1. 1 Safety at School Verena Wyvill Brown, MD, FAAP

2. 2 Learning Objectives The participant will be able to: Identify logistical issues with schools that increase children’s susceptibility to abuse and neglect while in school. Recognize the impact of bullying as a form of child maltreatment. Discuss teacher-student dynamics that increase susceptibility to sexual abuse, physical abuse, and psychological maltreatment.

3. 3 Scope of Maltreatment at School Maltreatment in schools is a global problem. Includes bullying, physical abuse, sexual abuse, emotional abuse, exploitation, neglect Committed by students and teachers Every country needs to collect data on the scope of violence that children experience, but today’s presentation will provide examples of a few countries that have collected this data.

4. 4 What is Bullying? “Aggressive behavior that is intentional, repeated over time, and involves an imbalance of power or strength.“ - United States Department of Health and Human Services, Stop Bullying Now, 2009

5. 5 Children at Risk for Bullying Children perceived to be different from peers, weak, or not able to defend himself/herself Gender, culture, language, religion, body size, any disability Children with low self-esteem A child with few friends A child who does not get along with peers www.stopbullyingnow.gov

6. 6 “Suffering at School” Violence Against School Children in Malawian Schools Survey (Burton, 2005) Looked at physical, sexual, economic, and emotional violence among primary and secondary school students in Malawi 4, 412 children were interviewed from February to March 2005 Objective of the study was to “assess the extent and nature of gender based violence in Malawian schools”

7. 7 Perceptions of Safety in Malawian School Children 24% of children were afraid of walking to school Reasons for fear: 71% of children feared being attacked 13% of children feared being bullied Older children seemed to have more fears than younger children

8. 8 Perceptions of Safety in Malawian School Children 27% of children knew someone who had problems on the way to school 19% of children had problems themselves

9. 9 Malawi Study: Safety on School Grounds 30% of children feared places on school grounds (school periphery, gardens, sports fields, bathrooms) Feared being physically attacked (45%), sexually attacked (17%), fear of bullies and wild animals (15%)

10. 10 Malawi Study: Who is Bullied Girls were more likely to be bullied than boys All types of violence were more common among children older than age 13 71% of bullied children experienced bullying more than once 58% of children who had been sexually touched had been victimized more than once

11. 11 Malawi Study: Child Experiences Of all children surveyed: 99% reported being bullied 24% were forced to have sex (both penetrative and non-penetrative) 14% had been touched on the genitals or breasts 4% age 13 years and over were forced into oral sex

12. 12 Malawi Study: Bullying by Gender More girls were bullied overall: 36% Boys 64% Girls More girls were victims of sexual touching and forced sex, but boys were affected as well

13. 13 Malawi Study: Children < 13 Years of Age Of children age 13 and younger: 72% experienced bullying, including: Beating Punching Kicking Hitting/Slapping Verbal abuse/Threats Commonly by similar aged children or siblings

14. 14 Malawi Study: Sexual Abuse of Children < 13 years of Age Of children less than 13 years of age: 9% were touched on the genitals and breasts 7% were forced to have sex (both penetrative and non-penetrative)

15. 15 Malawi Study: Perpetrators 94% of bullied children knew their bully 89% of children who were sexually touched knew the perpetrator 89% of children who were forced to have sex knew the perpetrator 61% of children experienced sexual touching by a classmate 49% of younger children were bullied by other classmates

16. 16 Malawi Study: Sexual Abuse by Teachers 1/3 of children reported that teachers at their schools demanded sex in return for good grades 84% of younger children and 34% of older children knew of someone sexually victimized by a teacher 20% of teachers were aware of these transactions 74% of these knew that it was happening at their schools

17. 17 Malawi Study: Reporting 3/5 to 2/3 offences are reported, usually to a parent, teacher, or police Reasons given by children for not reporting They did not feel that reporting was needed Fear Embarrassment Guilt

18. 18 Malawi Study: Sexual Violence Reporting 61% of forced sex reported 64% of sexual touching reported 60% of oral sex reported Girls were more likely to report than boys

19. 19 Malawi Study: Fears About Reporting Sexual Violence Sexual violence at home tended to stay unreported due to: Shame and stigma Fear of lack of support and rejection At school: Fears of further victimization Fear of failure in classroom

20. 20 Malawi Study Conclusions Abuse is common and a source of fear Violence occurs at home, on way to school, and at school Fundamental changes must occur at a societal level about how physical and sexual violence is viewed and dealt with

21. Bullying in Cyprus Study from the Republic of Cyprus (Theoklitou, 2012) 1339 pupils from 4rth to 6th grade 22% experienced overall abuse 9.6% experienced physical abuse 53% experienced neglect 33% experienced emotional abuse No significant difference among grades No difference in teachers’ gender in perpetrating abuse

22. 22 Bullying Prevalence: United States United States Health and Human Services, 2009: 19.9% of high school students bullied on school property 5% of high school students missed at least 1 day of school in 30 days due to fear of bullying on school property or en-route More females than males were victims of bullying

23. 23 Bullying in U.S. by Population

24. 24 Feeling Safe at School in U.S.

25. 25 Emotional Abuse in Zimbabwe Study obtained information from teachers and regional offices of the Ministry of Education (Shumba, 2002) From 1990 to 1997 11 years was the mean age for emotional abuse Study found that female teachers are perceived (by teachers) as the more common perpetrators

26. 26 Zimbabwe Study: Types of Emotional Abuse Perpetrated by Teachers Shouting at students Scolding students for mistakes Using vulgar language toward students Public humiliation of students Placing negative labels on students (stupid, ugly, etc)

27. 27 Zimbabwe Study: Reporting Emotional Abuse Under-reporting was a problem One case was reported during the studied 7 years The teacher had threatened to impregnate his 25 female students Study theorized that the abusive behavior is being seen as a child rearing practice, rather than abuse

28. 28 Bullying and Violent Behavior 1999 Youth Risk Behavior Survey (United States) In 9 through 12 grades: 29% of males (and 6% females) carried guns in previous 30 days 44% males had been in physical fights 27% females had been in physical fights

29. 29 Relationship Between Bullying and Violence Study 2003 United States study looked at whether bullying and being bullied were associated with future violent behavior (Nansel, 2003) Surveyed children from grades 6 through 10

30. 30 Bullying and Violence Results: Violent behavior more common amongst boys 15% of boys had carried weapons in school in past 30 days. Only 4% of girls. Bullying (whether being bullied or being the bully) was associated with greater odds of carrying weapons and fighting (and being injured) Study concluded that there was a strong relationship between bullying and violent behaviors

31. 31 Effects of Bullying Depression Anxiety Loneliness Loss of interest in activities Decreased school achievement Decreased self-esteem Health complaints (stomach aches, headaches) Increase in violent behavior www.stopbullyingnow.gov

32. Effects of Bullying 2012 study of Turkish children: Victims of bullying were 3 times more likely to Feel helpless Feel excluded 2 times more likely to Feel loneliness Have a decreased mood Have sleeping problems Experience morning fatigue 32

33. Effects of Bullying Other symptoms in the study included: Headaches Stomach aches Back aches Bully-Victims also showed increases in these symptoms Bullies were more likely be irritable 33

34. Effects of Bullying on Academic Achievement 2013 study from Norway looked at whether or not bullying affected academic achievement 7343 students ages 15 to 16 21% reported suffering some form of abuse 16.9% by another student 14.6% in the past 12 months 34

35. Effects of Bullying on Academic Achievement Violence and bullying were associated with lower grades Students in schools with more bullying did not perform as well academically Another study in USA in 2008 Found that being a victim of bullying was inversely correlated with grade point average 35

36. Long Term Effects of Bullying 2009 study followed 2540 Finnish boys since 1981 Gathered bullying information when boys where 8 years old in 1989 (6% bullies, 6% victims, 3% bully-victims) Followed up with them 10 to 15 years later Bullies were found to have more antisocial personalities disorders Victims were found to have more anxiety disorders Bully-victims were found to have more antisocial personalities and anxiety disorders. The study also looked at psychological issues for each group at age 8. 36

37. Prevention Programs 2007 study Reviewed 2090 articles pertaining to intervention; 26 studies that met selection criteria Divided intervention types into 5 categories: Curriculum intervention Whole-school multidisciplinary interventions Targeted social and behavioral skills groups Mentoring Increased Social Work support 37

38. Prevention Programs Curriculum Intervention: 10 studies evaluated this method Included lectures, educational videos, written curriculums Ranged from one session to multiple sessions over 15 weeks 6/10 studies did not show a significant decrease in bullying 38

39. Prevention Programs Whole-School Multidisciplinary Interventions 10 studies evaluated this method (2 of them disparate results) Included: Rules and sanctions Teacher training Classroom curriculum Individual counseling Training on conflict resolution 7/8 had positive outcomes 39

40. Prevention Program Social and behavioral skills group training 4 studies evaluated this method ¼ reported positive changes Other methods One study looked at mentoring; mentored children were found to report bullying less often Another study examined the effect of increasing school social workers to address specific behavior problems Study found significant decrease in reported bullying in primary school, but an increase in secondary school 40

41. 41 Steps to Prevention Assess the amount of bullying occurring in schools Engage and educate the community to build a bully free environment Create policies and rules (and follow them) Create a safe environment where bullying can be talked about Create a culture of acceptance, tolerance and respect for others Educate students and staff about rules, expectations, and how to intervene to stop bullying www.stopbullyingnow.gov

42. 42 How to Stop Bullying When You See It Do not ignore it Separate the children involved Assess any possible need for medical attention Reassure the children and other bystanders Talk to the children involved separately; do not question them in front of others Call the police when weapons, serious threats, sexual abuse, hate motivated violence, or other illegal acts are involved Ask the bullied child what can be done to make them feel safe www.stopbullyingnow.gov

43. 43 Summary Abuse and neglect in school is a global problem Bullying can take the form of physical abuse, sexual abuse, emotional abuse, and neglect Children who are bullied are more likely to have behavior and academic problems Bullying prevention can occur with good communication and understanding, and low tolerance for these behaviors

44. 44 References Burton, P. Suffering at School: Results of the Malawi Gender-Based Violence in Schools Survey. Institute for Security Studies, 2005. Arslan, S et al. Bullying and Victimization Among Turkish Children and Adolescents: Examining Prevalence and Associated Health Symptoms. European Journal of Pediatrics. 2012; 171: 1549-1557. Glew, G et al. Bullying and School Safety. Journal of Pediatrics. 2008; 152: 123-128. Nansel, T et al. Relationships Between Bullying and Violence Among US Youth. Achieves of Pediatric Adolescent Medicine. 2003; 157: 348-353.

45. References Sourander, A et al. What is the Early Adulthood Outcome of Boys Who Bully or are Bullied in Childhood? The Finnish “From a Boy to a Man” Study. Pediatrics. 2007; 120: 397-404. Shumba, A. The Nature, Extent, and Effects of Emotional Abuse on Primary School Pupils by Teachers in Zimbabwe. Child Abuse and Neglect. 2002; 26: 783-791. Strom, I et al. Violence, Bullying, and Academic Achievement: A Study of 15-year-old Adolescents and their School Environments. 2013. Available online. 45

46. References Theoklitou, D. Physical and Emotional Abuse of Primary School Children by Teachers. Child Abuse and Neglect. 2012; 36: 64-70. Vreeman, R et al. A Systemic Review of School- Based Interventions to Prevent Bullying. Archives of Pediatrics and Adolescent Medicine. 2007; 161: 78-88. www.stopbullyingnow.gov http://mchb.hrsa.gov/chusa11/hstat/hsa/pages/22 5b.html 46