U4 Critical Thinking Class - Essay

Author(s): Diana Mahoney Source: Pediatric News. 42.10 (Oct. 2008): p30. Document Type: Article Copyright: COPYRIGHT 2008 International Medical News Group http://www.imng.com/ Violence in schools often has its roots in bullying, and recent research suggests that attempts to uproot the problem may first involve gathering information about bullying and victimization, and then undertaking a "whole-school" intervention to address the issue. Most media reports pointed to a link between bullying and the extreme school violence events such as Virginia Tech or Columbine that the perpetrator was bullied as a child or teen. Take for example Seung Hui Cho of Virginia Tech and Dylan Klebold and Eric Harris of Columbine. [ILLUSTRATION OMITTED] Seung Hui Cho was a socially awkward young man who was mocked throughout high school for his shyness and for the strange way he spoke. A 2002 study conducted by the U.S. Secret Service and the U.S. Department of Education regarding 37 incidents of targeted school shootings and school attacks that occurred in the United States from 1974 to 2000--, including the 1999 Columbine murders--determined that 71% of the shooters felt bullied, persecuted, or injured by others before the attack (www.secretservice.gov/ ntac/ssi_final_report.pdf). That the majority of youth involved in school shootings have been bullied certainly does not mean that bullying in and of itself causes school violence, but it does drive home the fact that bullying and victimization are important risk factors for dangerous behavior that cannot be ignored, according to Dr. Tarshis, director-of the Bay Area Children's Association in Cupertino, Calif. It also highlights the fact that, as much as we know about bullying and its adverse effects, there are many questions we still can't answer, he said. "We know from longitudinal studies that higher levels of bullying and 'victimization are associated with poorer mental health outcomes, but it's impossible to quantify what amount of bullying leads to some of the negative sequelae that have been observed," Dr. Tarshis said in an interview. "So, while we know, for instance, that children who score highest on victim and bully scales are most likely to have worse scores on clinical measures of anxiety and depression, we

can't say something like, '6 months of consistent teasing is 70% likely to cause a clinical diagnosis of depression.'" There are a number of reasons for this. "One factor is that some children are much more resilient to traumatic events than others. Thus, a resilient child may be able to tolerate high levels of bullying without any negative consequences, while a child who is not as resilient may have poor mental health outcomes with what may seem like minor infractions. This is something we see in child psychiatric clinics very often," he said. Another consideration, he noted, is "the lack of a consistent, valid instrument for measuring bullying and victimization in children" in order to develop group norms to explain variance. To address the latter consideration, Dr. Tarshis, along with Colleague Dr. Lynne C. Huffman of Stanford (Calif.) University, recently developed and tested a simple questionnaire for use in school settings to gather comprehensive information on bullying and victimization. The Peer Interactions in Primary School (PIPS) questionnaire is a single-page survey consisting of 22 multiple-choice questions about direct bullying (physical violence or threat of harm) or indirect bullying (social ostracizing, teasing, dirty looks, or rumor spreading). With funding from the National Institutes of Health, the investigators administered the PIPS questionnaire to 270 third-through sixth-grade students in California and Arizona. According to the results, nearly 90% of the students experienced some degree of victimization by bullies, and almost 60% participated in some form of bullying. Among those students who reported being bullied, "most answered 'sometimes' or "a lot" to the seven victimization questions on the survey, which suggested a fairly high levels of victimization," Dr. Tarshis said. Subsequent analyses of the PIPS questionnaire demonstrated high reliability, strong construct and concurrent validity, and high internal consistency (J. Dev. Behav. Pediatr. 2007;28:125-32). In addition to being an easy, useful tool for measuring the extent of bullying behaviors in school settings, the PIPS questionnaire may be most valuable in the development, implementation, and analysis of anti-bullying interventions, said Dr. Tarshis.

"Because bullying is so multidimensional--cutting across home, school, and peer relations--it is exceedingly difficult to arrive at interventions that can document clear benefit in reducing harm," he explained. "PIPS could be used as a validated pre-and postmeasure for any manualized intervention or school program hoping to decrease bullying and victimization." And without question, such help is desperately needed. Even though bullying has been identified as a pressing public health issue and a majority of schools nationwide have taken up the cause, there are few indications that such attention is paying off. Of more than 300 available bullying interventions identified in a 2004 review of bullying and victimization in the United States (Bullying in American Schools: A Social-Ecological Perspective on Prevention and Intervention. Espelage DL, Swearer SM, eds. Mahwah, N.J.: Lawrence Erlbaum Associates; 2004), "not 1 meets the full criteria for recommendation as an evidence-based intervention, and only 6 have been tested against a control group with positive results," Dr. Tarshis said. Similarly, a review of 26 studies of school-based interventions found that a lot of them had little impact on bullying outcomes overall (Arch. Pediatr. Adolesc. Med. 2007;161:78-88). "We found that many common methods of dealing with the problem [of bullying], such as classroom discussions, role playing, or detention are ineffective," said Dr. Rachel Vreeman of Indiana University, Indianapolis, the lead author of the study. The news from the Indiana study was not all bad, however. "Whole-school interventions involving teachers, administrators, and social workers committed to culture change did appear to curb bullying somewhat, particularly in the junior and senior high school-aged kids," Dr. Vreeman said in an interview. (See box.) Dr. Tarshis said that the apparent benefit of the "whole-school" approaches over the other intervention methods makes sense. "'Bullying and victimization must be addressed as a systems issue, making changes in school, peer, and home environments," he said. "And since we know bullying and victimization begin at very young ages, our best chance for change is to intervene beginning in kindergarten, with changes in curriculum, staff attitude, and parental education."

For optimal effectiveness, however, interventions should specifically target "bystander" youths who are neither victims nor bullies, as well as the victims themselves, he said. "Bystanders should be recognized as a strong force in identifying bullying behavior and making it unacceptable," Dr. Tarshis stated. Dr. Carl C. Bell, chief executive officer and president of Community Mental Health Council Inc., Chicago, agreed. He said in an interview, "It takes a certain social norm to support bullying, and trying to change that norm might result in less trauma for those of us who get bullied. Toward this end, one strategy that I've seen used with some success has involved engaging the bystanders in intervention efforts to diminish support for bullying." Dr. Tarshis added that, with respect to the victims, "we know from clinical work that, at times, no matter how much we intervene in the school setting to try to prevent bullying, it's not always successful. In these cases, the best chance we have is to work with the victimized children to 'tune up" their mental health to prevent continued negative consequences." Dr. Bell continued, "We know, for instance, that "catastrophizing" about trauma promotes succumbing to trauma. When someone is traumatized, if their response is, "Oh my God, I will never survive this trauma unscathed,' they are usually right. In this way, attitudes about the lack of resilience are a significant driver of how people experience the trauma. By highlighting bullying as a rather common traumatizing phenomenon, we give permission to catastrophize the experience of being bullied. "On the other hand, if people have a sense that there is something they can do to master or cope with the experience of traumatic stress, they will be more successful in preventing it from sticking to them. It follows that giving victims of severe bullying a sense of self-efficacy as it relates to the experience of being bullied is a critical protective factor against certain harmful consequences," said Dr. Bell, who also serves as director of public and community psychiatry at the University of Illinois at Chicago. "The importance of developing protective factors," he said, "is relevant to the bullies as well as the victims. Behind anger is often hurt. Many bullies hurt people because they themselves have

been hurt. Building up the social fabric that surrounds bullies is a good point of intervention as well, as it addresses the issue of minimizing trauma in the bullies." Model Program Is 3-Pronged Approach Multidisciplinary, whole-school anti-bullying interventions have been shown to be more effective at curbing bullying and associated behaviors than curriculum-only interventions. One multilevel, multicomponent intervention that has been associated with reduced bullying behaviors in the classroom is the Olweus Bullying Prevention Program designed by Dan Olweus, Ph.D., of the University of Bergen (Norway). The program, which is offered to all public schools in Norway, is being implemented in a growing number of public schools in the United States. Recognized by the University of Colorado's Center for the Study and Prevention of Violence as 1 of 11 "Blueprints for Violence Prevention" and by the U.S. Substance Abuse and Mental Health Services Administration as an exemplary program, the Olweus intervention attacks bullying at school-wide, classroom, and individual levels. In the United States, the Olweus program is supported by Clemson (S.C.) University (for more information, see www.clemson.edu/olweus). Schoolwide Interventions * Administration of an anonymous bullying questionnaire to all students. * Formation and meetings of a bullying prevention coordinating committee. * Staff training. * Development of schoolwide rules against bullying. * Development of a coordinated system of supervision during break periods. Classroom-Level Interventions * Regular classroom meetings about bullying and peer relations.

* Meetings of parents of kids in each class. Individual-Level Interventions * Meetings with children who bully. * Meetings with children who are targets of bullying. * Meetings with the parents of children involved. BY DIANA MAHONEY New England Bureau Mahoney, Diana