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Psychiatrists can play a key role in efforts to alleviate the problem of school violence, said a panel of experts at this year's APA annual meeting in Toronto. The biopsychosocial approach to understanding children and families can be useful in preventing violence, working with traumatized children, and evaluating programs for dealing with violence, they said.
The recent rash of school homicides in the United States has pressured schools to implement programs to deal with violence rapidly, said Joan E. Kinlan, M.D., a child and adolescent psychiatrist in Washington, D.C. Efforts range from installing metal detectors to organizing peer mediation programs, she said, but many of them are untested or of questionable value. Other panel members discussed activities and programs that do work to curb violence.
Schools need to establish safe milieux, said Carl Bell, M.D., a clinical professor of psychiatry and public health at the University of Illinois and co-principal investigator of the Chicago African American Youth Health Behavior Project. For example, he said, most schools have a plan for what to do when a firebell rings, but their contingency plans for dealing with violence are not well thought out.
"Kids don't feel safe," he said. "As a result of not feeling that adult protective shield, they bring their own protective shield-guns."
Some policies, such as requiring clear backpacks, not allowing backpacks, using spot metal detectors, and removing lockers can be a deterrence, but they may not be enough, said Bell. The school management needs to deliver a clear message about the safety rules of the schools and give students a notion of ownership.
When everyone-kids, teachers, principals, school board members-are clear about the mission to have a safe environment, kids will feel safer and will even report peers who endanger others' safety, said Bell.
In addition, he continued, bonding and a sense of attachment to the community are important aspects of children's lives that can prevent them from becoming perpetrators of violence. "If parents and kids are attached to the school and children are monitored, you see more responsible behavior," said Bell.
Another important aspect of violence prevention is identifying high-risk kids and dealing with them in constructive ways, said Bell. Teachers can distinguish these children from others by the second grade, he said, but schools don't have constructive ways of dealing with them. The discipline-oriented approaches now used should be replaced with treatment-oriented approaches, he said.
For example, conflict resolution, peer mediation, and mentoring are useful in alleviating problems of violence. "Clearly the social skills training programs do work," said Bell. In addition, he said, children need to be screened to determine who has been traumatized and may have difficulties learning conflict resolution. Training in conflict resolution can actually retraumatize children, making it difficult for them to learn the skills being taught, he said. Some children may need medication to help them to calm down and be able to think, he added.
Engaging children in sports, ROTC, music, volunteer work, and other activities is also an important part of violence prevention, said Bell. Traumatized kids perpetrate violence because they have been in situations that made them feel scared and helpless, he said, and participating in activities helps them develop a sense of accomplishment and power.
"If we can help children take the experience of trauma and sublimate it into a helpful behavior, then we have transformed their difficulties," he commented.
Panelists gave numerous examples of programs in schools that have reduced the number of violent incidents. Joseph J. Palombi, M.D., a child and adolescent psychiatrist in Falls Church, Va., discussed the Curry School of Education at the University of Virginia Youth Violence Project. The project conducts research, provides information, and assists in setting up violence prevention projects.
Panelists encouraged psychiatrists to take an active role in preventing school violence. Normally, everyone does evaluations, but no one does anything about the problems they uncover, said Paul Jay Fink, M.D., a former APA president. Psychiatrists can help schools set up programs, activities, and ways of meeting the needs of individual children, he said. "The schools need us. They have no tools, no sophistication, and very little help."
Kinlan said that many school counselors are poorly trained and don't know what to do to prevent problems of violence. Psychiatrists can mentor them, she said. She advised psychiatrists to work with principals and to start with elementary schools where they may accomplish things more easily.
Fink described his experience as a community activist as an example for psychiatrists who want to work on the problem of school violence. He started the Physician Adopt-a-School program in Philadelphia in which he and other doctors work with schools to prevent violence. In his adopted Pierce Middle School, Fink organized a monthly summit meeting in which about 20 people, including counselors, teachers, the principal, vice principals, community mental health workers, probation officers, and others discuss cases and ways to handle them. We give schools alternatives, he said. When the group requests help from the Philadelphia Department of Human Services, they invite a DHS representative to their meeting to ensure assistance.
"We are empowering people in schools to respond to the needs of their children without being punitive," said Fink.
The large and complex problem of school violence calls for a complex solution, said Bell. "We have to stop being reductionistic. There are many different motivations for violent behavior. We need to tease them out and address them specifically, or we're not going to get very far."
Information on the Youth Violence Project and other related programs can be found on the Web at curry.edschool.virginia.edu/curry/centers/youthvio.