Mental Health Recovery and Support Services

1. A Non-profit Behavioral Health Managed Care Company Bullying 04/15/11 - Pocono Medical Center In partnership with Richard Silbert, M.D. Senior Medical Director Community Care 570-496-1311 silbertrr@ccbh.com

2. AHECArea Health Education Center • Enhancing access to health care through educationCommunity experiences for health professions’ students Promoting Health Careers Preceptor / health practitioner support Support of community partners

3. Director of Advocacy and Community Mental Health Services Kathy Wallace Our mission is to promote mental well-being, support Recovery for adults who have a mental illness, Resiliency in children and adolescents who have emotional disorders and Everyday Lives for persons who have mental retardation and other developmental disabilities and provide to them advocacy and culturally competent services. Scranton Administrative Office 846 Jefferson Avenue, P.O. Box 1368Scranton, PA 18501 Toll Free: 1 (877) 315-6855TTY: 1 (877) 962-5593 Wilkes-Barre, Pottsville, Allentown, Hershey Bloomsburg, Lehighton

4. Announcing: A.F.S.P. of Greater NE PA coming ~ July 2011 The American Foundation for Suicide Prevention (AFSP) is the leading national not-for-profit organization exclusively dedicated to understanding and preventing suicide through research, education and advocacy, and to reaching out to people with mental disorders and those impacted by suicide. www.afsp.org www.outofthedarkness.org

5. About Community Care… • Founded in 1996 • Licensed 501 (c)3 (not-for-profit) behavioral managed care company • Part of UPMC – an integrated health system in Western PA • Major focus – publicly funded behavioral health care system • Presence across the state, now including Erie and in New York

6. Australian Kids & PSA on Bullying

7. Bullying is Not a Fact of Life – Change Your Attitude • Every bullying episode really has three victims: the bullied (or target), the bully, and the bystander. • The “Bystander”: New research suggests that students who witness their peers endure verbal or physical abuse could become as psychologically distressed, if not more so, by the events as the victims themselves. • American youths rate bullying and teasing as their biggest problem according to a survey by the Kaiser Family Foundation. • Bullying affects a child’s health … interferes with learning and can lead to absenteeism and in some instances to school violence. • 2/3 of the 41 school shooters in 37 incidents reported that it was because they were bullied and were motivated to get revenge. • Last month, Senator Bob Casey introduced the Safe Schools Improvement Act in Congress. • Just 20% Of Children Who Are Picked On Tell A Teacher And Only 50% Tell A Parent.

8. Pennsylvania • H1067(2008) requires each school to adopt or amend an existing policy on bullying and incorporate it into the school code of conduct. ("School setting" is defined as the school, school grounds, in school vehicles, at a school bus stop, or any activity sponsored, supervised or sanctioned by the school.) • Cyber BullyingH1067(2008) includes an "intentional electronic act" in its definition of bullying in the school setting and requires each school to adopt or amend an existing policy on bullying and incorporate it into the school code of conduct. • HazingNo state policy addressing elementary or secondary schools. Source:National Association of State Boards of EducationLast Updated: 4/6/2009

9. Identify red flags indicating the presence of bullying • Some children may withdraw, while others may get angry and seek revenge. • Unexplained damage or loss of clothing and other personal items; • Evidence of physical abuse, such as scratches; • Loss of friends; • Reluctance to participate in activities; • Loss of interest in favorite activities; • Unusually sad, lonely or depressed; • Unusually angry and aggressive; • Problems with eating or sleeping; • Headaches, stomachaches, or other physical complaints; • Decline ins school achievement; and/or • Thoughts of suicide.

10. Cyberbullying - said to be the worst kind of bullying. Electronic harassment is as real as and often more frightening than face to face bullying. Much like stalking or other types of assault the victim can often feel helpless, frozen, isolated, ashamed and not likely to reveal what is going on to parents or sometimes even to friends. Cyber Bullying is verbal and indirect bullying and involves using electronic devices such as computers, cell phones and pagers to harass others by posting comments or pictures on blogs, Web sites, text messaging, instant messaging and e-mails. Cyberbullying can involve: • Spreading rumors • Instant messaging hurtful messages • Getting others to post or send hurtful messages • Excluding someone from an online group

11. It is intended to make the victim feel frightened, humiliated, helpless and too often – hopeless. • Cyberbullying is anonymous. Perpetrators can torture and harass without detection. • Cyberbullying is relentless. It can be conducted 24/7 appearing constantly on the phone and computer that a young person uses on a daily basis for school and social connections. • Cyberbullying assaults privacy boundaries in a way that magnifies the horror as it makes damaging material public to an infinite audience that can instantly download, save or forward to others.

12. Warning Signs of Cyberbullying Your child/student may be a victim of cyberbullying if he/she: • Unexpectedly stops using their computer or cell phone; • Appears nervous or jumpy when an instant message or email appears; • Appears uneasy about going to school or outside in general; • Appears to be angry, depressed, or frustrated after using the computer or cell phone; • Avoids discussion about what they are doing on the computer or cell phone; or • Becomes withdrawn from usual friends and family members.

13. AAP Suggested Questions – Does your child: • come home with torn, damaged, or missing pieces of clothing, books or other belongings? • have unexplained bruises, cuts or scratches? • seem afraid of going to school, walking to and from school, riding the school bus or taking part in organized activities with peers? • appear sad, moody, teary or depressed when he or she comes home? • frequently appear anxious and/or suffers from low self-esteem?

14. The Extent of Bullying - With Cyberbullying the extent it occurs needs to take into consideration after school. • Suicide - kids who are bullied tend to be 5 times more likely to be depressed, boys are 4 times more likely to be suicidal; bullied girls are 8 times more likely to be suicidal. • It should be emphasized that the data from studies are average estimates that do not highlight the great variation between different schools. Even within the same community/school district, one school may experience bullying problems at a level two or three times higher than that of another school.

15. Extent con’t. • Four in ten teens have experienced online bullying • Girls are twice as likely to be victims and perpetrators, usually engaging in social sabotage of others • Boys are more likely to target girls and less aggressive males; • Sexual and homophobic harassment is emerging as a prevalent aspect of cyberbullying • Cyberbullying is most prevalent among 15 and 16 year olds • The more that young people share their identities and thoughts on social networking sites as Twitter and Facebook, the more likely they are to be targets than those who do not use the sites. • Non-physical forms of bullying are most prevalent.

16. As of October 2010…. • New data on bullying show that 17 percent of American students report being bullied two to three times a month or more within a school semester, with girls and boys having similar rates. For students who have been bullied, significant numbers reported being bullied for long periods. • 16 percent of girls boys reported having been bullied for about a year. • 23 percent of girls and 30 percent of boys said they had been bullied for several years. • 7.5% of students reported being bullied because of actual or perceived sexual orientation.

17. Cyberbullying • Four in ten teens have experienced online bullying • Girls are twice as likely to be victims and perpetrators, usually engaging in social sabotage of others • Boys are more likely to target girls and less aggressive males; • Sexual and homophobic harassment is emerging as a prevalent aspect of cyberbullying • Cyberbullying is most prevalent among 15 and 16 year olds • According to surveys, only 35% of cyberbullied teens and 51% of preteens told parents. –(WHY?)

18. 2009 PA Youth Survey or PAYS PA Commission on Crime and Delinquency

19. What are the long-term consequences of teen bullying behavior? Teens (particularly boys) who bully- • Are more likely to engage in other antisocial/delinquent behavior (e.g., vandalism, shoplifting, truancy, and drug use) into adulthood. • Are four times more likely than nonbullies to be convicted of crimes by age 24, with 60 percent of bullies having at least one criminal conviction. Teens who are bullied- • May develop physical symptoms such as headaches, stomach pains, or sleeping problems. • They may be afraid to go to school, go to the bathroom or play on the playground at school, or ride the school bus. • They may also lose interest in school, have trouble concentrating, and do poorly academically.

20. Effects of Bullying Bullied • Low self esteem • Anxiety • Feelings of helplessness • Self-blame for problems • Social withdrawal • Excessive dependence • Depression • Headaches • Sleep problems • Suicide • School shootings Bullies • Bullies damage themselves. – Every time they bully they become more removed emotionally and learn that they get what they want through force. • Bullies are 4 times more likely to be convicted of a crime. • Higher rate of school drop outs for both bullies and those bullied.

21. Who May be Bullies? Children and adolescents who seek to intimidate others through bullying may have any of the following disorders: 1. Conduct disorder: -great difficulty following rules and behaving in a socially acceptable way. They are often described as delinquent, rather than mentally ill. Although these children usually have low self-esteem, they often project an image of toughness. Many children with a conduct disorder may also have coexisting conditions including mood disorders, anxiety, PTSD, or ADHD. 2. Oppositional Defiant Disorder. - an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the youngster‘s daily functioning. Research shows that youngsters with conduct and oppositional defiant disorders are likely to have ongoing problems adjusting to adulthood if they and their families do not receive early and comprehensive treatment. 3. Depression. Children who bully are often suffering from depression themselves.

22. As of January 2011…. Now new research suggests that bullying by peers can increase the risk of the victim developing psychotic symptoms later in life. • The new study, published in the American Journal of Psychiatry, used valuable data from the Environmental Risk Longitudinal Twin Study, which follows 2,232 twin children and their families. Mothers of the children were interviewed and, at age 12, children were asked about bullying experiences and psychotic symptoms, such as hallucinations, delusions or paranoia. The presence of psychotic symptoms was verified by a doctor. • The study found that children who were bullied by peers were more than twice as likely to experience psychotic symptoms at age 12 compared with children who did not suffer similar trauma. This risk remained present even when the researchers controlled for other factors that could contribute to mental illness, such as socioeconomic deprivation, IQ and genetic disposition to mental illness. Children who were bullied and who also experienced maltreatment by adults were more than five times more likely to develop psychotic symptoms. However, enduring a traumatic accident did not significantly increase the risk. • All types of trauma were associated with a higher risk for psychotic symptoms at age 12, but the effect was especially strong and consistent across time for trauma characterized by intention to harm.

23. Known and Effective Prevention Techniques Bullying programs need a comprehensive and integrated approach, school, parents & teachers as partners, based on clear expectations and consistent consequences, followed by counseling for perpetrators, support for victims, and education of the silent majority. • To start: Give a student questionnaire and a staff survey to determine the nature and the extent of the problem. • Hold teacher in-services to review results of the survey/questionnaires, discuss the problem and plan. • Provide training for all school staff. • Make sure students know what bullying is. Use classroom trainings. Teach students what to do when they observe bullying. • Establish a confidential reporting system in the school that allows students to report victimization. • Develop strategies to reward students for positive behavior. • Take immediate action/intervention when bullying is observed.

24. Here’s What Kids Need to Know: • Never give out personal information online, whether in instant message profiles, chat rooms, blogs, or personal websites. • Never tell anyone but your parents your password — not even friends. • If someone sends a mean or threatening message, Stop- Don’t respond to the bully- even to the first offense -it only escalates the problem. • Save the evidence- print copies and save the messages.  Young children can be instructed to shut off the monitor if something upsetting appears (not the computer) and/or CALL YOU. • Never open e-mails from someone you don’t know or from someone you know is a bully. • Don’t put anything online that you wouldn’t want your classmates to see, even in e-mail. • Don’t send messages when you’re angry. Before clicking "send," ask yourself how you would feel if you received the message. • Help kids who are bullied online by not joining in and showing bullying messages to another.

25. Bullying doesn’t end at the school doors. • Expect Respect- that goes for parents and teachers too. You cannot have an anti-bullying program without parents and teachers role modeling respect! • Community activities- make program known in community. What Parents can DO for Cyberbullying: • Keep your home computer is a busy area of your house. • Set up e-mail and chat accounts with your children. Make sure that you know their screen names and passwords and that they don’t include any personal information in their online profiles. • Regularly go over their instant messenger "buddy list" with them. Ask who each person is and how your children know him or her. • Discuss cyber-bullying with your children and ask if they have ever experienced it or seen it happen to someone. • Tell your children that you won’t blame them if they are cyber-bullied. Emphasize that you won’t take away their computer privileges – this is the main reason kids don’t tell adults when they are cyber-bullied.

26. What Doesn’t Work • A school-wide assembly to discuss bullying-Simple, Short Term Solutions and piece meal approach such as just lessons teaching children, staff in-service, and/or school assembly. • Zero Tolerance Policies – • Affects too many children (1 in 5 admit to bullying). • Threats of severe punishment may discourage adults and children from reporting bullying they observe. • Children who bully need positive and pro-active role models. 3. Conflict Resolution/Peer Mediation • Bullying is a form of victimization, not conflict. • Mediating a bullying incident sends the message that both parties are responsible. The appropriate message is that no one should ever be bullied and we are going to immediately stop it. • Mediation further victimizes the child who has been bullied. It will be upsetting to the child to face his or her tormentor in mediation. 4. Group treatment for Children Who Bully. • Group members reinforce others’ anti-social behaviors

27. What to Do When Bullying Continues or Gets Worse and you need additional help, consider

28. Information and Data on Injuries & Costs • MILLIONS of dollars have been paid out to students and teachers who have been bullied or injured in public schools. • Legal experts believe the figures estimated may be just the tip of the iceberg. Under laws introduced several years ago people are ineligible for compensation unless left with permanent psychological damage assessed at greater than 10 per cent. To win compensation for physical injuries, they must prove body damage of more than 5 per cent.

29. The Economic Cost of Sexual Orientation Bullying at School California stats: Harassment based on actual or perceived sexual orientation costs California school districts at least $39.9 million each year due to school absenteeism due to feeling unsafe to attend school. Legal action adds to the overall costs.

30. LGBTQ • Nine out of 10 LGBT students (86.2%) experienced harassment at school; three-fifths (60.8%) felt unsafe at school because of their sexual orientation; and about one-third (32.7%) skipped a day of school in the past month because of feeling unsafe (GLSEN National School Climate Survey 2009). • LGBT students are three times as likely as non-LGBT students to say that they do not feel safe at school (22% vs. 7%) and 90% of LGBT students (vs. 62% of non-LGBT teens) have been harassed or assaulted during the past year. (GLSEN From Teasing to Torment 2006) Sexual minority youth, or teens that identify themselves as gay, lesbian or bisexual, are bullied two to three times more than heterosexuals. (Nationwide Children's Hospital, Columbus, OH 2010) • LGBT youth in rural communities and those with lower adult educational attainment face particularly hostile school climates (JG, Greytak EA, Diaz EM – Journal of Youth & Adolescence 2009)

31. Resources used for this program come from: www.eyesonbullying.org Children, Youth and Families Education and Research Network Cyberbullying Research Center http://www.stopbullying.gov/ The American Academy of Child and Adolescent Psychiatry (AACAP) American Academy of Pediatrics http://www.aap.org/