Bullying: Information and Interventions for the Primary Care Provider

Bullying: Information and Interventions for the Primary Care Provider Alexandra Hayley Quinn, PsyD Swedish Medical Group What is Bullying? The use of physical or emotional power to control or harm others Repetitive Power Imbalance Intentional Bullying Stopbullying.gov Language has Power • When children are labeled as "bullies" or "victims" it may: • Send the message that the child's behavior cannot change • Fail to recognize the multiple roles children might play in different bullying situations • Disregard other factors contributing to the behavior such as peer influence or school climate • Instead of labeling the children involved, focus on the behavior. How Prevalent is Bullying? 35 30 25 20 15 10 5 0 Elementary School Middle School High School % of kids reporting victimization in past 12 months 12 past in victimization reporting % of kids Jansen et al., 2012, The National Bullying Prevention Center, 2018; CDC, 2019 Types of Bullying and Common Bullying Behaviors Verbal Teasing Name Bullying Calling Physical Spitting, Harm or Physical Tripping, Threats Bullying of Harm etc Taking/ Excluding & Damaging Alienating Personal Property Creating Relational Embarrassing Spreading Aggression Situations Rumors Stopbullying.gov; Bradshaw, et al. (2017) Bullying Trends by Age Group & Type Cyberbullying: A Deep Dive • Rarely occurs in isolation • Pervasive and Persistent • Difficult to remove • Occurs 24/7 • Wider audience • Spreads more rapidly • Perception of anonymity • Higher prevalence among girls and peaks later than “traditional” forms of bullying Zuckerman (2016) Cyberbullying Continued Type Description Harassment Repetitive, offensive messages sent to a target Outing and trickery Discovering personal information about someone and then electronically sharing that information without the individual’s permission Exclusion Blocking an individual from electronic groups/chats Impersonation Pretending to be the victim and electronically communicating negatively or inappropriately with other as if the information is coming from the victim Cyberstalking Talking someone by sending repeated threatening messages Sexting Sending nude/inappropriate photos of another person without that individual’s consent Flaming Posting aggressive insults directed at the target Kowalki et al. (2014) What is the Difference? Intimate Partner Hazing Harassment Stalking Teasing Meanness Violence Violence or Unwelcome Repeated Use of Comments that Behaviors that threats of conduct based on harassing or embarrassing and are intended to are meant to violence that a protected class threatening often dangerous be playful, funny, upset or hurt the occur between that is severe, behavior such as or illegal activities or to get feelings of two young pervasive, or following a by a group to attention in some another person people who are, persistent and person, damaging initiate new way; perceived as that occurs one or once were, in a creates a hostile a person’s members. benign or hurtful or two times. relationship. environment. property Stopbullying.gov Risk Factors for Being Bullied Ethnic minority Physical Obesity or Different Chronic illness or immigrant disability Underweight appearance status Behavioral Learning Foster Poor family Problems & Poor Poverty disability care/group home functioning Self-Esteem Familial Parental Lack of close Internalizing Exposure to interpersonal substance use or relationships Problems & Poor trauma Self-Esteem violence MH problems McClowry et al. (2017), National Bullying Prevention Center (2017) Outcomes of Being Bullied • Less adherence with treatment plans • Poor management of chronic conditions • Stress • Depression, anxiety, suicidal ideation • Involvement in crime • Substance use • Somatic complaints • Increased absenteeism • Insomnia • Reduced investment in academics • Young adults who were victimized as children have higher rates of: • Agoraphobia • Depression • Anxiety • Panic disorder • Suicidal ideation McClowry et al. (2017), National Bullying Prevention Center (2017) Horner, G. (2018), Stopbullying.gov Local Data: Bully Victimization x Psychological Adjustment Signs and Symptoms of Being Bullied • School avoidance • Somatic complaints • Sudden non-compliance or poor management of health conditions • Changes in appetite/eating • Emotional lability or behavioral outbursts • Increased or emergence of substance use • Suicidal ideation • Depression and/or anxiety Eisenberg & Aalsma (2005) Risk Factors for Children who Bully • Two subtypes of children who Bully: • Well-connected to their peers, have social power, are overly concerned about their popularity, and like to dominate or be in charge of others. • Isolated from their peers and may be depressed or anxious, have low self esteem, be less involved in school, be easily pressured by peers, or not identify with the emotions or feelings of others. • Risk Factors: • Witnessing or experiencing abuse • Permissive parenting style • Seeing or experiencing bullying by siblings • High need for power/Challenging authority • High levels of Intolerance or general negative view of others • Difficulty following rules • Have a positive view of violence • Have friends who are Bullies Espelage & Swearer (2003), Stopbullying.gov Children who Bully and Associated Problems Dropping out of More likely to carry Increased substance Earlier sexual school/academic a weapon on and off use* activity failure* campus* Depression, anxiety, More fights & Intimate partner Criminal convictions and increased fighting related violence or child as an adult* suicidal injuries* abuse ideations/attempts* *Also true for kids who are bullied and Low self-esteem* Bully-victims Juvonen & Graham 2014), Nansel et al., (2003), & Zuckerman (2016) Risk Factors for being a Bully-Victim • All of the risk factors for being bullied and bullying others • Emotional dysregulation • Hyperactivity • Low social competence • Poor problem-solving skills • Poor self-esteem • Negative perceptions about others • Peer rejection and isolation • Negative influences from those peers with whom the child interacts • Disconnectedness from school Espelage & Swearer (2003) Bullying and Suicide • Suicidal ideation is more common among kids who are involved in bullying • Girls are at higher risk than boys • Kids who identify as LGBTQIA and kids with learning disabilities are at particularly high risk • Bully-victims are the most impacted group • Bullying involvement explains only a small proportion of the variability in suicidal ideation Hinduja & Patchin (2010), Kim & Leventhal (2008) Protective Factors • When bystanders intervene, bullying stops within 10 seconds 57% of the time • improves self-esteem and more peer acceptance of the victim • Labeling an incident as bullying can be important because it influences whether students tell an adult, as well as how adults respond to the student’s report • Culture of prioritizing diversity in schools • Having a wide peer group • High rates of resilience • Good relationships and parents and siblings US Department of Health & Human Services, Hawkins et al. (2001) Role of the PCP: Brief Interventions to Help Prevent • Encourage parents to talk daily with their child about relationships at school • Check screen/media use and advise parental monitoring • Reduce stigma by normalizing and validating the impact of bullying • Educate about bullying and social media safety, how to be an upstander • Encourage connection to school and self-esteem building activities McClowry et al. (2017), Stephens et al. (2018), AAP (2019) Screen • AAP recommends annual screening started at age 6 • There are no evidence-based screening tools for identification of bullying – HEEADSSS is a good start • Start with rapport-building questions that are broad and open ended • Determine scope and intensity of the problem • How long has it been happening • Where is it occurring • Who is involved • Has it been reported/what has been done • Screen for other mental health issues and risk factors Treat • Identify a supportive network around the patient and a location that the patient can go when bullying occurs • Educate the patient and their parent about what bullying is • Convey the following key points: • It is NOT their fault. They are not to blame. • They are NOT alone. You are here to help. • It is the adults’ responsibility make the bullying stop. • Bullying is never okay and they have the right to be safe. • No one deserves to be bullied. • They have the right to feel safe at school. Treat, continued • Problem solve ways that the patient can respond to the bullying • Provide link to school bullying policy in your area/district • Motivational Interviewing if needed to encourage disclosure to school and/or parents • Ask what the patient would like done about the bullying and what steps are needed to make that happen (See Bullying Action Plan form in presentation resource library) • Identify strengths and self-esteem building activities • Offer self-care plan and coping strategies • Monitor/treat comorbid symptoms • Refer to mental health treatment Treat, continued The National Bullying Prevention Center (2018) References • Bradshaw, C.P., Sawyer, A.L., & O’Brennan, L.M. (2007). "Bullying and peer victimization at school: Perceptual differences between students and school staff." School Psychology Review, 36(3), 361-382. • Finkelhor, D., Turner, H.A., Shattuck, A., & Hamby, S.L. (2015). Prevalence of childhood exposure to violence, crime, and abuse: Results from the national survey of children’s exposure to violence. JAMA Pediatric,

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