The ABCs of Bullying: Addressing, Blocking, and Curbing School Aggression

(6 hours $29)

Module 1: School Bullying: What It Is and Why It Hurts
"I used to bully people. I used to bully people in almost every kind of way. I did it because that was what lots of my friends did. . . .
My friends and I were walking home from school one day, and I saw a kid. I thought I would be cool and get cocky with him.
The person I was cocky with ended up being 4 years older than me. The person walked up to me and tackled me into the ground. I felt like he had broke my spine. Then he punched me repeatedly.
After he had left, my friends helped me up. I was mad my friends didn't help me. They told me I deserved it. Him tackling me left an imprint in the ground.
The next day we walked by that spot and the imprint was still there. It stayed there for almost a week." -Letter from a Bully/Victim1

Not Just Child's Play

The image of the class bully lording over weaker students goes back as far as the one-room schoolhouse. The class bully hasn't disappeared from our schools' classrooms, playgrounds, hallways, bathrooms, cafeterias, stairways, and school buses. In fact, children today have to put up with not only physical and verbal threats and intimidations, but also new forms of bullying. These new forms include spreading rumors through e-mails and cell phones, or using the Internet to cause distress.

Today's children aren't any more likely than their parents to place an encounter with a bully among their fondest memories of childhood. Those who argue otherwise might try explaining why so many adults can instantly recall not just the first, but also the last names of the individuals involved in childhood bullying incidents.

At one time, school bullying may have been viewed as a "rite of passage" that built "character." Today, however, it's no longer regarded as just something that happens during playground routines. Educators, health and mental health practitioners, parents, and community members are realizing that it is a serious problem that can lead to more severe long-term problems for individuals and communities. Some experts believe that bullying should be considered a special form of child abuse-sometimes called "peer abuse," the cruelty of children to each other.2

Federal researchers have found that bullying is related to more serious forms of violence-both for the victims and for the bullies-including frequent fighting and the carrying of weapons. Bullying is also associated with a higher risk of substance abuse.3

Not all aggressive behavior among children and youth should be considered "bullying." Bullying is generally defined as repeated physical, verbal, sexual, or psychological attacks or intimidation by one individual who is perceived as being physically or psychologically stronger than another. In a general sense, a student is being bullied or victimized when he or she is exposed, repeatedly and over time, to negative actions on the part of one or more other students.4

An Underreported Problem

How serious is the problem? Many students fail to report bullying to teachers and other adults, making bullying an underreported problem. As researchers probe more deeply into what goes on among school-aged children, however, alarming statistics are surfacing:

• According to the results of a nationwide survey funded by the National Institute of Child Health and Human Development,5 bullying affects nearly one out of every three U.S. children in grades 6-10.
• One third of high school students polled about issues related to school size said their schools had serious problems with bullying.6
• A review of 1999 data collected by the Federal government on school safety among 12- to 18-year-old students found that approximately 36 percent of students reported seeing hate-related graffiti at school.7
• Fifty-five percent of 8- to 11-year-olds and 68 percent of 12- to 15-year-olds say bullying is a big problem.8
• A nationwide survey highlighted by the Centers for Disease Control and Prevention (CDC) found that 6.6 percent of students in grades 9-12 had missed at least one day of school during the 30 days preceding the survey because they felt unsafe at school or on their way to or from school.9
• A survey by the American Association of University Women found that although students today are likely to be aware of school sexual harassment policies, 8 in 10 students -- both boys and girls -- said they experienced some type of sexual harassment in school. The results were the same among urban, suburban, or rural schools.10

There are signs that bullying is on the rise. According to the National Education Association (NEA), in recent years, "bullying has become more lethal and has occurred more frequently" than in the previous two decades.11 The National Association of School Psychologists (NASP) has called bullying "the most common form of violence in society".12

Groups such as the NEA, NASP, American Medical Association, and the American Bar Association have launched major initiatives to draw attention to the issue. Partly in response to several highly publicized school shootings across the country in recent years, several State legislatures have passed laws requiring schools to adopt antibullying policies.

The Fear Factor

Adults have a responsibility to understand-and intervene-when antisocial behavior crosses the line and becomes bullying used to gain control or power over another individual. Intervention also means empowering children, particularly the victims and those who are witnesses to bullying, to be part of the solution.

Recognizing bullying for what it is shouldn't lead to the conclusion that schools are dangerous breeding grounds for crime and violence. The CDC notes that the majority of injuries that occur at schools are unintentional and not violent. Less than 1 percent of all homicides among children and adolescents are school related.13

However, there is no doubt that bullying can increase the "fear factor" in school environments.

The Consequences of Bullying

Research on bullying is still in the embryonic stages in this country. However, available figures indicate that school bullying can have major social, educational, health, and other consequences for the children who bully, the children who are bullied, the witnesses of violence, and their communities:

• Youth who are bullied have higher rates of suicide, depression, post-traumatic stress disorder, and substance abuse.14
• Hostile kids who mistrust others are much more likely than their peers to develop physical symptoms linked to diabetes and heart attacks in the future.15
• Youth who bully others frequently behave badly in school and are more likely to smoke and drink alcohol.16
• According to the latest Secret Service Safe School Initiative, almost 75 percent of students who used violent weapons at school (e.g., guns or knives) to attack others felt persecuted, bullied, threatened, attacked, or injured by others prior to the incident.17

In one State, half of all reported hate crimes were committed by juveniles-the most severe and violent of these were nearly always preceded by years of bullying.

Bullying and Violence

A groundbreaking report published in the Archives of Pediatrics and Adolescent Medicine in 200318 found that bullying at home or at school may lead to more aggressive behavior as the child gets older. The report analyzed information from a 1998 survey of more than 15,000 students in grades 6-10 in public and private schools across the United States. The report identified bullying as a strong risk factor for possible violence in the future. Among those who pose the greatest risk for violence are bullies who often feel threatened themselves.
The study found that both children who bully and those who are bullied carry weapons to schools:

• About 50 percent of boys and 30 percent of girls who had bullied others in school reported carrying a weapon.
• Thirty-six percent of boys and 15 percent of girls who had been bullied carried a weapon.
• Youth who are bullied and who also bully others away from school were nearly 16 times more likely to carry a weapon.

The short-term consequences of bullying for the victim are more than a black eye from a fight or a damaged reputation from an e-mail message. Those who are bullied feel tense and afraid and unable to concentrate on their studies. However, available figures indicate that bullying is coming at tremendous health, educational, and other costs to society.

Impact on Learning

Bullying can distract bullies, victims, and witnesses from learning. Bullies who are plotting their next attack or victims who are consumed with anxiety and fear about their next encounter with a bully will have difficulty focusing on the lesson at hand. Witnesses may:19

• Be afraid of associating with the victim for fear of lowing their social status among their peers, or fear retribution from the bully and becoming victims themselves;
• Fear reporting bullying incidents because they do not want to be considered a "snitch," "tattler," or "informer";
• Experience guilt or helplessness for not standing up to the bully on behalf of their classmate;
• Be drawn into bullying behavior by peer pressure;
• Feel unsafe, a loss of control, or unable to take action.

Truancy

Bullying is having tremendous health, educational, and other costs on society.

Truancy has been labeled one of the top ten major problems in schools in the United States and identified as one of the most powerful predictors of delinquency. Many students stay home from school because they are afraid of being bullied.20 Students who are not in schools learning may find other, less acceptable ways to occupy their time. About half of serious violent juvenile victimizations occur between noon and 6 p.m.21

Decreased school attendance hurts the individual and society. Absence from school affects a student's achievement, promotion, graduation, self-esteem, and employment potential. Independent of the lost educational opportunities, truancy comes with other societal costs.

Bullying's Long-Term Effects

The effects of bullying extend beyond the school years. Bullying may lead to criminal behavior for those who bully and future health and mental health problems for both the bully and the victims:

• Six out of 10 kids identified as bullies in middle school are convicted of a crime by the time they reach age 24.22
• Years after experiencing bullying, adults who were bullied as teens have higher levels of depression and poorer self-esteem than other adults.23
• Children exposed to violence either at home or at school often suffer long-term problems such as anxiety, depression, post-traumatic stress, low self-esteem, anger, and self-destructive behaviors.24

Yet, despite its prevalence, bullying often is overlooked or downplayed as a problem among parents and educators. Many bullying activities take place out of the view of adults. But even those activities that occur within plain sight are frequently ignored:

• As many as one-fourth of elementary and middle school teachers don't understand the seriousness of bullying or putdowns and, therefore, intervene in only 4 percent of bullying incidents.25
• More than two-thirds of middle school students believe that schools respond poorly to bullying.26

Most school bullying doesn't lead to headline-grabbing incidents of students brandishing guns in mass attacks against their perceived enemies. The consequences of bullying are often less obvious, yet nonetheless damaging and lasting. Left unchecked, bullying creates an atmosphere of intimidation and fear that can send a message to students that aggressive and violent behavior is accepted.

Environmental Factors

Bullying exists within an environment of other forms of violence and aggression by and toward youth:

• The U.S. child homicide rate (2.6 per 100,000 for children younger than 15 years) is five times higher than the rate of 25 other industrialized countries combined, according to the CDC.27  
• Suicide is the third leading cause of death for adolescents. The rate of suicide among adolescents increased 128 percent between 1960 and 2000.28
• According to a 2001 National Household Survey on Drug Abuse (NHSDA) Report, 28 percent of the nation's youth have participated in a serious fight either at school or at work, have taken part in a group-against-group fight, or have attacked others with the intent of seriously hurting them.29
• The U.S. Department of Justice reports that juveniles are twice as likely as adults to be victims of serious violent crime and three times as likely to be victims of assault.30
• In one-third of the sexual assaults reported to law enforcement, the victim is under the age of 12.31
• According to a comprehensive 1995 study of the prevalence of violence among youth, approximately 8.8 million youths indicated that they had seen someone else being shot, stabbed, sexually assaulted, physically assaulted, or threatened with a weapon.32
• An estimated one in eight 17-year-olds have experienced post-traumatic stress disorder at some point in their lifetimes, according to the same study cited above.33
• The average child sees 16,000 murders on television by age 18. Although homicide rates have decreased, network news coverage of homicides has ballooned.34

Cost of Violence

The annual cost of the violence affecting young people and others in society is estimated at a staggering $425 billion in direct and indirect costs relating to the criminal justice system, security, treatment, and lost productivity and quality of life.35

Putting aside the larger questions about the degree of violence in society, however, parents, teachers, students, and communities can do something about school bullying. The time to start is now.
"Karla was the type of girl everyone loved to pick on. . . . She was picked on every day at school. And I don't mean just once a day, I mean all day, every day.

. . . After Karla moved, I was feeling really horrible about what I'd done. I was the most sorry that she moved without warning. . . . They just picked up and left. . . . the thing I regret most is not saying that I was sorry.
So Karla, if you're out there. I'm so sorry. And I mean that from the bottom of my heart." -letter from a bully. 36

Myths and Facts

Despite increasing research and publicity about bullying, several myths still exist. See if you can separate the myths from the facts below:

Children who bully are loners.
This is a Myth: This myth has been proven wrong by research that shows bullies tend to have a following of peers who approve of their behavior or at least go along with it.

"Sticks and stones may break your bones, but names can never hurt you."
This is a Myth: As any professional knows, this childhood nursery rhyme is not true. Verbal and emotional bullying, both direct and indirect, does hurt children. Physical bullying is easier to recognize. A more realistic rhyme is "sticks and stones can break your bones but words can break your heart".

All children can get bullied, even if they look "normal."
This is a Fact: All children can potentially be victims regardless of how "normal" or different they may seem. As an earlier section pointed out, the reasons why a child may become a victim of bullying are endless. That doesn't mean children who are "different" do not get bullied. They do.

Most adults think bullying is the same as normal peer conflict.
This is a Fact: Bullying can often be difficult to discern from rough play or normal conflict. A study on the ability of lunchtime supervisors to distinguish students' play fighting from true aggression found that supervisors were more likely to mistake aggression for play than the reverse.

Only a small number of children are affected by bullying.
This a Myth: Just about every student in a school may be affected by bullying, either as a victim, the bully him/herself, or as a witness. As bystanders, students are often confused and fear for their own safety. A conservative estimate is that 10 percent of students are chronic victims of bullying.

Parents can help prevent bullying by becoming involved in their child's schooling.
This a Fact:  Many adults don't know about bullying, either with their own children or in the schools. Many parents are not aware of what goes on in their child's school. Many students believe adults will not intervene even if they do report the bullying.

Bullying happens mostly in plain sight of others.
This a Myth:  Most bullying behavior occurs out of the sight of any adult, so adults need the cooperation of students to alert them to the behavior. Students need to know that the adults will take swift and appropriate action in their defense.

Summary

• Bullying is a major problem, particularly in elementary and middle schools, and comes with major costs for the individual and society.
• Bullying can lead to more serious problems, including substance abuse, depression, and criminal behavior.
• Intervention programs, adults, and in fact, the whole community must respond to bullies, victims, and children who are witnesses.
• Several myths about bullying persist. These myths can affect the prevention and intervention efforts to stop bullying.

Module 2: The Role of Bullies, Victims, and Witnesses

Peer-Peer Aggression

"In a 2001 survey commissioned by the Kaiser Family Foundation, more 8- to 15-year-olds picked teasing and bullying as 'big problems' than those who picked drugs or alcohol, racism, AIDS, or pressure to have sex." Fight Crime: Invest in Kids, 200337

Bullying is "exposure, repeatedly and over time, to negative actions on the part of one or more other students."38 It is an imbalance of power. This definition is based on work by the Norwegian researcher Dan Olweus, who pioneered the field of bullying research in the 1970s.

After three young boys committed suicide in Norway in the early 1980s, efforts by Olweus and others resulted in a nationwide bullying prevention campaign in Norway. The program has become the international standard for bullying prevention.39

Bullying encompasses more than physical acts; it can take the form of:

• Name calling
• Threats
• Verbal or other forms of shunning.40

Most bullying shares the following characteristics:

• It is aggressive behavior or intentional "harm-doing";
• It is carried out repeatedly and over time; and
• It occurs within an interpersonal relationship characterized by an imbalance of power.41

When Does Bullying Happen?

Research on bullying and bullying prevention efforts is more recent in the United States than in Europe, where there has been public awareness of bullying for 20 years.

Although children are less likely to be bullied as they get older, research indicates that bullying behavior tends to peak in late middle school or early high school. Older bullies just tend to pick on younger victims.42, 43 Bullies also tend to encourage others to help in the bullying or to carry out intimidating acts.44

The Role of the Peer Group

Early adolescence is a particularly vulnerable time for students because it is a time when their peer groups are becoming more and more important. As children begin to yearn for independence from their parents, they turn to their peers for assurance, identity, and comfort.45 Part of that assurance or acceptance comes in the form of stratified groups among boys and girls. These groups reflect status. Elevated standing for boys is frequently based on being tough, aggressive, and athletic. For girls, physical attractiveness is a central determinant of social status.46

The transition from elementary to middle school, which usually requires children to adjust to new facilities and the presence of older children, can cause some children a lot of stress. Changing from one school to another can often lead to an increase in emotional and academic difficulties, such as dropping grades, loneliness, and anxiety.47

Some researchers speculate that the process of attempting to define a place in a new social structure may promote bullying behavior. If bullying pervades the social norm of the middle school, then children entering middle school who want to "fit in" start to copy the behaviors of those kids they see as popular.

Recent studies have supported this theory. In one study of 452 fourth- through sixth-grade boys, 13 percent were rated as aggressive and popular by their teachers.48 The peer group in particular, and the school's social climate in general, therefore support the bullying activity. The challenge then becomes how to teach children to handle the stressors of a new environment and pressures to belong without practicing hurtful behaviors.

Children Who Bully

Boys and girls who engage in bullying behavior tend to have a need to feel powerful and in control. They seem to get satisfaction from inflicting pain or hurting their peers, both physically and emotionally. They also tend to show little sympathy or empathy for others and to defend their actions by claiming the victim provoked them.49,50 Most of the research has been done on boys who bully. Generally, children who bully:51,52

• Are aggressive with others (including parents and teachers)
• Frequently hit or push other children
• Are physically strong and socially dominant
• Have a positive view of aggression
• Have trouble following rules
• Show little empathy for others
• Are emotionally immature
• Are irresponsible
• Show inadequate social skills (also true for bully/victims)
• Seek attention (think fear equals respect)
• Are often contemptuous of both children and adults
• Are often academically below average
• Cannot and will not accept responsibility for their actions

The Role of Self-Esteem

There are conflicting data regarding the self-esteem of bullies. Dr. Mona O'Moore studied more than 8,000 children and found children who have been bullied, children who bully others, and children who were both bullied and who bullied others had significantly lower global self-esteem than did children who had neither bullied or been bullied. The children who both bullied and were bullied had the lowest self-esteem of all.53

There are bullies who appear to have self-esteem, but in truth are self-centered, narcissistic, and impressed with the power showered upon them. Ervin Stuab, Ph.D., professor of Psychology at the University of Massachusetts, says that "the self-esteem of aggressive boys appears to be very vulnerable, very fragile. Its maintenance requires specific circumstances and behaviors on their part. This raises the question whether we can consider it a genuine positive self-esteem."54 Popularity is often only skin deep, because most bullies' friendships are based on fear, not respect.55

"You may think ur safe now, but ur so gonna take a plunge down the popularity level, it is inevitable. Most of us realize what a [expletive] loser you are"
- Internet bulletin board posting at a private girl school.56

Traits of Children Who Bully

Bullies often share the following traits:57

• Gender. More boys report bullying than girls. When researchers directly observe girls interacting on the playground, however discrepancies between genders are not as great. Boys report more physical forms of bullying; girls tend to bully in indirect ways, such as gossiping and excluding.
• Age. International studies have shown the highest rates of bullying among 11- and 12-year-olds, although bullying among younger kids is becoming more common.
• Temperament. Bullies tend to have low thresholds for frustration.
• Aggression. Bullies tend to be aggressive not only toward their peers, but also toward their teachers and family. They have positive attitudes about aggression and can easily be provoked.
• Physical Strength. Boys who bully tend to be physically stronger and have a need to dominate others. Girls who bully are not necessarily stronger than other girls in their class. They often are smaller in size.
• Lack of Empathy. Bullies have little empathy and show little remorse for their actions.

"For 2 years, Sam, a quiet 13-year-old, was a human plaything for some of his classmates. The teenagers badgered Sam for money, forced him to swallow weeds and drink sour milk. When Sam's torturers were asked about the bullying, they said they pursued their victim because 'it was fun.'"58

Although general characteristics tend to show up for those kids who are bullies, bullying is really a continuum of behaviors. In other words, no one characteristic will define bullying, but rather, a combination of several traits and characteristics shape the behavior.

It is natural to want to label a kid either a bully or a victim, but researchers have discovered that it is more accurate to look at specific instances of bullying behavior because some kids can be both bullies and victims.59 Moreover, children often fail to identify obvious bullying behaviors as such. In one study, adolescents reported practicing bullying behaviors or reported being victims of bullies, but these same children did not associate the actions as "bullying".60

Why Children Bully

There are many reasons why a child may bully others or display behaviors that are hurtful and intimidating. These include:61,62

• Frustration. A child feels impaired or out of control and has not learned adequate ways to deal constructively with this frustration. The bully may have an undiagnosed learning problem, or may have an unresolved emotional problem.
• Rewarded. The bully is rewarded for his/her behavior and feels a sense of power.
• Victim of abuse. The child is being abused at home and is expressing his or her anger at younger or smaller children at school.
• Victim of neglect. The child's emotional, spiritual, and developmental needs are not being adequately met.
• The child is being bullied. If responsible adults have repeatedly failed to address the child's victimization, the child learns that exhibiting aggressive behavior may be the only way to avoid the bullying environment.
• Influence of others. The child may have fallen in with the wrong crowd (e.g., one that supports and practices violence, as well as drugs and alcohol).
• Poor or no role model. If the child does not have a positive role model at home to reflect proper means of expressing anger and/or frustration, the child then learns destructive behaviors.
• Conduct disorder. A bully may have a conduct disorder. If left undiagnosed, the disorder may lead to other personality disorders.

A high school student who cried as she recounted being tormented in middle school described how she finally stopped the abuse: "I picked out another girl, someone worse off than me. . . . Then the others forgot about me."63

Children Who Are Bullied

Just as there is no one definitive profile of a bully, there is no one profile of a child who gets bullied. The reasons a child becomes bullied may include:64

• Being fat or thin
• Being tall or short
• Being quiet or creative
• Having big ears or small ears
• Being from a different culture or having a different religion or ethnicity
• Having different tastes or likes
• Having the "wrong" clothes (wearing clothes that are not "cool" at the time)
• Wearing glasses or braces
• Being homosexual-or believed to be gay or lesbian
• Being unwilling to use strength to defend him or herself
• Any imaginative "excuse"

"A high school boy originally from Turkey said that when he first moved to the United States, he wore the same clothes he'd worn back home and found that he was taunted as 'gay'"65

In short, the list of possible reasons for being bullied is endless. To some extent, the reasons also are irrelevant because they are merely excuses for the bully to continue his or her behavior. The child who is bullied becomes the useful object for the bully to displace his or her anger, frustration, or aggression.

Traits of Children Who Are Bullied

Although there is no single type of victim, for some children, the following characteristics may be present before the bullying occurs; for others, they may appear as a result of the victimization:66

• Gender. Boys and girls are equally likely to report being victimized.
• Age. Victimization decreases as children get older. Research has shown that almost one-fourth of victims are children in grades 1-3, whereas it drops to 12 percent in grades 7-8. Younger children are more likely to be bullied by older children; children in higher grades are more likely to be bullied by their peers.
• Temperament. Many bullied children tend to be anxious and withdrawn. This is more indicated in preschool children than older school-age children.
• Physical Appearance. Research has not supported the popular misconception that victims must have some unusual physical trait or be considered ugly by the bully. Many children who are bullied have no discernable physical trait that is unusual, yet still get picked on.
• Self-esteem. Children who are bullied often report low self-esteem, though it is likely that in many cases, the low self-esteem is the result of the victimization.
• Anxiety. Boys and girls who are bullied report symptoms of anxiety, such as tenseness and fearfulness.

Experts tend to characterize children as either "passive victims" or "bully-victims". Bully-victims also are sometimes called "provocative victims".67 Passive victims tend to comprise the many children who are bullied.

Did You Know?
Boys and girls are equally likely to report being victimized.

Passive Victims

Children who can be characterized as passive victims or submissive victims68 share certain qualities. Often, these children are:69

• Cautious
• Sensitive
• Insecure-unable to assert themselves among their peers
• Socially isolated
• Lonely

"If you treat people like dirt, like nothing, that's how you're going to feel." -quote from a bully70
Other characteristics often found in passive victims include:71, 72

• Being physically weaker than their peers (particularly boys)
• Displaying "body anxiety" when scared of being hurt, having poor physical coordination, and not being athletic
• Having difficulty making friends
• Having poor social skills
• Crying or getting upset easily
• Having difficulty standing up for themselves in peer groups
• Relating better to adults than to peers

Passive victims represent roughly 80-85 percent of all victims.73 It is worth noting that some of the characteristics of passive victims may be seen as contributing factors as well as consequences of victimization.74 For example, if a child feels and acts insecure, his or her behavior may signal to others that he or she is an easy victim for bullying. The insecurity may therefore be viewed as contributing to the abuse. However, a child who is bullied regularly also is likely to experience insecurity because of the bullying behavior.

Bullies often engage in a "shopping process" to find students who will become their preferred victims, according to Gary Ladd, Ph.D., professor at the University of Illinois. They look for students who reward them by showing distress, who relinquish tangible resources, and who are less likely to retaliate or report them.

Bullies may pick any excuse to justify their intimidating and hurtful behavior, but research indicates that children with disabilities have a higher likelihood of becoming victims of bullying. These disabilities may include muscular dystrophy, cerebral palsy, or stuttering.75

Children With Disabilities

As noted earlier, bullying behavior is a problem that schools nationwide face. Most bullying research has focused on children as a whole. There is not as much research looking at bullying within subgroups of children, such as those with any form of disability. Bullies tend to focus on peers who seem vulnerable, and having a noticeable disability adds risk to a student's safety. Schools tend to label and separate students based on athletic or academic aptitude. This provides an atmosphere ripe for bullying and teasing.76

In addition, many children with disabilities do not participate in general education classes, mainstream clubs, or athletic programs-they are instead placed in special education, an additional "label." This separation perpetuates a lack of understanding and interaction among students with and without disabilities, as well as among staff outside of special education.77

With severe bullying, equal access to educational opportunities and benefits for youth with disabilities can be eroded, including denial of rights under the Individuals with Disabilities Education Act (IDEA), and provisions of a Free Appropriate Public Education (FAPE).78

Bully-Victims

Bully-victims, also called provocative or aggressive victims,79 display many of the same characteristics as passive victims, except they tend to be hyperactive (though not always formally diagnosed with Attention Deficit Hyperactivity Disorder) and have trouble concentrating. This particular type of victim is not as prevalent as the passive victim, comprising just 5 percent of those children who are bullied.80 However, these children tend to be quick tempered and try to fight back if they feel they have been insulted or attacked. They are more likely to alienate their peers and teachers.81 When they are bullied, they tend to be bullied by many students or the entire class. Provocative victims also tend to bully those people who are younger or weaker than themselves.82,83
In particular, most provocative victims:84

• Have difficulty concentrating
• Are restless, hyperactive, impulsive, and create tension
• Are clumsy, immature, and exhibit irritating habits
• Are sometimes disliked by adults, including teachers

Bully-victims or provocative victims often create problems for the entire school community and are more likely than passive victims to be referred to special education services. Unfortunately, special education placement, while often necessary, often exacerbates the bullying because students who receive special education services are more likely than students in regular classes to be bullied.85

Complaining about the community's reputation for racial harassment at sporting events, one student said, "Other schools don't want to come here to play us. Even their cheerleaders get taunted."86

Recent research has shown that these types of victims should be monitored carefully, as they frequently display not only the social-emotional problems of victims, but also the behavioral anti-social problems of bullies.87,88

Provocative victims also were shown to have poorly modulated affect and behavior. Their impulsivity, hyperactivity, and emotional dysregulation (e.g., emotional outbursts) were very reactive, quite likely a main reason they emerge as likely targets of bullying.89

Although provocative victims often have inappropriate outbursts of emotion, they seem to internalize their emotional distress. In self-reports, they acknowledge feelings of depression and anxiety, possibly related to their difficulties coping with negative feelings.90 Among all types of bullies and victims, provocative victims are the most disliked by their peers, being the most highly rejected group or subgroup.91 Knowing the correlation between victimization and poor psychosocial functioning, this subgroup of children who are bullied and bully seem particularly at risk.

Children Who Witness Bullying

Witnesses and bystanders also play important roles in the dynamic of bullying. Witnesses display different attitudes and reactions towards a direct bullying situation.92
Olweus developed categories of witnesses and bystanders to help understand the complex dynamics of bullying. Besides the bully and victim, there are:93,94

• Followers or "henchmen." They take an active part, but do not start the bullying.
• Supporters/passive bullies. They support the bullying, but do not take an active part.
• Passive supporters/possible bullies. They like the bullying, but do not display open support.
• Disengaged onlookers. They watch what happens, but do not take a stand.
• Possible defenders. They dislike the bullying and think they ought to help, but do not.
• Defenders of the victim. They dislike the bullying and help, or try to help, the victim.

Multiple studies have shown that peers are present in more than 85 percent of bullying incidents.95,96 Peers who do not see the bully suffer negative consequences for his or her behavior are more likely to copy the behavior themselves.

Two recent studies, one from Canada and the other from Finland, found that in most instances, peers were involved in or witnesses to a bullying incident, as opposed to having the bully and target alone. In fact, in the Canadian study, peers were involved in 85 percent of the bullying incidents.97

When children are interviewed, they tend to align themselves with the bully, not the victim.

Children who witness or participate in repeated bullying may become desensitized and lose the ability to recognize the detriments to aggressive behavior. They only see the positive rewards from someone who wields power. Children who have a proclivity for aggressive behavior and are more impulsive are more likely to copy the bullying behavior. Research has shown that children's empathy for victims decreases as they get older,98 which affects whether they are likely to intervene in a bullying situation.

When bullying occurs on the playground, peers may play a large role in encouraging the aggressive behavior by gathering around and watching. Research consistently shows that a majority of peers do not intervene, and in fact, act in ways that maintain the behavior.99,100 When children are interviewed, they tend to align themselves with the bully, not the victim.
It is important to note that there are children who do try to intervene, either directly (with the bully) or indirectly (by telling a teacher or another adult). These children, research has found, tend to have a higher social status in general. Their status as class or group leaders enables them to take some of the power away from the bully and therefore establishes more balance.101

The Importance of Witnesses

Studies indicate that roughly 30 percent of students are either bullies or victims or both (within a school term). That makes 70 percent of the student population potential witnesses. Some researchers believe that the witnesses to bullying are the key to eliminating bullying because they are the sizable majority in any school.102

Although this student population wields the most power and has the most opportunity to change a school, they are not a homogeneous group. Of course, the entire school community must support system change to support any bullying prevention effort. In the book "Bullies, Witnesses & Targets: Helping Children Break the Chain," SuEllen and Paula Fried describe six categories of witnesses:

"Tattling is when you are trying to get someone in trouble. Reporting is when you are trying to get someone out of trouble.

• Inactive. These children are somewhat aware of the bullying, but try to avoid incidents and shield themselves from dealing with the bullying.
• Angry. They become angry at the victims for not deflecting the bullying. They blame the victim for their inaction, which forces the witness to be an audience to the continued abuse.
• Fearful. These witnesses confess that it hurts them to see their classmates being victimized. They think about doing something to stop the bullying, either by intervening themselves or telling a teacher, but fear the potential wrath of the bully.
• Voyeur. These kids get pleasure from watching others get taunted and bullied or are relieved they are not the victim.
• Accomplice. They cause the most harm because of their collusion. They laugh at the bullying and join him/her in the behavior as a way of ingratiating themselves with the bully. Accomplice witnesses give the bully more power, status, and popularity because they join in the act, which would not get as much attention if the bully acted alone.
• Helpful. These children actually try to help the victim either by directly intervening or getting an adult to stop the incident. Helpful witnesses understand the difference between tattling and reporting.

Methods of Bullying

Children and adolescents may use a variety of methods to hurt one another. The most well known form of bullying is physical aggression. This may include hitting, kicking, punching, or destruction of property. Verbal bullying may include teasing, name-calling, and taunting a child to make him or her angry. Physical and verbal bullying are both considered direct forms of bullying.

There also are indirect forms of bullying. Examples include spreading rumors, excluding others from a group, and enlisting someone else to assault someone for the bully.

Role of Gender

Researchers are still examining the role of gender in bullying and aggression. When it comes to bullying, both girls and boys bully, although the methods may differ. Research has suggested that males are more likely than females to be violent and to physically bully both other boys and girls.103,104 Some research has shown that boys tend to be physically aggressive and are more easily provoked by physical behavior. Girls, however, tend to be relationally aggressive with other girls and are provoked by that behavior, not physical behavior.105

Relational aggression involves attacking the relationships of people and hurting people's self-esteem. It is subtler and involves behaviors such as spreading rumors, withholding friendships, ignoring, gossiping, or excluding a child from a small group of friends.105,106 More focused research is needed to investigate the impact of gender on school bullying and youth violence.

Traditionally, aggression has been accepted by society for boys and men. In school, aggression may be rewarded for boys. As reflected by the social status of peer groups for boys in middle and high school, aggressive boys tend to hold higher status among their peers. Aggression in girls, however, is not as accepted or as well studied as aggression in boys. Overall, physical aggression has received the greatest attention from researchers, educators, and parents when examining the consequences of bullying.

Most females engage in comparatively low levels of aggression, thereby popularizing the notion that females are less aggressive than males.107 With closer study, however, it appears that the nature of the aggression differs from that of their male peers. Female youth practice what has been called "relational" aggression.108 This covers behaviors such as:109

• Manipulating one's relationships with peers;
• Purposefully ignoring someone when angry (giving the "silent treatment");
• Spreading hurtful rumors or talking about someone; and
• Telling others not to play with or talk to a certain classmate as a means of retaliation.

In each of the above examples, social relationships are used as the vehicle for harming a peer, not physical acts. Both physical and relational victimization have been found to predict certain social and psychological adjustment problems (e.g., peer rejection, loneliness) beyond aggression.110 This could be described as using a more indirect approach to bullying.

Sexual Bullying

In addition to verbal, physical, and psychological bullying, there also is sexual bullying. Sexual bullying occurs when one student is harassed by another student(s) with unwanted words or actions. Examples of sexual bullying include:111,112

• Unwanted jokes, comments, or taunts about sexual body parts
• Teasing about sexual orientation or starting rumors about sexual activities
• Passing unwanted notes or pictures about sex
• Physically intrusive behaviors, such as brushing up against or grabbing someone in a sexual way or forcing someone to engage in unwanted sexual behaviors
• Spreading sexual rumors
• Pulling at clothing in a sexual way or pulling clothing down or off
• "Flashing" or "mooning"

Hearing derogatory and hurtful words and becoming victim to physical aggression can severely affect a youth's education, and mental and physical health. These students are more apt to skip school due to the fear, threats, and property vandalism directed at them.

Using Technology To Bully

Technological advances have created new ways for one child to bully another. Some adolescents use cell phones to bully others. Abusive phone calls can range from silent "breather" calls to swearing, shouting, or making threats.113 Another common form of cell phone bullying is using text (txt) messaging to send threats or abuse. Bullies often find a way to hide their phone numbers from the victim.

Many teenagers use the Internet to create Web logs or "blogs," which are online journals or diaries. Blogs can be easily accessed by anyone on the Internet and are easy to set up and maintain. One survey found that 10 million blogs are expected to be up and running by the end of 2004.114 The vast majority of bloggers are teens and young adults; 90 percent of them are between 13 and 29 years old. Although adolescence is a turbulent time when peer relations dominate, some teenagers use personal information gathered from another person's blog in hurtful ways such as spreading rumors or gossip.115

In Great Britain, making anonymous, or abusive phone calls or electronic messages is a criminal offense. The definition covers anyone who uses a public telecommunication system:116

• To send a message or other matter that is grossly offensive or of an indecent, obscene, or menacing character; or
• To cause annoyance, inconvenience, or needless anxiety to another, or to persistently send a message that the person knows to be false.

Summary

• Bullying affects most children, either directly or indirectly, and takes many forms.
• There are several types of victims and players in the complex process of bullying.
• Witnesses to bullying comprise the largest percentage of children in a school.
• All forms of technology can be used by a student to bully or intimidate another student.

Module 3: Factors Contributing to Bullying and Violence

Youth Violence and Aggression

"It appears that bullying is not an isolated behavior, but a sign that children may be involved in more violent behaviors." -Duane Alexander, M.D., Director of the National Institute of Child Health and Human Development117

The deaths of 12 students and 1 teacher in a suburban Colorado school by two troubled-and bullied-youth, who then committed suicide, etched the word "Columbine" in the American psyche. Columbine and other highly publicized school shootings garnered countless media reports and public commentary, including a report by the Surgeon General118 and antibullying efforts by State legislatures and the U.S. Government.

Rarely does bullying reach the level of violence that erupted at Columbine. Even low-level bullying, however, has the potential to escalate into mental health, substance abuse, or other problems. For many students, bullying may be just one manifestation of other problems present in the home, at school, or in the community.

Because experts now know that bullying may increase the level of fear in schools, as well as violence outside of schools, substance abuse, and other problems, parents, educators, policymakers, and others must understand the factors contributing to the problem to design effective responses.

Risk and Protective Factors

Children do not live in a vacuum. Their behavior may result from the interaction of multiple factors, some specific to the individual and others that are situational, familial, or societal.

The presence of "risk factors" puts an individual at higher risk of aggressive behavior, such as bullying. Conversely, the presence of "protective factors" may ward off bullying behaviors. Examples of protective factors include parent supervision and participation at school, peaceful conflict resolution in the home, and parental discouragement of aggression. Decreasing risk while increasing protective factors is the goal of bullying prevention.

Risk factors usually do not exist independently. That is, several risk factors may be present in one child. One study found that a 10-year-old exposed to six or more risk factors is 10 times more likely to be violent by age 18 as a 10-year-old exposed to only one factor.119

Risk Factor Timing

The timing of the occurrence of risk factors also determines whether a child has an increased risk of violence. Effective prevention programs must not only consider the range of risk factors present (in the individual as well as the environment), but that in the developmental process, these factors are more likely to be significant.

The fact that risk factors are present does not mean that a child is predetermined to commit bullying and other aggressive acts. No single risk factor or combination of factors can predict with certainty that violence will occur, nor does the presence of protective factors ensure that violence will not occur. Recognizing risk and protective factors serve the purpose of predicting the likelihood of bullying and violence and identifying points of prevention at the individual and community levels.

It is interesting to note, however, that when third-grade students were asked to identify classmates who were bullies, 25 percent of the 8- and 9-year-olds they identified as bullies had a criminal record by the age of 30.120

Did You Know?
A 10-year-old exposed to six or more risk factors is 10 times more likely to be violent by age 18 as a 10-year-old exposed to only one factor.121

Individual Factors

Individual factors affecting bullying and aggression include:

• Behavioral characteristics
• Biological influences, such as the chemical makeup of the brain or developmental problems

A child's personality and interpersonal behaviors often play a role in determining the likelihood that he or she will become a bully or a bullying victim. Examples of personality traits include shyness, outgoingness, contentedness, irritability, patience, resourcefulness, and determination.

Children who are more impulsive and active, with dominant personalities, may be more inclined to bully.122 Children who are anxious, insecure, cautious, socially isolated, or who lack social skills may be more inclined to be victims.123

A child's temperament, or the way he or she interacts with others, can be affected by his or her physical characteristics, such as height or weight, attractiveness, health problems, or the presence of a physical, emotional, or other kind of disability. Individual risk factors may include HIV, fetal alcohol syndrome, or retardation.124 Although the presence of any one of these risk factors does not mean a child will be overly aggressive or become a victim, each plays a role in how the child interacts with those around him or her.

Many children and youth who behave violently may have a long history of emotional and behavioral problems. Although it is important to avoid stereotyping or labeling of individuals with certain personality traits, it is nonetheless worth noting that experts have identified certain behavioral patterns that may be warning signs.

Warning Signs for Violence

The Commission for the Prevention of Youth Violence has identified warning signs of youth violence and recommends consultation with a mental health professional for youth who demonstrate any of the following:125

• Frequent loss of temper
• Frequent physical fighting
• Significant vandalism or property damage
• Making serious threats
• Extreme impulsiveness
• Alcohol and other drug abuse
• Easily frustrated
• Hurting animals
• Preoccupation with violent or morbid themes or fantasies in schoolwork, artwork, or choice of entertainment
• Carrying a weapon
• Name calling, abusive language
• Bullying or being bullied
• Truancy
• Excessive feelings of rejection, isolation, or persecution
• Gang affiliation
• Depression, despair
• Low self-esteem
• Threatening or attempting suicide
• Extreme mood swings
• Deteriorating school performance
• Being witness to or the subject of domestic abuse
• Setting fires
• Preoccupation with weapons and explosive devices
• History of discipline problems
• Social withdrawal
• Blaming others for difficulties and problems

The Surgeon General's Report on Youth Violence lists a number of risk factors that may be present in the individual that can help predict the onset, continuity, or escalation of violence either at a young age (ages 6 to 11) or later (ages 12 to 14):126

• General offenses
• Physical violence
• Substance use
• Being male
• Aggression (among males)
• Hyperactivity, restlessness
• Difficulty concentrating (among males)
• Risk taking
• Crimes against persons
• Antisocial behavior
• Exposure to television
• Medical or physical condition
• Low IQ
• Dishonesty (among males)

Substance Abuse by the Student

Substance use is a major risk factor in increasing the probability of youth violence in both the early onset and late onset of violence. Statistics bear out this link between alcohol and violence. For example:

• According to one study, 40 percent of students who drank alcohol at school also carried a weapon at school, compared with 4.4 percent of those who did not drink.127
• High school girls who smoke, drink, or use marijuana are more than twice as likely to report having been in a physical fight in the past 30 days as those who have never smoked, according to a study looking at the effects of substance abuse among girls and young women.128
• Children who drink alcohol by seventh grade are more likely to commit criminal and violent acts and have other problems, according to a RAND Health study.129

The American Medical Association found that compared with adolescents who were non-drinkers, adolescents who were drinkers:130

• Scored worse on vocabulary, general information, memory, memory retrieval, and at least three other tests.
• Experienced a 10-percent decrease in verbal and nonverbal information recall performance in a year's period.
• Indicated "significant" neuropsychological deficits in youth ages 15 and 16 with histories of extensive alcohol use.
• Performed worse in school and were more likely to fall behind and have an increased risk of social problems, depression, suicidal thoughts, and violence.

Familial Factors

Familial factors contributing to bullying and aggression include: 131

• Substance or alcohol abuse by someone in the family
• Certain kinds of parenting behaviors toward the child
• Family violence
• Lack of warmth and involvement on the part of the parents
• Overly permissive parenting
• Lack of setting clear limits for child
• Lack of or inadequate parental supervision
• Harsh, corporal punishment
• Child maltreatment, such as sexual or physical abuse

As every parent knows, one of the best ways to teach a young child a new skill is to show by doing. Unfortunately, the technique is all too effective when it comes to behaviors that adults may not want children to emulate. Children who experience violence either as victims or as witnesses "are at increased risk of becoming violent themselves," according to the U.S. Department of Justice's Office of Juvenile Justice and Delinquency Prevention (OJJDP).132 These children:

• Begin committing crimes at a younger age;
• Commit nearly twice as many offenses as non-abused children; and
• Are arrested more frequently than non-abused children.

Children need not experience the abuse themselves to be harmed. OJJDP notes that children who have viewed or heard violent acts often have the same lasting effects as those children who are direct victims.

Research continues to show that, among some children, parental permissiveness toward aggression and harsh, punitive parenting both may lead to aggression and therefore bullying.133,134 More specifically, some parents may encourage their kids to be tough and aggressive. Many boys from these types of families end up being not only aggressive, but angry, argumentative, and disruptive.135

Children need not experience the abuse themselves to be harmed.

These aggressive boys learn that their self-esteem or self-image should be based on their strength, power, and physical superiority over others. They do not learn that a positive image includes competence, good performance in school, and good relations with family and peers. Parents who use coercive parenting instill fear very early in their children. They often do this by using techniques that create an inequality of power such as physical punishment, yelling, and name-calling.136,137

Lack of Support

Disciplinary practices vary widely from family to family. Whatever the style, if the parent is not consistent, the child suffers. For example, if a parent overlooks misbehavior one day yet severely punishes the child the next day for the same behavior, the child does not learn right from wrong. Mixed messages from the parents where one says one thing and the other says something different also can confuse a child. Familial behaviors have the potential to strengthen or weaken a school-aged child's ability to relate to peers and behave appropriately.

Compared with past generations, new mothers today often do not have the social supports of family and community that help provide positive models of child rearing and discipline. They often feel overwhelmed, isolated, and unprepared. When a mother is unable to care for her child early in the child's life, that child does not bond securely with the mother. This often leads to deficiencies that may show up in the child as a lack of empathy, trust, and reciprocity of feelings. Parents also may have problems such as alcoholism or drug abuse and mental illness.

Socioeconomic factors can serve as risk factors for children and youth. Many families need to work more than one job to make ends meet. Often, kids are left for long periods of time after school with little or no adult supervision. The impact can range from a parent being unable to provide homework help to a lack of recreational and cultural opportunities in a violent neighborhood. Limited social and economic resources also contribute to parental stress, child abuse, and family breakups.138

Substance Abuse by Family Members

Alcohol and substance abuse-whether by the student or by family members-increases the likelihood that the student will turn to violence. According to the National Association for Children of Alcoholics (NACOA), families affected by alcoholism report higher levels of conflict than do families with no alcoholism.139 Alcohol abuse also is linked to domestic violence. Most welfare professionals cite substance abuse as a cause of or contributor to at least half of child maltreatment cases.140

Children of addicted parents may indicate problems that make them susceptible to bullying. In general, children of parents who abuse alcohol have higher rates of school absenteeism and are more likely to leave school, or be referred to the school psychologists than are children of non-alcohol-abusing parents.141

Societal and Community Factors

Societal and community factors affecting bullying and violence include:

• Bigotry
• Poverty
• Easy access to alcohol and weapons
• Poor schools
• The prevalence of violence in the media and popular culture142

Outside of the family, one of the major factors contributing to youth violence is the impact of peers.143 Many adolescents spend up to 40 percent of their non-sleeping time alone or with peers (or adults) who might negatively influence their behavior.144 Another study has put the figure even higher, noting that adolescents spend only 4.8 percent of their time with the parents and 2 percent with adults who are not their parents.145

A particular school's climate also plays a significant role in influencing the dynamics of peer relationships.
"She told me about the bullying, and I did listen to her. I listened but I didn't hear." -a mother whose immigrant daughter had been repeatedly bullied and eventually brutally beaten within plain sight of the bus driver after leaving the school bus.146

School Factors

Schools with a high incidence of bullying tend to have a lack of adequate adult supervision (especially during breaks) and an overall indifferent or accepting attitude toward bullying.147 What this often means is that less noticeable verbal attacks aimed at another student may not get corrected. If a child is verbally attacked on a regular basis, his or her view of school and peers is tainted and often negative.

A child's attitude toward and performance in school may influence whether he or she turns to bullying and violence. Many factors contribute to school performance, including peer group and family dynamics. Gang membership is identified as a high risk factor among youth who experience a late onset of violence, along with neighborhood influences, such as crime, drugs, and disorganization.

For many children and youth in the throes of adolescence, the peer group replaces the family in holding the most influence. As a result, efforts to create an antibullying culture among schools must incorporate the role of the peer group.

"The behavior, attitudes, and routines of teachers . . . have a decisive effect on the extent of bullying in the individual school or class."148

Violence in the Media

American children are bombarded by information and images from television, movies, music videos, video games, the Internet, and other mass-media outlets. Most of the research on the impact of the media and its connection to aggressive behavior in children has been limited to television. The body of research indicates that exposure to media violence increases children's aggressive behavior in the short term and encourages aggressive attitudes and emotions, which may in turn lead to aggressive or violent behavior.149

Research on new media forms, such as cable television programs, video games, and the Internet, is in the initial stages of development. The Surgeon General's report noted that some experts have hypothesized that the hands-on nature of some of the new media may result in dramatically different behavioral outcomes than the more passive forms of entertainment from movies and television.

Not only do many American children spend hours a day being entertained by a television or a computer game, but much of the content and programming they are exposed to is violent. A National Television Violence Survey that examined the content and amount of violence on American television found that:150

• Forty-four percent of the violent interactions on television involve perpetrators who have some attractive qualities.
• Sixty-one percent of television programs contain some violence, and only 4 percent of television programs with violent content feature an anti-violence theme.
• Nearly 75 percent of violent scenes of television feature no immediate punishment for or condemnation of violence.

The debate over the extent and impact of media violence raises numerous issues relating to government and/or self-regulating of the media industry, as well as educational efforts and technological advances that can help parents monitor children's access to media. As research unfolds and the debate continues, the best approach is for families to be proactive in determining what their children are exposed to and how often.

In addition to questions about its impact on children's behavior, the prevalence of new media raises concerns about how children are adapting technological advances to bully their peers. Many parents, educators, and others are just waking up to the realization that children and youth are posting messages on Web sites and using cell phones and the internet to spread rumors and to harass or abuse their peers.

Protective Factors For Bullying and Violence

Schools, parents, and communities have a responsibility to eliminate risk factors that make children and youth vulnerable to bullying and violence. Combined with the effort to eliminate or reduce risk factors affecting behaviors, communities also may increase the factors that increase the resilience among students to stay clear of risky behaviors.

Many youth, including those who are subject to multiple risk factors, have the personal strength and resilience to help them avoid problems such as alcohol, drugs, and school violence. American culture is peppered with stories of how individuals have achieved the highest levels of success against all odds. As with risk factors, some characteristics of resilient children are at the individual level; others are at the family or peer level.

"No student should be afraid to go to school because of bullying, and no parent should be worried that their child may be bullied." -from Make Time to Listen, Take Time to Talk brochure

Whether at the individual, family, school, and peer group level, protective factors can help moderate the effect of negative influences. Researchers are increasingly aware of the importance these protective factors play in improving public health.

Protective factors that may help buffer the risk of youth violence include:151

• Having a positive outlook on social situations
• Being aware of consequences for bad behavior
• Enjoying warm, supportive relationships with parents or other adults
• Having friends that parents approve of
• Being supervised by parents
• Being committed to school
• Winning recognition for involvement in positive activities
• Living in a neighborhood free of crime, drugs, or other symptoms of community disorganizations

What Makes Resilience?

The capacity to withstand hardship requires several strengths. These include:152

• Insight: learning how things and people work
• Independence: knowing when a relationship is unhealthy and how to set boundaries
• Relationships: learning how to make and maintain healthy relationships
• Initiative: generating constructive activities and creatively solving problems
• Creativity and humor: using creativity and humor to express complex emotions or to reduce tension
• Morality: knowing right from wrong and standing up for those beliefs

Developmental Assets

The Search Institute, which supports practical research for healthy development, has identified 40 developmental "assets" that can help build resiliency in an individual, children, groups of children, and communities. The Institute has surveyed more than 2 million youth across the United States and Canada since 1989 and found a "strong and consistent relationship between the number of assets present in young people's lives and the degree to which they develop in positive and healthful ways".153

Some of the assets may be manifested externally in the family or community. These external assets include:

• Family and community support;
• Caring adult relationships;
• The setting of boundaries and expectations; and
• Constructive use of time.

Other assets are present internally, including:

• Having an enjoyment of learning;
• Reading for pleasure;
• Having positive values and a caring attitude;
• Having a sense of equality and social justice;
• Having a healthy lifestyle and healthy attitude toward sex; and
• Possessing social competencies and having a positive identity.

The fewer assets a youth has, the more likely he or she is to engage in risky behaviors. A Search Institute survey conducted during the 1999-2000 school year of more than 200,000 youth in grades 6-12 in more than 300 communities across the United States found that young people from all racial/ethnic groups who engaged in high-risk behaviors reported, on average, only six to nine of the 40 developmental assets. The same survey found that youth who did not engage in high-risk behaviors, had, on average, 23 or 24 assets.

Clearly, there is a need for what the Search Institute calls "asset-building." The Search Institute found that overall, the average youth in grades 6-12 has fewer than 20 of the 40 assets. Most successful programs to address school violence and bullying aim to build protective assets among children and youth so that they can develop in positive and healthful ways.

Understanding the role protective factors play in school violence does not preclude addressing systemic problems that contribute to school violence, such as poverty, drugs, and crime. Notwithstanding the need to help individual students at risk, addressing the causes of bullying and school violence also requires a consideration of the broader public policy issues present in the home, school, and community.

Strategies for Promoting Resiliency

To prevent your child from being bullied:154

• Instill self-confidence in your child.
• Help your child establish good social skills.
• Teach your child to speak out for himself or herself.
• Teach your child to seek help, if harassed, from you and other caring adults.

To prevent your child from bullying:155

• Present yourself as a model of nonviolent behavior.
• Clearly state that violence is not acceptable.
• Assist your child in finding nonviolent strategies for anger management and conflict resolution.
• Seek help from mental health/school counselors to help stop bullying and aggressive behavior.

Practitioners also can help youth develop resiliency. Some strategies include:156

• Identify the youth's assets.
• Identify the family's assets.
• Role model positive behavior.
• Encourage learning and participation in extracurricular activities.
• Encourage the youth to explore and identify his or her values and beliefs.
• Teach communication skills, problem solving skills, and decision making skills.
• Promote community involvement.
• Help youth to identify goals and find the resources to help achieve these goals.
• Set clear expectations with the youth.
• Encourage the youth to develop a positive sense of self.

Summary

• The presence of risk factors within the individual, family, or community can help predict the likelihood of violence.
• Protective factors at the individual, family, school, and peer group level can help moderate the effects of negative influences.
• Substance abuse, either by the individual or by a family member, is a major risk factor for youth violence.
• Youth who have inner strength and resilience may avoid problems, such as alcohol, other drugs, bullying, and school violence.

MODULE 4: Screening and Assessment

Mental Health Counselors

"Having a child who is bullied means seeing your child become an outcast, frozen out, and completely isolated... 'I wouldn't wish the grief and helplessness I feel on any parents, but I wish you and your children could actually feel just for a short time what my daughter and our family have had to live with for the last 6 months or so. Then perhaps you would understand."-Mother of a victim of bullying.157

The mental health field is filled with varying and often overlapping professions. These include mental health counseling, psychology, social work, marriage and family counseling, professional counseling, psychiatry, and school counseling.158 Many, if not all, of these professions work with children, either in private practice, community-based clinics, or schools. All mental health professionals benefit from an understanding of the complexity of bullying and school-based violence. The knowledge is bound to enhance the quality of clinical work with children.

School-based mental health professionals need to work within the framework of the larger school system, paying attention to family and community concerns at the same time. This framework includes a recognition and respect for the increasingly diverse populations within our schools, including many students who may be using English as a second language.

It is important for school professionals to remember that formal interviews with a student about psychosocial/mental health concerns require the signed informed consent from a parent or legal guardian. If possible, students also should provide informed consent.

Cultural Competencies

There are certain cultural competencies that counselors should have in the fight to combat violence and bullying in the schools. These include:159

• Becoming aware of and changing any of their own "dominator" attitudes toward racial, cultural, and religious differences. This refers to beliefs about a person being better than another or more deserving than another based on his or her race, culture, or religion.
• Modeling how to live using partnership values.
• Teaching students about the role fear and lack of understanding of cultural, racial, and religious differences play in bullying incidents.
• Conducting in-service trainings with teachers and other school staff about the causes and effects of bullying and how to intervene, including those situations that involve racial or cultural overtones.
• Helping to create a positive school climate that involves everyone and designing interventions that ensure that no one is marginalized for any reason.
• Structuring small counseling and cultural awareness groups for students to explore the stereotypes and cultural ignorance to discover what they have in common.
• Becoming part of the proactive process to prevent bullying, such as helping to establish antibullying policies.
• Reaching out to those students who appear marginalized, stigmatized, or victimized, and those who are bullies.

Assessment/Screening

Nearly every student encounters distractions in the home or in the peer group that can make learning difficult. Some students, however, face more serious barriers on a daily basis that may prevent them from learning, interacting with peers, and growing emotionally. Being a victim of bullying falls under this category.

School staff and mental health professionals are confronted with children daily who are doing poorly in school as a result of emotional and/or psychosocial problems. To provide an environment in which students can learn and succeed, school professionals need effective tools to assess the nature of the problems and resources for change.160 This module discusses assessment and screening of general behavioral and/or emotional problems, as well as those directly related to bullying behavior.

Professionals should consider a number of clinical issues with children and adolescents before addressing and diagnosing children.

Definitions

Assessment is a broad-based concept that includes diagnosis, screening, and diagnostic testing. In practice, the overall aim of assessment is to collect information about the client and make judgments as an aid to decision making.

The judgments may refer to what happened in the past (what caused the problem), the present (how severe is the problem), or the future (how the problem may improve with a certain intervention). There is some controversy in the field regarding the approaches used in assessment because even when objective data are used, decisions often are made subjectively.161 However, assessment still remains an important step in beginning to identify a student's problem.

Because young children do not always fall neatly into specific mental health categories, mental health professionals need specialized skills and training to do the assessment. The National Association of School Psychologists (NASP) promotes early childhood assessment practices that are:

• Developmentally appropriate, ecological, comprehensive, skills based, and family focused.
• Conducted by a multidisciplinary team.
• Linked to intervention strategies designed for young children, rather than to categorical classification.
• Based on comprehensive, educational and/or behavioral concerns, rather than isolated deficits identified by individual assessment.
• Nondiscriminatory in terms of gender, ethnicity, native language, family composition, and/or socioeconomic status.
• Technically adequate and validated for the purpose(s) for which they are used, including the provision of norms for minority children and children with physical disabilities.162

Functions of Assessment

The major purposes of assessment can be grouped into four functional categories. These include:163

• Identification. Data are used to help find and label the focus of interest. This focus may be a child's problem or behavior, as well as a particular strength.
• Selection. Data are used to help make decisions about general changes in status. These changes usually revolve around decisions about the general nature and form of intervention needed (e.g., educational, psychological, or medically necessary treatments).
• Planning for specific change. Data are used to determine immediate and short-term objectives and procedures for accomplishing long-term goals. Examples are specific plans or prescriptions for a given day's intervention.
• Evaluation of intervention. Data are used to decide whether the intervention was effective based on positive and negative outcomes.

Functional Behavioral Assessment

Almost all professionals in the field agree on one thing: No one knows exactly what causes problem behavior. Schools have frequently reacted to bad behavior by suspending problem students. However, if the underlying causes are not addressed, the behavior will repeat itself and possibly get worse after students are suspended.

Functional behavioral assessment is an approach that diagnoses the causes of problem behavior (such as bullying) and identifies likely interventions. Functional behavioral assessment looks beyond the behavior itself and focuses on the underlying biological, social, affective, and environmental factors that initiate, sustain, or end the behavior.164 Research has shown that focusing on "why" the student behaves badly, or the underlying motivation, is more effective than focusing on the behavior alone.

Did You Know?
Research has shown that focusing on "why" the student behaves badly, or the underlying motivation, is more effective than focusing on the behavior alone.

Behavioral Problem

Before a functional behavioral assessment can be effectively implemented, it is necessary to pinpoint the behavior causing discipline problems. Many factors play a role in a student's inability to behave appropriately or to learn. These include:165

• Deficiencies in basic living and opportunities for development:
1. Lack of food in the home
2. Inadequate clothing-substandard housing (also being homeless)
3. Lack of transportation
4. Family income at or below the poverty line
5. Immigrant-related concerns (e.g., limited English, legal status)
• Observable problems:
1. School adjustment problems
2. Relational difficulties (insensitivity to others, dysfunctional family situation)
3. Substance abuse
4. Abuse by others (physical, sexual)
5. Emotional upset-delinquency
• General stressors and underlying psychological problems associated with them:
1. External stressors (perceived) and deficits in support system
2. Competence deficits (low self-efficacy/self-esteem, skill deficits)
3. Threats to self-determination/autonomy/control
4. Perceiving threats to valued relationships
5. Psychopathology
• Crises and emergencies:
1. Personal/familial (such as domestic violence)
2. Subgroup (such as the death of a classmate)
3. School-wide (such as a shooting on campus)
• Difficult transitions:
1. Associated with stages of schooling (entering or leaving middle school)
2. Associated with stages of life (puberty)
3. Associated with changes in life circumstances (moving, death in the family)

Behavioral Causes

Because problem behavior stems from a variety of causes, it is best to examine the behavior from as many different perspectives as possible. It is best for the student when schools have teams of teachers, mental health professionals, and school nurses to examine problems. This allows the entire team to reflect on what purposes are being served when the student engages in the bullying behavior.
Questions that can help the team decide on appropriate intervention include:166

• Is the problem behavior linked to a skill deficit? Does the student understand what behavior is expected of him or her? Does the student realize that he or she is engaging in unacceptable behavior, or has that behavior simply become a habit?

• Does the student have the skill (or knowledge), but for some reason not the desire, to change his or her behavior? Sometimes a student can perform a skill or behavior, but does not behave consistently or in all school settings. This is often called a "performance deficit." In some cases, the student's behavior is being rewarded by attention from teachers or peers. In this case, the team may need to ask additional questions when developing an assessment plan. These may include:
1. Is there value to the student acting in this particular way?
2. Is the problem associated with certain social or environmental conditions?
3. What current rules or routines does the student consider irrelevant?

If the problem is both skill- and performance-based, what supports does the student need to help him or her adapt the behavior (e.g., disrupting classroom, not listening) more appropriately? These supports may be school or mental health supports as well as skill-based supports (e.g., anger management, relaxation, communication skills).

Behavioral Plan

Whatever the approach, the behavior plan should be inclusive and proactive. The assessment plan should be linked to a behavior plan. Positive behavioral interventions may include:167

• Replacing problem behavior with appropriate behaviors that serve the same function as the inappropriate ones (e.g., getting attention).
• Increasing the appropriate behaviors.
• Making necessary changes to the environment to encourage acceptable behavior rather than reward inappropriate behavior.
• Providing necessary supports for each child.

Assessment Techniques

There are two main techniques that can be used in an assessment: the indirect assessment and the direct assessment.

Indirect Assessment

This is sometimes referred to as an "informant" assessment. It relies heavily on structured interviews (mostly in the form of a questionnaire) with students, teachers, parents, guardians, or other adults who have direct responsibility for the student.168 The Inventory of Wrongful Activity is another example of a questionnaire. There are many commercially available assessments and questionnaires that can help a school or mental health professional conduct an indirect assessment. Questionnaires also may be given to teachers to conduct a school-wide assessment of problems such as bullying, substance abuse, and violence. One example is Handling Bullying: A Staff Questionnaire.

The National School Safety Center has developed a short checklist of characteristics of youth who may be at risk for causing school violence. These characteristics serve to alert school administrators, teachers, and other support staff of the needs of students, especially those with emotional or behavioral issues. Some characteristics identified in the checklist include such things as: a history of tantrums and uncontrollable angry outbursts, habitually makes violent threats when angry, has brought a weapon to school, and has a background of drug abuse.

Direct Assessment

Direct assessment involves observing and recording situational factors surrounding a problem behavior (e.g., antecedent and consequent events). The observer, usually an evaluator, examines the student in the setting where the problem behavior is most likely to occur. The evaluator records this data using an Antecedent-Behavior-Consequence (ABC) approach169 and creates a matrix or scatter diagram to identify patterns of relationship among variables. Direct assessment requires observation over a longer period.

Understanding the Nature and Scope of Problems

What specific areas and topics should be addressed in an assessment? The answer depends on the current status of various aspects of a student's daily life. One approach to the interview has been developed by Dr. Henry Berman of the University of California, Los Angeles (UCLA) Department of Psychology. It is known as HEADS (Home, Education, Activities, Drugs, Sexuality).170

HEADS provides a way to start the interview or assessment; it is not a diagnostic tool. It gives a mental health professional a place to start in an interview. Problem areas discovered can be explored in more detail. The interview examines questions such as:

Home/Health

Place of residence:

• Where does the student live and with whom?
• Physical conditions at the home?
• Family status, relationships, and problems (separation, loss, conflict, abuse, lack of supervision, victimization)?

Physical health:

• Developmental problems?
• Somatic complaints?
• Accident proneness?
• Indications of physical or sexual abuse?
• Indications of an eating disorder?
• Recent physical injury/trauma?

Emotional health:

• Anxieties? Fears? Anger? Frustration?
• Frequent and extreme mood swings?
• Self-image (degree of perceived sense of competence, self-worth, control over daily events, gender concern, self-acceptance)?
• Isolation or recent loss?
• Hopes and expectations for the future?
• If unhappy, is he/she depressed?
• If depressed, is he/she suicidal?

Education

School functioning:

• Grade, special placement?
• Learning (level of skills)?
• Performance (daily effort and functioning, grades)?
• Motivation (interests, attendance)?

Relationships at school:

• Behavior (cooperation and responsiveness to demands and limits)?
• Special relationships with any school staff?
• Plans for future education?

Activities

Types of interests:

• How does the student spend time?
• Interest or involvement in music?
• Art?
• Sports?
• Religion?
• Culture?
• Gang membership?

Responsibilities:

• Caring for siblings?
• Chores?
• Job?

Relationships with peers:

• Any close friends?
• Separation/loss?
• Conflict?
• Abuse? Neglect?
• Victimization?
• Alienation?

Relationships with other adults:

• Positive role models?
• Supportive community?
• Supportive home?

The following categories also should be included for students in upper middle school and high school:

Drugs

• Substance use or abuse?

Sexuality

• Active sexually?
• Considering becoming active sexually?
• Is, has been, or wants to be pregnant?
• Problems with identity?

Other Indicators

The mental health professional interviewing the student and/or his or her family also should be alert to indicators of psychological and mental health problems of the student, including:171

• Appearance: Dress, grooming, or unusual physical characteristics.
• Behavior: Activity level, mannerisms, eye contact, manner of relating to therapist/parent, motor behavior, aggression, or impulsivity.
• Expressive Speech: Fluency, pressure, impediment, and volume.
• Thought Content: Fears, worries, preoccupations, obsessions, or delusions.
• Cognition: Orientation, vocabulary, abstraction, and intelligence.

Mood/Affect: Depression, agitation, anxiety, hostility, or irritability.

•  
• Suicidality/Homicidality: Thoughts, behavior, stated intent, or risks to self and others.
• Attitude/Insight/Strengths: Adaptive capacity, strengths and assets, cooperation, insight, judgment, and motivation for treatment.

Other general questions include: What is going well? What is going not so well? How pervasive and serious are the problems? What seems to be the causes of the problems? What could be done to make things better?

The student and family should always be asked for input in developing strategies for problem solving. By involving the student, the professional helps him or her to identify the problem and begin to process the underlying factors influencing the problem. It also allows the mental health professional to assess the student and family commitment to change.172

Talking With Kids

According to the Center for Mental Health in Schools at the UCLA Department of Psychology, there are specific communication skills that will help promote an effective and open dialogue with kids. In general, effective communication involves being able to talk with, not at, others. An active listener avoids prying or judging. Rather, he or she understands when it is appropriate to share information and relate one's own experiences. Some suggestions include:173

• Creating the context for dialogue:
1. Create a private space and a climate where the youngster can feel it is safe to talk.
2. Clarify the value of keeping things confidential.
3. Explore dialogues when the time or condition is right -- do not push if it isn't.
4. Utilize methods other than just conversations, such as working together on a project while talking.
• Establishing credibility as a listener:
1. Respond with empathy, warmth, and understanding (express appropriate reassurance and praise, minimize criticism and confrontation).
2. Show genuine regard and respect (the ability to transmit real interest and acceptance of the other's feelings).
3. Use active and undistracted listening.
4. Validate and affirm a student's observation whenever appropriate.
5. Keep in mind that you want the student to feel more competent as a result of the interchange.
• Facilitating talk:

An active listener avoids prying or judging.

1. Avoid interrupting.
2. Start slowly, avoid asking questions, and minimize pressure to talk.
3. Encourage the child to take the lead.
4. Humor can open the dialogue -- sarcasm has the opposite effect.
5. Give the child your undivided attention. Show that what the child is saying is important, which helps develop positive attitudes and skills for oral communication.
6. Ask open-ended questions, not yes or no questions.
7. Include another child or small group if a child is reluctant to talk alone.
8. Help a child find the words to describe feelings by sharing your own observations about his or her behavior (i.e., "It looks like something made you angry" or "You seem sad today").
9. Be sure to make positive interactions outweigh the negative interactions when a child has an emotional, behavioral, or learning problem.
10. Respect the need for short periods of silence -- the silence is part of the process and allows a child to think about the issue without the pressure to talk.

Referring Students to a Mental Health Professional

The following guidelines can be used when working with students who have repeatedly been victimized by bullying, are victims of domestic violence, or have been subject to an incident of school violence. In making a referral, teachers need to stress that it is not a sign of parents' failure if they are not able to help the child themselves. It also is important to realize that early action will help the child resume his or her normal school activities faster.

A child's ability to deal with the stress may depend on the form of victimization or the nature of the crisis. A child who is abused at home will likely suffer additional trauma if bullied at school. That child may have insufficient coping skills to handle the stress both at home and at school.174

Preschool and Elementary School
Consider referring the student/family for professional help if the child:

• Seems excessively withdrawn and depressed
• Does not respond to special attention and attempts to draw him/her out
• Begins to display regressive behaviors (thumb sucking, soiling clothes) for extended periods of time
• Exhibits extreme signs of anxiety, such as excessive clinging, irritability, eating or sleeping problems, for more than 1 month

Middle and High School
Consider referral to a mental health professional if the student:

• Is consistently unfocused and disoriented
• Is severely depressed or despondent or shows agitation, restlessness, or pacing
• Shows signs of self-mutilation
• Seems unable to take care of his or her appearance (bathing, changing clothes, eating, etc.)
• Repeats ritualistic acts
• Uses drugs or alcohol
• Is unable to make simple decisions or carry out everyday functions
• Shows excessive preoccupation with one idea or thought -- especially one that is violent to self or others

Tip for Professionals
In making a referral, teachers need to stress that it is not a sign of parents' failure if they are not able to help the child themselves.

Warning Signs of Bullying/Victimization

Children may exhibit warning signs of being a victim of bullying. A child may be a victim of bullying if he or she:175

• Returns from school with torn, missing, or damaged clothing, books, or belongings
• Has unexplained cuts, bruises, and/or scratches
• Has few, if any, friends
• Appears afraid to go to school
• Has lost interest in school work
• Complains of stomachaches or headaches
• Has trouble sleeping and/or has frequent nightmares
• Appears sad, depressed, or moody
• Appears anxious and/or has low self-esteem
• Is quiet, sensitive, or passive

If any of the above characteristics are present, a teacher, school personnel, or parent should follow up with the student first to explore what may be going on, then contact the appropriate mental health professional. The problems may or may not be related to bullying.

Bullying Characteristics

In the specific context of bullying, it is important for a teacher to differentiate between bullying behavior and normal peer conflict, particularly when other behavioral, emotional, or mental health issues may be present.

There are three defining characteristics of bullying:176,177

1. Intent to harm. The bully finds pleasure in taunting or trying to dominate the victim and continues even after the victim is in distress.
2. Intensity and duration. The bullying continues over a long period of time, and the effect is damaging to the victim's self-esteem.
3. Power of the bully. The bully uses age, strength, or size to overpower the target.

Other defining aspects of bullying have to do with the effects on the victim:

1. Vulnerability of the victim or target. The target is sensitive to teasing and cannot adequately defend him or herself. Physical or psychological qualities also may play a role in being bullied.
2. Lack of support. The target feels isolated and vulnerable. Often, the target does not report the incident due to fear of retaliation.
3. Long-term consequences. The damage to the victim's self-esteem is often long lasting and may lead the student to withdraw from school and peers or makes them more aggressive.

Peer Conflict

In contrast, a normal peer conflict will not contain any of those elements found in a bullying-target relationship. Peer conflicts involve the following five factors:178

1. Freedom of expression. Peers do not insist on getting their own way.
2. Willingness to communicate. Peers give reasons when they disagree.
3. The relationship is valued. Peers apologize or try to find win-win situations.
4. Negotiation is an option. Peers will bargain and negotiate to get their needs met.
5. Disengagement is an option. Peers can change the topic or walk away.

Depression

It is increasingly important for all school personnel and administrators to be aware of possible depression in children who are targets of bullying. Olweus found in his research that being bullied in middle school is predictive of low self-esteem 10 years later. He also found that by age 23, children who were bullied in middle school were more depressed and had lower self-esteem than their peers who had not been bullied.179 In the general population, roughly 2.5 percent of children and up to 8.3 percent of adolescents suffer from depression.180

Research is showing that the onset of depression is occurring earlier than in past decades. Not only is depression occurring earlier, it seems to persist and recur through adolescence and into adulthood.181 Awareness of depression is critical when working with elementary and middle school children because children's behavior and the factors that affect their behavior will determine their success later in life. Depression in children may have a hereditary link, but the school environment plays a big role in shaping a child's mental health as well. For example:

• Students receive an average of 213 verbal put-downs per week, or 30 per day.182
• Ten percent of students who drop out of school do so because of repeated bullying.183
• Ninety percent of all students felt that bullying caused social, emotional, or academic problems for those students who were bullied.184

The diagnostic criteria and key defining features of major depressive disorder in children and adolescents are the same as for adults. However, depression in children is often harder to recognize and diagnose, and symptoms differ depending on developmental stages.185,186 Children have a harder time verbally expressing how they are feeling and describing their moods. Unless parents are aware of some of the signs of depression in children, they are often unable to see a child's behavior for what it is.

Tip for Families
Unless parents are aware of some of the signs of depression in children, they are often unable to see a child's behavior for what it is.

Signs of Depression in Children and Adolescents

Mood disorders, such as depression or dysthymia, substantially increase the risk of suicide. The incidence of suicide attempts reaches a peak during the midadolescent years. More than 90 percent of children and adolescents who commit suicide have a mental disorder.187 Depression often is present in these children. Research has shown that at any one time, between 10 and 15 percent of the child and adolescent population have some symptoms of depression.188
Between 10 and 15 percent of the child and adolescent population have some symptoms of depression.
Symptoms of depression in children and adolescents may include:189

• Frequent vague, nonspecific physical complaints such as headaches, muscle aches, stomachaches, or tiredness
• Frequent absences from school or poor performance in school
• Talk of or efforts to run away from home
• Outbursts of shouting, complaining, unexplained irritability, or crying
• Being bored
• Lack of interest in playing with friends
• Alcohol or substance abuse
• Social isolation, poor communication
• Fear of death
• Extreme sensitivity to rejection or failure
• Increased irritability, anger, or hostility
• Reckless behavior
• Difficulty with relationships

Anxiety Disorders

In childhood and adolescence, the presence of anxiety disorders (which includes separation anxiety disorder, generalized, social phobia, obsessive-compulsive disorder) is higher than any other mental disorder. In fact, researchers estimate that 13 percent of children and adolescents in the United States have some anxiety disorder.190 A child who manifests excessive anxiety behavior is likely to worry about all aspects of his or her environment, including:191

• Academic performance
• Sporting activities
• Being on time
• Natural disasters
• Peer relationships
• Appearance

Research has shown that children who are the victims of bullying have a higher rate of anxiety disorders (mostly social anxiety) and loneliness.192,193 In one study, recurrent victimization was a strong predictor of self-reported symptoms of anxiety and depression for girls, but not for boys.194

Children who are anxious often become overly conformist, perfectionist, or unsure of themselves. Their anxiety limits their ability to achieve self-fulfillment; they seek approval and reassurance from those around them. With social phobia, worries branch out also to include:

• Fear of being embarrassed in any social setting
• Fear of speaking in front of a class or in public
• Fear of eating, drinking, or writing in public

Physical manifestations of social phobia include:195

• Heart palpitations
• Tremors
• Sweating
• Diarrhea
• Blushing
• Muscle tension
• Panic attack (in severe cases)

Anxiety disorders tend to be long lasting, often remaining through adulthood, although they may become less severe. Often, the child adapts by hiding the anxiety better. Life events may either reassure the child or exacerbate the anxiety and disorder.

Did You Know?
Thirteen percent of children and adolescents in the United States have some anxiety disorder.

Conduct Disorder in Children and Adolescents

Conduct disorder is a component of the disruptive disorders that also includes oppositional defiant disorder (ODD) and attention-deficit hyperactivity disorder (ADHD).196 These classifications seem to be a collection of behaviors rather than a coherent pattern of mental dysfunction.197

Children with conduct disorder rarely respond to punishment or any reward system for good behavior.           
General characteristic behaviors of the disruptive disorders include:198,199

• Aggressively fighting
• Bullying
• Intimidation
• Physically assaulting another
• Sexually coercing another
• Being cruel to people and/or animals
• Easily losing temper
• Deliberately refusing to comply with requests
• Blaming others for their own mistakes
• Continually being angry and resentful
• Vandalism, setting fires, and smashing windows (in high school)
• Theft, truancy, and early substance use (late middle school and high school)
• Precocious sexual activity (i.e., in late middle school and high school)

In preschool boys, high reactivity, difficulty being soothed, and high motor activity may indicate risk for ODD. Often, ODD is a precursor of conduct disorder in the middle and high school years.

Depending on how it is defined, as many as 1 to 4 percent of all 9- to 17-year-olds have a conduct disorder. Children with an early onset of the disorder (before age 10) are usually male.200 Conduct disorder is hard to diagnose and hard to treat. Generally, diagnosis is contingent on the presence of three or more of the above behaviors over a year's period, with at least one behavior within 6 months of the evaluation.201

Bullying others is common with children with conduct disorder. However, conduct disorder is not based on one incident of misconduct, but rather, behavior that permeates all aspects of a child's life, both in school and at home. Unfortunately, children with conduct disorder rarely respond to punishment or any reward system for good behavior.202

Children with conduct disorders tend to come from families with excessive amounts of dysfunction and chaos. This often includes lack of supervision, frequent changes in caregivers, poverty, neglect, and alcoholism.

Alcohol Use Disorders (Mainly in Adolescents)

Most assessment and diagnostic criteria for alcohol use disorders (AUD) have been conducted on adults, as defined by the The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). However, as more research is conducted on adolescents, there have been screening tools developed to help compensate for certain limitations. The DSM-IV describes two primary AUDs: alcohol abuse and alcohol dependence. Adolescents tend to have alcohol abuse because they haven't had the time to develop a long-term dependence.
Alcohol abuse is a type of drinking that is accompanied by one or more of the following behaviors within a 12-month period:203

• Failure to fulfill major work, school, or home responsibilities.
• Drinking in situations that are physically dangerous, such as while driving a car or operating machinery.
• Recurring alcohol-related legal problems, such as being arrested while under the influence of alcohol or physically hurting someone while drunk.
• Continuing to drink despite ongoing relationship problems caused or worsened by the effects of alcohol.

Alcohol dependence can include all of the signs of alcohol abuse, but is more serious. The person may be unable to stop or control his or her drinking, even after trying. He or she may exhibit tolerance of alcohol or show withdrawal symptoms with the absence of alcohol.204 This person is said to be addicted to alcohol.

DSM-IV is used by most professionals who work in addiction to help diagnose anxiety disorders, affective disorders, psychotic disorders, and substance abuse disorders.

Approximately 11 million youth in the United States under the age of 21 drink alcohol.

In the DSM-IV, substance abuse is defined as "a maladaptive pattern of substance use characterized by hazardous or compulsive use or the presence of role impairment or recurrent legal problems, but without evidence of tolerance or withdrawal." Most people who meet the criteria for substance abuse eventually will meet the criteria for dependence if they continue to use (American Psychiatric Association, 1994).

Approximately 11 million youth in the United States under the age of 21 drink alcohol.205 Nearly half of them drink to excess, consuming five or more drinks in a row. This pattern of excessive underage drinking does not stop once the person reaches legal age. The pattern of alcohol abuse often continues into adulthood.

Warning Signs of Alcohol Abuse

Sometimes it is difficult to tell if a teenager or young adult has a drinking problem. Most teenagers and young adults will not walk up to someone they are close to and ask for help.

There are signs that alcohol or other drugs are taking control of someone's life. Some of these signs are easy to see. Others are not. If a child has one or more of the warning signs listed below, he or she may have a problem with alcohol or other drugs:

• Getting drunk or high on a regular basis
• Lying about things (like where or with whom the child hangs out) or about how much alcohol or other drugs he or she is using
• Avoiding his or her parents to get drunk or high
• Giving up activities he or she used to do, such as sports or homework
• Hanging out with friends who drink or use drugs
• Having to drink more to get the same high
• Believing that he or she needs to drink or use other drugs to have fun
• Pressuring others to drink or use drugs
• Drinking and driving
• Taking risks, including sexual risks
• Having frequent hangovers
• Feeling rundown, hopeless, depressed, or suicidal
• Getting in trouble with the law
• Being suspended from school for an alcohol- or drug-related incident

Summary

• Assessments aid school personnel, mental health professionals, and parents in identifying the needs of a student and determining a course for treatment or intervention.
• All school personnel need to know the appropriate conditions for referring a student to a mental health professional, either within a school or in the community.
• There are many serious emotional and behavioral concerns that mental health counselors face when working with elementary and middle school children.
• Numerous diagnostic interviews and questionnaires exist for professionals to use when screening/assessing a child for emotional, behavioral, or psychiatric symptoms.

MODULE 5: Treatment for Children and Adolescents

Why Do Some Children Become Bullies?

There are several theoretical perspectives that aim to describe why certain kids bully and others are bullied. Not all have received strong empirical support, but are nonetheless found in the research. Some possible explanations include: 206, 207

1. Maternal-Child Relationship. This theory, which examines a child's early relationship with his/her mother, states that children in preschool and early school years who are sheltered from social interactions are ill equipped for normal interactions later. These children do not know how to handle conflicts that arise. When there is a conflict with a peer, these children exhibit inappropriate behavior that makes them different from their peers. They therefore become targets for bullying and victimization. These children are often timid, lack independent conflict resolution skills, and lack age-appropriate social skills.
2. Victim Hypothesis. This theory posits that bullies are attracted to the demeanor of overly anxious children and youth -- that there is something about that particular child that seems to be more vulnerable than his or her peers.
3. Difference Hypothesis. This attributes bullying victimization to external attributes of the child or youth. This could include obesity, vision impairments, braces, poor motor skills, cerebral palsy, disabilities, learning disabilities, sexual orientation, etc.
4. Social Identity Theory. A person's social identity is shaped by the school environment (including peers) and his or her interactions with it. If identification with the school is strong, then the school becomes a positive reference group for the student. For some bullies, evidence shows that the school community may not be so positive. As a student drifts towards a delinquent identity, the school environment becomes a negative reference.
5. Reintegrative Shaming Theory. At some level, many bullies feel shame for their behavior (though they may not consciously recognize it). Feeling shame can act as a barrier to positive identification with a school. Youth learn either adaptive or maladaptive shame management as they age. Youth who can recognize their wrongful behavior, take responsibility, and make amends can let go of the shame. For those students who do not know how to do this, their shame can be turned into anger, therefore pulling them away from their peers and a positive identification with the school. 208

Yet not all children who fit into one of the above categories falls prey to bullying. How a child reacts to the bullying can often determine how long bullying continues. Children with good coping skills, as well as those able to use a sense of humor, are less likely to become continued targets of bullies.

Clinicians can consider the above theoretical perspectives as they examine bullying in the context of the increasing importance of the peer group during late elementary and middle school. Early adolescents, seeking autonomy from their parents, turn to their peers to discuss problems, feelings, fears, and doubts. However, this reliance on peers exists concurrently with the need for status. 209 It is during this time that peer groups become distinct, and issues of acceptance and popularity become highly important.

Social-Interactional or Social-Ecological Perspective

International research supports the view that the peer group and other outside factors influence bullying. This framework is called the social-interactional or social-ecological perspective. This perspective considers bullying behaviors to be the result of complex interaction between a person's internal characteristics (e.g., impulsivity) and the social environment (e.g., peer group behaviors/attitudes, school social system). 210 Bullying is not just the result of two individuals having characteristics that make them prone to becoming a bully or a victim of bullying, but rather is a process that unfolds within the larger social environment. This environment includes influences of peers, teachers, administrators, the playground and classroom environments, and family.

Stress Perspective

When children transition from elementary school to middle school, they often experience stress. Although this area hasn't been extensively studied, there is some evidence that this transitional stress may cause bullying behavior. A child may feel the need to quickly establish his or her status in the new social structure. 211

Education studies have shown that changing from one school to another often leads to an increase in emotional and academic problems that are not present with kids who stay in the same school. Bullying may be the way some kids deal with this new, more stressful environment. 212

Tips for Professionals
Education studies have shown that changing from one school to another often leads to an increase in emotional and academic problems that are not present with kids who stay in the same school.

Social Learning Theory

Researchers who have examined behaviors of kids just entering middle school have found that bullying incidents increase during the first year of the transition.213 Researchers have speculated that if bullying is part of the larger school culture (in middle school), then those kids just entering the school are trying to assimilate.

Learned behavior theory demonstrates that people -- and kids are no exception -- easily learn behaviors from those around them. Clearly, some of the behaviors are not appropriate or healthy. Many kids who have learned bullying behavior have not yet learned how to interact positively in the social structure of the school. Sixth graders who want to fit in, for example, may adopt behaviors such as teasing and bullying, modeling those older kids who have been in the school longer and have more power. 214

In the 1970s, Albert Bandura, a researcher and psychologist, created and pioneered the social learning theory. This approach examined the phenomenon that people (and especially children) will model behavior usually considered outside the norm. Through hundreds of studies with children, Bandura identified three conditions that influence the likelihood of modeling. Children are more likely to imitate a model when:215

• The model is a powerful figure.
• The model is rewarded rather than punished for the behavior.
• The model shares similar characteristics with the child.

In the context of bullying, the bully clearly holds a position of power and often suffers no negative consequences for his or her actions. Reinforcement often comes from a bully's peers who either join in the bullying, gather to watch, or silently condone the behavior by not offering to help the victim or stop the bullying.216

Yet not all children who fit into one of the above categories falls prey to bullying. How a child reacts to the bullying can often determine how long bullying continues. Children with good coping skills, as well as those able to use a sense of humor, are less likely to become continued targets of bullies.

Clinicians can consider the above theoretical perspectives as they examine bullying in the context of the increasing importance of the peer group during late elementary and middle school. Early adolescents, seeking autonomy from their parents, turn to their peers to discuss problems, feelings, fears, and doubts. However, this reliance on peers exists concurrently with the need for status.217 It is during this time that peer groups become distinct, and issues of acceptance and popularity become highly important.

Clinical Interventions With Children

Increasingly, schools are beginning to adopt approaches to school bullying and violence that involve all relevant players in a child's life. Although the most successful bullying prevention approaches involve the entire school 218, sometimes children need individual attention with a mental health professional. Specifically, when working with a child who bullies (or is a bully/victim), the professional can ask specific questions, with the answers sometimes determining the course of intervention. These questions include:219

• Did you plan to (add specific incident: e.g., take the other boy's lunch money) beforehand, or was it a sudden urge?
• Why did you pick on that particular person?
• What were you thinking when you did it? (Example: "I need the money," "I'll look cool.")
• How did you feel when you did it? (Example: excited, thrilled, frightened, powerful)
• How do you think the other boy felt?
• What's happening in your life or in your family that may be upsetting you?

When the professional understands the details of what happened, they can determine how to help the child. Using the example of stealing another boy's money, if the child stole the money because he saw it sitting on a lunch tray and had a sudden urge to grab it, he will need to learn to recognize his impulses and to stop them when they are inappropriate. If he planned to steal the money, pre-selected a victim, and stole because he wanted to look important, he will need to learn positive ways to make friends and gain peer acceptance.220

Mental health professionals use a variety of therapeutic approaches with children depending on the age of the child and the nature of the problem(s). At times, a combination of different psychotherapeutic approaches may be helpful. In some cases, a combination of psychotherapy and medication may be necessary.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a behavioral approach that has been used in treating a variety of anxiety disorders and mood disorders in adults as well as in children and adolescents. CBT has been found to be most effective with mild depression and anxiety disorders such as social phobia. 221 The CBT approach asks a person to examine his or her thought process, which then leads to reflection on emotions and feelings. This approach is based on the theory that thoughts, beliefs, and attitudes determine emotion and behavior.222

CBT involves teaching youth about the thought-emotion-behavior link and working with them to modify their thinking patterns. This will lead to better, more adaptive behavior, especially in stressful situations.223 Many children have not been taught adequate coping skills. They have internalized negative thoughts about their self-worth. Using CBT, the therapist works to identify the underlying thinking that is causing unwanted or painful feelings. The therapist then helps the child replace this distorted thinking with thoughts that enable healthier and more appropriate behavior. 224

CBT is helpful to use when working with children who have been involved in bullying or any other victimization because many suffer from anxiety and/or depression. In practice, the mental health professional can work with the child to teach him or her to recognize the way they talk to themselves before and/or after an incident. Thoughts affect how a child will feel, which then will determine ways a child will act. In a bullying situation, a child who is bullied may be telling him/herself, "I am not good enough to be treated well" or "My feelings are not as important as others are." These thoughts can often lead to lower self-esteem and depression.

If that child can learn to change their self-talk, then they can learn positive ways to address the bullying while raising their self-esteem. Even aside from the context of bullying, research shows that depression is increasing among children, and children are being affected by depression at an earlier age. Almost 20 percent of adolescents may experience at least one episode of depression by the time they reach 18.225 Adolescents in particular may have a multitude of symptoms, including depression, suicidality, impulsivity, and behavior problems.226

Applying Cognitive-Behavioral Techniques in a Classroom

Cognitive-behavioral interventions (CBI) can be effective in helping teachers provide students with the tools necessary to control their behavior. It involves teaching the use of their self-talk to make them aware of how their thoughts affect their resulting feelings and emotions. Researchers consider the internalization of self-statements fundamental in developing self-control, so those children whose self-statements are negative have negative beliefs about themselves. This can contribute to behavior problems, including aggression and victimization.227

By using rewards, modeling, role-plays, and self-evaluation, teachers or other school staff can use the CBI approach with all students or those who have demonstrated higher risk for behavior and emotional problems. The following is an example of this approach: 228

A boy gets teased and wants to push the peer back. This behavior can be mediated by inner speech such as "That makes me mad, but first I need to calm down and think about this."

In this example, as in all cognitive-behavioral interventions, the overt behavior (hitting or pushing) is mediated by cognition ("I'm going to let him have it.") The premise is that if a child can change his or her thoughts (cognition), the child can learn to change his or her behavior. Modeling from the teacher is crucial for students to develop their own techniques for changing thoughts. A teacher may walk a class through the process by sharing comments with the class, such as, "What she said just now makes me really angry, but I won't say anything now. I'll talk to her later." The teacher should be sure to also share the outcome: "I'm glad I didn't say anything. It turned out to be just a misunderstanding." As a result, teachers are helping students think about their thinking.229

In a CBI classroom, students would use the following sequential strategy when approaching a problem: 230

• Stop and think before acting. They are taught to restrain aggressive responses through the use of inner speak.
• Identify the problem. Students are required to distinguish the specific aspects of a situation that may elicit aggressive responses.
• Develop alternative solutions. Each student generates at least two alternative solutions to aggressive behavior. These could include thinking about something else until he or she is able to relax, or moving to another location.
• Evaluate the consequences of possible solutions.
• Select and implement a solution.

Tip for Professionals
Modeling from the teacher is crucial for students to develop their own techniques for changing thoughts.

Multisystemic Therapy

Multisystemic therapy (MST) is a mental health service that focuses on changing how youth function in their environment (e.g., home, school, and community). MST works very well with problem behaviors such as conduct disorder, substance abuse, severe depression, suicidality, and delinquency.231 This is a very intense approach that calls for monetary resources to implement. Although it has not been tested for bullying, it has been found to be effective for serious conduct disorders.

MST is designed to promote positive social behavior while decreasing problematic behavior. The therapist focuses on identifying family strengths to improve parenting skills and support networks. MST is part of larger family therapy techniques that involve the entire family in the therapeutic process, including grandparents, caregivers, and siblings.232

Play Therapy

Play therapy is ideal for younger children and those who are unable to verbalize their feelings and thoughts. Play therapy also can give older children and adolescents the freedom to express themselves in a way other than talking. This approach involves the use of toys, blocks, dolls, puppets, drawings, and games.233 There are many toys appropriate for play therapy, and individual therapists often choose toys based on themes. Most young children under the age of 9 or 10 cannot use words effectively to express their feelings and haven't yet mastered abstract thought. Playing comes naturally for children and allows them to demonstrate their feelings through the manipulation of the available toys.234

The therapist's role is to observe the child and the nature of the child's play. He or she can examine how the child uses materials and identifies themes or patterns to understand the child's problem.235 Children have better receptive language skills than expressive language skills. In other words, they are able to understand ideas and concepts better than they are able to express them. Play therapy not only allows children to express themselves through play, but allows the therapist to verbally express observations and communicate ideas to the child.236

There are different approaches to play therapy. Each approach differs in defining the role of the counselor and the way the counselor interacts with children and their parents. Some therapists adhere to one approach for all of their clients. Many others use an eclectic approach depending on their own personal beliefs and the population they work with.237 Play therapy relationships differ from other modalities. In the Adlerian approach, the counselor's job is to observe the child in the room, understand how the child's environment is brought into play, and articulate that understanding to the child.238

Client-Centered (Nondirective) Play Therapy

In nondirective play therapy, the child directs the play with no interpretive input from the counselor. Influenced by Carl Rogers and Virginia Axline years ago and researched significantly by Garry Landreth, this client-centered approach follows several rules:239

• The therapist must develop a warm, friendly relationship with the child as soon as possible.
• The child is accepted exactly as he or she is.
• The therapist establishes a climate of permissiveness so that the child feels free to express his or her feelings completely.
• The therapist remains alert to the child's feelings and reflects them back to the child to encourage insight into his or her behavior.
• The child, not the therapist, has responsibility for making choices and for change.
• The therapist does not direct the conversation or play in any manner.
• The therapist establishes those limits only as necessary for safety and to make the child aware of his or her responsibility in the relationship.

In general, this approach aims to empower the child to gain self-awareness, decisionmaking skills, and acceptance of self. What the child believes about himself or herself is more important than what the child knows, for it is this self-perception that drives the behaviors and emotions.240

Three distinct categories of toys are used (similar to the Adlerian approach, which uses five categories). These include:241

• Real-life toys
• Acting-out, aggression-release toys
• Toys for creative expression and emotional release

Play Therapy (Counseling) in a School Setting

Play counseling stems from the broader play therapy field, but has been adjusted to reflect school counselor's needs for a short-term intervention that is consistent with the school's education-related goals.242 Play counseling is similar to play therapy in that the use of games, toys, and other creative materials is used to encourage a student to overcome obstacles. This approach is very helpful to children who have a hard time verbalizing frustration and/or anger. Toys allow a child who bullies to act out his or her feelings in a safe environment. Children who are bullied also are given the chance to express their feelings in a way that does not further victimize them. A counselor could use this approach to:243

• Communicate with students
• Help students build a wider range of skills
• Improve peer relationships to prevent bullying, school violence, and other serious problems
• Improve students' adjustment to school and the classroom
• Address the needs of at-risk students
• Try to remove the emotional and behavioral obstacles to learning

Play counseling is especially appropriate for students younger than 12, when a child becomes more able to use cognitive and abstract reasoning.244, 245 Younger children tend to process information and develop their skills through the use of play. Older students can still appreciate play counseling by using board games, art, sand trays, and creative ways to tell their life stories (i.e., bibliotherapy -- therapy by means of having a child write their life story).

Using play counseling in a school setting usually requires getting parental approval or at least notifying parents as to the approach being used. The interventions are usually short term, lasting between 6 to 8 weeks at 30-45 minutes each. All sessions remain confidential, just as with any other therapy session.246 Play counseling offers an alternative to those students who may resist formal therapy, or those who are withdrawn, isolated, oppositional, or defensive. Research has shown that children learn best in hands-on, activity-based situations.247

Schools that actively encourage the use of play counseling by their school counselors usually do so with a team approach so that the teachers and parents also follow a child's progress and learn ways to encourage new skills and behaviors.

Seeking Help for a Child

Parents usually are the first to recognize possible mental health problems in their child, but the decision to seek professional help is not an easy one. If possible, the parent should try to talk to the child openly and gently about his or her feelings and concerns. Parents also may want to talk to the child's teachers, doctor, members of the clergy, or any other adults who know the child well.248

Did you know?
Behavioral and emotional signs that something may be wrong sometimes differ depending on the age of the child. The following is a list of possible signs (not exhaustive) that may help a parent determine if professional help is needed:249

Younger Children

• Marked fall in school performance
• Poor grades in school despite trying very hard
• Excessive worry or anxiety (e.g., regular refusal to go to school, go to sleep, or take part in regular activities)
• Hyperactivity, fidgeting, constant movement beyond normal activity
• Persistent nightmares
• Persistent disobedience/aggression (longer than 6 months)
• Frequent temper tantrums

Pre-Adolescents and Adolescents

• Marked change in school performance
• Inability to cope with problems and daily activities
• Marked changes in eating and sleeping habits
• Many physical complaints
• Sexual acting out
• Depression shown by sustained, prolonged negative mood and attitude
• Abuse of alcohol and/or drugs
• Eating issues (fear of becoming fat, or restricting eating)
• Threats of self-harm or harm to others, self-injury, or self-destructive behaviors
• Aggressive or nonaggressive violation of rights of others

Summary

• There are several theoretical approaches that can describe the nature of bullying and victimization.
• Children come to school with various social, emotional, and/or behavioral issues.
• Mental health professionals utilize a variety of therapeutic modalities when working with children and families, in school settings, and in the community.
• Parents play an important role in determining whether a child needs special mental health services.

MODULE 6: Prevention and Intervention

Prevention Is Everybody's Business

One of the most damaging aspects of bullying in schools is that it poisons the atmosphere of learning for everyone. All students need to feel safe and secure in order to learn, and learning entails much more than the academics. Middle school students, in particular, are focused at that age on peer acceptance and vulnerable to messages about what is acceptable behavior for "fitting in." Prevention efforts must recognize the role of the peer group, as well as the relationship between the person who bullies and the person who is bullied.

Promoting this environment of health and safety is a community-wide responsibility. Lack of adult supervision, acceptance of bullying behavior, and inconsistent enforcement of rules provide fertile conditions for the propagation of bullying activities. Many children who are bullied can't always handle the problem on their own. Adults must play a significant role.

Studies have shown that the most effective programs aren't those that rely on negative, punitive measures. Effective prevention programs promote positive and just practices, while also setting firm limits to unacceptable behavior. Some schools and communities have created exemplary programs to reduce bullying

and its detrimental effects on children. Replicating these programs and creating new responses can reduce the "fear factor" in the nation's schools.
"It is not malicious acts that will do us in, but the appalling silence and indifference of good people." -Dr. Martin Luther King, Jr.

Comprehensive Prevention Strategies

Research and experience suggest comprehensive efforts that involve administrators, teachers and other school staff, students, and parents who are concerned about school violence and bullying are more likely to be successful than those based solely in the classroom.250, 251 Comprehensive intervention encompasses clearly worded policies and stated codes of behaviors with consistent and supportive follow-through. Many resources needed come from the existing school community, including all school staff (including hall monitors, cafeteria workers, janitors), administrators, and parents.

It takes time to change attitudes and behaviors. But a community that perseveres can be successful.252

More than 10 years ago, Harvard University convened international experts on school violence and bullying to study prevention strategies. Sponsored by the National School Safety Center and the Federal Office of Juvenile Justice, Delinquency and Prevention, the practicum included prominent researchers, mental health professionals, and school and law enforcement personnel. This effort resulted in the development of a list of services, strategies, and suggested training classes for addressing bullying. It also led to the recommendation that schools provide:253

• Rules against bullying that are publicized, posted school-wide, and accompanied by consistent sanctions
• Student and adult mentors who assist victims to build self-esteem and to foster mutual understanding of and appreciation for differences in others
• A "buddy system" that pairs students with a particular friend or an older student who is aware of the buddy's class schedule and is available if help is needed
• An on-campus parents' center to recruit parents to participate in the educational process, volunteer, and assist in school projects and activities
• Parenting and anger management classes for adults
• Behavior contracts signed by students and parents, and written behavior codes for students, teachers, and staff members
• Discipline policies that emphasize positive behaviors rather than punishments for wrong behaviors
• Training for all adult supervisors in cafeterias, playgrounds, or other "hot spots" where bullying is known to occur
• Classroom and school-wide activities designed to build self-esteem (for those who are bullied) by spotlighting special talents, hobbies, interests, and abilities of all students

Did You Know?
Comprehensive efforts that involve administrators, teachers and other school staff, students, and parents who are concerned about school violence and bullying are more likely to be successful than those based solely in the classroom.

What Can Schools/Administrators Do?

All staff at a school should be aware of what steps are necessary to help prevent and stop bullying. As a first step, school staff should be aware of the purposes bullying may serve for the children who bully. These include:254

• Attention, recognition, prestige, or acceptance in a peer group. (Creating a climate that does not tolerate bullying removes the social power of bullies.)
• Access to an activity or item. Some students use bullying as an excuse to get what they want (e.g., extortion, intimidation).
• A lack of understanding of social, cultural, psychological, or physical differences.

Planning for Safe Schools

A safe school is the result of careful planning and research, and a thorough understanding of the school's environment and community is critical to its success. Many schools have found it helpful to begin by creating an antibullying planning worksheet to ensure all avenues have been considered. This multisystem approach sends a clear and consistent message to bullies and victims alike that bullies are not in charge and all children deserve to be safe.255

The Olweus Bullying Prevention Program created by Dan Olweus has been identified as one of the Substance Abuse and Mental Health Services Administration's Model Programs (http://modelprograms.samhsa.gov/) as well as one of 10 model violence prevention programs by the Center for the Study and Prevention of Violence (www.cspv.org). The core elements for school-level interventions in this program include:256, 257

• Assessing school needs and goals by using an anonymous questionnaire to poll the student body on the nature and extent of bullying problems
• Forming a bullying prevention coordinating committee
• Providing in-service days for teachers to review findings of the questionnaire, discuss the problem, and plan the prevention efforts
• Holding school-wide events to launch the program and incorporating antibullying themes and activities into the curriculum
• Increasing supervision in areas that are known "hotspots" for bullying, including the cafeteria and playground
• Developing school-wide rules and consistent consequences for violations against bullying
• Developing a system to reinforce positive behaviors
• Holding staff discussion groups to enhance understanding and motivation
• Involving parents in school activities and ensuring parents and schools are aware of available resources in the community

The Olweus program also involves class-level interventions (e.g., class meetings about bullying) and individual-level interventions.

If adults do not provide the intervention students need, then students will take matters into their own hands.258
The Maine Project Against Bullying has designed a tool called the Grade 3 Survey. This survey was given at 165 schools in Maine to establish some baseline data on bullying in that state. Counselors can adapt this survey to help assess the bullying problem at their particular school, or it can be used at multiple schools in a given county to provide a broader picture of the problem.

The purpose of the survey is to help school teams make a brief assessment about:

• The nature and extent of bullying
• How children have reacted to bullying and what the consequences have been (in terms of their feelings of safety and well-being)
• Whether they have informed others, and if so, what were the outcomes?
• Students' perceptions of their own aggressive behaviors at school
• Gender differences in all of the above

Choosing the correct bullying prevention program for a particular school can be confusing and overwhelming. Olweus's Bullying Prevention Program has been incorporated into many school systems nationwide. However, other programs may better fit the needs of a particular school. Schools can start the process of choosing a bullying prevention program by asking the right questions.

Antibullying Policies

When trying to reduce bullying in a school, the entire school administration should agree on and develop its own policy and procedures for dealing with discipline, which is followed by all school staff. In addition to implementing consistent discipline, all adults should model respectful and appropriate behavior. Procedures may include: 259, 260

• Intervene immediately. Stop the bullying behavior as soon as you see it or hear about it.
• Talk to the bully and the victim separately. If more than one child is involved, talk to each of them individually, in quick succession.
• If a peer mediation program is already in place, be careful with referrals where bullying is involved because of the power imbalance between bully and victim. The target may feel additional intimidation and/or may not have the communication or assertiveness skills necessary for successful mediation.
• Consult with other school personnel to understand the wider implication of the new policies within the larger school community.
• Expect the bully to minimize or deny his or her actions. Inform all bullies of the school policy and rules, class codes, the school sanctions, and the expectations for behavior.
• Reassure the victim. He or she needs to know that measures will be taken to address the bullying behavior.
• Inform the parents immediately about the incident.
• Follow up until the situation is resolved.

For students who are the victims of bullying:261

• Involve them in groups and situations to make friends and develop social skills (e.g., peer support group, new student orientation, or cooperative learning group).
• Encourage them to participate in assertiveness training.

For students who bully:262

• Reeducate them as to their behavior, its impact, and resulting consequences.
• Determine what situations require sanctions, such as removing privileges, detention, etc. Some schools mandate that aggressive children must complete social skills modules designed to reduce aggression and build empathy during detention.

For students who are witnesses:263

• Educate witnesses on the difference between tattling and reporting.
• Encourage witnesses to support victims rather than bullies.

What About Teachers?

Teachers are the single most effective deterrent to bullying. Schools that have actively reduced bullying have teachers that are committed, can recognize bullying, and know how to safeguard their students against it.264 Teachers need to use their influence to get curricula to implement that promotes kindness, communication, cooperation, and empathy.265
Teachers can also:

• Discuss and post rules as to how to behave. Increase student ownership of rules by soliciting input from students.
• Implement immediate consequences for aggressive behavior and immediate rewards for inclusive behavior. Possible sanctions include having the bully:266
1. Discuss the incident with the teacher, principal, and/or parents.
2. Pay for damaged belongings.
3. Spend time in the office or another classroom.
4. Forfeit recess or other privileges.
• Conduct class meetings to discuss bullying and what to do about it.
• Model respect for individual differences and develop empathy.
• Explain that "reporting" and "tattling" are not the same.
• Acknowledge improved behavior by those who bully.
• Institute a "bully box" for students to report bullying instances confidentially.
• Teach bystanders to make friends with the victims of bullying.
• Keep a log of bullying incidents to identify patterns in bullying behavior.267
• Do not expect students to resolve things themselves. Mediation between victim and bully has been shown to be ineffective. 268, 269, 270

Sample Basic Classroom Rules of Behavior
(For any class teaching bully-free messages)

• Bring books, pencil, and paper.
• Be in your seat when tardy bell rings.
• Follow directions.
• Complete assignments.
• Show courtesy and respect for others.
• Help others who are being bullied by getting adult help and/or speaking out. (This can be school-wide.)
• Try to include ALL students in activities.

What Can Social Workers and School Counselors Do?

Enlisting the help of school counselors and social workers in the school setting (or social workers who work with children in a community-based setting) can make a big difference in preventing and curbing bullying. The science of social work uses an ecological framework toward prevention and intervention that views clients as intricate parts of larger systems.

According to this framework, bullying represents the culmination of an array of variables associated with home, school, community, and even the media and entertainment.271
The social work perspective encourages the cooperation of many systems in the child's universe, including his or her family and the larger school community. Specifically, school social workers can:272

• Assist children who are targets of bullying to seek support from teachers, parents, and other family members.
• Assist parents and other family members in providing support to the child.
• Assist students in recognizing and identifying qualities and behaviors that may be related to the bullying incident and help them make changes when appropriate.
• Assist children (bullies and victims) in identifying their strengths and help them channel their strength toward decreasing the bullying.
• Be familiar with the school's and state's (and/or county's or district's) policies on bullying behavior.
• Help develop and enforce a school-wide policy statement if one does not exist.

Emotional Health Education

In addition, social workers can work with the teachers to include emotional health education in the curriculum, which can help prevent students who are bullied from becoming bullies themselves, and can help all students develop self-acceptance, respect, and tolerance for others.273
This process allows students to talk about painful feelings rather than covering them up or distorting them. Components of this emotional health approach include:274

• Teaching students to identify, rather than ignore, negative feelings about the bullying and other circumstances.
• Helping students recognize that, unfortunately, exclusion, rejection, and humiliation are part of life, but people can learn the emotional skills to overcome difficult situations.
• Encouraging teachers and other school staff to talk to the students openly about loss and rejection.
• Training teachers and other school staff to become positive and emotionally healthy role models.

What Can Parents Do?

Parents are an essential element in the school's effort to create a safe and orderly learning environment.
Parents can do the following:275, 276, 277

• Set standards of behavior, limits, and clear expectations for their child, in and out of school.
• Provide a secure attachment for their child.
• Be as positive as possible with the child. The goal for parents is to provide five positive comments for every negative one directed at a child.278
• Monitor their own behavior and aggression. Demonstrate behavior at home between adults that is not bullying or aggressive. Children copy parents' behaviors--good or bad.279
• Provide appropriate models of conflict resolution.
• Model empathetic behavior.
• Offer suggestions/advice for dealing with problematic peers.
• Encourage children who are bystanders to bullying to act appropriately.
• Be concerned and responsive regardless of whether their child is the reported bully or the victim. Offer support, but do not encourage dependence.280
• Become involved in their child's school life by reviewing homework, meeting teachers, reading with their child, and attending school functions.
• Build a network of other adults, parents, and students to discuss school safety and other issues.
• Give children the social skills they need to navigate through their own school experience.
• Teach children to have respect for differences.
• Explain the difference between an assertive and an aggressive response.
• Be an advocate for bullying prevention in brownie and scout groups, athletic programs, and other youth activities.
• Share stories about their own childhood experiences with bullying.

For the Child Being Bullied

The behavior of parents will differ depending on whether their child is being bullied or is the child who is bullying. Children who are bullied tend to be scared and fragile and should never be blamed for the incident. All children deserve to be treated with respect and courtesy.281 If a child has been a victim of a bully, parents should:282, 283

• Find out in detail what happened. Listen to the child and do not interrupt until he or she is finished.
• Contact the child's teacher, school counselor, and school administrator to alert them to the incident and ask for their cooperation.
• Avoid blaming anyone, especially the victim.
• Refrain from encouraging the child to be aggressive or strike back.
• Discuss assertive alternatives to responding to bullies and role-play responses with the child.
• Be prepared to contact an attorney if the bullying continues and if the school does not take appropriate action for the child.
• Encourage the school to work collaboratively with you and others to take the bullying seriously and investigate the facts.
• Keep a log book (with the child if possible) describing the incidents of harassment or bullying, when they occurred, who took part, and what was said and done. This can strengthen a parent's case when contacting the school principal and/or teachers.
• Be patient. If often takes time for someone to change negative behaviors and interactions.

Increased threats may cause many victims of bullying to suffer in silence or pressure their parents not to contact the school. . . . However, most bullied children eventually feel a great sense of relief when the situation is dealt with.284

For the Child Who Bullies

Parents of children who bully must work closely with the school to resolve the situation. Although it is difficult for most parents to hear something negative about their child's behavior, it is very important in a bullying situation for the parents to act immediately.

Parents need to remember that, as noted earlier, children who are aggressive towards their peers are at high risk for other anti-social behaviors such as criminality and misuse of alcohol, tobacco, and illegal drugs.285
Steps parents can take include:286, 287

• Find out in detail why your child is bullying.
• Listen. It is hard to listen to criticism of your child, but remember, the well-being of your child is at stake.
• Spend more quality time getting to know who your child's friends are and what he or she does with them. Children need to feel their parents listen to them.
• Do not blame others for your child's behavior.
• Point out that bullying behavior is not acceptable in the family.
• Try to model appropriate methods for handling issues of power or the inequality of power.
• Specify the consequences if the bullying persists.
• Teach and role-play appropriate behavior.
• Follow up with the teacher and administration and track improvements.
• Try to channel the aggressive behavior toward something positive like sports, where teammates need to play by the rules. Explore other talents the child may have and help him or her develop them.

What Can Students Do?

Students play a very important role in helping a school eradicate bullying. Students may not know what to do if they witness a bullying incident or become the target of bullying themselves. Students can:288, 289, 290

• Seek immediate help from an adult. If adults do not hear about the incidents, they cannot act to disrupt and stop the behavior.
• Report bullying/victimization incidents to school personnel.
• Speak up and/or offer support for the victim.
• Participate in the development of school safety planning through committees and organizations.
• Encourage their parents to become involved in school activities.
• Become a buddy for a younger or quieter student.

What Victims/Bully Victims Can Do

It is important that students learn appropriate tools to address bullying. Any adult, including teachers, school counselors, and parents, can help provide students with the skills necessary to deal with bullying. Students can be taught to:291

• Ignore the bully's behavior whenever possible.
• Use social skills, such as assertiveness, negotiating, sharing, taking turns, inviting others to participate, assisting others, and asking for permission instead of using aggression and intimidation (when the victim is also a bully).
• Leave the situation.
• Rebuff in a firm manner.
• Protect themselves emotionally and physically (without using retaliation).
• Request that the bully stop, and then walk away; if this does not work, then tell the teacher.
• Use humor.
• Agree with the bully (this takes the power away from the bully).
• Spend time in groups.
• Practice what to say in front of a mirror or with friends.

What Victims Should NOT Do

These children can be taught, through role-playing, specific ways to help them NOT to:292

• Cry or act hurt in front of the bully.
• Lose their temper.
• Escalate the situation.
• Return the aggression.
• Get others to gang up on the bully.
• Tease back.
• Call the bully names.
• Bring weapons to school.

For Children who Bully

Children who bully should be:293

• Monitored and rewarded for appropriate behavior and for improvements (e.g., reduced incidents of bullying and increasingly longer periods of no bullying).
• Given clear sanctions for acts of bullying. (Punishing bullying behavior without acknowledging the experience of the victim can foster frustration and more aggression. Support bullies when they are victims.)

For Witnesses and Bystanders

Witnesses and bystanders can play a large role in stopping bullying at a school. They can be taught to:294, 295

• Request that the bully stop.
• Seek immediate adult help if the bully does not stop.
• Speak up and/or offer support to the victim (e.g., pick up his or her books, offer words of kindness).
• Privately support those being hurt with words of kindness.
• Take the bully aside and ask him or her to "cool it."
• Express disapproval of the bullying behavior by not joining in the laughter, teasing, or spreading rumors or gossip.

Prevention Programs That Work

Research indicates schools that emphasize enforcement and punishment measures to respond to aggression and violence are ineffective. A joint study by the U.S. Departments of Education and Justice found that the student reports of bullying were the same regardless of the presence of security guards, hallway monitors, and metal detectors.296
Compared with 20 years ago, researchers today have a clearer understanding of what approaches work best within the school setting and are able to identify "best practices" and model programs. Some of the information is coming from students themselves.
Many prevention programs have been developed to address the issues related to school violence and bullying. No one prevention program is appropriate for every school. Each school has unique needs. Educators and administrators must assess programs to find a good fit with their school. Among those that have been proven promising are the following, which are listed alphabetically.
The Olweus Bullying Prevention Program
Dan Olweus, considered by most to be the pioneer in bullying research, developed the first research study in Norway in 1970, which served as the basis for this prevention program. He has continued to refine and expand his contribution to research on bullying. In the 1990s, he began working with two professors at Clemson University who conducted the first evaluation study of his prevention program in the United States. The Bullying Prevention Program has been identified as a Model Program by SAMHSA and by the U.S. Department of Justice's Office of Juvenile Justice Delinquency Prevention and by the Center for the Study and Prevention of Violence (CSPV), University of Colorado.
Bully Proofing Your School
The Bully Proofing Your School Program was developed in Colorado in 1996. It is designed to work in elementary and middle school settings. The program is a comprehensive school climate program designed to create a safe and caring school community by shifting the power away from bullies and into the hands of the caring majority of students.
BullySafe USA
BullySafe USA is a comprehensive program that offers common terminology, concepts, and strategies for bullying prevention and intervention for students, educators, parents, and community leaders.
The Don't Laugh at Me Program (DLAM)
DLAM is a program out of Operation Respect, Inc., that is working to transform schools into more compassionate, safe, and respectful places. The program was founded by Peter Yarrow of the music group Peter, Paul and Mary in collaboration with Educators for a Social Responsibility. It is designed to reduce the emotional and physical cruelty children can inflict on one another, often in the form of ridicule, bullying, and sometimes violence.
Peaceful Schools Project/Menninger Clinic
The Peaceful Schools Project, created and run by the Menninger Foundation's Child and Family Center in Houston, Texas, focuses only on the elementary level grades (K-5). The program also includes a research component that is examining the results of antibullying efforts.
Promoting Alternative Thinking Strategies (PATHS)
This curriculum is a comprehensive program for promoting emotional and social competencies and reducing aggression in elementary school-age children. The program is designed to be used in a multiyear format by teachers and counselors.
Safe Culture Project
This bullying prevention program is originally from Iowa, but has been implemented in States from Maine to California.
Steps To Respect Program
The Steps To Respect Program is a bullying prevention curriculum designed to decrease bullying at a school and help students build more supportive relationships with one another. The program's dual focus is based on the research showing that friendships help protect children from the harm of bullying.

Summary

• Prevention is a shared responsibility. School personnel, administrators, parents, and community members all can contribute to stopping bullying in the schools.
• School administrators and teachers can use several strategies to help reduce and/or eradicate bullying behavior.
• Parents and children play a large role in the collective effort to stop bullying. Many strategies for parents and children can effectively strengthen a child's ability to deal with bullies and help prevent the behavior in the future.
• Many promising prevention programs exist for curbing school violence and bullying in particular.

MODULE 7: Legal and Ethical Issues

Bullying and the Law

Is it against the law to bully? What are the rights and responsibilities of schools, parents, and students when it comes to providing a safe environment for learning? What are a school's obligations when a student has confided in a counselor about a bullying incident? What are a school's legal obligations when a student says he plans to harm himself or others?

These are just a few of the legal and ethical issues schools and mental health professionals must address when working with children on bullying and family violence.

As with many complex social problems, these questions demand more than a simple "yes" or "no" answer or legal citation. Some bullying behaviors, such as racial or sexual bullying, are a violation of civil rights laws. Physical bullying can be charged as an assault. Some forms of bullying, such as teasing and intimidating, however, are not illegal. In describing bullying actions that had left her daughter devastated, one mother noted of her daughter's tormentors, "Nothing they do (or don't do) is against the rules." 297

Whether or not the bullying behavior is technically illegal, creating lasting change among communities that have acknowledged the presence of bullying requires more than a legalistic response. At the same time, communities are aware of the need to use the law to protect the rights of individuals and to prevent actions for which they might be liable.

Laws that clearly define duties and rights also serve the purpose of sending the message to students, parents, and the public that bullying behaviors are not acceptable. Absent strong standards, including legal ones, schools and communities that fail to "adapt to circumstances," as the Chinese proverb says, may find themselves in an antagonistic relationship with victims and members of the public who will seek legal and other remedies to bullying problems.

Federal Law

Compared with European countries, the United States has been slow to respond to school bullying. However, several laws have been passed over the last 7 years that require States to take action to curb bullying behaviors. 298
The No Child Left Behind (NCLB) Act of 2001, Title 20 (Education), contains a drug and violence prevention component under Safe and Drug-Free Schools and Communities (Title IV). The NCLB Act retains State formula grants already in existence and national discretionary activities for drug and violence prevention. It also: 299

• Allows a student in a persistently dangerous school, or a student who is victimized at school, to transfer to a safe school.
• Requires States to report on school safety to the public.
• Requires school districts to implement drug and violence prevention programs of demonstrated effectiveness.
• Requires Local Education Agencies (LEAs) that receive Safe and Drug-Free Schools monies to have a detailed plan for keeping schools safe. The plan must include:
1. Appropriate and effective discipline policies
2. Security procedures
3. Prevention activities
4. A student code of conduct
5. A crisis management plan for responding to violent or traumatic incidents on school property

In addition, the NCLB Act made specific requirement changes to the Safe and Drug-Free Schools and Communities program addressing: 300

• Mandating community service for expelled or suspended students
• Creating a school security and technology resource center
• Creating a national center for school and youth safety to:
1. Provide emergency counseling, enhanced security assistance, and a toll-free hotline for students to report violence and/or criminal activity
2. Provide information and outreach (best practices, clearinghouse for model school safety programs, etc.)
• Creating a Safe and Drug-Free Schools and Communities Advisory Committee
• Mandating a detailed local plan for Safe and Drug-Free Schools

In the context of sexual bullying, the Office of Civil Rights (OCR) has passed comprehensive policies prohibiting discrimination within all programs and activities. OCR enforces Title IX, which prohibits discrimination based on a student's sex in schools receiving Federal funds. 301

The U.S. Supreme Court has clearly stated that a school district is liable if administrators knew or should have known that bullying (some methods legally termed harassment) was occurring and failed to take immediate and appropriate action. 302

Federal Lawsuits

Numerous families have filed Federal lawsuits in the past couple of years on behalf of their children, who were repeatedly bullied at their schools. Schools have a responsibility to provide a safe learning environment that is conducive to learning. A sampling of suits includes:

• The family of a boy that was bullied on a school bus sued the Eugene, Oregon, School District in September 2003. 303 The act was caught on videotape and broadcasted throughout Oregon and nationally. Casey, the young boy, was repeatedly attacked beginning in 2001 when he was 11 years old. The parents kept reporting the incidents and naming the attackers, but the school district failed to prevent continuing assaults. Some of the attacks took place in front of teachers. The case is still pending.
• In 1999, a mother sued a Chicago-area school district for reckless disregard for not preventing a bully from beating her son. 304 Derek, her seventh-grade son, was beaten so badly in sixth grade that he suffered a concussion. The bully exhibited a pattern of violent behavior even after school officials were warned of that behavior by a father of another boy who had been beaten by the same bully the day before.
• A Seattle, WA, senior filed a lawsuit against the Kent School District for 5 years of harassment, threats, taunts, and an assault that landed him in the hospital. 305 The student was repeatedly bullied because he was gay. He said even a teacher taunted him saying, "I don't need another girl in my class."

Federal Initiatives

In recognition of the magnitude of the problem, as well as schools' responsibility to provide a safe learning environment for students, the U.S. Government has launched a multiyear public education campaign on bullying. This campaign aimed at children 9 to 13 years old and adults reflects years of hard work and collaboration by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, and the Center for Mental Health Services.

The Bullying Prevention Campaign also uses a variety of communications messages to reach 9- to 13-year-olds to help prevent bullying. In keeping with the practice of leaving States responsible for education, the U.S. Government does not dictate specific laws relating to bullying for all States, but leaves it up to each State to pass its own legislation. However, all States are required to provide all students with an accessible, competent, and safe learning environment.

State Laws

How do States adapt the Federal requirements under the Safe and Drug-Free Schools provision described above? Many States have taken legislative action to stop bullying, harassment, and hate crimes. Most of the legislative responses require the State's Department of Education, school districts, and school boards to develop policies and procedures to prevent bullying.306 Most of the State laws cover bullying that occurs on school grounds and at school-sponsored activities.

Unfortunately, there is no national mandated and uniform school crime reporting to help schools assess issues and concerns. Only a little more than a dozen states now require crime reporting in grades K-12. One of the reasons that national legislation hasn't been developed is that educators don't like to report problems and deficiencies that may exist on their campuses. 307

The National Conference of State Legislatures has compiled a list of State actions that relate to bullying, harassment, and hate crimes. States that have passed formal laws on bullying include California, Colorado, Connecticut, Georgia, Illinois, Louisiana, Mississippi, Nevada, New Hampshire, New Jersey, Oklahoma, Oregon, Vermont, Washington, and West Virginia.

Other Organizational Responses

Several national organizations have recognized the devastating effects bullying can have on children's mental and emotional health and have rallied together to study the issue and issue information to members and the public. These organizations include the American Psychological Association (APA), American Medical Association (AMA), American Medical Association Alliance, National Association of Attorneys General, National Education Association, American Academy of Child and Adolescent Psychiatry, and National Parent Teacher Association, Prevent Child Abuse America, among others.

Bullying is such a timely and important public health issue. As advocates for America's health, it is our responsibility to be at the forefront of this issue so we can make our schools a safer place for children to learn, play, and grow. - Patti Herlihy, National President, AMA Alliance

Confidentiality and Minor Consent

Federal confidentiality and due process laws protect the general rights of individuals as established in the 14th Amendment. States have the leeway, however, to design laws concerning confidentiality among different professions. Most students are classified as minors and are subject to additional protections.

For the Mental Health Professional

The following material has been adapted from the Center for Mental Health in Schools at the University of California, Los Angeles. (2002). An Introductory packet on confidentiality and informed consent. Los Angeles, CA: Author unless otherwise noted.

The fundamental intent of confidentiality is to protect a client's right to privacy by providing reassurance that what the client says will not be shared with others without his or her informed consent. Mental health professionals discuss matters of confidentiality as a matter of course to encourage openness and communication with their clients, especially adolescents who strive for independence and autonomy. Mental health professionals have many obligations to their clients -- legally, ethically, and morally.

However, privacy and confidentiality are not absolute rights -- especially when working with minors, where there are unique legal and ethical considerations. State laws also specify limitations on privileged communications between counseling professionals and clients. Some States protect only disclosures about alcohol or other drug use. Others give broad protection, child abuse being one of the only exceptions.
The APA acknowledges that there are times when information obtained in the therapy session should be shared with others. APA emphasizes that only persons closely related to the case should be told any privileged information. In some cases, these people may include teachers and/or parents, if sharing the information will benefit the client more than keeping it confidential.

Therapists and/or school counselors should explain the limits of confidentiality when working with students to help them realize the consequences of their actions. The following scenario illustrates how a therapist may discuss the limits to confidentiality with a student: 308

• "Although most of what we talk about is private, there are three kinds of problems you might tell me about that we would have to talk to other people about. Those are: (a) If I find out that someone has been seriously hurting or abusing you, I would have to tell the police; (b) If I find out that that you have a plan to hurt yourself, I would have to tell your parents; and (c) If you tell me you have a plan to hurt someone else, I would have to warn that person."
• "What you have shared today is very important. I know you are not ready to talk about this to your parents, but it is the kind of thing that I told you at the beginning that I am required to tell them."
• Regarding having to break confidentiality, "I know that if I do so you will be upset with me and it will be hard for you to trust me anymore. I feel caught in this situation. I'd like us to be able to work something out to make this all come out as good as we can make it."

Tips for Professionals
Mental health professionals and teachers must be aware of Federal confidentiality laws and State protections guarding confidentiality and minor consent to ensure ethical and legal practices.

Informed Consent

School professionals may not make decisions about assessment/treatment and/or placement (e.g., special education) without the informed consent of a parent. Informed consent is a legal term that refers to a person's agreement to allow something to happen after the person has been informed of all the risks involved and the alternatives.

Awareness of informed consent and, by definition, considerations of the parent and student, have become important in screening, diagnosis, and placement practices in the schools. For special education, informed consent is the norm under Public Law 94-142. 309

Schools have legal obligations relating to the issue of competence when providing mental health services. Competence refers to an individual's ability to receive and process information, make decisions, and choose alternatives. 310

To give informed consent, a person must have: 311

• The ability to give consent
• Adequate information to do so knowledgably
• Not been coerced or threatened to give consent

Accepted criteria are based largely on age and mental status. Surrogates (parents or guardians) can provide the consent for children as well as adults who are diagnosed as mentally retarded, autistic, or psychotic.

Although not all legal experts agree on the situations that require a child's consent before undergoing psychological or educational interventions, it is generally accepted that the child's consent is not required in situations where the child is either extremely dangerous to others or unable to protect or care for himself or herself.

Basic information the child needs to understand the context of assessment, treatment, and/or placement include: 312

• Purpose of the procedures (why person is there, what the person will be doing)
• Risks and benefits of the procedures
• Alternatives to the procedures
• Assuring child that participation is not required
• Ensuring all questions are answered

Did you Know?
School professionals may not make decisions about assessment/treatment and/or placement (e.g., special education) without the informed consent of a parent.

For the Teacher

The following has been adapted from Rachael Kessler. (2003) Guidelines: The dilemma of Confidentiality.
Teachers, like mental health professionals, have to follow certain exceptions when it comes to protecting a student's confidentiality. The limits include:

• Suicide threats or ideation
• Child abuse
• Drug/alcohol use on school property

All three of these conditions require immediate reporting to an administrator, followed by an appropriate referral. At times, teachers also may feel concerned about a student's well-being or safety. In these cases, the teacher should talk to the student first and try to allow the student to be part of the process. However, if the teacher cannot reach the student and/or the issue mandates immediate action, the teacher must break confidentiality and make a report.

When dealing with emotional issues such as bullying and victimization, teachers need to talk with and not to students. This type of dialogue shows mutual respect and empathy for the child's situation.

Teachers and school counselors can play an important role in helping students understand the concept of confidentiality with regard to others' private thoughts and/or feelings. An effective way to begin a dialogue is to ask the student why they think people repeat something told to them in confidence. In discussing this, the adolescent begins to better understand the importance of respecting other's privacy and the legitimate reasons to share what others are feeling.

One of the biggest issues with confidentiality and sharing of information that teachers need to understand is gossip. Gossip plays a significant role in the dynamics of power and popularity among students and their peers. Students must be taught how to explore the ethical issues involved in sharing confidential information and must develop an understanding of how gossip can hurt. Students also need to understand when they have an obligation to report an incident or comment and that such should not be considered a form of "tattling."

Summary

• When bullying becomes harassment or takes more severe forms, it is illegal.
• Several States have adopted legislation to address bullying, harassment, and intimidation.
• Mental health professionals and teachers must be aware of the student's right to privacy when addressing school violence concerns, as well as any legal mandates concerning privacy.
• Students also must be aware of the legal and ethical obligations involved in bullying activities.

You have completed reading the text. Next, take the Course QUIZ.

REFERENCES

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