is really key. When we have conversations with business leaders, organizations, community members, they immediately respond, "How can I help? I want to be part of the solution." They've never thought about their role in prevention. And then we're letting them know what we're hearing from youth, that they want to be part of the solutions. They want safe spaces and community: that might be trails, you know, green space in the community; some might want afterschool programming; some might want skateboard parks, right? But we need to help them come together with youth to decide on the solutions, what's best for the community.

JOHNSON:
Are you encouraged by the feedback you get from others in the community once they find out this is an issue and that they can play a role?

TINKHAM:
Very encouraged, yes. That is the strength of the program, that people do want to be part of the solution. They just have not recognized what their role is—again, business leaders, faith leaders, cross-sector organizations. And when we return to the communities later this summer with the Youth Thriving Guide, which is really a roadmap for action that brings youth to part of the solution, I think that that will help communities think about investments to support youth, and, more importantly, look at policies and practices within their communities that really keep youth from thriving.

An example might be not allowed to be in the park after 7:00 p.m. You know, so they don't have a teen center, they don't have a skateboard park, they want to gather downtown in the park but the signage says they have to be out by 7:00. Or it might be a business who says, you know, move along, you know, no loitering, but there's okay for two adults to stand there and sip on coffee for 20 minutes and chat it up.

So, we're just looking at shifting the culture, that youth are seen as having an equal voice and really their future to lead communities, right, these young people.

JOHNSON:
The roadmap is in process, but can you give us a peek or at least a preview of the categories? I think you used some examples there, but what else is going to be included in this document?

TINKHAM:
Yeah, so, it's helping people understand the need to bring cross-sector stakeholders to the table—including youth—and recognizing that it's a shared agenda, so we've included tools and resources on what that means. We have keys that we will be introducing to understand the strength of youth and youth's role from the development of an adolescent, as an example. Also, about how to move to action, so how we take the action plan and move it to action within a community. It has a lot of resources to learn more about the developmental assets of youth: as an example, what does collective impact mean? What does community resilience need? A lot of terms for shared understanding.

JOHNSON:
So, a complete guide for people, organizations that want to get involved to be part of the solution and not take forever to get it going.

TINKHAM:
Exactly. And more importantly for community members, you know, if two neighbors say, "I'm really concerned about this alarming rate of youth mattering in my neighborhood, my community. I'm concerned about youth suicide in my community. We've just recently had some young people's suicide at the end of school this year. You know, what can we do about this? You know, I want to be part of the solution." And this guide is a tool that they can pick up and start the work.

So, it's not public health-focused. It's written really clear language for community members. Certainly we expect the engagement of coalitions and organizations; but in rural Maine, we may not have a coalition or a public health group that can do this work. So it's really, we built this for the community to do the work.

JOHNSON:
You're trying to empower even one individual to get involved and make a difference.

TINKHAM:
Yes, we are.

JOHNSON:
At the end of this, are you hoping that there'll be even more interest in taking the roadmap to the next level if that's even possible?

TINKHAM:
Well, I think we're looking to see it implemented statewide. Again, some of our rural communities trying to hook business leaders and community members to do the work. I can see it being replicated across the country. There already is interest in cultivating youth mattering initiatives across the country, which is very positive. Looking at primary prevention, right, is really trying to really go way upstream or deal with the problem before, you know, there is early onset substance use, as an example, or even use of tobacco. I mean, how can we connect our youth, right, so they are feeling like part of their community?

JOHNSON:
If you had to sell this whole idea in an elevator, how would you do that?

TINKHAM:
Youth are our future. Each of our communities are unique and our counties are unique in Maine, and together, we need to be part of the solution. And we need to listen and recognize the value that youth bring to the future of their community as the next workforce, right, returning to community to live and to work. And we can together prevent many of the diseases of despair in the state of Maine.

JOHNSON:
Thanks for listening to Public Health Review.

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This show is a production of the Association of State and Territorial Health Officials. For Public Health Review, I'm Robert Johnson. Be well.