BULLYING AND THE MEDICAL HOME RESPONSE

1. BULLYING AND THE MEDICAL HOME RESPONSE

2. Disclaimer This material was developed by the American Academy of Pediatrics under award #2012-VF-GX-K011, awarded by the Office for Victims of Crime, Office of Justice Programs, US Department of Justice. The opinions, findings, and conclusions or recommendations expressed herein are those of the contributors and do not necessarily represent the official position or policies of the US Department of Justice.

3. What is bullying? Bullying is a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. Bullying can take the form of physical contact, words, or more subtle actions. • American Psychological Association

4. What is bullying? • Bullying involves a real or perceived difference in power between the perpetrator and the victim. • Forms of bullying includes: • Teasing • Threats of harm • Spreading rumors • Purposefully excluding peers from activities • Attacking physically or verbally • Cyberbullying is a type of bullying that happens via emails, text messages, or online.

5. How big is the problem? • 30% of children between 6th and 10th grade have either been bullied or have been bullies themselves. • Both perpetrating and experiencing bullying has been associated with violence-related behavioral markers, including weapon carrying, frequent fighting, and associated injuries. • Clear association of subsequent development of depression and suicidal ideation. • Also a relationship with somatic symptoms and the development of long-term disease morbidity and outcomes manifesting in adulthood. AAP Policy Statement: Role of the Pediatrician in Youth Violence Prevention Committee on Injury, Violence, and Poison Prevention, 2009

6. More facts about bullies • Both boys and girls can be bullies. • Boys more likely to engage in physical bullying. • Girls more likely to engage in social / verbal bullying. • Bullying is not confined to classrooms, but also on the playground, and in the neighborhood while going between school and home

7. More facts about bullies • Bullies tend to target children who cry, get angry, or give in easily to them. • Specific groups of children may be targets, including LGBT youth and children with disabilities or special health needs

8. Role of the pediatrician in the Medical Home • Anticipatory guidance – prevention of bullying • Identification of children at risk • Understanding the patient’s strengths and protective factors (resiliency) • Helping patients create a safety plan for when things “heat up” • Referral to mental health and community resources when necessary • Follow up with patient that recommendations were followed (tracking)

9. How do I find it?Asking the Right Questions • Few standardized tools for pediatric practices • Surveillance and interviewing are more viable options • Embed questions in pre-visit questionnaires • Ask directly during the visit • Need to remember to be respectful of confidentiality and privacy • Key message: “You aren’t alone, it’s not your fault, and I can help.”

10. Universal Questions to Elicit Bullying • For patients: • Do you ever feel afraid to go to school? Why? • Do other kids every bully you at school, in your neighborhood, or online? • What do you do if you see other kids being bullied? • Who can you go to for help if you or someone you know is being bullied?From www.stopbullying.gov • For parents: • Has your child been bullied or hit by others? • Has your child demonstrated bullying or aggression toward others?From Bright Futures

11. Targeted history during chronic illness • Also important to consider bullying in cases of chronic somatic complaints like headaches, stomach aches or sleep problems. • Using the HEADSS mnemonic can help elicit the history Home and environment Education Activities Drugs Sexuality Suicide / Depression • The pediatrician can strengthen the relationship with thechild by reminding him/her of “conditional confidentiality”

12. Key protective factors • Safe, cohesive neighborhood • Parental warmth and monitoring • Connection with a caring adult • Strong friendship(s) with other children

13. Building Resiliency in Kids • Have a conversation with the patient to help them understand steps they can take the next time the situation heats up. • Engage parents to help children learn to: • Look the bully in the eye • Stay calm • Walk away to get help • Respond in a firm voice to the bully

14. Key points in responding to bullying • Don’t blame the child for being bullied • Don’t encourage children to fight back • Telling the child to ignore the bullying may cause it to escalate • Bystanders may also be affected by bullying in that they don’t often know how to respond

15. When does a child need outside help? • The provider’s assessment should include an evaluation of the patient’s immediate safety • A mental health professional may be needed if: • The child is experiencing severe mental health consequences (depression, anxiety, suicidality) • The child has particular difficulty in discussing the bullying • The child is experiencing severe impairment in daily activities

16. Resources for Parents, Children, and Providers • Many school districts have programs to address bullying and other violence within schools. • Parents and providers should advocate for schools to intervene on persistent or high-risk bullying behaviors • Self-education resources exist for parents and children

17. National Resources • Futures Without Violence website www.futureswithoutviolence.org • www.thatsnotcool.com – Web site for teens about dealing with cyberbullying • www.stopbullying.gov • Big Brother/Big Sister - www.bbbs.org

18. Other Practice Resources from the AAP • Connected Kids - www.aap.org/ConnectedKids/ • Feelings Need Checkups, Too • Bright Futures – www.brightfutures.aap.org • Bright Futures in Practice: Mental Health - www.brightfutures.org/mentalhealth/ • Medical Home for Children Exposed to Violence Project - www.aap.org/medhomecev • National Center for Medical Home Implementation - www.medicalhomeinfo.org (Tips for identifying your community resources) • www.healthychildren.org – Web site for parents, includes parenting resources and tips

19. Thank you! Thank you for utilizing this component of the online training toolkit, produced by the American Academy of Pediatrics Medical Home for Children Exposed to Violence project. Additional resources on intimate partner violence and other similar issues can be found on the project Web site: www.aap.org/medhomecev Many thanks to R.J. Gillespie, MD, MHPE, FAAP for developing the content for this presentation.