Evidence Centre seminar: December 2019

Protective Factors for Children at Highest Risk of Adverse Childhood Experiences - video transcript

Matt Walsh - Senior Research Fellow with the Centre for Social Data Analytics (CSDA) at Auckland University of Technology:

Thank you, Paula.  Really happy to be here today to talk about what we've been working on for the last two years.  Also very fortunate that we were even able to have funding from the Growing Up in New Zealand data to do secondary data analysis, so we haven't collected any of this data but since it's available and there's funds, luckily from here in MSD, to look at the data.  I'm very happy to bring that up.  Let's see how we switch -- I can stay on this slide too, okay, there we go.

So, just some background on me, so I'm -- you can probably hear I'm from America, I've been here two years, and prior to coming here I worked for the Department of Children and Families, which is a little like OT in Wisconsin.  So, when I'm coming at all of these researchers I'm in academia now but I kind of know that none of this works without interacting with the programme and policy analysts that are at OT.

So, the goal here is to kind of say what we have and then kind of have you guys have lightbulb moments, hopefully, to then have connections that we can actually bring this somewhere further than in academia.

So the goals for today, first talk about ACEs, Adverse Childhood Experiences and one of many ways to measure bad things happening to children.  Then to talk about, there's been four rounds of this secondary data analysis funding from Growing Up in New Zealand and we were lucky to get some money from the first round and now the current round that's going in the third, so talk a little bit about what we did in the first round and how that informed what we're doing now in the third round and then talk about the current work.

So, just to start off with, how many people here are familiar with ACEs and the ACE literature that's out there?  So, good, that's great because it's been about 20 years ago, actually even longer, that they first had a study in California where a researcher tried to figure out why some of these morbidly obese women that they had worked with, so many of them had been reporting sexual abuse as they were children.

And it came through now 20, 25 years later in a huge wealth of literature that's kind of talking about Adverse Childhood Experience.  And what they really are, just intensive and frequently occurring sources of stress.  So, things that are happening over and over again that a child's witnessing or experiencing, that then changes their biological processes for how they are interacting with the world.  So, fight and flight responses, everything seems to be correlated with these frequently occurring stresses that are happening.

Then originally they had decided they were all in these areas here of abuse, neglect and household dysfunction.  So, abuse and neglect, that's very key to what's going on at Oranga Tamariki but household dysfunction, things like having a parent that's under mental illness or having a jailed parent, experiencing a divorce, these are all different Adverse Childhood Experiences and they're common.  So, throughout the world a lot of the literature is from Europe and from North America but more than two-thirds of adults in general have at least one of these adversities when they're growing up.

The literature really says the more you have the worse off it is.  It's a very clear dose-response that you see.  They also normally clump them together, they don't try to say, "Okay, this one's worse than the other."  We're going to try do that a little bit, even though I don't usually like to do that.  But normally it doesn't matter which one it is, they all seems to have the same way of changing the biological response in the child.

I'd say there's probably 10,000 scientific reports that seem to be going through Adverse Childhood Experiences and in any area you can think of there are correlations between having these adversities in childhood and then having these bad outcomes; that could be cancer, death due to cardiovascular disease, experiencing risky behaviour yourself like smoking, even educational outcome and occupational outcomes.  There's pretty much -- you name the outcome and somebody probably has a study looking at ACEs in that study.

The goal here was to say since there weren't as much research going on with ACEs here in New Zealand, the first was to say, can we use the Growing Up in New Zealand study to look at -- can we measure ACEs in these children?  So the kids right now in Growing Up in New Zealand are about ten, so they were enrolled in about 2009.  The good thing about this -- it's almost 7,000, it's all in these three pointed-out DHBs, so Auckland, Manukau and Waikato.

So the original, about 7,000 women were enrolled and the good thing for our study is that once they enrolled the participants, they had really good retention rates through the first five years.  They're still collecting data now but that's good because you will see all of our data comes from what's happening when they're 4½ years old.

So that first round, there were two reports that came out, they're both searchable.  If you kind of just look for Walsh and Adverse Childhood Experiences or MSD you'll find the reports.  There's a whole bunch of limitations that are going to be included in there and methods that I’m going to be skipping but they are located there, so if I'm skipping things that you want to know, I'll point you to those but I can also talk about them as well.

What we found is, yes, you can measure adversities in children through the same standard ways that they had done for the Dunedin study that was before it.  By the time the children are 4½, more than half of them have experienced at least one.  So, that's the zero, the blue bars, it's the per cent that 47% that had zero, 30% had one and the other, about 25%, had more than two.

So that was not surprising for people that are looking at it but if you are like telling people that aren't used to the Adverse Childhood Experience literature that's usually something they're like, "That's not good".  So the first step that we wanted to do is, can we predict?  At the Centre for Social Data Analytics where I work we do a lot of predictive analytics using administrative data, either through the IDI or through other sources and other partners.

The first thing is, can we predict based on what we would call the administrative data, data that's already known about a child when they're born, can we predict which ones were most likely to have adverse experiences?  So, we use a subset of the full sample randomly selected, 3,500 children and we looked at everything we knew about them when they were born.  We are able to segregate or put them all in a line, from the lowest risk of having ACEs to the highest risk of having ACEs, so about putting people in little groups of 700 kids per group.

What we were able to find is that, after we did this risk, we were then able to follow them up for 4½ years and see who actually had ACEs.  You will see that we are able to predict who is most likely to have these ACEs, so in this case the highest risk group, more than 55% had at least two or more ACEs by the time they're 4½ years old.

Of course that means 45% didn't have ACEs and so the goal of the research isn't really to look at who is going to have ACEs and find the risk factors for ACEs, it's really to say, who did we predict to have ACEs and who didn't have ACEs and what is the resilient factors for those children that didn't have ACEs?  What can we learn from them that might give us more information for how to protect children from Adverse Childhood Experiences?  So, as I said, 55% had two or more ACEs, that's this bottom row but 21% of these children that were at the highest risk didn't have any.

So, the first part of our research was to say, okay, Growing Up in New Zealand collected thousands of variables about pretty much anything you can think of and it's probably in there.  What can we find that isn't already something we use for the predictive model, something that we know already about when they're born?  Do they have a lot of litter in their neighbourhood?  Do they interact well with their partner?  What can we find out that might help us understand which children are at the highest risk but actually have no adversities?

So lots of dots here, each one of these dots is a factor that was found to be associated with doing well, so being at a high risk but not actually having any.  The first thing that came out to me was there's a lot of dots at the parent/partner.  From the child welfare background that I have, we had a lot of policy levers in Wisconsin to cut a deal with family finances, "Okay, we can give you this support that you need".

& We also had a lot of -- the social workers are sent in to kind of watch the interaction between the parent and the child, that's like the key that we were looking at in Wisconsin.  And a little bit of parent health and wellness, you can find programmes and policies that kind of help the mum get the resources they need.

But we almost never, at least in Wisconsin, looked at this parent/partner, sometimes that was because there's a thought that the partner is the one is causing the problem, separate from the partner.  But in this case it seemed like -- so the dots by themselves are good because that's something we find but also the further you're over -- I can't do like your left and your right, I get a little confused.  So the higher the number, these are standardised, so that means they're having the larger effect.  Not only are there more dots but they're also stronger.

Not only that but if you were to think about the number of factors we looked at, like I said, Growing Up in New Zealand was collecting a whole bunch of different things and it's based on the researchers doing that data, since it's secondary data analysis.  They really were focusing on these community and neighbourhood factors.  In fact, there's about 750 factors we were looking at, of which a third of them were under community and neighbourhood, whereas only about 60 to 65 factors were found in parent/partner.  So, not only do we have the most number found in parent/partner but we also had the fewest things that could have come through.

So, to me the first things that came through is, okay, we need to maybe think about how we engage this parent/partner relationship more than we are doing.  Maybe they're doing more here in OT but at least in Wisconsin this is an area that we haven't been focusing on as much.  As we are waiting for other things to come, that was the main goal of that first part but there was some time to look at other things and Growing Up in New Zealand really collected a lot of really amazing school readiness, it might not be the best term, 'school readiness', because all children are ready for school when they turn five.

But school readiness exams that they looked at, can you write your name?  So, the top one is if I clap once, can you clap twice, this inhibitory control?  They also looked at here's a list of upper case and lower case letters, can you identify these letters?  How many can you identify in 60 seconds?  A gift-wrapping test, which is a little like the marshmallow test, if you've heard of that, which has now been a little bit debunked.  Effective knowledge is, can you tell if you look at a face if it's happy or sad, that's the effective knowledge?  Number and name writing, can you write numbers on a piece of paper?

And somebody would evaluate, yes, they seem to be able to write numbers.  And then counting up from 1 to 10 and 10 to 1, those are self-explanatory.  These are standard tests that they are administering to all the children that are 4½ years old.  If you go back to that original 10,000 articles that are on outcomes, almost none of them are, do you already see negative outcomes by the time the children are 4½?  This was kind of an opportunity to look at that in Growing Up in New Zealand.

These are small.  The goal that you should see is that every one of these things is kind of declining.  So as you go up here, these are the number bases that the child experiences, zero to four or more and every single one of these, if you go up to how many letters can you name, you see that by the time you get to three or four more you have more than half the children can identify more than one letter in 60 seconds on a sheetful of letters, whereas for the children that had zero ACEs, three-quarters of them could.

All of this here kind of showed that a very dose-response kind of fit with the literature already, does response and negative effects of these ACEs that are happening.  That finding there was what kind of drove the whole second round of what we're doing and what we're now working with OT with, with Paula and Eyal, to kind of say, okay, let's look at the school readiness, is this the same in teen mothers?  Do we see the same trends for that subgroup of population?

& Then also a lot of these factors, a lot of questions like, what can you change?  What would you change from a policy standpoint here at MSD or at OT?  How would you change this to kind of help the children that are experiencing ACEs?  So the first thing we did was we segregated the same analysis we saw before where we said it was over half of the children had experienced at least one ACE.  This is now based on the age of the mother at the birth of the child.  If a mother was less than 18 at the birth, about 60% had experienced zero or one and then here for the 18 and 19 group it's a little bit higher, so 60% -- oh, little lower I guess, 55% had zero or one, so that's a little worse for the children.  The larger of these three areas, that's the two, three or more ACEs.

You can see that there is a definite association with mothers that are having babies as teenagers, their children are experiencing more adversities.  Again, not a surprising finding for anyone who is looking at this and it's not because of the teen mum, it's for a whole bunch of other reasons that are going on.  The question then is, who do we approach?  If we want to minimise Adverse Childhood Experiences, we just involve all teen mums or should we use this sort of predictive approach that we were talking about earlier where you look at all the factors you know and try to decide?

If that's your question preventing Adverse Childhood Experiences, what you have here are these curves of -- if you remember before I kind of made a big line of people and I split them into five groups.  I should have probably split them into ten because this example now has them all split into ten groups.  I have this whole line from the lowest risk for the predictive model all the way to the highest risk for the predictive model and I'm looking at the top 10%.

& So this is this group, so this would be that area that I'd highlighted before and if I was doing the five groups it would be nine and ten together.  What you'll know teen mums, mothers that have the babies when they're still teenagers, they do have slightly higher risk of having Adverse Childhood Experiences because the line is slightly above it but you would still want to not just select all teen mums because, as you can see, there's a lot of teen mums here that are at much lower risk than choosing the whole population based on the predictive model.

Policies that are just saying, okay, we're just going to roll all teen mums, might not be the best use of resources.  If you knew the two things, you knew whether or not they're a teen mum and you knew their predictive score, if you only had enough money to -- if you first select teen mums that are in ten, that would be the area that you'd want to focus on most.  But then the next one you'd want to focus on all people are at ten before you would start taking teen mums that are lower.

& That's like the first thing to me because there are a lot of programmes and policies everywhere that just kind of make it easy and say, okay, if you're a teen mum you're going to be enrolled.  That said, that was to prevent Adverse Childhood Experiences.  If you want to get school readiness better for children you'll see that on every one of these curves, so teen mums are grey again and the non-teen mums and the higher you are the better you are at passing that school readiness test.

At every area, no matter where you are in the curve, teen mums' children are doing worse.  In fact, if you look at this here, at zero ACEs, a teen mum at zero ACEs only 52% are passing this letter test, that's how many letters they can name in 60 seconds.  So if you kind of go across that, that's like the equivalent of a non-teen mum with three or more ACEs.  Again, it's always kind of complicated, like do you want to deal with preventing ACEs or do you want to deal with actually having the children be school ready?  I guess it might depend if you're at OT or MOE or who knows what your priorities might be.  But every one of these and you'll see these are just two that I'm showing to kind of split it up but every one of the six school-readiness tests in every single instance for the same level of ACEs the teen mum is always doing worse than the non-teen mum, mothers that have children in their teens; I'm not sure how to phrase that without tongue-twisting.

Again, it kind of shows that instead of dealing with just bucketing all teens maybe in this case you would, if you really wanted to be having children ready, you would be like, well, it doesn't matter.  Teen mums need the services because all their kids, on average, are doing worse on the school-readiness test.  That was the first thing we started connecting with Paula and Eyal here at the evidence centre.  Then they really kind of pushed back and said, "It's good you're doing this total ACEs thing but I want to look at individual ACEs and which ACEs are important or not".  I pushed back as much as I could but then I thought, okay, it makes sense; they seem to want this.

I went through the process and this is a little hard to tell, the number is the number of the school-readiness tests, so there's up to seven tests that we are looking at.  This total is kind of what I was showing before, so six out of the seven school-readiness tests were statistically associated with having ACEs.  So the total number of the ACEs, the more ACEs you have the less likely you would be ready for school, if we're using this terminology.

Splitting it up you'll see that it really seems to be driven by the physical abuse indicator.  Now, that could just be because for children that's the one that they're feeling more and more often and that's what's causing the different response, biological response.  But it could also be, who knows?  There's hundreds of reasons; I could just sit there and make something up.  But it's interesting and I think it's interesting for OT because that's one of the main areas that you guys are focusing on is physical abuse and mental abuse.

Unfortunately, there's no neglect currently being collected, so we couldn't see that one.  But these are the ACEs again and you'll see, we did look at the teen sample because that was the goal for this.  The numbers get real small in the teen sample, so you can't see it too much.  But, again, you will see that the physical abuse seems to be the one that seems to be most associated with the school-readiness exams.  So, that was the teen portion of it.

The other portion I'm going to say, okay, what can we do with children that have already experienced ACEs?  The first time we went through we went through all these factors that were in community and parent/partner.  Now we wanted to look at factors, the governmental programmes that are going on.  What are the factors, preference, quality, access, kind of the health services' research terminology that's used often?

We ended up choosing healthcare, early care and education, social services and splitting them into those four buckets.  If you look at this you'll see that most of the factors that Growing Up in New Zealand were collecting were on health service utilisation, so that's the biggest bucket there; 135 out of the 372 but there are other buckets that we're looking at.  Doing the same thing that we did before where we kind of like see which one of these 372 factors are associated with each of the tests, kind of seeing how important they are for the tests we did.  We start getting a whole bunch of -- we can spit out graphs like this to the end of time.

Hard to follow exactly, it wasn't as clear to me and when I looked at the parent/partner one that was like, okay, well that's obvious, that's parent/partner, not like that but it's something that we're now looking at.  Here it's a lot harder to say, I mean you have more dots in the healthcare utilisation but, like I just said, there were a lot more factors that we were looking at for healthcare utilisation.  So this is where we really need people to kind of be excited about their own programmes, to look at what the results say for them, try to decide what does this mean for what we're doing and how could we change what we're doing, based on these results?

Another thing that we are kind of working on, so a follow up to what we just showed there is to kind of say, okay, these were interactions, so these are children that have ACEs have a different effect for the programme that you're looking at.  One example that I'm going to go through, just in the physical abuse and the total ACEs there is almost 100 of these.  Some of them make sense, some of them don't.  They're all proxies, so don't ever think, okay, this is going to your GP, you shouldn't go to your GP when you're 24 months because it's not the GP that's doing it, it's all this other stuff that might be associated with going to a GP.

So here we have a red line, those are people that have the physical abuse indicator, so there's an indication that they're having this Adverse Childhood Experience of a physical abuse.  The blue line are children that don't.  You can see that if they don't report, so there's a question, who did you do your well child check with when you were 21 to 24 months old?  One of the options is the GP.  The people that don't say, yes, they went to their GP, these are these people here and you can see that there's not that much difference in their scores for school readiness for whether or not they went to the GP when they were 21 to 24 months old.  But if they report going to the GP and they had Adverse Childhood Experiences, for some reason you'll have to get the people that are involved with GP programme and policing to kind of realise -- I mean we can come up with the fun ones ourselves but they're all just kind of -- for some reason people that go to their GP that have been physically abused, that's a real big indication that they're not going to be ready for school for this test.

Counting up is a score of, can you count up to ten?  If they go one, two, three, four, five, six, seven, they stop right there they got 7.  If they start at two and they go to ten, they get 8.  So, the score over here is how many numbers in a row that they got.  Most children that don't go to the GP seem to be pretty much right around 8½ and maybe they skip the seven, like my four-year-old seems to skip a lot.  But for some reason if you have been physically abused or you have an indication of being physically abused, again, the definitions for physical abuse are not quite the same as OT; you will have to go back to those reports to kind of see the differences.  But for some reason they have a worse score.

The question is, what do you do about that or what could you do about that?  Again, trying to write this in another different way here is, if you use the GP during your 24-month well-child exam, it may not indicate whether or not you can count to ten but if you have a physical abuse indication as well, that is an indication.  If I'm a doctor and I get people coming in, if I don't know anything about them I would just think, they're probably going to be about 8.5 to 9.  But if there's some screenings to all that might give the same indication for a physical abuse, I would automatically know, not because of their coming to the GP, but I would automatically know these children might need more services.

If there was a way to kind of then think, okay, can we get the people in the room that are involved with setting policy and programmes for what surveys need to go out for the GP or the 24-month well-child exam, can we add this component into them?  If we can, what services can we offer in addition to those kids that have indications for physical abuse?

Like I said, there's 100 of these, so really kind of requires working through them individually with the programme and policy analysts themselves because I can play with numbers all day and it doesn't really get anywhere.  The goal here is really kind of say, what do we have to work with, Paula and Eyal to kind of package that to a point that somebody can read that and understand if they want to be involved with that?  There's a lot of limitations for the research that we did and the methods that we used.  The biggest one is there is no a priori hypotheses, we just threw -- there was 100 things that came out.  There is probably 2,000 tests that are going on.  There's going to be spurious findings, to know that this is the first step to kind of start the conversation to do an intervention and to do a test that might go through.

The goals for what we want to do, one is increase awareness of ACEs.  There were still -- glad I saw a lot of hands but it's also OT, so you guys are kind of involved with this area a lot more.  The first part is really to set up a strength base, so try to say, okay, what are these protective factors?  Then we also want to develop strategies for the mother/partner and then for the work that we're doing right now is to really give more information to people that are doing programmes for teens and then also going through these examples and finding partners that want to go through it.

So, I really want to thank the Growing Up in New Zealand staff who gave us access to all the data and really thank Paula and Eyal and everybody else that I work with and thank you for listening.

End of transcript.

Supporting Young People in Aotearoa - video transcript

Shae Ronald - CEO at Youthline Auckland Charitable Trust:

Tena koutou katoa.  (20 seconds of Māori spoken)

So lovely, such a warm welcome here this morning.  Thank you for having me, and it's so nice to see some familiar faces in the room so thank you for coming along, it means a lot.  I am very privileged to be the CEO at Youthline and I just wondered how many people have had some involvement with Youthline, if you could put your hands up?  A few in the room, okay.  So we've been going for 50 years next year and we were set up so that young people who weren't accessing services could be supported by other young people.  We were set up in 1970 and we have nine centres across the country, including three centres up in Auckland.  We supported over 35,000 -- you'll see it's just under 35,000 young people last year.  We've got a helpline, we've got face to face counselling, youth mentoring and programmes in the school and community throughout the country.

We work as a collective impact model and so all the centres are separate legal entities who work together under a collective impact model to provide a national helpline across the country, and that's a 24/7 helpline.  There's an example there of a quote.  We recently evaluated our helpline and a quote from a young person:

Now, I know there's lots of people in this room who work with children and young people and I do totally want to acknowledge the big mahi that we've got in relation to children and young people, and I wanted to talk today about what we're seeing in relation to increased level of risk around the children and young people contacting us.  These are some of our stats from the last year, so we managed 273,410 contacts to our helpline, and that was through phone, we've got email, we've got text and webchat.  That's a lot of people reaching out for help, and a lot of those are young people and a number of them are families and parents reaching out for support for their children and young people.  Sadly two out of five texts that we've been receiving are around anxiety, depression, self-harm and suicide, and one out of five around suicide.  And since January this year those numbers have doubled, so we are now seeing a doubling of the level of risk in the young people contacting us.  So, as I explained before, we have three doorways, we talk about young people coming in to get help to learn and grow and to contribute, and those are some of the services we provide that I talked about earlier. 

I wanted to talk to you about the State of the Generation research, that's the nationally representative survey of New Zealand young people.  So Colmar Brunton have been undertaking this research for us every sort of two to three years, and it's been fascinating watching the changes in young people over those years.  For the researchers in the room these were the objectives of the research.  It was really to find out what issues are facing young people, how are they seeking help and how might we better support them, all of us across the country.  Young people came from across New Zealand who are involved in the research, it took place in July and August of this year and 406 16 to 24 year olds were involved.  This shows a sample profile, you'll see the mix in ages, ethnicity, so we had -- just of note, 16% Māori or Pacific and 17% Asian.  We particularly wanted to find out how things were going for young people in those communities, and the spread across the country there. 

So we weren't surprised to hear that a large number of young people think they're viewed negatively by our communities.  What we thought was sad was that of those young people Māori and Pacific young people and 16 and 17 year olds were more likely to think that they were viewed negatively by our communities.  A number of young people knew where to get support.  We asked them, "Do you know where to go to get support?  Can you get support when you need it?"  Many said they did and they could, but again we were concerned that still around one in ten young people don't feel they have positive ways to cope and would not reach out for help and don't think their friends would reach out either, and that Māori and Pacific young people and 16 and 17 year olds all were less aware of where they could go for support.

We weren’t surprised with New Zealand's high youth suicide rate, that 83% of young people viewed mental health as the biggest issue facing their generation.  Again we weren't surprised that there was a significant increase in the number of young people who were stating that suicide was a big issue for young people.  Interested to see and interesting in the work we all do that young people are thinking that drugs and alcohol have gone down in relation to the significance of those issues in young people's lives.  But when we looked at that it just reflects what we're seeing at Youthline.  It would be interesting to hear from others whether or not it's reflecting what you're seeing in your work as well. 

When we asked young people about ranking those issues, and also what did they think was the single biggest issue facing young people, you'll see that mental health again is hitting the top of the list.  What was interesting is that the environment and sustainability is coming up really high for young people as seeing that as like the biggest issue facing their generation, and also economic uncertainty and debt.  So just thinking of some of those contextual factors around young people and the environment, and not surprising we're seeing such an awesome uprising of young people in relation to advocating for sustainability and a better environment for all of us. 

We were interested in the demographic breakdown around how different groups of young people and communities of young people saw the issues in their communities, and interesting to see that Māori and Pacific young people were more likely to mention that they were seeing suicide and drugs as a big issue for their communities, and that Asian young people mentioned racism.  Also again not surprising but, you know, of note, 16 and 17 year olds really thought that mental health was the absolute biggest issue for their group.

& Some gender differences.  It was clear from this survey that young women had a greater perception of the issues that are facing young people than young men, and we can only sort of surmise what that might be about.  Some people might say it's around the development rates in relation to women and men but, yeah, interesting, we've got some very aware young women in our communities.  We asked young people what did they mean when they talked about stress, just to unpack that a little bit, and what came through there was around stress and expectation in relation to education, in relation to social media, in relation to expectations of society in a fast moving world.  So there's a quote there from a young person, I'll just see if I can read it:

"High expectations in a fast paced growing world which is difficult to adapt to.  People are getting out of touch with reality and away from social support like friends and family."

And you'll see in this survey research friends and family play such a critical role in young people's lives and in their mental health and wellbeing, so that young people are seeing the kind of breakdown of social support is important for us to take notice of. 

So we asked young people did they feel they had received the support that they were looking for, and unfortunately since 2016 the rates of young people who said no, they hadn't, have actually significantly increased.  The issues that they're looking for support for, again not surprisingly mental health coming out at the top there, and 16 and 17 year olds were more likely to be seeking support for those issues. 

So there's a breakdown there where young people aren't getting the support they're seeking it's around mental health.  It's really clear there, a hugely significant change from 2016.  Those are some of the key issues.  When young people felt that they were helped, you know, how were they helped, family and friends coming up top there and, you know, that's something that we just keep on emphasising, you know, in relation to making sure that families and friends are equipped to support young people in their lives as well as making sure that young people themselves are equipped to be able to manage their own mental health and wellbeing.  Another quote:

They were there when I needed to talk but also were there to ask questions to make me talk."

And it came out here in the research the importance of actually reaching out to young people, so asking if young people are okay.  And we know it's a bit of a myth that if you ask if someone is okay, especially if they're experiencing suicidal thoughts or in that kind of a space that it will make it worse.  It doesn't make it worse.  It's really important that we do ask and make sure that we are available as a resource if someone's having a hard time.  So that came out there, which we thought was -- it's really good that young people are saying what would make a difference for them.

What came out most around how they better could have been supported was around someone who was non-judgemental.  So someone who might have similar experiences and also counselling, counselling has come out through this research as something that young people think is a really important platform for them to be able to support their mental health and wellbeing.  So, you know, that's something we're really hot on, I expect numbers of you are hot on it, it's just making sure you're providing like a confidential non-judgemental space that young people feel they are free to kind of talk about whatever is going on for them without judgement. 

We asked, we know there's been lots of conversation about suicide, youth suicide, and we felt there hadn't been many voices of young people in there in relation to what do young people think should be done, what's going on, you know.  So we put in these questions for the first time this year, so what would make the biggest difference in relation to reducing New Zealand's high youth suicide rate, and this is what young people told us.  Remove the stigma about talking about mental health, provide better support in schools, and equip and empower young people with the tools and resources to be able to support and manage their own mental health and wellbeing.  And there was a theme there around social media, which is interesting and something for us to unpack, in relation to the pressure that young people are feeling from that.  It raises questions, I've been talking with Facebook about what are they doing to help make sure that their platforms are as safe as possible for young people and are as supportive as possible for young people who might be experiencing difficult times.  They're doing some good stuff, which is great.

It was great to get this, like really smart, not rocket science, pretty building block stuff, and when we're thinking about suicide prevention strategy and suicide prevention office, we think it's vital that young people are involved and that they are saying what's going to -- what are going to be the meaningful solutions for them.  I don't feel there's enough of that, you know, kind of in the public dialogue around this at the moment.  We asked young people where do they go for help and again, probably no surprise for any of us, friends, families coming up top there.  We were happy to see that young people are still accessing helplines, that's good, and interesting for Māori and Pacific young people that family and whanau came out even higher.  So, really, really important in relation to Māori whanau that they are as much as possible equipped to support their rangatahi to be able to handle the challenges that they're facing, and that makes a big difference for young people.

And young people are going to Google to find out answers to their problems, and what we're finding at Youthline is that young people are going to Google to find out how bad they are, so they might feel anxious, how anxious are they, you know, they want to see are they on a scale of one to ten.  So self-assessment tools and things like that seem to be becoming more important, yeah, so that young people can kind of find out for themselves and then hopefully seek support and help depending on where they end up on that. 

A bit concerned that TV shows are such a massive source for young people of information, and that social media had gone down a bit but interestingly when young people were probed about that they named a whole lot of social media sites as places they were going to get information.  But helpful, hey, for us working with young people to understand these are the sources, to make sure that our services are utilising channels and mediums that young people are engaging with.

We launched a chat bot this year which is a little AI tool called Sam and young people can go on there, and families, and adults supporting young people, and there's a list of 20 questions that young people developed that are common questions that seem to be of importance to young people, and they can get information straight out from the chat bot.  And it's interesting of that 52% of people coming through that are converting to speak to a counsellor, so there's still this desire to want to seek further help, which we think is great. 

And, as I said before, counselling, so young people are saying face to face counselling is by far the most important support platform for them, which is interesting because so many young people we work with aren't that keen on the face to face as much as more of the -- of technology.  So, important that we keep on our kanohi ki te kanohi engagement with young people and make sure that we've got free, non-judgemental counselling available across the motu for all young people who might need support.  There's a significant increase in numbers of young people saying that helplines were an important platform for them, and for Māori and Pacific that youth groups and youth mentoring, probably no surprise for numbers of us, the most important support platform. 

; So there was a general awareness kind of question which might be interesting for people in this room who are from some of these organisations.  Youthline was the most recognised youth support organisation, we're really pleased to see that, and 71% nationally 60% in Auckland in terms of awareness.  I mean, I'll let you read that but interesting, you know, in relation to as an organisation, you might not know, our helpline, we only get $90,000 for our 24/7 helpline and it costs us $1.1 million to run it.  So we fundraise -- have to fundraise over $1 million a year just to keep our helpline going, and we know and we're thankful, the only Government funding we get for our helpline is actually from Oranga Tamariki, which is amazing, and we're thankful for that.  And we know, as you probably do too, oodles of money is pumped into some Government initiatives and they're not getting the kind of cut through that some of the existing organisations who have been around and done the hard yards are getting.  So I think it's important, I have as much as possible advocated to the Government that we need to make sure that existing organisations are strengthened, don't just keep starting new initiatives that ultimately don't seem to sustain.

So the numbers of young people who'd contacted these organisations, again we were really thrilled that a quarter of young people or their friends had contacted Youthline.  Family Planning, yay, that's awesome to see.  Really cool to see.  And lots of young people hadn't contacted any support organisations, which is also interesting given what young people are telling us about mental health being the biggest issue, given we have the highest rate of youth suicide in the developed world. 

So just a recap, 16 and 17 year olds and Māori and Pacific Island young people are less likely to feel that they are viewed positively, and when we think about the disproportionate rate of Māori and Pacific young people who are dying by suicide in New Zealand, you know, it does raise some questions around if you think you are not valued and society is not seeing you in a positive light, what does that do around messaging for yourself about who you are as a person and how positively or negatively you might view yourself.  And, you know, just thinking about your stuff too, Matt, around adverse child experiences.  Like I found your research fascinating and thinking about if you grow up not having that kind of positive self-talk and support, no wonder our kids are having a hard time when they come out the other end. 

So something for all of us there.  And the majority of young people know where they go to get help, 73% which is great, but 16 and 17 year olds who are more likely to be seeking support around mental health issues do not as much as the others.  Again, I know I've told you this but the three things around reducing our youth suicide rate for young people, removing the stigma around talking about mental health, providing better support in schools, and empowering young people to manage their own health and wellbeing.  And there was talk in the survey about doing that from a young age and doing that kind of from a base that young people can then build on.  When we look at who did and didn't receive support the 32% who felt they didn't receive the support that they wanted said it would have been -- made a difference for them if someone could -- there could have been someone for them to talk to who was non-judgemental, who could associate with their experiences, or if they had access to regular counselling.  So having people reach out to them would be beneficial rather than having -- them get through the barriers of embarrassment and other barriers in terms of reaching for help -- reaching out for help.  So we've -- you know, we know that cost, embarrassment, sometimes fear that there won't be a culturally appropriate response, those are the kind of things that are sort of stopping young people that came through in the research in relation to reaching out for help. 

Platforms.  The majority of New Zealand youth, so 69%, perceive that face to face counselling is providing the best support for young people, and their friends and family are critical and information sources, the internet there was the highest source of information.  We know that 35% of all that had been surveyed only had ever contacted a support organisation, and there's the barriers and cost there, embarrassment and cost -- sorry, the barriers to getting help -- embarrassment and cost, feeling their issues are not big enough.  I find that fascinating given what we're seeing, and what's come through in the survey.  Not wanting to talk to someone, and uncertainty of what might happen.  So it kind of reminded us again about the importance of making sure that young people understand what's going to happen with their information, what's going to happen if they're at immediate risk of harm to themselves or others, what sort of privacy they're entitled to and where we will need to pass on information.  It's very hard to read this one here so I'm just going to read it here, Māori and Pacific Island youth are more likely to mention embarrassment, fear of judgement, trust, not culturally acceptable, not sure if their culture will be understood.  Again reiterates for us the need to be providing culturally competent services for Māori and Pacific and rainbow communities and all the other communities.

So there's a question there that we have been asking ourselves about how can we make sure that we support young people to overcome the barriers approaching us, and I would ask you to ask that of yourselves too in relation to any services you provide to young people, what might be the current barriers at the moment, and is there anything else you could do to reduce those barriers for young people. 

So that left us with these discussion themes, which I've already kind of talked through today, but just to kind of leave with you so that you do kind of ponder them and keep thinking about them.  Is it any surprise that mental health came out as the biggest issue?  Lots of shaking heads, no.  Is that what you're seeing in your services?  Yeah, and in policy and -- yeah.  It makes me think we're in this kind of rising tide, it does feel like a rising tide and, yeah, we need to see how we can bring it back down.  We talk about a community of people who care, so we talk about building communities of young people who care for young people.  We're really pleased, like our 300 and something volunteers, most of them are young people supporting other young people.  So that is pretty cool.  How do we do that more in our communities, and again how do we make sure we remove the barriers to young people seeking support.  These are the lovely team who worked on this research at Colmar Brunton, and I've got copies of the report here if anyone wants them, and of course feel free to contact me any time, I'm happy to talk further.  So thank you for your time.

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