Brown University – Hasbro Children’s Hospital study: School violence is a very big issue

19 Jan

The Centers for Disease Control (CDC) writes about school violence:

In the United States, an estimated 50 million students are enrolled in pre-kindergarten through 12th grade. Another 15 million students attend colleges and universities across the country. While U.S. schools remain relatively safe, any amount of violence is unacceptable. Parents, teachers, and administrators expect schools to be safe havens of learning. Acts of violence can disrupt the learning process and have a negative effect on students, the school itself, and the broader community.
2013 Understanding School Violence Fact Sheet Adobe PDF file [PDF 250KB]
http://www.cdc.gov/violenceprevention/pdf/school_violence_fact_sheet-a.pdf
School violence is youth violence that occurs on school property, on the way to or from school or school-sponsored events, or during a school-sponsored event.
What is School Violence?
School violence is a subset of youth violence, a broader public health problem. Violence is the intentional use of physical force or power, against another person, group, or community, with the behavior likely to cause physical or psychological harm. Youth Violence typically includes persons between the ages of 10 and 24, although pathways to youth violence can begin in early childhood.
Examples of violent behavior include:
Bullying
Fighting (e.g., punching, slapping, kicking)
Weapon use
Electronic aggression
Gang violence
School violence occurs:
On school property
On the way to or from school
During a school-sponsored event
On the way to or from a school-sponsored event
Data Sources:
Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance System (YRBSS) 2009 National Youth Risk Behavior Survey Overview. Available from URL: http://www.cdc.gov/healthyyouth/yrbs/pdf/us_overview_yrbs.pdf.

School violence is a growing issue.

Linda Carroll of NBC News reported in the story, School violence lands more than 90,000 a year in the ER, study finds:

Despite all the lip service given to battling bullying, many kids are still being seriously hurt while on school grounds, a new study shows. Each year more than 90,000 school children suffer “intentional” injuries severe enough to land them in the emergency room, according to the study published in Pediatrics.
Though there was a decrease in the number of intentional injuries at school over the last 10 years, it was minor, said study co-author Dr. Siraj Amanullah, an assistant professor of emergency medicine and pediatrics at the Alpert Medical School at Brown University.
“We were surprised,” Amanullah said. “With so much emphasis on school safety and bullying now, we expected a bigger decline. Ninety-thousand per year is quite huge.”
And keep in mind, Amanullah said, the study was only looking at kids who turned up in the ER. This could just be the tip of the iceberg.
“Bullying is so underreported,” said Amanullah, adding that children are still reluctant to tell anyone because often little gets done about it. “We were hoping this study would bring more attention to the problem.”
Amanullah and his colleagues pored through data from the National Electronic Injury Surveillance System — All Injury Program collected from January of 2001 through December of 2008. The ER reports include a plethora of detail, including the type of injury, whether it occurred at school and whether it was the result of an accident or was intentional.
While cuts and bruises were the most common injuries at 40 percent, fractures accounted for 12 percent, brain injuries for 10 percent and sprains and strains another 7 percent. The vast majority of injuries — 96 percent — were the result of an assault, with most perpetrators identified as friends or acquaintances. A full 10 percent of the assaults involved multiple perpetrators.
Part of the problem may be the adults that kids model themselves after. An article published in the same issue of Pediatrics reported that bullying behavior by coaches is quite high — and that the schools often make excuses for the behavior if it’s a winning coach.
A survey cited in the article found that 45 percent of kids “reported verbal misconduct by coaches, including name-calling and insulting them during play.”
During the study period, a total of 7,397,301 injuries occurred at school, of which 736,014 were intentional. The new study shows “that almost 10 percent of injuries are intentional, which means there’s a lot of violence going on in the schools that doesn’t include football, or hockey, or volleyball or tripping and falling and getting hurt,” said Patrick Tolan, a professor at the University of Virginia and director of Youth-Nex, the U.Va. Center to Promote Effective Youth Development.
Part of the solution may be increased monitoring of the kids, Tolan said. “Every school should assume they have an issue,” he added. “They should be looking at where and how both intentional and unintentional injuries are occurring….” http://www.nbcnews.com/health/school-violence-lands-more-90-000-year-er-study-finds-2D11898820

Citation:

Emergency Department Visits Resulting From Intentional Injury In and Out of School
1. Siraj Amanullah, MD, MPHa,b,c,
2. Julia A. Heneghan, MDc,d,
3. Dale W. Steele, MD, MSa,b,
4. Michael J. Mello, MD, MPHa,c, and
5. James G. Linakis, PhD, MDa,b,c
+ Author Affiliations
1. Departments of aEmergency Medicine and
2. bPediatrics, Alpert Medical School of Brown University, Providence, Rhode Island;
3. cInjury Prevention Center, Rhode Island Hospital, Providence, Rhode Island; and
4. dDepartment of Pediatrics, Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
Abstract
BACKGROUND AND OBJECTIVE: Previous studies have reported concerning numbers of injuries to children in the school setting. The objective was to understand temporal and demographic trends in intentional injuries in the school setting and to compare these with intentional injuries outside the school setting.
METHODS: Data from the National Electronic Injury Surveillance System–All Injury Program from 2001 to 2008 were analyzed to assess emergency department visits (EDVs) after an intentional injury.
RESULTS: There were an estimated 7 397 301 total EDVs due to injuries sustained at school from 2001 to 2008. Of these, an estimated 736 014 (10%) were reported as intentional (range: 8.5%–10.7% for the study time period). The overall risk of an EDV after an intentional injury in school was 2.33 (95% confidence interval [CI]: 1.93–2.82) when compared with an EDV after an intentional injury outside the school setting. For intentional injury–related EDVs originating in the school setting, multivariate regression identified several demographic risk factors: 10- to 14-year-old (odds ratio [OR]: 1.58; 95% CI: 1.10–2.27) and 15- to 19-year-old (OR: 1.69; 95% CI: 1.01–2.82) age group, black (OR: 4.14; 95% CI: 2.94–5.83) and American Indian (OR: 2.48; 95% CI: 2.06–2.99) race, and Hispanic ethnicity (OR: 3.67; 95% CI: 2.02–6.69). The odds of hospitalization resulting from intentional injury–related EDV compared with unintentional injury–related EDVs was 2.01 (95% CI: 1.50–2.69) in the school setting. These odds were found to be 5.85 (95% CI: 4.76–7.19) in the outside school setting.
CONCLUSIONS: The findings of this study suggest a need for additional prevention strategies addressing school-based intentional injuries.

Here is the press release from Hasbro Children’s Hospital:

Hasbro Children’s Hospital National Study Finds High Number of Pediatric Injuries Caused by Violence at School
1/14/2014
________________________________________
Siraj Amanullah, MD, MPH, an emergency medicine attending physician at Hasbro Children’s Hospital, recently led a study that found children between the ages of five and 19 still experience a substantial number of intentional injuries while at school. The study, titled “Emergency Department Visits Resulting from Intentional Injury In and Out of School,” has been published online ahead of print in the journal Pediatrics.
Amanullah’s team analyzed data from the National Electronic Injury Surveillance System All Injury Program from 2001 to 2008 to assess emergency department (ED) visits after an intentional injury. Of an estimated 7.39 million emergency department visits due to injuries occurring at school, approximately 736,014 (10 percent) were reported as intentional, such as those from bullying and peer-to-peer violence.
“This study is the first of its kind to report such a national estimate,” said Amanullah. “The 10 percent number may not seem large, but it is alarmingly high when you consider that such a significant number of intentional injuries are occurring in the school setting, where safety measures meant to prevent these sorts of injuries, are already in place.”
The study also identified gender and age disparities. Boys were most likely to be identified as at risk for intentional injury-related ED visits from within the school setting, along with all students in the 10- to 14-year age group; whereas girls were most at risk for intentional injury-related ED visits from outside of the school setting, along with the 15- to 19-year age group.
Additionally, both African-American and Hispanic ethnicities were found to be associated with higher risks for intentional injury in the school setting compared to outside school. “The important point about these disparities related to specific ethnicities and specific age groups is that the findings suggest that preventive safety efforts in the school setting may need to be tailored for the groups that carry much of this injury burden,” said Amanullah.
James Linakis, MD, PhD, associate director of pediatric emergency medicine at Hasbro Children’s Hospital and co-author of the study, added, “We know that the risk of hospitalization was found to be higher from intentional injury-related ED visits versus unintentional injuries.” Linakis continued, “In supervised environments such as schools, we have a great opportunity to implement additional prevention strategies and reduce the number of seriously injured children who we are seeing in emergency departments nationwide.”
The study highlights the continued public health impact of bullying and peer-to-peer violence. While there are substantial numbers of emergency department visits due to intentional injuries occurring in U.S. schools, there are still likely many others that do not result in ED visits.
Michael Mello, MD, MPH, director of the Injury Prevention Center at Hasbro Children’s Hospital who also contributed to the study, added a reminder that these injuries not only affect the physical health, but also the emotional health of children, families and both victim and perpetrator. “As parents, guardians and physicians we need to keep talking to our children and patients about this physical and mental health burden. It is our responsibility to address the issue of violence and bullying, both in and out of school, just like prevention efforts for any other medical illness,” said Mello. http://www.lifespan.org/Newsroom/News.aspx?NewsId=64730/Hasbro-Children%E2%80%99s-Hospital-National-Study-Finds-High-Number-of-Pediatric-Injuries–Caused-by-Violence-at-School/#null

One of the best concise guides to preventing school violence is the National PTA Checklist.

The National PTA Checklist recommends the following actions:

1. Talk to Your Children
Keeping the lines of communication open with your children and teens is an important step to keeping involved in their schoolwork, friends, and activities. Ask open-ended questions and use phrases such as “tell me more” and “what do you think?” Phrases like these show your children that you are listening and that you want to hear more about their opinions, ideas, and how they view the world. Start important discussions with your children—about violence, smoking, drugs, sex, drinking, death—even if the topics are difficult or embarrassing. Don’t wait for your children or teens to come to you.
2. Set Clear Rules and Limits for Your Children
Children need clearly defined rules and limits set for them so that they know what is expected of them and the consequences for not complying. When setting family rules and limits, be sure children understand the purpose behind the rules and be consistent in enforcing them.
Discipline is more effective if children have been involved in establishing the rules and, oftentimes, in deciding the consequences. Remember to be fair and flexible—as your children grow older, they become ready for expanded rights and changes in rules and limits. Show your children through your actions how to adhere to rules and regulations, be responsible, have empathy toward others, control anger, and manage stress.
3. Know the Warning Signs
Knowing what’s normal behavior for your son or daughter can help you recognize even small changes in behavior and give you an early warning that something is troubling your child. Sudden changes—from subtle to dramatic—should alert parents to potential problems. These could include withdrawal from friends, decline in grades, abruptly quitting sports or clubs the child had previously enjoyed, sleep disruptions, eating problems, evasiveness, lying, and chronic physical complaints (stomachache or headaches).
4. Don’t Be Afraid to Parent; Know When to Intervene
Parents need to step in and intervene when children exhibit behavior or attitudes that could potentially harm them or others. And you don’t have to deal with problems alone—the most effective interventions have parent, school, and health professionals working together to provide on-going monitoring and support.
5. Stay Involved in Your Child’s School
Show your children you believe education is important and that you want your children to do their best in school by being involved in their education. Get to know your child’s teachers and help them get to know you and your child. Communicate with your child’s teachers throughout the school year, not just when problems arise. Stay informed of school events, class projects, and homework assignments. Attend all parent orientation activities and parent-teacher conferences. Volunteer to assist with school functions and join your local PTA. Help your children seek a balance between schoolwork and outside activities. Parents also need to support school rules and goals.
6. Join Your PTA or a Violence Prevention Coalition
According to the National Crime Prevention Council, the crime rate can decrease by as much as 30 percent when a violence prevention initiative is a community-wide effort. All parents, students, school staff, and members of the community need to be a part of creating safe school environments for our children. Many PTAs and other school-based groups are working to identify the problems and causes of school violence and possible solutions for violence prevention.
7. Help to Organize a Community Violence Prevention Forum
Parents, school officials, and community members working together can be the most effective way to prevent violence in our schools.
8. Help Develop A School Violence Prevention and Response Plan
School communities that have violence prevention plans and crisis management teams in place are more prepared to identify and avert potential problems and to know what to do when a crisis happens. The most effective violence prevention and response plans are developed in cooperation with school and health officials, parents, and community members. These plans include descriptions of school safety policies, early warning signs, intervention strategies, emergency response plans, and post-crisis procedures.
9. Know How to Deal With the Media in a Crisis
Good public relations and media relations start with understanding how the media works and what they expect from organization’s that issue press releases, hold press conferences, and distribute media kits.
10. Work to Influence Lawmakers
Writing an editorial for the local newspaper, holding a petition drive, speaking before a school board meeting, or sending a letter to your legislator can be effective ways to voice your opinion and gain support from decision makers for violence prevention programs in your community. Working with other concerned parents, teachers, and community members, you can influence local, state and even federal decisions that affect the education, safety, and well-being of our children. http://www.pta.org/content.cfm?ItemNumber=984

School violence is a complex set of issues and there is no one solution. The school violence issue mirrors the issue of violence in the larger society. Trying to decrease violence requires a long-term and sustained focus from parents, schools, law enforcement, and social service agencies.

Resources:
A Dozen Things Students Can Do to Stop School Violence http://www.sacsheriff.com/crime_prevention/documents/school_safety_04.cfm

A Dozen Things. Teachers Can Do To Stop School Violence. http://www.ncpc.org/cms-upload/ncpc/File/teacher12.pdf

Preventing School Violence: A Practical Guide http://www.indiana.edu/~safeschl/psv.pdf

Related:

Violence against teachers is becoming a bigger issue https://drwilda.com/2013/11/29/violence-against-teachers-is-becoming-a-bigger-issue/

Hazing remains a part of school culture https://drwilda.com/2013/10/09/hazing-remains-a-part-of-school-culture/

FEMA issues Guide for Developing High-Quality School Emergency Operations Plans https://drwilda.com/2013/07/08/fema-issues-guide-for-developing-high-quality-school-emergency-operations-plans/

Study: 1 in 3 teens are victims of dating violence https://drwilda.com/2013/08/05/study-1-in-3-teens-are-victims-of-dating-violence/

Pediatrics article: Sexual abuse prevalent in teen population https://drwilda.com/2013/10/10/pediatrics-article-sexual-abuse-prevalent-in-teen-population/

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