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A Study of Violence in Schools _______________________________________________________________ Krisi Howe The College of Idaho February 2013 ii Abstract The American Psychological Association (APA) guidelines provide rules for preparing manuscripts. This template provides a basic layout based upon the 6th edition of these guidelines. The APA guidelines define an abstract as a single paragraph, without indentation, that summarizes the key points of the manuscript. The purpose of the abstract is to provide the reader with a brief overview of the paper. The total length should not exceed 120 words, with each sentence written concisely. iii Table of Contents Abstract ............................................................................................................................... ii List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter One: Introduction .................................................................................................. 1 Background of the Problem .................................................................................... 1 Statement of the Problem and Purpose ................................................................... 1 Research Questions ................................................................................................. 1 Significance............................................................................................................. 1 Delimitations ........................................................................................................... 1 Limitations .............................................................................................................. 1 Definitions............................................................................................................... 1 Assumptions............................................................................................................ 1 Chapter Two: The History of Violence in Schools ............................................................. 2 Introduction ............................................................................................................. 2 Chapter Three: International Violence in Schools .............................................................. 3 Introduction ............................................................................................................. 3 Chapter Four: Bullying in Schools ..................................................................................... 4 Introduction ............................................................................................................. 4 Chapter Five: Cyberbullying............................................................................................... 5 Introduction ............................................................................................................. 5 Chapter Six: Mental Health Issues and School Violence ................................................... 6 Introduction ............................................................................................................. 6 Significance............................................................................................................. 6 iv Early School Prgrams ............................................................................................. 8 Treatment ................................................................................................................ 8 Current Research ................................................................................................... 10 Conclusions ........................................................................................................... 11 Chapter Seven: Traditional Preventive Programs ............................................................. 14 Introduction ........................................................................................................... 14 Chapter Eight: Innovative Approaches to School Violence ............................................. 15 Introduction ........................................................................................................... 15 Chapter Nine: Case Study-Attitudes of Caldwell Teachers .............................................. 16 Introduction ........................................................................................................... 16 Descriptive Statistics or Demographic Data ......................................................... 16 Findings from Open-Ended Questions.................................................................. 17 Chapter Ten: Conclusions and Recommendations ........................................................... 18 Conclusions ........................................................................................................... 18 Recommendations for Practice ............................................................................. 18 Recommendations for Future Study ..................................................................... 18 References ......................................................................................................................... 19 Appendix A ....................................................................................................................... 20 Appendix B ....................................................................................................................... 24 Appendix C ....................................................................................................................... 25 v vi List of Tables vii List of Figures 1 Chapter One: Introduction Background of the Problem . Statement of the Problem and Purpose Research Questions The following questions guide this study: 1. xxxxxxxxxxx? 2. yyyyyyyyyyy? Significance This study will have significance Delimitations The following were delimiting factors for this study Limitations The following factors were limitations affecting the study Definitions 1. xxxxxx 2. xxxxxx Assumptions The following assumptions guide this study 2 Chapter Two: The History of Violence in Schools Introduction 3 Chapter Three: International Violence in Schools Introduction 4 Chapter Four: Bullying in Schools Introduction 5 Chapter Five: Cyberbullying Introduction 6 Chapter Six: Mental Health Issues and School Violence Introduction On April 16, 2007, Seung-Hui Cho killed 32 people, wounded many others, and ended his massacre by committing suicide on the campus of Virginia Tech in Blacksburg, Virginia. Seven months later on December 5, 2007, Robert Hawkins shot and killed 8 people at a Von Maur department store in Omaha, Nebraska. Even more recent is the shooter of the Batman movie theater massacre in Aurora, Colorado, who was later identified as PhD student James Holmes. Holmes killed at least 12 people and injured as many as 50, during the midnight premiere of the movie at the Century 16 Movie Theaters in Aurora early July 20, 2012. Just a mere five months later, on December 14, 2012, Adam Lanza fatally shot twenty children and six adult staff at Sandy Hook Elementary School in the village of Sandy Hook in Newtown, Connecticut. Before driving to the school, Lanza shot and killed his mother, Nancy Lanza, at their Newtown home. As first responders arrived, Lanza committed suicide by shooting himself in the head. After each of these crimes, it was quickly reported that the perpetrators had previously received psychiatric care, prompting questions as to whether and how their mental illnesses may have led to these appallingly violent acts, whether mental health professionals could have (or should have) foreseen such massacres, and whether adequate treatment might have prevented them. Significance The relationship between mental illness and violence has been the subject of scientific research for the past 20 years, during which substantial progress has been made in identifying the risk factors empirically related to violence (1). The relationship 7 between mental illness and violence has a significant effect on mental health practice (2) and policy (3), guides allocation of the limited resources in the mental health and criminal justice systems (4), and serves as the basis for imposing mandatory treatment to protect public safety at the expense of patients’ self-determination and liberty (5). Reliable data is needed to properly inform public perception about the relationship between mental illness and dangerousness (6) to avoid potentially unwarranted stigmatization of people with mental illness (7). The scientific literature on the association between mental illness and violence is inconclusive for several reasons. First, to establish that mental illness causes violence, it is necessary (though not sufficient) to demonstrate that mental illness precedes later violence; however, cross sectional epidemiological studies analyze correlations between past violence and current or lifetime psychiatric diagnoses. Second, when research has been longitudinal, it has primarily focused on the risk of violence for individuals already in clinical or institutional settings (9) instead of samples representative of the general population. Research using those longitudinal samples has contributed substantially to understanding important risk factor for violence in people with mental illness (10) but, by virtue of the inclusion criteria used, is arguably limited in describing whether or to what extent severe mental illness is an independent risk factor for violence. Third, empirical studies often combine all violent acts into one composite variable (11) owing to limited statistical power to distinguish specific forms of violent acts (i.e. substance-related violence, severe violence with weapons), leaving unanswered the question of whether mental illness predicts some kinds of violence but not others. 8 Early School Programs Psychologists have found that children who act in antisocial ways are less likely to be accepted by classmates and teachers. They participate less frequently in classroom activities and do more poorly in school than their more emotionally positive, pro-social counterparts (11). These programs have also shown effectiveness in reducing the likelihood that children will engage in delinquent behaviors. Another factor that will be further considered later is the unfortunate lack of the resources and funding in schools that would be necessary in order to support school-based mental health programs meaning that kids are simply not receiving treatment (20). School-based mental health consultation programs, for example, pair psychologists, social workers, and psychiatrists with local school districts in order to identify, assess, and treat young children who are in serious emotional and behavioral trouble (12). Clinicians from local community mental health organizations observe classrooms, provide teachers with training, and provide child- and family-centered psychotherapy. However, programmatic success is reliant in great measure on the extent to which programs succeed in enlisting families' participation. It may also be unreasonable to expect long-term emotional and behavioral gains on the part of young children if their families continue to face chronic, structural stressors that erode children's psychosocial health (13). Treatment According to CNN journalist Aaron Carroll in 2012, the funding for mental health programs in schools is lacking tremendously and not only that, but public opinion is still split on the matter of how to treat and diagnose those with mental disorders. With 9 resources lacking the general consensus on managing those suffering from mental health disorders is more reactive than preventative. This is evidenced in observing the American juvenile justice system, which certainly provides an array of rehabilitation programs, but none of which are offered until after the student has already committed a crime. Public opinion varies on how to address this issue. Many believe that corrective facilities are to function as environments aimed at retributive justice for the victims. Unsettled opinions on the matter of how to go about treatment, whether treatment is rightfully deserved or functions as only a Band-Aid to a major problem or who exactly should be paying for all these programs brings to light the fact that this is a huge research problem, clinical problem and societal problem in our nation that is just beginning to surface. In a survey conducted by our small research group an anonymous participant advocated, “I think that there needs to be some mandatory reporting from mental health professionals. Adam Lanza and the others who have committed these acts have already broken laws by bringing guns to school. I think more awareness of these individuals that live close to or have a connection with a school, kind of like sexual predator identification should be implemented.” Many different suggestions have been made as to how to go about getting funding for school driven mental health programs and how to sway society from being reactionary to being preventative in providing rehabilitation treatment. This has raised other issues though including where to draw the line in terms of the privacy and confidentiality for persons with mental disorders and how to go about making people aware of their special cases without furthering stigmatization. A large amount of the public actually agree with our survey participant and in fact want a national database of the mentally ill, which would be posted for the public. The National 10 Rifle Association has been the biggest supporters of this public database and released a statement saying 38 states have the technology and public support to launch the site now. Current Research Recent studies bearing on the relationship between psychiatric disorder and violent behavior suggest that although risk of violence is elevated somewhat in persons with severe mental illness (15) the large majority of these persons do not commit violent acts (16), and the causal determinants of violent behavior in this group are perhaps as varied and complex as those in the general population (17). Psychopathology seldom leads to assault, but it may converge with other risk factors that, together, significantly increase the likelihood of violent behavior (18). Numerous surveys of psychiatric inpatients, outpatients, homeless and mentally ill persons, and emergency room patients have found that a large proportion of persons in treatment for mental health problems have at some time been victims of violent physical or sexual abuse (19). The long-term psychological effects of victimization and trauma exposure may be compounded by substance abuse, homelessness, adverse social environments, and treatment noncompliance—with the net result that risk of violence is markedly increased in certain subgroups of persons (19). To what degree does each of these kinds of variables contribute—independently or in convergence—to violent actions by persons with mental illness? Jeffrey W. Swanson, PhD in the Department of Psychiatry and Behavioral Sciences, at Duke University Medical Center, examined this question using a multivariate analysis of pooled samples of treated individuals with SMI in 4 states N=802). 11 This study examined the prevalence and correlation of violent behavior by individuals with severe mental illness. The Participants (N = 802) were adults with psychotic or major mood disorders receiving inpatient or outpatient services in public mental health systems in 4 states. After 1-year of the study the prevalence of serious assaultive behavior was 13%. Three variables—past violent victimization, violence in the surrounding environment, and substance abuse—showed a cumulative association with risk of violent behavior. Violence among individuals with severe mental illness is related to multiple variables with compounded effects over the life span. Interventions to reduce the risk of violence need to be targeted to specific subgroups with different clusters of problems related to violent behavior. Conclusions According to Jeffrey Swanson’s research severe mental illness does not independently predict future violent behavior, challenging perceptions that mental illness is a leading cause of violence in the general population. Still, people with mental illness did report violence more often, largely because they showed other factors associated with violence. Consequently, understanding the link between violent acts and mental disorder requires consideration of its association with other variables such as substance abuse, environmental stressors, and history of violence. Numerous public shootings have sparked countless government studies aimed at examining how postsecondary institutions can improve the identification of students with serious mental illnesses and provide them with appropriate treatment. University officials also face confusion about when it is appropriate and legal to release educational and health information that is generally covered by privacy laws. 12 Despite widespread media attention following violent attacks on college campuses, evidence exists that colleges are actually less prone to violent crimes than society in general. According to a report prepared by the School Violence Resource Center, the overall U.S. murder rate is 43 times higher than the murder rate on college campuses. The rates of forcible rapes, robberies and aggravated assaults are also significantly lower on college campuses. Nevertheless, when violent incidents occur, the public is quick to point out the need for improved safety measures on college campuses. One of the most common responses to campus violence at both the state and university levels has been the creation and use of threat assessment teams (13). These teams take a coordinated approach to identify, prevent and assess behavioral threats to public safety on college campuses. While details of these teams vary somewhat among institutions, numerous colleges nationwide have created multidisciplinary teams that are both investigational and interventional. In the wake of the Virginia Tech shootings, Virginia’s legislature passed more than 30 bills dealing with a variety of issues raised by the shootings. One bill signed into law by Governor Kaine requires state colleges in Virginia to develop crisis and emergency plans and campus threat assessment teams. Another policy focus is to ensure that mental health services are available to students at postsecondary institutions. A report to the Massachusetts Department of Higher Education in June 2008 found that 83 percent of its colleges provide on-campus mental health services for students. Among those schools, however, only about half provided specialized services (e.g. substance abuse, suicide prevention and eating 13 disorders). The report recommends that all colleges provide both generalized and specialized mental health services that are easily accessible to students. 14 Chapter Seven: Traditional Preventive Programs Introduction 15 Chapter Eight: Innovative Approaches to School Violence Introduction 16 Chapter Nine: Case Study-Attitudes of Caldwell Teachers Introduction Descriptive Statistics or Demographic Data Note: Below is the format for tables in APA 6th edition For example: 17 Findings from Open-Ended Questions 18 Chapter Ten: Conclusions and Recommendations Conclusions The results of this study support the contention that Recommendations for Practice Recommendations for Future Study 19 References 20 Appendix A 1. Steadman HJ, Mulvey EP, Monahan J, Robbins PC, Appelbaum PS, Grisso T, Roth LH, Silver E. Violence by People Discharged from Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods. Arch General Psychiatry. 1998; 393-401. 2. Friedman RA. Violence and Mental Illness: How Strong is the Link? New England Medical. 2006; 2064-2066. 3. Appelbaum PS. Violence and Mental Disorders: Data and Public Policy. American Psychiatry. 2006; 1319-1321. 4. Cole TB, Glass RM. Mental Illness and Violent Death: Major Issues for Public Health. JAMA. 2005; 623-624. 5. Monahan J, Bonnie RJ, Appelbaum PS, Hyde PS, Steadman HJ, Swartz MS. Mandated Community Treatment: Beyond Outpatient Commitment. Psychiatry Serv. 2001; 1198-1205. 6. Penn DL, Kommana S, Mansfield M, Link BG. Dispelling the Stigma of Schizophrenia II: the Impact of Information on Dangerousness. Schizophr Bull. 1999; 437-446. 7. Silver E, Teasdale B. Mental disorder and violence: an examination of stressful life events and impaired social support. Soc Probl. 2005; 62-78. 8. Harris GT, Rice ME. Risk Appraisal and Management of Violent Behavior. Psychiatry Serv. 1997; 1168-1176. 9. Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, Wagner HR, Rosenheck RA, Stroup TS, McEvoy JP, Lieberman JA. A National Study of Violent Behavior in Persons with Schizophrenia. Arch Gen Psychiatry. 2006; 490-499. 21 10. Elbogen EB, Van Dorn R, Swanson JW, Swartz MS, Monahan J. Treatment Engagement and Violence Risk in Mental Disorders. Br J Psychiatry. 2006; 354360. 11. Grossman D, Neckerman H, Koepsell T, Liu P, Asher K, Beland K, Frey K, Rivara FP: Effectiveness of a Violence Prevention Curriculum among Children in Elementary School. JAMA 1997; 1605–1611. 12. Olweus D: Bullying among Schoolchildren: Intervention and Prevention, in Aggression and Violence Throughout the Lifespan. Edited by Peters R, McMahon R, Quincy V. London, Sage Publications, 1992; 100–125. 13. Limber SP, Nation MM: Bullying Among Children and Youth, in Combating Fear and Restoring Safety in Schools. Edited by Ar- nette JL, Walsleben MC. Washington, DC, US Department of Jus- tice, Office of Juvenile Justice and Delinquency Prevention, 1998; 5. 14. Swanson J, Holzer C, Ganju V, Jono R. Violence and Psychiatric Disorder in the Community: Evidence from the Epidemiologic Catchment Area Surveys. Hospital Community Psychiatry. 1990; 761–770. 15. Swanson J. Mental Disorder, Substance Abuse, and Community Violence: an Epidemiological Approach. In: Monahan J, Steadman H, eds. Violence and Mental Disorder: Developments in Risk Assessment. Chicago, Ill: University of Chicago Press; 1994; 101–136. 16. Estroff S, Swanson J, Lachicotte W, Swartz M, Bolduc M. Risk Reconsidered: Targets of Violence in the Social Networks of People with Serious Psychiatric Disorders. Social Psychiatry Epidemiology. 1998; 95-101. 22 17. Monahan J, Steadman H, Silver E, et al. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence. New York, NY: Oxford University Press; 2001. 18. Goodman L, Rosenberg S, Mueser K, Drake R. Physical and Sexual Assault History in Women with Serious Mental Illness: Prevalence, Correlates, Treatment, and Future Research Directions. Schizophrenic Bull. 1997; 685–696. 19. Mullen P, Martin J, Anderson J, Romans S. The Long-Term Impact of the Physical, Emotional, and Sexual Abuse of Children: A Community Study. Child Abuse and Neglect. 1996; 7–21. 20. Carroll, Aaron E. Get Serious about Mental Health Care. CNN. Cable News Network, 18 Dec. 2012. Web. 04 Feb. 2013. 23 24 Appendix B 25 Appendix C