NORTH EASTHAM — The results of the Nauset Regional High School Youth Health Survey were about more than numbers for the region's substance abuse task force when it met June 3.

For example, 94.56 percent of students responding said they never had a day when they stayed away from school because they felt they'd be unsafe there or on their way—but eight of the 147 who answered said they did. “There shouldn't be one kid” in that situation, Principal Dr. Christopher Ellsasser said as he reviewed the results with the group.

Task force chair Dr. Ann Caretti, director of student services, agreed. “With some of these questions, one is too many,” she said.

The 15 percent of Nauset's 960 students who responded made for a positive profile, with almost all belonging to a club or team, not smoking, not using someone else's prescription drugs, always wearing a seatbelt, never drinking and driving, and being physically active. The vast majority's grades were A's and B's.

But even with a sample who seem to have a lot going for them, there were concerns. More than three-quarters of respondents said they felt extremely anxious or worried to the point of interference with daily activities. Their concerns included “academic stress, feeling isolated/alone, worried about the future, relationships with friends/classmates, and body image/physical appearance.” Homework and grades provoked academic stress.

A little more than a quarter answered either “no” or “not sure” when asked if they spoke to a trusted adult “regarding things that are bothersome.” Eighteen percent, or 27 students, seriously considered suicide, with 13 reporting making one or more attempt.

“It's the most troubling thing we have on our mind,” Ellsasser said. “We're identifying students and then not having the resources to know what to do. Then they go somewhere and come back and there's little or no change... Do we just send you home? What support can we provide?”

Several members of the task force spoke of their frustration with the lack of mental health services on the Lower Cape, while noting that there are groups working at the local and state levels to improve that situation. “We all agree that mental health is completely underserved,” said the task force's Ginger Marks, a member of the Orleans School Committee. “I really am thrilled that at least we are trying to shine a light on it. The more you shine a light, the more the stigma goes away.”

Meanwhile, said Ellsasser, “our response has been, 'Train the adults.' Provide as many opportunities as possible to normalize conversations (with) students and continue to look for resources beyond the school. That's where it gets frustrating and scary.”

He's hopeful that changes to the school's advisor-advisee program may provide help with a variety of concerns. “Our goals are to get the numbers down so we can build relationships between advisors and the families,” he said. “That pretty much doesn't exist. I'm coming out of a school where an advisor had eight to 10 kids and worked with the family on a regular basis. I'm headed that way (here). The next step is educating parents about what we want the advisory to be, saying adult to adult, 'We need you to join us in the effort.”

Advisors and advisees meet for 35 minutes every Wednesday. “The programs I've seen work meet every day for 10 minutes,” the principal said. “You create a relationship. You check in every day through your highs and lows. Once a week is not enough.”

Having adults, in the school and in the homes, model the behaviors they want to see in their students is critical, according to Ellsasser. “Adult behavior is the driver in all of this,” he said. “Kids don't smoke cigarettes. You look around; adults have pretty much stopped. Everybody is drinking alcohol. (They're) on the phone in cars. What do you expect the kids to do? If you want a change in student behavior, look at your own behavior.”

Through student assemblies, according to the principal, Nauset has detailed “the dangers of vaping, the importance of having an inclusive and diverse community and being aware of hateful or discriminating language or symbols, and the importance of peer leadership.” That last factor played a role in reducing vaping on campus.

“There were students who came to us around vaping and said, 'You need to look at the cause,'” Ellsasser said. Later in the meeting, he said the school was “pretty extreme with how we responded. If you were caught vaping, you were told to go home, talk with your family, take a couple of days, check with your doctor, find out what's going on. We see this as a health concern... The family would come back and meet with me and the assistant principal. We'd want to hear their plan.”

Even in the relatively small sample of the nearly 1,000 students at Nauset, 18.5 percent reported having sexual contact against their will, 14 percent said they had been bullied and 12 percent had experienced online bullying.

“Students seem more at risk when they're with people they don't have a history with or contact,” Ellsasser said. “That sets up for miscommunication around personal boundaries... young people in an awkward position dive into their phones... talking it out is not a skill we see.”

He said he's noticed that among students the staff has interacted with this year, “communication around boundaries and expectations and what's OK and not OK seem to be grayer and grayer all the time... It does seem that they spend an awful lot of time communicating with each other not face to face.”

Nevertheless, he said, “clearly there is right and wrong and that should be crystal clear to everyone.” He hoped to see more “education on face to face interaction and building respect and trust, doing even more than in the past to push back on this false world they live in (on line) where nobody gets hurt. We need to pull that into the face-to-face world and say a lot of people get hurt.”

The survey “is a jumping-off point for further conversations,” Caretti said, regarding “individual guidance, health classes, advisor-advisee” relationships. “We know what conversations have to occur.”