Prevention & Intervention
Playground Politics Across the Lifespan as a Public Health Crisis: Summarizing Bullying Prevalence, Effects, Cost, Possible Solutions, and Prevention Suggestions
Various forms of violence across the lifespan including school age bullying, cyberbullying, child maltreatment, sibling bullying, teen dating violence, college hazing, intimate partner violence, workplace bullying, elder abuse, and large-scale violence are all forms of bullying that have power imbalance, intent to harm, and repetition in common. This suggests that researchers and practitioners working in these distinct, but related fields of violence can and should apply the bullying framework to their work.
There is also overlap between perpetration experiences and individuals who behaved violently in one context (e.g., school, work) are more likely to behave violently in other contexts. Further, youth engaged in peer violence were more likely to be violent towards dating partners and adults who abused their partners were more likely to abuse their children.
Note: Black arrows indicate a causal relationship or association supported by ample research evidence; white arrows indicate a possible causal relationship or association that needs additional research.
According to the CDC’s National Center for Injury Prevention and Control, Adverse Child Experiences (ACEs) are traumatic events that occur during the first 18 years of life. Investigators from Kaiser Permanente conducted the seminal research on ACEs in the 1990s. The original ACEs included emotional, physical and sexual abuse, neglect, exposure to intimate partner violence, mental illness, separation/divorce, substance abuse, and parental incarceration. However, subsequent research has shown that additional adversities, such as bullying, peer and community violence, and economic hardship, should be considered as ACEs because they display similar impacts on health and life outcomes. Exposure to ACEs in childhood leads to disrupted neurodevelopment, which causes social, emotional, and cognitive impairment. This stress and impairment raise the risk for adopting health risk behaviors (smoking, drinking) as coping mechanisms, which in turn increases disease, disability, and social problems in adulthood, ultimately increasing the chances of premature mortality.
Our goal is to use the public health model for addressing social issues using this sequence:
Defining the Problem -> Identify Risk and Protective Factors -> Develop and Test Prevention Strategies -> Assure Widespread Adoption.
Child Maltreatment Prevention and Programs
Nurse Family Partnership (NFP) is a nurse home visiting program for first-time pregnant mothers that sends nurses to work one-on-one with the pregnant women to improve prenatal and child rearing practices through the child’s second birthday. Specific objectives include improving women’s diets; helping women monitor their weight gain and eliminate the use of cigarettes, alcohol, and drugs; teaching parents to identify the signs of pregnancy complication; encouraging regular rest, appropriate exercise, and good personal hygiene related to obstetrical health; and preparing parents for labor, delivery, and early care of the newborn.
The Triple P-Positive Parenting Program is a comprehensive, community-wide system of parenting and family support. Five intervention levels were designed to enhance parental competence and prevent or alter dysfunctional parenting practices, thereby reducing an important set of family risk factors both for child maltreatment and for children’s behavioral and emotional problems. The existing community workforce crossing several disciplines and settings (such as family and social support services, preschool and childcare settings, elementary schools and other community entities with direct contact with families) is trained to deliver the Triple P system of interventions. This workforce is then responsible for delivering the program to parents. Using systematic training including videos, workbooks, and tip sheets, the Triple P program aims to enhance parental competence and prevent or change dysfunctional parenting practices and thereby reduce child maltreatment. Five core principles are used to support parents: (1) establishing and maintaining a safe, engaging environment, (2) establishing and maintaining a positive learning environment, (3) helping parents use assertive discipline, (4) helping parents maintain reasonable expectations, and (5) helping parents take care of themselves.
Sibling Violence Prevention and Programs
The More Fun with Sisters and Brothers program (MFWSB) targets emotional competencies and prosocial behaviors in youth ages 4 to 8 years of age. The program targets seven competencies: 1) initiating play with a sibling, 2) methods for accepting an invitation to play, 3) methods for declining an invitation to play, 4) perspective taking, 5) identifying and discriminating between emotions, 6) regulating emotions, and 7) problem solving/conflict management. The program teaches children how to identify, monitor, evaluate, and modify emotional reactions.
School-Aged Bullying Prevention and Programs
KiVa is an antibullying program that has been developed in the University of Turku, Finland. KiVa includes both universal actions to prevent the occurrence of bullying and indicated actions to intervene in individual bullying cases. The Olweus Bullying Program, OBPP, is arguably the most famous anti-bullying program. It is a universal, multi-level, multi-component program that is appropriate for all grade levels. Reductions in bullying and victimization are generally positive in evaluation studies, but many results are mixed. Steps to Respect is a universal bullying prevention program for elementary school students. The program was designed to reduce bullying and destructive bystander behaviors, increase prosocial beliefs related to bullying, and increase social-emotional skills through a grade appropriate literature unit and other educational materials and lessons. Positive Action (PA) is a universal, school-based intervention designed for elementary-, middle-, and high-school students that aims to decrease risk factors (e.g., bullying, violence, substance use, family conflict) and increase protective factors (e.g., academic achievement, school attendance, parent-child bonding; National Registry of Evidence-Based Programs and Practices, 2014).
Considering all of these programs, we recommend an eclectic approach that integrates the best ideas and emphasizes highly consistent implementation. In our opinion, the best ideas are: form an anti-bullying committee consisting of school leaders (shows administrative buy-in), teachers, representatives from student government, and self-nominated students from each grade level, provide meaningful roles, beginning as early in school as possible, promote inclusive relationships and build valuable team memberships, teach bystanders to be upstanders, Interactive Theater can be very powerful for working with support groups for victims or the overall school population of students, empathy is vital for preventing bullying.
Cyberbullying Prevention and Programming
Second Step is a well-known and highly tested social-emotional learning program (SEL) for middle school students that targets risk and protective factors connected to aggression, violence, and substance use. Lesson content focuses on empathy and communication, bullying, cyberbullying, sexual harassment, emotion regulation, problem solving, and substance abuse prevention. One simple yet common strategy to prevent cyberbullying is providing educational information to youth, parents, and school personnel on what cyberbullying is and how to avoid being a victim. Tip sheets and websites (e.g., https://www.stopbullying.gov/cyberbullying/what-is-it/index.html, http://www.cyberbullying.ca/, https://www.prevnet.ca/) are often helpful resources.
Teen Dating Violence Prevention and Programming
Safe Dates is a 10-session dating abuse prevention program for middle- and high-school students that aims to increase participant knowledge about the differences between healthy and abusive dating in addition to the causes and consequence of dating abuse. Topics of the sessions include defining caring relationships, defining dating abuse, why people abuse, helping friends, overcoming gender stereotypes, equal power through communication, how we feel/how we deal, and preventing sexual assault. In addition to these educational sessions, which are usually conducted in school, there is a community component that provides support groups and activities for youth. Similar to the other forms of violence and bullying previously discussed, parents should take an active role in opening up a dialogue with their children about dating violence.
Hazing Prevention and Programs
University of Arizona Life Skills Program and the National Collegiate Athletic Association created a program called Step Up! Be a leader, Make a Difference. This program is a prosocial behavior and bystander intervention program that aims to educate students about how to proactively help others. Hazingprevention.org is a national, nonprofit organization that aims to help prevent hazing through education, advocacy, and community engagement and includes online hazing prevention training (hazingprevention.org, 2018). In addition, Stop Hazing (Stophazing.org, 2019) is another educational website that provides hazing prevention resources including a hazing prevention toolkit for school campus professionals, access to state anti-hazing laws, webinars, infographics (information about hazing with pictures that could be printed and posted around a school campus), and interactive data.
Intimate Partner Violence Prevention and Programs
The National Domestic Violence Hotline (1-800-799-7233) is available for anonymous help and support. Further, there are multiple trauma-focused interventions for survivors of domestic violence. Programs in shelters and mental health agencies, while helpful, are simply too late to prevent victimization trauma.
Workplace Bullying Prevention and Programs
Few interventions exist that address workplace bullying. Two studies examined the Civility, Respect, and Engagement in the Workforce (CREW) intervention, an organizational/employer level intervention, the goal of which is to assist work units in identifying their strengths and areas for improvement in regard to civility. A multilevel intervention looked at the effectiveness of a combination of policy communication, stress management training, and negative behaviors awareness training.
Elder Abuse Prevention and Programs
One key way to prevent elder maltreatment is by identifying it. Many maltreated elders suffer in silence, thus, screening by healthcare providers by interviewing the elderly could be helpful. However, difficulty arises due to a lack of valid and reliable screening tools, the fact that the abuser often accompanies the elder person to appointments, and the victim might be too frail or confused to answer questions accurately. Therefore, clinicians should be well educated on elder maltreatment (through workplace training on elder abuse) and should be aware and sensitive to the signs and symptoms; clinicians should rely on their knowledge as opposed to screening instruments for elder abuse identification.
Large Scale Bullying Prevention and Programs
Preventing group-based bullying requires reducing both the joy of power and the power of prejudice. This happens through social action and legislation; individuals speaking out and banding together in advocacy against social inequalities. We strongly assert that bullying across the lifespan should be viewed as a public health priority, if not a pandemic.