Identifying, Treating, and Preventing Teen Violence

preventing violenceAt the recent Cincinnati Children’s Pediatric Mental Health Conference, Drew Barzman, MD presented a workshop on “Violence In Our Schools: What Can We Do”. Barzman offered a definition of school violence, ‘Violence is a person’s or group’s behavior or language that causes another person to become hurt, physically or psychologically. It can include assaults-physical fights or attacks with guns or other objects, bullying, extreme teasing, or physical or emotional intimidation- taunting or name calling, for example. Violence can be directed against students, staff, or teachers and can occur at any time of the day or night.’ And, as we’ve seen violence may extend to cyber-bullying according to some definitions.

Dr. Barzman opened his presentation with some clinical examples. In one example a 12-year old girl is referred to (your) outpatient clinic for threatening to kill the teacher and other students. She’s made drawings and is obsessed with violent video games. She has witnessed extreme violence in the past and her parents are divorced. Is she at risk for school violence? Father does not believe in mental health treatment; does come to appointment; they deny any psychiatric symptoms or concerns. There are no easy answers and responses will vary by school, by district, by region, by provider.

This portion of the workshop was then supported by statistics: “Children and adolescents were involved in 12% of violent crimes in 2007. (Puzzanchera, 2009); and in 2008, there were 2.11 million arrests of children and adolescents in the United States. For many adolescents, exposure to violence or contextual socio-demographic factors- poverty, environment- is a leading cause of violent behavior; not mental illness. “Pediatric violence is a common and major public health problem that increases the risks of drug and alcohol abuse, violence in adulthood, abusive parenting, suicide, and incarceration.” (Tremblay et al, 2004).
Barzman continued, ‘School violence is difficult to predict. It’s difficult to predict when and whether an individual will complete and violent act versus empty threats.’ Children and adolescents account for 12% of violent crimes in 2007; 33% of students report being in a physical fight and 6% brought a weapon to school. He then discussed characteristics of school shooters: age 6-18 but most between 14 and 15 years old; male; almost always white; isolated-loner. As we’ve seen in last week’s shooting in Washington, the perpetrator was popular and did not fit the stereotype. The motive of the shooter is ‘to punish those who bullied, taunted, rejected or shamed.’ There is a precursor- ‘threat of violence- all said what they were going to do prior to (the) act.’ Personality traits include anger, hate, depression; a strange sense of humor. There may have been suicidal threats, discipline problems, psychosis and violent writing or drawings according to Verlinden et al, 2000.

Risk factors in the family include ‘authoritarian childrearing attitudes, conflict, violence, harsh, lax or inconsistent disciplinary practices, lack of involvement/supervision in the child’s life, low emotional attachment to parents or caregivers, lower parental education and income, parental substance abuse and criminality, poor family functioning, monitoring and supervision of children.’ Coupled with access to firearms, violent video games, media and/or music, it takes very little to trigger a teen explained Barzman. (Verlinden et al, 2000) Community risk factors include poverty, diminished economic opportunity, transiency, high levels of family disruption, low community participation, and social disorganization. The conclusion is that many students could potentially be violent, but it’s nearly impossible to predict, even with red flags.

The latest mental health information is often not shared (or cannot be shared due to HIPPA or lack of parental consent). Barzman explained that often ER personnel are not trained to do forensic psychiatric assessments, and psychiatric intake response personnel are not comfortable evaluating school violence. There is a duty to warn the guardian of a threatened student, or to hospitalize a child; to admit the teen to the ER to protect both. Cincinnati Children’s is working on a school violence risk assessment tool to assist schools in preventing aggression -as has been done with suicidal ideation. Using computerized interview and school safety system using natural language processing, this tool will help to prevent aggression, hospitalization, arrest and suspension. Identifying and preventing violence is a fluid and changing art- more than a science, with many school authorities banning apps, changing policies, even banning backpacks. There are no easy answers.


‘Social-media posts prompt backpack ban’ The Columbus Dispatch Metro & State Tuesday, November 11th, 2014

[photo credit: Monkey Business Images/Dreamstime 10401177 Young Man Sitting In Playground Smoking]


About Communications

Communications and Social Media @ Sequel-Pomegranate Health Systems
This entry was posted in adolescent psychiatry, behavioral health, behavioral health disorders, pediatric psychiatry, psychiatric care, residential treatment and tagged , , , . Bookmark the permalink.

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