strategies such as zero tolerance are ultimately not particularly helpful. the research shows. we want to understand more about bullying for many reasons but one reason is there are a good number of small but critical numbers who are involved in behavior's and victims and we want to make sure that we can understand the experiences and find ways to support all youth. i'm excited for our panel today who will be presenting some of the research and intervention that was supported to help us explore these issues. are they ready? have them all come out and i will introduce them. [whispering]

>> i will briefly introduce our speakers. you have their full bios in your book. i don't want to take any more time from their presentations. we start with dr. dorothy espelage from the department of educational psychology at the university of illinois, she has been conducting research on bullying, homophobic teasing, sexual harassment and dating violence and she will start by reviewing the risk factors associated with aggression and bullying and discuss how bullying is based on gender based aggression. >> thank you. good morning. so we have 12 minutes to take you through 20 years of research so hopefully you had your coffee. what i first want to do is to because we have 12 minutes i want to talk to you about what

we know, if we retain take this study and look at the extent to which they looked at 123 studies and say what do we know about those kids that bullied others. if we look at this analysis across 153 studies from cross-section studies meaning a snapshot. if you look at a child who believes others at high rates what do we see that occur? and what we find is decrease social confidence, academic challenge, negative attitudes toward the this and a family characterized by conflict but if you look closely you will see that these types of outcomes were moderated by age, as the kids age they became more popular within the context of their peer groups and you will hear more about that from dr. ferris. if you want to talk about moving

forward from cross sectional studies and you heard from the department of justice that the assumed link between bullying and criminality. if we look at the criminal behavior and mental health and if you did begin to those studies you ultimately find that those kids who were in cage in bullied across wanted to know analysis are at risk for criminal involvement, alcohol and drug use, challenges within their occupation but the reality is there might be a -- association. once they look at the other risk factors in the environment that association between bullying and criminality was reduced. there at a point where there might be some kids that bullied others that may have this criminal trajectory but that may not be the story for all kids. the bottom line is a limited number of longitudinal studies that untapped the mechanisms and

variables that explain why kids bullied others. there are few longitudinal studies but consider how bullying is related to the negative outcomes and why the mechanisms are underlying these processes. what i want to do is show you research funded by the centers for disease control and appreciate my project -- the late merrill hamburger which funded this work and driving those research budgets and what we know about kids that bullied others? what we do see here and what i am showing you is the sample and a demonstration of the research, to understand what are these kids like that bullied others? looking at 1100 fifth through eighth graders tracking fifth through eighth grade over a two year period and show you our findings. you may not be impressed by this beautiful longitudinal crazy modeling but i am and my team is and this bill is on those cross sectional researchs which limits

our ability to understand the nuances mechanisms of how it is that kids begin to bull the others. what i am going to walk you through is three waves of data from fifth grade to seventh grade and what this shows is four boys and this is the boy model, boys that are in homes where there are high rates of family violence and sibling aggression are more likely to bullied others longitudinal the and look at the era from one to two and that is not the complete picture. in fact engagement sins bullying of the other children places them at risk forin bullying of the other children places them at risk for alcohol and drug use. the red circle predict alcohol and drug use which predict further bullying perpetration. as much as we focus on cross sectional data very limited. we need to understand the mechanism. this would say family violence

might be one of those potential risk factors we should really think about in prevention efforts rather than the apologizing those who will be others. one of the complex longitudinal analysis is due to believing they may do so in reaction to conflict or violence within their home and if we see sibling aggression and a proxy for family violence we may think about bullying prevention efforts addressing some of that. at the same time it may be particular risk for using substances. i want to find a story in a short amount of time and seeing how complex the association with bullying and sexual violence and homophobic perpetration. not just the kids believe others but the social million of middle school may lead them to engage in other forms of bullying and that could be homophobic teasing and ultimately if kids are in schools in which there's

promotion of masculinity and endorsement of what we would call heterosexual norm it may be they have to demonstrate their heterosexuality by engaging in sexual violence over time and my colleagues talked about this as potential sexual violence pathways. and we have done a number of studies looking at bullying, homophobic contend the extent to which kid that boule also engage in direct homophobic banter to others and engage the sexual violence literature to say what is happening within the context of early adolescence and end bullying perpetration a training ground in some ways for homophobic cancer and kids feel the need to demonstrate their heterosexuality by sexually harassing one another publicly. it is just that. bullying perpetration and homophobic perpetration are linked and i feel comfortable

about that and i also hypothesize that buoying perpetration and homophobic teasing would be associated with later onset of sexual violence perpetration and let's take it more to a point where we might be able to intervene and that is this idea that bullying perpetration and its association with sexual harassment or sexual violence perpetration longitudinal in maybe strongest for what adhere to traditional masculinity. we heard yesterday from the young man that he has a man up. demonstrated why he engaged in bullying perpetration towards others. when we look at the first hypothesis i want you to recognize when we look at this middle school sample and look at those kids that are engaging in high rates of bullied and we find people numbers between males and females, 12%. more alarming is fighting we continue to see since 2000 and the number of kids engaging in homophobic and tearing toward others were 34% of the boys engaging ms. behavior at high

rates and 20% of girls in beijing in miss behavior at high rates. a suggestion that bullying perpetration is common. 12% but homophobic bantering content directed toward others is more common. let's look at another beautiful model at 9:00 in the morning. dorothy espelage will show you a causal transactional model for association between those kids that bullied others and those that than direct homophobic bantering to others during early adolescence. those words we think are so innocent play a major socialization role. it may stem from bullying perpetration in early adolescence. if the bullied prevention program is not addressing homophobic bantering the use of that language will probably be ineffective given these really strong longitudinal links. take away messages here. homophobic name calling is prevalent in middle school.

it is not just in the state of illinois. we are finding it in a deer states. youth who bullies resort to homophobic name-calling over the middle school years. we have a causal link and we feel strongly about replicating in multiple studies. we also find bullied prevention programs should include that discussion. around the language that marginalize not just belgae bt --lgbt use but those who are gender nonconforming. also showing a series of studies that bully and homophobic bully oomf is linked to sexual violence over time and that is what the circles show and longitudinal analysis. six months difference. one from wave 1 to five a two year difference. wanted to know association among

leading, homophobic entering and sexual-harassment perpetration. rather than showing you another beautiful diagram that has even more circles on is i want to tell you about our moderating analysis. bottom line is what this shows. longitudinal if kids bully others in fifth or sixth grade they have a high propensity to engage in sexual violence perpetration they endorse traditional masculinity ideology and this is for boys and girls. if they both believe boys are stoic and not express their emotions then there will be an increase from leading to sexual violence perpetration over the middle school years. we should remember sexual violence perpetration in middle school rihanna not necessarily talking about sexual assault but we are talking about commentary and sexual rumors that may be precursor to other forms of violence as kids transition to high school. what are the implication

prevention into that many of them but we must consider as we think about who are these kids that bully others? there is great complexity and what they bring to the table whether it is violence in the home or a sibling aggression where a model with behavior. i have chosen to focus on something very amenable in prevention and that is the use of homophobic banter and expression of sexual violence that stems longitudinal the from bullying. we must address this in our believe in prevention program. it is one area where we can. people are starting to do this and we must address homophobic than during and ways in which sexual violence perpetration is expressed in order to promote activity in our schools. thank you. [applause] >> thank you. now we have dr. robert ferris. is research focuses on social networks and how they are

structured and how they structure and are structured by conflict and aggression and he will talk about social network drivers of aggression and bullying. >> thank you for having me. i appreciate the opportunity to talk to a new community of people that i am not usually talking to. is the microphone ok? i also am going to have to compress many years of research into a few slides. about 20 slides. that is also too many so i will also for a lot of the details. all of my research lately has focused on 2-1/2 questions. the first 1-1/2 questions are who victimizes who and why. this is 1-1/2 questions because the answers to both these questions are linked. the motivation it turns out drives the targeting. the second question is what happens to them as a result of their involvement in aggression? the data i used come from two

different communities. the first is a enlarge study of adolescents in north carolina, smalltown and some what rural areas of north carolina. the second study is a wealthy suburb of new york city on long island. different communities but the kids are age -- 8 through twelfth grade and we followed them over a period of time. different periods of time. these are longitudinal studies that allow us to disentangle causal relationships. some of the things i focus on in my research is social network analysis which is a fancy way of saying i severe relationship between people and how those relationships are mink in larger web. a lot of social network analysis is focused on positive relationships like friendships that we collected friendship relations of these kids. we can create social maps of the schools but on top of that we

also collected data on who is speaking on who. who is bullying him and victimizing whom and that the new layer of questions we can focus on. we also know what they are doing. physical violence or ostracism and so on and how frequently it occurs and the idea of social network analysis is best illustrates in pictures. this is a hypothetical school where the dots represent students and the lines between them are friendships. is probably looks like a bird's nest but there are important ideas that come through here. there is some clustering in the school net works. to -- kids don't all aggregate equal the. a cluster. you can see there are denser regions of this diagram and more peripheral and sparse regions. there are kids who very in popularity and centrality in these networks and that might

have implications. one possible pattern we might observe will look like this where we see kids on the margins of these social networks are picking on other kids who are marginal and that is due to lots of reasons that might occur. what we actually find in our data is the opposite. as kids become more central their involvement in aggression both as perpetrator and as a victim increases. their rates of aggression increase as they climb the social hierarchy. that begins to taper off once they approach the top. in these terms once they reach around the 4 or 5 level of centrality you don't have to worry what that means but it means they are very central. there's a hub and their aggression and victimization rates tend to taper off. what we are finding is the bulk

of aggression occurring within the center of these networks rather than periphery. there is one exception. there are kids who we call -- to not receive fringe of nominations, elevated risk of being picked on by other classmates. with that exception, most of it is occurring at the center. this is a dyadic level. this is an illustration of rates of aggression at the dyadic level between tears of kids which tells us that the highest rates of aggression are occurring when those kids are relatively high status. relatively central. that is the orange area on the top right of the graft. we are seeing a lot of it occurring between relatively high status kids targeting of their high status kids. they are also finding most

aggression occurring within so see a demographic categories. on the west side the rates of aggression are highest within racial groups rather than across so more african-americans likely to target african-americans and caucasians the same. with gender there's a different pattern. highest rates are within gender but you see a more crossing gender lines and the blast crew that we look that is sexual categories and we see higher rates of involvement in aggression among lgbt use. they self identify with those categories. we also see bully immigration tes to occur within relatively short social distance. we see more of it occurring

within friendship groups rather than across the school net works. not like kids are picking on complete strangers. they're picking on kids who are friends of friends. the rate of aggression declines the farther apart they are. this is consistent with the notion there is a lot of targeting of rivals. it is a process of trying to climb social hierarchy. there is narrative evidence that this is occurring within friendship groups. and won't read this out loud. and the stories come from kids who reported their experiences on a web site called bullying.org. talking about how their friends turn on them and friendship groups involved lot of harassment. and this is what we see. everything i have been talking about so far. kids in the middle are targeting other kids in the middle.

this is coded by gender and you can see the same through different schools and long island school and the same pattern by grade in school when you see most of the aggression occurring in the dense core of these networks. why do they do it? status motivation really driving this. the more kids care about being popular the more likely they are to become aggressive but moreover the more their friends care about their friends being popular the more likely there becomes aggressive. your influence process, this is a game in which kids are using aggression to climb social hierarchies. last question, what happens as a result of their involvement? we find for victims this is very standard. in our data we find the number of classmates that pick on you is associated with substantive

increase anxiety and depression and anger levels and they become marginalized socially so victims lose social network centrality and less -- these are standard affects from other data as well but what we found is these effects are worse for high status victims. i will talk about that later on. the aggressor side. the question i propose or ideas i propose are ways in which kids climb hierarchy's and one of the questions is whether it works. our kids aggressive actually gain status? to address that question my colleague and i gathered information from the high school yearbook with rate indicators of who was a high status kid so we identify the elites in these schools and look at who their friends were using social

network data and try to predict whether aggression at one time point predicted their status two years later. what we found is aggression, kids who were more aggressive or more likely to reach one of the social circles but also depending on who their victims were and who they targeted mattered for their status prospects and also comes at a psychological price. even though they're gaining social status and also increasing anxiety and depression and losing--somewhat paradoxically. what i would like to do is leave this with a question rather than a summation. i want to recap and find two patterns of work here. kids are vulnerable kids getting harassed and targeted as we might expect but we also see a process of relatively high status kids jockeying for social position and with damaging

consequences across the board. one of the questions i would like to propose, what are the implications, if this is something kids are using to climb social hierarchy and if actually works how can we reach full prevention programs to address this process. if it is working or being rewarded what are prevention programs going to do about it. how can they change that dynamic? thank you. [applause] >> next we will have dr. joseph wright from the children's national medical center as well as professor and vice chairman of the department of pediatrics and professor of emergency medicine and health policy at george washington university school of medicine and public health and he is going to talk to was about mental and physical health impact on youth who

engage in bullying behavior. >> good morning, everyone. i would like to shift gears a little bit. nothing to disclose other than i am a card-carrying member of the academy of pediatrics and one question i want to ask you to think about as we move through my presentation is for those of you who are parents in the audience, have you had an opportunity to think about your pediatrician, your child's pediatrician as a player with regard to bullying prevention? the other lens i am coming from as the 20 year member of the department of emergency medicine at children's national medical center which is one of the busiest pediatric -- has one of the busiest pediatric emergency department with 100,000 visits and a dimension that because this is where i got my clinical introduction to the issue of

bullying and frames this morning. not only do we have at children's national great deal of exposure through the emergency department but for my colleague who is pictured and one of the publications manages the clinic for health-related problems associated with bullying. not surprisingly most of his patients in that clinic are victims and not identify -- you are familiar with this epidemiology. i show it to point out the small percentage of children who are bully victims is an important category 2 be cognizant of and we will come back to that with regard to practical approaches but this is the question i get most often from my colleagues. what is all the fuss?

isn't this just kids being kids? the answer i have come to give is the issue of concern is the association with the development of more serious behavior's with retaliatory behavior is down the line and health consequences which may not be evident in the acute care situation. the question is bullying the tip of the intentional injury icebergs? is this a concern from a clinical standpoint we need to pay attention to? from the standpoint of the literature as recently as a decade ago it comes from an editorial of the journal of the american medical association. there was not a great deal of evidence at all that showed a relationship of bullying or being bullied with risk for more

serious violence downstream. over the course of the last decade there has been a great deal of work and i am sure most of you are familiar with this work at the national institute of child health and human development that demonstrated that there is not only an association but also an association that is greater for bullies with regard to frequent fighting and injury that bring children to my attention in the emergency department that these associations are stronger for bullies and their targets. we heard from all the speakers this morning, the higher likelihood of a number of other behavior is downstream. substance abuse and get them a -- academic performance, truancy and crime conviction down the

line. one of the issues that we were concerned about in our clinical environment was that of retaliation and i mentioned to you the small percentage of children who are bully victims may represent in my practice a large percentage of kids who present in the clinical space and so we conducted a study that was supported in part by funding from the health resources administration and emergency medical service for children's program to take a look at the children who were presenting to us as assault victims in the emergency department, and interesting findings are wanted to share with you that 64% disagreed with the statement that i believe that revenge is a good thing. however, when we asked the

question if someone hits you you hit them back 77% endorsed that statement. this is a little confusing to us but what we've learned is the adolescent's perception of their attitude towards fighting had the greatest single impact on their response to this survey. it really opposes a bit of a conundrum. as we activate young people to the actors and to be advocates and participate in the prevention of bully in one of the challenges is what are the attitudes of their parents and households? it is really at a crossroads and something that for me certainly as a pediatrician who has to counsel both paren and children at the same time a bill challenge as to how to do that.

this actually speaks to what we are all well aware of in the yellow. analysis from the secret service that looked at the incidents following columbine to look at cases of mass casualties shootings in two thirds of the cases the analysis revealed the attacker felt persecuted or threatened or injured before the incident. ..

>> there is so much misinformation and lack of information that parents have, um, it is critical particularly for pediatricians who have many more contact opportunities with parents of young children than other clip in additions -- clinicians. but in terms of at the individual level what is it that we can actually incorporate into the practice as part of anticipatory guidance, as part of the way that you actually get information and talk to young people in the office space, what is it that pediatricians can do? well, three years ago the american academy of pediatrics really got onboard with this in a big way and published this policy statement around the role of a pediatrician in youth violence prevention with a big focus on bullying. and i wanted to take a moment just to share with you, and by the way, what i'm going to show

you was supported in part by work from, funding from doj and the ojjdp to fund a curriculum that the american academy of pediatrics has published called connected kids and has made available to all its members. so let's see if this technology will work here. this is a pediatrician with a bully victim. >> the other kid has a black eye. >> that's a good question. no one be in your shoes ever wants to be here, jason. and i totally understand why you don't feel like being here. but i asked your mom to wait outside so i could talk to you by yourself, because i think when stuff like this is going on, it's much easier to have these conversations one-on-one. so i understand you're having some trouble at school. >> nobody cared back in the fourth grade when it was me getting kicked around. now all of a sudden everybody's all concerned.

>> and you probably feel like that isn't fair. and you're right, it isn't really fair. they should have cared when it was you. and i care now, and i care both for the kids that you're giving a hard time to, and i care for you. because what you're doing is actually bullying. and it's not okay. and we need to help you figure out another way to resolve your conflicts besides bullying the kids that are getting on your nerves. >> they just bother me. they think they're better than everyone else. just like to keep 'em in line. >> but you know that's really not your job to keep them in line, right? it's your job to keep yourself in line, not to keep anybody else in line. do you think these kids are scared of you? >> they better be.

>> okay. so this is a facsimile of an office visit that points out a couple of very fundamental approaches that may not be evident to the pediatrician, the clinician, the office setting. the very simple approach of open-ended questioning, being able to allow the young person to tell a story. and sometimes that's tough to do in the pressured confines of an office visit. the other thing is, um, obviously separation from the parent. and we can talk about the value or the importance of that, but again, i just wanted to share with you this morning from a clinical perspective what it is and how this presents in the clinical space and how we might activate clinicians, specifically pediatricians, to participate. thank you. [applause]

>> and now we'll have dr. nancy riestenberg join us who will be talking about restorative and other strategies for supporting students who bully. she has over 25 years of experience in the fields of violence prevention education, child sexual abuse prevention and restorative measures in schools, and she's currently a school specialist for the minnesota department of education, so let's give her a round of applause. [applause] >> oh, good morning, everyone. i'm very honored to be here. however, i do have to make just one correction, i do not have a ph.d., but if you want to give me one, i'd really appreciate it. [laughter] i feel so welcomed here in washington. when i came here yesterday, i thought, oh, they thought about me, it reminds me of minnesota in january. thank you. [laughter] actually, though, i just do want to say that it has been really wonderful to work always with the staff here at the u.s. department of education over the

18 years that i've worked for minnesota. i have found them enormously helpful, so thank you. um, what i would like to talk about today -- and here is the fancy clicker -- is restorative practices, our strategies to support students involved in bullying. but before i talk about that, about ways to hold students accountable without sending them away and to build community in the school, i want to, um, first -- what do i do, press z that? -- talk about the well. i want to tell a little story. some of you are probably quite familiar with this. this is about the beginnings of public health. there was a neighborhood in london back in the 1800s where people were getting very sick from cholera, and they would leave the neighborhood, and they would go to the hospital, and they would get better, and they would come back to the neighborhood and get sick again. and it wasn't until they figured out that people were getting sick because the well that everybody drank from in the well was causing that. so they were able to overcome

the cholera epidemic. so i talk about this in way of illustrating that in a school the same thing that we learned from that well in soho holds true. you can have fabulous interventions in the office or the counselor's office, but if the child comes back to a classroom or a playground that is not healthy, that is not safe, supportive and positive, your intervention is not going to be very strong. so when we think about preventing things in a school, preventing bullying in a school, it's not just about how we intervene, it is about how we create that climate that is healthy and welcoming to everyone. so in regards to restorative practices as the framework for making that safe, caring environment and using those interventions, i'll give you this definition from morrison and sanderring. restorative practices in schools are ones that sustain safe and just school communities grounded

in the premise that human beings are relational and thrive in context of social engagement over control. there's a lot to be said, probably would take me a couple of hours to unpack all of those words, but i'd like to identify two key ones for this morning, community and relational. community, building community through creating healthy relationships is the key component of a restorative school. now, a lot of people think about restorative practices in schools in regards to the intervention, that is a circle to repair harm or family group conferencing. and for those who are not familiar with that, the basic idea is you have a trained facilitator who brings together the person who was harmed, the person who did the harm, and anyone else that was affected by the bullying or any other harm that happened in the school whether those are bystanders or peers, family members, teachers and other staff, administrators, community members. and all of those people

together, because they have agreed to come together voluntarily, talk about what has happened, what were they thinking about at the time, what have they thought about since, how were they affected by what happened, and what can be done to identify solutions for the person who hurt somebody to make amends, to give back to the community and to make a plan for how that behavior is not going to continue. and also to attend to the needs of the person who was hurt and perhaps make plan to help support them so that everyone can restore order and get back to a safer learning environment. but that intervention, as i said, is only as good as the healthy environment that people would go back to. and so in a restorative school we think in terms of primary, secondary and tertiary prevention from the vantage point of relationship. with everybody in the school, we want to reaffirm relationship, teach the skills of relationship which is basically teaching

people social/emotional skills, teaching them how to get along, teaching the behaviors we want to see. with the eye towards creating community amongst everyone. and then if something goes wrong at a low level, we would look to repair those relationships, and we would rebuild relationships if some big problem happened, ongoing bullying or some kind of fight where students needed to take more time to put things back together again. you may recall yesterday the triangle that, um, i forget his name right now, isn't that funny when there's a timer in front of you? [laughter] pbis. well, someone will shout it out, i'm sure, gave the triangle of red, green and yellow. i have inverted that, so we're looking from the top because i wanted to emphasize the fact that we would do an intervention for bullying not by sending somebody away, but by keeping them close in, and that the child who needs the intervention

in the office is also always going to be getting the learning and the education and the connection in the classroom with reaffirming relationships. um, so why would we want to think about relational practices for bullying in particular? that's the question, i guess, that was given to me, and we have famous people up on this slide. but bullying is a relational problem that requires relationship solutions. it occurs in a peer context, as the beautiful, wonderful what kind of slide that was with all those lines on it, the dot slides so eloquently illustrated. and so we need to think about how we can engage all of those people that are involved in bullying. if you do an intervention in the office however wonderful and the one student who did most of the bullying or you think was the instigator is remorseful and regrets what they have done and says that they're not ever going to do it again and after a three-day suspension goes back

to the same peer group that no one has asked any questions of and that peer group is expecting them to continue to keep their status by picking on someone else, you're not going to make any kind of headway. you need to think in terms of the larger group and how can you engage that. restorative practices is like an accordion. you can make it as large or small as you want depending upon the circumstances. and then students regularly involved in bullying as a bully or a victim or a bully/victim, we found in our analysis of associated experiences, most of them were negative which were more accurately illustrated by the other speakers today. so a restorative process gives you the opportunity to also look at the larger context that the child may be involve inside and to seek, make that as an opportunity to provide extra supports as well. now, with the analysis that was done of bullying prevention efforts throughout the world, the following list of things

were found to provide reductions in bullying, parent training, etc. but i'd like to highlight the fact that you have nonpunitive disciplinary mets. -- methods. there's a growing body of research that indicates that's not very effective. and why did something go away? oh there, we go. boy, when you have to talk fast, you get nervous about anything that goes wrong. at any rate, the idea here is the hold people accountable in a real way, in an honest way and to help people learn from what has happened and to try to repair the harm that they have done. and in that way you help students associate power with kindness as opposed to harm and help people empathize with each other. it also provides for home school communication because if the problem is large enough and it makes a lot of sense, bring into the process family members instead of having to hide behind

data practices. i can't tell you what i did to the person who has been haranguing your kid for the last two and a half years. have them come in and participate with the parents of the child who did the harm as well so that everyone, all of the adults, the schools and the family can work together to provide support and to hold people accountable. um, and then having relationship intentionally taught and thought about in the classroom helps to create for more effective classroom management. so now i'd like to tell you a story as a way of illustration. to try to point out to you, um, how important it is in my mind for us to not just shop at the the schoolhouse door in terms of thinking that the schools are going to be able to take care of this problem. because particularly when we think about electronic aggression which can happen 24/7

in all different kinds of settings, this is a problem that is as much about the community, it's as much about family as it is about the school. and so my illustration for you is about the response of a county, actually, to a very large sexting case. and sometimes you're doing that because you're trying to keep a relationship, and sometimes you're doing that because you're mean. so, yes, wright county is a rural county for the most part in central minnesota. it has cows, it has corn u it has lakes, it also has a nuclear power plant. it has ten school districts within the county, and the communities range in size from about a thousand to 30,000. and in this county back in 1996, um, the county attorney, the sheriff's office and the county social workers and probation all decided that it would be really helpful for them to hold regular meeting with the administrators

at each one of the school districts. and so everybody gets together individually at these school districts, at their buildings, once a month or quarterly to talk together about how the children are in the county and to see how they can work together. and in doing that they also create relationships with each other. um, they see each other, they know about each other, and so they can respond more quickly when some kind of problem happened. and problem happened one day in one of the middle schools in the cafeteria. what happened was that, like in many middle schools across the world, the kids could have their cell phones during lunchtime, and a couple of girls picked up this one boy's cell phone, and they scrolled through his pictures, and they went, ha! and they ran into the bathroom. they had found a picture that his girlfriend had sent to him when he asked her, send me something sexy. and they sent that picture, a couple of pictures actually, on

to four more students who then sent those pictures on to eight more students, and in a short period of time this picture was all over the school and halfway to madagascar and back again. so by the time they were able to find it, the adults, a lot of damage had been done. well, what are you going to do when you have 14 kids who are middle schoolers who have essentially committed a felony? because sending and receiving sexually-explicit pictures of somebody under the age of 18 is sending and receiving child pornography. so all of the adults got together, and they started talking about what would be the best way to respond to this. and we had the first family group conference for sexting in the state of minnesota as far as i could tell. because in wright county they have a restore ty justice -- restorative justice agent, and she was given this case. she brought together those 14 students and their parents to talk about what had happened and to figure out how to repair the

harm that had been caused and to try to divert them from being charge with the this very serious charge. when the conference started, some of the parents said why is my child here, what's the big deal? after all, you know, public people, football players, celebrities, they send pictures like this. um, it doesn't matter. but everyone agreed that they needed to talk things through when they found out that they could be charged with a felony. so they figured out what to do. they now have an outcome, or they now have education that happens for all of the parents, for all of the students on an annual basis, and they are seeing a decrease in the number of affected parties, decrease in the explicitness of photos, and the parents are more likely to support the school in enforcing their policies. so they were able to very more

clearly and more humanely help these students repair the harm that they had caused. um, we need to think about bullying preprevention as an opportunity to learn and help people repair the harm so they can get back to class because time spent in learning is the single best predicter of positive outcomes. thank you. [applause] >> let's thank all of our presenters for very thought-provoking presentations, and now we'll take time for questions. you can -- we'll have cards, um, you can write your questions down on cards and send them up to us, and we'll be happy to take, take those questions. while we're waiting, i have a question for dr. wright. you know, the question you asked about what's all the fuss, i

think, is really important. and how do we get the word out to all those people who can provide services and support to children in the schools and the families to really know what all the fuss is all about and to understand why this is such an important issue? >> well, thanks for bringing that question back up because i've been struck in the time that i've been doing this work, particularly with my own professional organization, about the steepness of the learning curve. and one area that i think is ripe as an opportunity is in professional development in the education sphere. i saw a map of the united states that showed the number of states that have as a matter of practice or regulation professional development

required, folks in the education environment. and it was a very small percentage of the united states, i can't quote it right now. but for folks like myself or, again, professionals who need to be the mouthpiece who have regular contact with parents and children in communities that is, i think, a piece of low-hanging fruit with regard to professional development. it's low cost, and i can, i can drum up some folks to start to participate right away. now, i didn't complete my homework, and i don't want to delay the q&a, but i asked the questions about how many parents in the audience had actually had their children's pediatrician in any way address bullying as a part of anticipatory guidance. okay, i see the lights are kind of bright, but i saw one hand go up here. not surprising. i assume there are more parents

whose children have pediatricians than this one gentleman. and that's kind of the response that i get as i move around the country. so we have a long way to go, valerie. >> thank you. we have a question for nancy riestenberg. how can school resource officers play a role in restorative strategies? >> in minnesota we have a number of resource officers who actually are trained in family group conferencing or circles to repair harm, so part of their response in schools or their partnership with the administrators in the schools is to be the person who facilitates that. and i think that when a resource officer is trained in youth development, in the brain research and learns all of the letters in special ed what those things mean, they are much more effective officer than if they think about using their power

always over students. they can be enormously effective in creating relationships with kids and helping them solve problems. >> for dr. faris, how does your hypothesis jibe with the fact that a majority of children with developmental disabilities or who are lgbt are bullied? >> um, is this on? okay. i think, actually, yeah, it may have been a little bit muddled in the presentation because of time, but we observe two different patterns in our data, and it's not inconsistent with the notion that there are some kids who are really vulnerable, who are perhaps a little different in some way than the school norm. those kids tend to be on the margins of the school social network, and we do find elevated rates of victimization among those kids. so it's sort of a bimodal distribution. the kids in the middle, but also

some kids, about 12%, who fall on the fringes of social life, are getting harassed at elevated rates. so both things, both patterns are occurring. >> for dr. espy language, can the bantering be extended to other areas such as racial and religious stereotyping and possibly later perpetration of hate crimes? >> that's a great comment. we have not analyzed the extent to which bullying and in this aggressive behavior predicts other forms of space. i mean, i think we can take from some of the bias-based literature and extrapolate, and that would be a nice hypothesis, but i tend not to extend beyond my data, but i also recognize that lgbt youth within the context of our schools are not the only vulnerable populations at risk. in the schools where we do other

forms of research, we do see at least at a correlational level associations between homophobic bantering and racial slurs, so it is something that, perhaps, we should look at in subsequent studies. >> okay. this is, i think, for two of our speakers. given that children may bully to climb the social ladder in school as we heard in one presentation, are there interventions programs that have been evaluated that focus on, quote, associating power with kindness from one of our other speakers? >> i'll take that. so haas the first time i've met bob, and i've been following his work, and we're both into the peer context and understanding that who you hang out with, birds of a feather flock together, but there's also a socialization process, so it's very, very clear that we could hypothesize that the low numbers we're finding may be due because we're not shifting that peer norm from an acceptance of aggression or bullying to these

pro-social behaviors. we are engaged, funded by the centers for disease control in a large randomized clinical trial in 36 middle schools where we are collecting social network data. we hope to be able, and we are finding, some significant reductions in intervention in aggression schools. we would like to dig deeper and see if that has something to do with changing the peer norms within those networks. but that's exactly where this basic research needs to go because regardless of how you look at the research, upwards of 80-90% of bullying is explained by who you hang out with, and we need to shift that peer norm into a more pro-social direction, and if we're not targeting it, that might be contributing to the low effect sizes that we're seeing. >> i have nothing to add. that put it perfectly. >> so that's your final answer. >> that's my final. [laughter] >> this is one of the most important questions, i think. it's from a student. she asks us to put ourselves in

the place of a bully, what methods would be most effective on you by a facilitator? put yourself in the place of of a bully. what methods would be most effective on you by a facilitator? anyone? >> i'm not sure exactly what you mean by a that a sill tater, but restorative principles work in part because they help this person who's done the bullying separate their behavior from who they are. so yesterday we had a wonderful illustration of a young man who went through a life trajectory, learned a variety of different things by trying out behaviors that in many instances were inappropriate. and very early on people could have said you are important, but this behavior is not. and we are going to support you because you are important to the community, and we're going to do that by helping you not engage in these behaviors and what do we need to do in order to do

that. and i think that that shows respect to the person who does the bullying, because after all, they're children. and they are trying to learn how to operate in the world. and they're getting lots and lots of mixed messages. and so that basic treating people with humanity in that regard, i think, is really critical. >> i would add to that that, um, if i were the bully, i would appreciate that someone understood that my behavior was adaptive whether it was climbing the social ladder or behaving the ways which i've responded to violence at home and in my community. so, again, separating it but seeing it more as adaptive, not necessarily as maladaptive. >> in the context of a health encounter, nonjudgmental, open-ended. just an opportunity for the young person to express and talk. >> well, that's a wonderful way to end this, um, open-ended.

we still have many m questions that have to be asked and answered and explored and studied, but we want to thank this panel for getting us started on the right track. let's give them all a round of applause, and thank you for your time and attention. ms. and that concludes this panel. [applause] ♪ ♪ ♪ ♪

>> hi, everyone. so as we transition through panels and get everyone micked up, i want to give you some outlines on what to do after this panel, on what we're doing. so as you can see in your program, it says break and mix and mingle. this is your time to network, and we want you to network. because one of the main points of this summit is for you to understand what everyone else in the room is doing. and, obviously, in two days we have no time to have each and every one of you get up and share your amazing efforts. so we wanted to give you an opportunity to talk about what you're doing, share materials with each other to make sure that you're not overlapping efforts and you can find ways to collaborate. so what we're going to do is we're going to collect in the three breakout rooms, we're

going to put the breakout rooms on the screen at the end of the session so you know where you're going, but we're going to gather specific organizations in specific rooms. so, first, we're going to have educational organizations and any federal agencies who want to share what they're doing in breakout room one. in breakout room two, we're going to have those cyberbullying organizations, and there are quite a few of you here today, join together in breakout room two. and in breakout room three, we are going to have youth safety organizations and also groups that represent specific populations such as lgbt or disability or the sikh population or the islamic population, etc., in breakout room three. if you don't fit in one of those categories, please, just join a group and share your materials and discuss. because that is really the purpose of this summit, in addition to sharing this great information with you, to make sure that we understand what each other is doing.

we are still waiting, so in that time i know we had, um, two groups who didn't get to report out yesterday. do we have a reporter from that group who might want to come out? well, we will have time at the end of the day today to talk about, um, our final breakout session after secretary duncan speaks in this afternoon. we will close up, we will talk about next steps for both the federal partners and for the organizations in the room and, hopefully, send you on your way to have another very productive year of bullying prevention. okay. so i'm getting the cue that we can bring up the panel. so, please, help me welcome marci hertz from the centers for disease control and prevention and james wright from the substance abuse and mental health services administration. [applause] ♪ finish. ♪ ♪

>> good morning, everybody. i'm very honored to be here today. as deb said, my name is marci hertz, and i am a health sign sign at this time, and i am honored to be comoderating this panel with my colleague, james wright. and really we've been thinking about this panel for several years now. um, of course, like all of you, we were paying a lot of attention to the media coverage about the potential relationship between bullying and suicide, and back in august of 2011 we convened an expert panel bringing researchers together to educate us about what the relationship is between bullying and suicide. um, and those articles from that expert panel are actually going to be published in the november 2012 issue of the journal's adolescent health. um, and that will be up on the cdc web site when that comes

out. and this panel really is an extension of that expert panel. that panel was just researchers. here today we have some researchers and some practitioners as well, so we're very excited, um, to be able to have both groups here with us today. we want to draw attention to the fact that each case is unique. so what you're going to hear today from the researchers at least are a summary of the research findings. we recognize this might not be the case in each particular instance. and as you'll hear from the presenters, we still have a lot to learn about this relationship. it does need a lot of further exploration. we are going to ask if you have questions if you would, please, write those on the index cards on your table. if you want them directed toward a particular presenter, if you could write their name on that, that would be wonderful. and there are staff around the room who will be available to collect those, and then we'll make sure to, um, answer as many of those questions as we can. um, so without further ado, i'm going to let james introduce our

wonderful expert panel, and i hope you are able to stay in your seats long enough to listen. i know it's a lot of presentations, um, back to back. thank you. >> okay. we have a short period of time, so without further ado, i'm going to go in order in which we're going to take, so alex crosby works at the surveillance branch of the center for disease control, the cdc. alex? [applause] and if you can, i'll introduce one at a time, and then we'll give them a short round of applause, and we'll start. iris -- [inaudible] one of five main strategic initiatives through the senate -- or through the suicide prevention branch. iris? [applause] alan acosta, he is the director at the l. gay and lesbian center. [applause] nicole cart rely, manager of outreach for afsp or american

foundation for suicide prevention. [applause] and finally, michelle ybarra, and i think she's still getted mic'd up. so i encourage you to read their bios, but we want to have enough time for everyone to present so, please, remember to write down those questions on the cards, and we'll take them. thank you very much. oh, and with that, i will turn it over to alex. >> good morning to all of you. and i wanted to thank the department of education, department of health and human services for the invitation to come in to talk with you today. what i'm going to be addressing are some of the risks and protective factors for adolescent suicidal behavior. as you've come to this conference to talk primarily about prevention of bullying, one of the things that you have

probably discussed is how bull bullying is associated with suicidal behavior s. so as part of what aisle talk about is trying to look at that context and trying to look at that association and try to see what do we know or what don't we know about that connection between suicide and bullying. um, suicidal behavior, as you may know, is an important cause of death among adolescents and definitely a portent cause of morbidity, sickness and illness among adolescents, so it's an important topic in regards to what is effecting the health of adolescents whether they're in school, out of school, in the community, wherever they are. why would suicidal behavior be considered an important public health issue? for many people suicidal behavior has been long considered solely the purview of those in mental health and behavioral health.

but we found when we started looking at it from a more comprehensive perspective in terms of public health, all of the things that public health involve, there are some important factors why it fits in there. the morbidity and mortality. as i mentioned, when you talk about 15-19-year-olds, suicidal behavior is the second or the third leading cause of death depending upon where you are in the country. morbidity, it is also one of the leading causes of injury among adolescents. public health would not really be involved in suicidal behavior unless there was a potential for public health to have to make a difference, to have an impact. and i think because of the perspective of public health, the focus on prevention that public health tries to be a convener and a facilitator, bring people together to talk about, to address, to bring together their skills and their talents to try to address suicidal behavior, it's another role that public health has. and then it also fit into the mission of public health. public health really tries to

prevent premature death, premature injury, premature disability and try to promote -- tries to promote healthy lifestyles. so as part of what i'll talk about in terms of laying out the framework for my, for my discussion today is what is the public health approach to prevention. and you can apry that to almost any -- apply that to almost any disease, diabetes, hepatitis, suicidal behavior. you start off with assess what the problem is, figuring out what's going on. is it going up, is it going down, where are the biggest impact, what are the most vulnerable populations. then you move on to identify the causes. why does it occur, why do we find that suicides, that males die of suicide about two or three times more than females, but when you ask about suicide attempts, females attempt suicide about two or three times more than males? why does that happen? what are the risk factors that are involved there? and then you move on to developing and evaluating the

programs and the policies. what works and also what doesn't. so if you determine that maybe substance abuse is a risk factor for suicidal behavior, you're now designing that program that tries to impact substance abuse so that you can subsequently reduce suicidal behavior. and then lastly, implementation and dissemination, how do you spread that message? once you've figured out what works and what momentum, you're now telling others, you're taking it from a pilot program to a broadly disseminated plan so others can do it. first to give you some of the descriptive analysis of what's going on in regards to suicide, here you can see at least in the green you can see that suicide is the third leading cause of death among those 10-14, also third among those 15-19. but actually if you go out into some of the western states, suicide is the second leading cause of death for those 15-19. and then when you look at those 20-29, it's the second leading cause in that age group. this is what the rates look like

when you look at the trend over time in regards to suicide, and you can see that among those older clements, 15-19-year-olds, we have some of the highest suicide rates ever, especially in the early '90s. rates have come down a little bit since then, but you can see if you compare the rates that we had in 1956 to ma we're now see -- to what we're now seeing in 2009, which is the most recent data we've got, they're still about four or five times what they were back then, and actually the last couple of years they've been going up again. so it's important for us to be paying attention to what's going on. this is when you look at suicide rates state by state, and you can definitely see that especially in the rocky mountain states suicide is very high. and this is historically -- this has historically been the case, that those states from the border of canada all the way down to mexico have some of the highest suicide rates in the united states. suicides are just a piece of the problem in regards to the

burden. they really tell you just kind of what the tip of the iceberg is, and there's many more hospitalizations due to suicidal behavior and even more emergency department visits. if you compare just the very top of the pyramid that the rates of suicide among the 10-17-year-olds is about 3.2 per 10,000. so for every 100,000 adolescents age 10-17, there's about three suicides. when you go down and look at emergency department visits, there's over 149 per 100,000. so the rate has been multiplied by almost 50. 50 times as many adolescents coming to emergency departments for suicide attempts than those that die. so the big burden there is definitely in those coming to emergency departments. you can see here that there's a big difference when you look at the slide with the trends, that males die much more of suicide than females.

especially focusing on the 15-19-year-olds, 20-24-year-olds, that bar in orange are the females. if you can see that the females attempt suicide much more than males do when we look at emergency department data. this is from the youth risk behavior survey in which we ask high school students all around the country, about 14,000 in the last survey, about suicidal thoughts, have you seriously considered suicide in the past 12 months? have you made a specific plan about how you might carry that out? did you make a suicide attempt? did you make a suicide attempt that required medical attention? you can see in 2011 which was the last year that the survey was done, about 7% -- so that's about 1 out of every 12 or 13 high school students in terms of attempted suicide say that in the past 12 months they've made a suicide attempt. these are the trends, and if you just focus maybe on the very end of that slide from 2009 to 2011, you can see that suicide attempts went up among

adolescents. it had been going down, but now it looks like it's reversed and started going back up again. again, kind of clueing us in that we need to be paying more attention to what's going on among our high school students in the united states. just as an example to show you in a few states they use that same survey and look at middle school students. just to illustrate that when they've asked it among middle school students compared to high school students, middle school students report even more than high school students do, and you can see there in the white and the green box, there are more junior high students say that they've considered suicide than in the same state, alabama, have made in terms of senior. this is looking at suicidal behavior among high school students by sexual identity. there's a few states, and this is the same -- or a few cities -- in which it's the same survey. they also asked about sexual orientation or sexual identity. here you can see especially when you focus on that first bar,

kind of black and white, that those who identify themselves as gay or lesbian are reporting much more suicide attempts than those who are heterosexual which is the smallest bar in the blue. why did it happen, what are some of the risk factors for suicidal behavior among adolescents? um, there are a number of different factors. one of the ways we try to look at it is what's called the social-ecological model. for that particular person, what are their risk factors. then you can look at the family and the friends. are there risk factors that exist within that kind of close, interpersonal group? then you can look within their community, what kind of factors exist within a person's community. and lastly in the broader society, what are the risk factors there. you can see there for some of the individual-level factors age makes a difference, that as you get towards older adolescence, you see increase of suicidal behavior in that group. mental illness is one of the big risk factors and especially

substance misuse, stressful life events can make a big difference. sometimes like breakup with a boyfriend/girlfriend, argument with a parent, those kind of things, school problems, legal problems, those kind of things in terms of stressful life events can put adolescents at risk for suicide. those are never really the only factor, but can play a role in the factors that involve adolescents. the peer and family level, if there has been a family his of of interpersonal violence, the way mom and dad settle something, dad knocks mom down. even though that adolescent wasn't a victim of violence, by seeing that, that actually predisposes them to suicidal behavior, and definitely those adolescents that have been victims of child abuse and neglect are at greater risk. there's also a few protective factors on this slide. you can see in terms of the commitment, spirituality is actually a protective factor among adolescents, and they're also among community. social support, a network of friends and family actually is

protective among adolescents against suicidal behavior. one of the things we've been looking at in regards to cdc is funding programs that promote connectedness. connectedness to school, to family, connectedness to positive peers, um, can make a difference in regards to suicidal behavior and protect against it. this is to let you see that it can be very complicated when you start looking at some of the risk factors for suicidal behavior. it really is a complex human behavior and complex phenomenon that there's no one thing that puts an adolescent or an adult at risk for suicidal behavior but is often an interaction of several different factors. and you can see here it starts down at the bottom talking about individual characteristics, the local world of the individual, that's kind of that peer and family relationship, then the macro environment of the community and then national and global factors. all of those factors can play a role.

these are some of the studies that have looked at what's called population attributable risk, and we're not going to go into all of the data here, but what this does is it tries to look at some of the factors that if you looked within the society, how much did these things contribute to suicidal a behavior? if you could eliminate this particular factor from a person's environment, how much of suicidal behavior would drop down? i know some of you are probably math teachers, you're seeing that they add up to more than 100. i huh, you're giggling -- uh-huh, you're giggling, you were looking at that. if you eliminated them, how much do they contribute, and you can see something like lower socioeconomic status contributes almost half to some of suicidal behavior depending upon what studies you're looking at. um, you can see their interpersonal losses and conflicts contribute, mental health also contributes. so all of those factors, none of those is 100%. all of those contribute somewhat to suicidal behavior among adolescents.

two broad strategies in terms of youth suicide prevention programs, one are strategies to enhance recognition and referral. can we teach people in communities to recognize those adolescents that are at risk and can then get them to the appropriate help? and then the second one is strategies that address known or suspected risk factors. if we know that bullying is a risk factor, can we make a strategy that addresses bullying? if we know that substance abuse is a risk factor, can we direct the strategy at substance abuse that helps reduce suicidal behavior, and there definitely are some successful strategies that do that kind of thing. lastly, implementation and dissemination, how do you do it. there's several examples of different programs that have been doing this, the garrett lee smith memorial act, suicide prevention lifeline, many tribal entities also to do suicide prevention have showed some

effectiveness, 1-800-273-talk, has also shown that it is able to get people to call or have people call on behalf of someone else and actually reduce suicidal behavior, and then there's also a national registry of evidence-based programs and policies that give, proven to be successful in regards to suicide prevention. so in conclusion, suicide is a significant public health problem resulting from an interaction of factors. there's no one thing that puts someone at risk for suicide, but it's often times an interaction. oftentimes it's something that is added on to the other risk factors that an adolescent might have. there's a broad responsibility for addressing the problem. it's not just the schools, it's not just the department of health, it's not just law enforcement, it's not just social service, it's always of them together working together to prevent suicide behavior. and there's multiple opportunities for action. there's a lot of places that the skills of all the different disciplines, of all those

different organizations can bring to bear on actually preventing suicide. thank you very much. [applause] [inaudible conversations] >> okay. and thank you, alex, and we're going to pass over to aye -- iris. do you want to stand? if you haven't been up here, we can see about three feet, and everything -- three seats, and everything else is empty. thank you, iris. >> thanks. i just realized i don't see over the top of that table. i was going to sit down. well, i want to share some thoughts today about the work that we do, particularly our project called native aspirations. and so in looking at the whole issue of bullying, which is one of the focuses in the project, i realized that, you know, everyone comes at defining their issue in a particular way if it connects up to whatever school

system they might be connected to, if they're working, you know, whatever elementary or secondary or even postsecondary. but one of the things that was striking to me as i looked at this definition is that for the work that we do, we have to look through the cultural lens of the communities that we engage. and in looking at that cultural lens, we have to look at the history. and in looking at the history of the issue of violence -- because suicide is violence, bullying is violence -- and in looking at that contagion, i began to realize that we had to come to an understanding in the way that we communicated with our communities about where some of these issues originated. and so it's so important to me in the definition of bullying that you take the time if you're

going to work with native populations to look to the history. and when you look at the history, you have to understand some concepts. one of them is kohl -- colonization, and as you look at the things that are on the center on this slide, you realize that many times you're dealing with communities that have been relocated from maybe where they originated, and they've been put on reservations. and maybe many times those reservations have numerous tribes that are living together, but historically they were not even from the same region sometimes. in looking at bullying and understanding the historical context, one of the concepts that comes forward is the issue of historical trauma. finish and how would you feel i

someone took away your ability to speak your language, outlawed it, how would it feel if someone created situations where you could not practice your spiritual faith, your fellowship. and over time when you look at the history of native populations, they went through many over generations of losing their land base, and all of that sort of comes together in a way where you look at a young person's identity of who am i. we're the only race of people, i believe, in this world that have to prove our membership through a blood quantum. to belong to our tribes. and so if you have that kind of definition of membership and you're not enough to be enrolled but you've been raised in that

community, that's a source of bullying that many times our communities are unable to talk about. but it's very painful, very hurtful. and so, you know, people are addressing those issues today. i come to the point where i find myself helping people to understand the complexity of this issue. and i look at all the data, i look at all of the statistics that face the communities, and i look at the alcohol rates, i look at the connection between suicide, bullying and alcohol abuse. i have to. because many times when we're listening to what's going on in our communities, those situations come out of alcohol abuse. and so you have to pay attention to everything that surrounds that issue.

if you look at all of these circles here, when you enter these communities, you have to be prepared to enter communities that are multicultural, they're multijurisdictional, they're multiinstitutional. so if you're going to bring an approach forward -- and we've learnedçó this through native aspirations -- that you have to deal with so many different systems and people that are layered in your community, that you have to be aware of sort of what you're, what you're taking on. and so at native aspirations, you know, some of the stories that have been shared with us about what works are many times not in the literature, they're not in the research because they're embedded in the community of the people. and they're looking to their own cultural ways of healing.

they're looking to their own practices of how can we -- i like the word "restorative." how can we restore our balance? how can we create situations of facilitation? because as you study oppression, one of the first skills that you lose is the ability to plan. and so you have to go back and teach those basic skills many times in the communities. so i want to show you a map here. these are the 65 different federally-recognized tribes that native aspirations works with today. we have several regions, and i appreciated the earlier map about the rocky mountains because that's basically where native aspirations began. when we have a suicide cluster in our communities, you know, those rates can go ten times higher than any place in the country. and we're looking at

communities, you know, up in alaska that have 19 young people, young males under the ageñi of 18 that are taking ther lives. and yet they come from such remote villages that there are maybe two to three hundred people that live in the village, they're a fly-in community access. they have a very different structure around subsistence. differences>x!ome to bear on the work that we do. we takeçó the communities throuh what we call the native aspirations journey, and we have lessons all along this journey that we've learned from communities around the issue of bullying. what do you do when you have an elected leadership, an elected tribal council that are bullies in your community? how to you, how do you engage that level of leadership?

how do you bring them to the table? told us, we don't know what native aspirations did to us, but for some reason we learned to forgive each other, and we worked together. we brought everybody to the table whereas historically there were a lot of issues and people could not come together to work on what they needed to do. and so in closing today i just want to show you as we do our assessment looking at all the cultural strengths of our people and buildingñi plans that are grounded in these issues as opposed to the deficits, it's very easy to go to what a community doesn't have as opposed to what they've survived with, what they've tapped into and what they build prevention from. we have used a lot of

evidence--based interventions, but we're finding in these communities that they're culture-based innovations and all these examples are what they're using to go forward, and can bullying needs to beñi interwoven among all of these. thank you. [applause]çó >> thank you, iris. and now we're going to turn itñr over toñi alan acosta.ñrñ3mj4(pó hardest part of this would be get anything and out of the chairs, so -- [laughter] well, thank you for this opportunity to talk to you today. um, i'm here to talk about project spin, suicide prevention and intervention now, which is a collaboration among the l.a. gay and lesbian center to endñi suicidal ideation.ñi just some quick basics, the l.a.

center is the lance armstrong lgbt -- lgbt organization in the world, a budget of over $60 million, 300,000 client visits a year. we do a wide range of medical and mental health services for clients who could not afford to get them otherwise. the l.a. unified school district, second largest in the country, 665,000 students more or less, more than a thousand schools, um, and they've also been a pioneer in addressing issues that face lgbtqñi kids. and many, many years ago started project ten which was a project for lgbt kids withinñi the schools. um, i won't spend much time on these statistics, because robert mcgarry did great job yesterday in his presentation, most of -- >> [inaudible] >> i'm not going ahead. i'm sorry. i should be -- there. that's all the statistics i just talked about. i'll remember now. robert did a great job yesterday

of talking about the statistics. i will say that there hasn't been a lot of data collected on lgbt people, and in particular lgbt youths. and i'd like to just sort of give props to the obama administration, um, for in many of their departments being real leaders in this area beginning to collect those statistics which will give us the data to come up with programs and strategies that are appropriate for the degree of the problem. um, what little data we do have shows it's clear enough though, the negative impact of homophobia and transphobia means that lgbt youth is are at greater risk of dropping out of school, and they experience harassment, violence, homelessness, hiv infection and suicidal ideation at much higher rates than their heterosexual counterparts. towards the end of 2010, um, it

was in this context that we have always thought about suicide among lgbtñr youth, but particularly at the end of 2010 with the media coverage of some very high-profile suicides -- and i should say at this point this presentation i also mean those who may not actually be lgbt. they suffer from the same discrimination and violence that lgbt kids do. so maybe gender nonconforming is a synonym for that as well. but at the end of 2010 we saw this coverage, this media coverage of very high-profile suicides among tyler clementi and others, and we got together, the executive staff of the center, and thought this is a particular moment in time that we have, we have the attention of people. and what is our responsibility

as one of, you know, one of the leading lgbt organizations in the country? and we didn't just want to issue a press releaseñi and say how terrible this was, because it is terrible. we'd known this had been going on for a long time. this was not news to us. so we decided, well, we were going to call up the president of the l.a. unified school board and just say we want to have a meeting with you. she was very open to that. we scheduled the meeting, and we had about an hourñi meeting with monica garcia, the president of the school board. it was an interesting meeting because we went in saying we didn't want -- of course, we wanted to solve the problem of lgbt suicide, but we were talkingñr aboutçó suac&dalñrok . conditions in which lgbtq kids would even consider suicide. so we were talking about a much broader kind of mental health perspective than just suicide. um, and, you know, it's -- i'm

sure if you work for a school district, you have a lot of people coming in and telling you what you should be doing and probably saying, and you should do that without us giving you any money, by the way. so monica, though, was very attentive, and at the end he said i get what you're talking about, you're talking about changing the culture of the l.a. unified schools. and we said that's exactly what we're talking about. and from that moment on really we had a very strong partnership with the school district leadership and the people who were working in this area. i am -- oh, i'm going backwards? oh, that's why. i just can't get this. okay, there we go. so we're looking at this issue in a holistic way meaning that the problem is not youth, it's society, it's transphobia and

homophobia. we want to look at it holistically, and we want to get beyond just a discussion of bullying, and that even though we see the connection and perhaps the catalytic nature of that, and we also wanted to talk about suicidal ideation, not just suicide. in order to address those large issues, we had to take a comprehensive approach, so this is kind of the practice we're using which was to attend to issues in a number of different areas. a number of them have been mentioned already today, mental health, family acceptance -- which we think is very important. karen ryan, if you haven't seen her work, it's really important work with. community involvement, getting community groups involved in this, churches, law enforcement and cbos and school safety. and the key kind of practical way of implementing this would be through collaboration. there's great work being done,

and there are a lot of organizations out there that are doing really great work in this area, and we weren't going to reinvent the wheel. so here you see some of our partners. i know we don't have lapd on here, but they are involved as well. in addition to trevor project, glsen, pflag and others, we also have health services, a great number of non-lgbt groups, aclu, have gotten involved with us as well and are sitting on the steering committee with this. in addition from lausd, we have health education programs and the board of, the school board. this is the model, basically, it establishes work groups around each of those areas that i've just talked about. um, and it's very practical. this is, work needs to be done in these areas, and we assigned people coming to the steering committee to these various

areas. the one area it seems perhaps wasn't completely practice-oriented was transgender support, and that's primarily because we saw as in society at large the discrimination, the violence, the mental health and health issues that the transgender community faces are so much more severe than anybody else. and we really wanted to put special attention on that. we began, um, partially with bully prevention because the lausd has done some really great work on that, and they've created a model that is quite good. and some of you may know dr. judy chasten who has really been a pioneer in putting together some of these workshops and trainings. so the work we do supports work that is already existing, we've always made that clear that we're not there to tell them what to do. we've felt part of this holistic approach is we think this can

have a broader impact by educating an entire community. we're teaching skills that apply to all forms of bias, and we hope that work will make those communities more safe and have a better educational experience as well. gender nonconforming youth in general, persons with disabilities, youth with different physical appearance, youth from diverse religious communities and recent immigrants and children of immigrants and, of course, in southern california it's a very, very important issue for us. we have seen sort of the demonization of those groups, and it's very important to work to help them. challenges, working with different cultural backgrounds, 90 languages in the lausd, many different cultural kind of perspectives. so the cultures of the lausd and ours as a cbo, often times you see things at the top of these organizations that don't always get implemented at sort of the ground level, and, um, so that's

been a challenge as well. we've had, i will just quickly go over our achievements. we've really changed the tone of the discussion in the lausd, we've greatly increased the number of trainings that are going on. now we're beginning to train the trainers which we think is very important and will leverage our work even further. um, i'm going to end with just a little bit of a pep talk because this is a huge, huge challenge to solve these problems. we didn't -- in many ways we're experts in certain areas, but we certainly weren't expert in other areas. but we felt that something needed to be done, and we couldn't wait for somebody else to take leadership in that area. so i would just encourage people in our small group, in our breakout group yesterday when we were talking about improving communication among groups, we came up with two words, convene and galvanize. and i depress the advice i would give is don't wait for -- i guess the advice i would give is

don't wait for somebody else to do that. leverage what you're doing already into something greater. thank you. [applause] >> thank you, alan. and now i'll turn it over to nicole from afsp. >> hi, everyone. thank you, to start, to dr. temkin and the other federal partners here today for organizing this summit and for giving afsp the opportunity to participate in this very important panel. i wanted to start out today by identifying some of the positive and problematic results of the recent emphasis that we've seen predominantly in the media, but also within the bullying prevention movement itself on bullying and suicide and the link between the two. um, i'll then briefly present the model for understanding youth suicide in the context of

multiple risk and protective factors, although we've already covered some of this today, so i won't go into too much detail there. and then the majority of this today will really focus on emphasizing and offering guy can on safe -- guidance on safe messaging around bullying and suicide. so over the past couple of years we really have seen very unprecedented attention by the international, national and local media, by social media, by advocacy groups, politicians, entertainers, film makers, there's now all of this attention on bullying and suicide. this has actually had a positive impact on the discussion. we have a much wider recognition of the serious harm that bullying inflicts. we are seeing increased awareness of the disproportionate burden borne by the most vulnerable youth. we're seeing a boost in anti-bullying legislation and programs at the federal, state and local levels, so all levels of government. and we're also taking part in a

very compelling national and grassroots conversation about these issues which has been really great. however, there's also a downside to this heightened anticipation that i want to highlight -- attention that i want to highlight here. we are seeing very frequent rhetoric that includes use of terms epidemic, suicide epidemic or bullying epidemic, and i'm going to go into much greater detail about why these terms are problematic on the next slide. we also have an incood lack of clarity around -- increased lack of clarity around what bullying actually is. no definition among states, school districts and within the media, and we also realize bullying may have different meanings for youth and for adults. so we're now seeing a very wide variance in estimates of the actual prevalence of bully, and we're seeing wide variety in legal and disciplinary measures as well. there's also now this expectation that bullying is a

factor in any suicide that occurs, especially among youth. this is regardless of any evidence of there being a link, um, to that effect. and we're also seeing very frequent violations of media relations for reporting -- recommendations for reporting on suicides safely. some of those, some of the reasons that we're interested in these recommendations is that there are very numerous research studies worldwide that have found that certain types of news coverage can actually increase the likelihood of suicide in vulnerable individuals, and that's based on the amount, duration and prominence of the media coverage. the risk of additional suicides actually increases when the story explicitly describes the suicide method, when the coverage uses very graphic or dramatic headlines or images and when there's repeated or extensive coverage that sensationalizes or glamourizes a death by suicide. and this is actually what we're

seeing in the reports of bullying in suicide as of late. they're very sensationalized in the headlines. we're seeing little attention paid to other suicide risk factors that we've covered today, most notably depression and other mental illness which we know is present in upwards of 90% of suicide deaths. we're seeing a focus on perm details -- personal details and the methods of suicide and repeated references to prior suicides of bullied youth, and this is actually creating a narrative of death by bullying or this bullycide narrative. and this is very problematic. those of us in the suicide prevention movement are very, very concerned about this. first and foremost, this death by bullying narrative is really normalizing suicide as a reaction to being bullied. it's empathizing frequency and similarities among teen suicide deaths, and that's making suicides seem normal, common or acceptable. and this increases the risk of

suicide contagion or those copycat or imitation suicides that we can see in those clusters. this narrative also fosters an emphasis on blame and punishment, and it's misdirecting our attention away from some of the bigger issues that we would rather focus on, um, notably getting treatment and support for those who are bullied and also bully others. we heard today that both of those groups and young people who are involved in both types of behaviors, um, are at risk. and we're also not keeping our attention on the bigger picture. which is recognizing and addressing those social values that actually provide models for bullying in greater society. this death by bullying narrative also advances significant misinformation about the causes of suicide and how it can be prevented. this narrative is implying that adverse life events lead directly to suicide regard he is of individual vulnerabilities in

the young person who died. it's focusing on a single factor as causing suicide which is rarely the case. as we saw today, a very, very complex relationship. suicide is most often caused by the number of factors, internal and external to the individual. and this narrative also views any attention that we pay to those individual vulnerabilities and differences within the youth as blaming the victim. and we're not trying to do that at all. we're actually trying to amend the conversation to make it more safe for young people who may currently be at risk. so what does the research tell us about this relationship? i'm not going to go into detail, you heard from some great experts today. but first and foremost, the studies are consistently showing that youth have been bullied, those who bully others and those who report both experiences are more likely to report depression, suicidal thoughts and attempts than those not involved. however, suicidal ideation and attempts occur in a very, very

small percentage of youth who are involved in bullying, and that's the message that we want to convey. the longitudinal studies are showing that when you look at youth who are bullied and are also depressed, those are the youth who are later at greater risk. if you take depression and other mental disorders out of the equation, the link between bullying and suicide decreases significantly. i'm going to skip over this here. oops. so this model here, this dual-risk model, it's really just answering the question, what does cause suicide in youth? to put it in summary form, there's a difference between individuals who are resilient or in a resilient state and those who are vulnerable. we see that in a resilient state people generally adopt to both negative and positive events, so regardless of whether or not there are stressors in their life, they can adapt to each situation equally well n. a vulnerable state on the

contrary, people adapt when things are going well, but when they're having a difficult time, when they're faced with negative or adverse events or stressors, this is when the consequences that we're seeing have negative outcomes. and resiliency and vulnerability are influenced by a multitude of factors. those that contribute to vulnerability to suicide are that die wrath sis, the red line that you see here that kind of goes down into the negative outcome. factors that contribute to that vulnerability include genetic influences, having a family history of depression or suicide, early adverse events, childhood me neglect and abuse. bipolar disorder, physical disabilities and chronic illnesses, certain personality traits, certain psychological and emotional sergeantistics -- characteristics, despair, hopelessness and also having a

history of ideation or attempt. all of these factors can contribute to vulnerability in young people. and then there are also factors that contribute to risk in already-vulnerable youth. um, these include later childhood/early adolescent stressors like bullying and peer relationship problems, also substance use, access to lethal means and that normalization of suicide or that death by bullying narrative that i talked about earlier. there's a very complex relationship between bullying and other factors, and we saw a really great slide that had lots of arrows, and you can see that it's not just a single, one cause that results in suicide among young people, but a varying number of factors. but what i really wanted to focus on today, um, was the safe messaging piece. and there are two really, really great resources that are available that give guidance about safe messaging on bullying

and suicide so we can avoid that contagion or that unsafe message that so often happens when we're talking about them in a very direct way. we want to encourage accurate and safe portrayal of suicide in all forms of the media, and these two resources can help with that. they basically are emphasizing the potential of the media to change public misperceptions and correctness about suicide, and they actually encourage the media to take a more active role in encouraging vulnerable people to get help. these two resources describe how media coverage can irease and decrease the likelihood of suicide in vulnerable persons, they emphasize the complexity of suicide causation, they encourage the media to offer hope and information about resources and provide recommendations for safe and sensitive language and reporting about suicide. the one on the right is available at reportingonsuicide.org, it offers a lot of really practical do this, not that type of information. the other talking about suicide

in lgbt populations that you see on the left, we're actually going to have those available later today at the mix and mingle, talk specifically about lgbt populations and also bullying and suicide and how we can talk more safely about those issues. that's it, thank you. [applause] >> thank you, nicole. and finally we'll turn it over to michelle ybarra. >> hi. wow, what a great panel, what an amazing morning it has been. also a lot of words, right? a lot of slides. so thank you so much for sticking it in, sticking it through. you can notice i'm at the end which means we are all getting towards the end. this is good news. so what i'm going to be doing today is perhaps maybe pulling it all together, the panel all together, and at the same time doing a deeper dive, um, into only of these issues. we're going to get into some data and, um, give some numbers to some of the things that we're

talking about in this terms of bullying and suicidal ideation. as we've been talking about today and i know that this is not the first time we've discussed it at this panel, rather at this, um, this conference, even last year there was this discussion about the relationship between suicide and bullying. and certainly, um, the media seems to have made a decision that there is a strong link. if you were to do a search on bullying-suicide, this is the first web site that comes up. very clearly, they say there's a strong link. so the media have decided, but what do the data say? well, as we've talked about already, suicide's the third most common cause of death among adolescents. suicidal ideation is important because it can be a precursor to suicide. so certainly not everybody who thinks about dying by suicide does, but it certainly is an important warning factor that we can take a look at.

and as we've been talking about an emerging risk factor in the literature for suicidal ideation and behavior is bullying. what we need to do, however, and as we've talked about in this panel is understand how bullying fits within this larger context of other risk factors that we know also can contribute to an increased risk for suicidal behavior and ideation. so today i'll be sharing some data from what we're calling the teen health and technology survey. we were in field in 2010 and 2011, we had a lot of ethical boards looking at our plans and approved, um, what we did. we did have parental permission waived because we were asking very sensitive questions, and we wanted to make sure our young people were safe and they weren't put in harm's way by taking part in our survey. we did do the survey online, and our participants were about 13-18 years of age, so we are talking about adolescents in the middle school and high school.

purposefully, we wanted to make sure that our groups were, that we had sort of a nice representation of age across, so it would make sense that our average is 15.6 years of age. and about on purpose half of our kids were male and half of our kids were female. and then we weighted the data so that they approximate a nationally representative sample, so about 70% are white, about 20% are hispanic, 7% represent, are self-reported to be lgbq, about a third are suburban, and about one in four report being born-again christian. so i think it's really important when we talk about, um, data that we are really clear about what exactly it is that we're talking about, and the only way to know that is, number one, understand where our data are coming from and, number two, understanding how we're measuring what we're talking about. so in our survey what we did is we took an item from a well-validated scale of

depression called the cescr, and there's an item on that scale, and it says i wish i were dead. and we asked young people, how often did you feel this way in the last two weeks? and they had fife different options from not at all or less than one day in the last week to nearly every day for two weeks. so what we'll be looking at today are those young people who said i wished i were dead one or two days in the last week or more frequently. the issue of how to measure in surveys bullying is an ongoing discussion, and that is beyond the scope of what we'll be talking about today. but i do want to be clear about how we measured it in our survey. we spent a lot of time thinking about how we can understand where bullying is happening across these multiple different modes, across these multiple different environments that young people have to try to figure out how to safely navigate in their lives and at the same time not double count, right? especially with convergence of technology, you can be online with your phone while you're at

school. and so how do we ask these questions so that we can understand what's going on? and the way that we now do it is we ask about mode, and we ask about type. so we said bullying can happen anywhere, at school, at home or other places you hang out. so not just at school. bullying can happen other places. in the past 12 months, how often were you bullied or harassed in person, by phone, text message, online or some other way. and then we asked young people about seven different types. we said, you know, again, in the past 12 months how often have others about your age bullied or harassed you by, and then hitting, kicking, pushing or shoving would be an example. okay? young people who said they'd been bullied either through the mode or any type, then we asked a follow-up question about differential power, and as you know, that's a key piece of what distinguishes bullying from other more generalized forms of

aggression. so we said thinking about the last 12 months, were you ever bullied or harassed by somebody who had more power or strength than you because the person was bigger than you, had more friends, was more popular or had more power than you in another way? we wanted to make sure that we were broad in our discussion about what power meant so that when young people responded, they had lots of different ways to determine whether or not their bully had more power. so in our sample what we looked at, what we'll be looking at today are young people who said, no, i have not been bullied or harassed through any of those modes or ways. and it's hard for me to now see the number. the number is 46%, it's that purple part of that slide. 46% said no to everything, okay? then we had 45% who said, yes, i've been bullied either through these modes and/or in these ways. and then we had 15% who said,

yes, and my bully had more power. so what we'll do from here on out, we'll talk about those 15% as being bullied, and we'll talk about those 45% as being victims of general adepression, okay? now, on the right-hand side what i want to share with you is recent suicidal ideation. 88% of our kids said, no, i haven't wished i were dead in the last two weeks. 12% said, yes. and you can see the frequency, so 6% said one or two days in the past two weeks i did wish i were dead, and then another 6% said they felt that way three or four days or more frequently. so when we put it together, when we say, okay, young people who report being victims of nonbullying adepression and of -- aggression and of bullying, what are their odds of reporting suicidal ideation compared to young people who have not been victimized by peer aggression in the past year? and what this slide shows is among all youth which is that

left-hand side, that young people who have been victims of peer aggression are 1.4 times or 40% more likely to report suicidal ideation in the past two weeks compared to those who report not being victimized. and that those who report being bullied -- so, again, the difference is the differential power -- so those who report being bullied are 3.6 times more likely to report recent suicidal ideation. ..

what we see is the relationship between bullying and suicidal ideation goes away so we still -- but nothing is statistically significant so what i'm going to do is i'm going to go here and then i am going to go here. so there is an association. absolutely and want to take into account what else is going on with these young people's lives it appears that other factors including depression, self-esteem and corset discipline by parents actually are stronger predictors of suicidal ideation for young

people. i am going the wrong way for lots of reasons. okay, so -- we also are interested, are concerned about sort of on line bullying versus in person bullying. this looks at it by mode and appointed the slide here is young people are much more like the to be bullied in person than any other way so for example we have got more than -- and i'm trying to do the math in my head. we have 38% who say they have been all he did not last year compared to 17% who has been bullied on line so that is twice as many who have been bullied in person so i think that is an important contextual factor. when we look at it across the mode there is again what we see is that being bullied is associated with suicidal ideation and when we take into account other important

contextual factors other contextual or seem to be more important in many ways in understanding suicidal ideation. so i'm going to leave it here, but i would like to acknowledge our funding from the nic hd. thank you so much. [applause] >> remind -- reminders if you have questions please write them on the cards and we will get them up here and read them out loud and have the panelists answer them. again if you have a specific panelist you are directing the question toward please write that or if you don't write anything we will assume it's anyone who would like to answer it can answer it. [inaudible conversations]

>> this field is for irs. your work has found feeling isolated from nontribal communities and perceived cultural insignificance in relation to non-native cultures contributes to negative behavior and suicide. in your work with youth in tribal communities, have you found that feeling isolated from nontribal communities and perceived cultural insignificance in relation to non-native cultures contributes to negative behaviors and suicide? >> well, some of the issues that you you know, intersect with that is there is a lot of border communities to these reservations, and you know just recently i was looking at some data about rates and the increase of rate and 75% of the rates were from nontribal

members and when i looked at that piece of information, i was surprised, and i thought you know, i thought we had made a lot of progress. i thought we had come a long ways but yet we still have a lot of work to do so yeah i think there is a lot of intersecting issues that come into play on the communities themselves and the ones that surround the reservation. >> thank you. >> could says the challenges in the muslim community is to encourage a healthy identity in a school in societal system that may be working to undermine that identity. what are practical methods of encouraging a change in culture? >> well, i will address part of that, and i think also alan, alan in terms of his conversation with l.a. unified schools has also talked about that. i think that part of that is engaging the administration of

the school, engaging students in the school, engaging faculty and staff in the school, in understanding some of the sensitivities that are there, and just like there have been some very successful bullying programs like the all wise program in which part of what they do is try to change the entire culture of the school such that bullying is not tolerated by anyone. if you see it you are going to report it so i think similarly you know in terms of promoting the positive aspects of cultures is you have to get the whole school involves. there are strengths and their weaknesses and there are positive things about diversity in our schools. we have to and courage and strength in and promote all that different backgrounds that people come from so that it's not looked down upon. those people are not ostracized. >> and alan maybe you can expand on this.

i know we focused a lot about the school district and the schools but a lot of times we spend so much more time in the community so how do we foster that system of change? >> we are trying to work with those groups, with religious groups and some of the people of color groups in the community to see how we might best implement some of that at home and in some of the institutions in which the church is and whoever else, wherever else people might gather. i do think that training to getting an elementary school with respect for all cultures is really important. i've said this over and over but kids get to the schoolyard and they have experienced in our case in the lgbt community a lifetime of home which will pick images and trans-phobic images in culture and it just has to start before they get there and also this notion that a lot of the teachers and administrative staff and schools really do want to do what is right but they don't know what is right and they are fearful of doing

something wrong so the training of teachers and administrators is really important. >> thank you. >> i will just say one thing about that, is, you know i think it's important that you empower young people to be the leaders and training and so that the adults have a perspective of the world, but when you train young people to embrace what those strategies might be and the two things by themselves, you you kw you see all kinds of really wonderful things happen. >> okay, thank you. we have about, think we have about 10 different notecards and we are going to get through as many as we can but great questions. >> we have a question from one of the students. you talked about this in your presentation so if you would take the first go at this one. bullying and suicide have been associated together in the term bully side. do you believe by using this term it forces victims to associate their bullying experiences of suicide or do you

believe it really doesn't have an affect? >> thank you or the question. i think that is something we are most concerned about. we think it is drawing the link between bullying and suicide especially for young people who may be at risk. they may be having thoughts of suicide and then seeing the images and seeing and hearing the word bullycide may make them think it's a normal reaction or something that is expected or on the contrary it debuted the only way that they see they can get their voices heard and that is all very dangerous and we really don't want to draw that association for them and we really want to change the dialogue into more encouraging gains in making sure young people know there are supports out there for them. >> any other response is? >> thank you. i think i have several questions

so i will try to combine them into one. but it's more about your final point and is there a call for relationship between suicide and bullied when taking into other factors and especially about when we are focusing on prevention. >> my training in public health week is use the word causal. i don't think we have that data to say that yet. i am not aware of anybody in the data who will say that but what we do see it is when we look directly, there does seem to be a relationship and when we zoom out and take the young person in the context of their lives, we see that there are other factors factors -- discipline from their parents. depressive symptomatology more generally that seems to be more helpful in explaining their relationship with suicidal ideation and bullying so as we have been talking about bullying

is just one factor but it's a multiple head. the young people do not start thinking about suicide and they don't attempt suicide because of one particular reason so a multitude of factors and bullying may be within the pathway and what we are seeing are there other factors that we need to be paying more attention to. >> and then there was another question michele for you. do we need to start separating general aggression from bullying when talking about prevention strategies? >> i think that we need to stop feeling the need to calling it bullying in order to give it weight. we need to it knowledge there's a spectrum of aggression and bullying has a particular type of definition that for researchers is important so that when we talk, when we use the same word -- young people who don't necessarily take that definition but are still being a addressed upon come it's important that they feel that people are paying attention to

them. from a prevention perspective, what we are seeing is that for example young people who say yes to differential power, my boley had more power than me, those kids are different than kids to say no, actually we were of the same strength. so in terms of prevention programs, i think we want to talk about aggression generally but we also do want to recognize there are more serious forms for example bullying that we need to pay particular attention to. >> i think it's really important because i wouldn't say probably the most common thing you hear is it feels like aggression to the lgbt kids and in the school says that is so. that is the comment that someone takes lightly and it's not directed at an individual but one lgbt kid hears that it's aggression. so i think that's a really important point. thank you. >> and i know we didn't

highlight this specifically but i wanted to open it up for comments about elementary youth that also have effects of bullying and how that carries some of the strategies we are using right now. >> right, so what we do, we work with our family coalition and we have a family service department at the center so there are ways to talk about these issues that don't, first i would say make parents mad because when you say you are going to talk about these issues and a lot of elementary school parents they think you are going to talk about and you're not. you are going to talk about respect of behavior and forming a community in a respectful way. so we are doing a lot of training of elementary schoolteachers and more importantly particularly in a culturally divorced -- diverse district, that has to start in the home, that respect and again a lot of times what we have found is lgbt kids -- lgbtq kids

have issues that parents just don't know and they are quite embracing once they learned and we have also found that it can't just be one session, we have to do it repetitively with parents and families. >> oftentimes when we are talking about some of the prevention programs at the elementary school level and even sometimes in the preschool level we are talking about things like teaching these children coping skills, teaching them pro-social skills so you are not necessarily talking specific way about suicidal behavior or talking necessarily about sexual orientation but you are teaching them how to work together and how to collaborate on things. one of the programs that has actually shown to be successful in regards to preventing suicide is one that was developed through johns hopkins called the good cave your gang in which what they do within the classroom is promote teamwork and how do you accomplish goals

within your classroom is you are working together so that all of you you and your team are making progress and making positive strides. so in that sense it's not necessarily saying we are not going to go out and talk about violence prevention but we are talking about how to work together, how to create social skills, how to cope with adverse events that occur in your life. who do you go to? have you created some kind of network and friends and family and others that when you do have trouble you know who you can go to to get some help. >> thank you. >> i think we are going to go with one final question and then i know you are scheduled for a break. if people have additional questions in the panels willing to stay we certainly want to do that but i don't want to interrupt people's breaks. there is a question here about anyone on the panel or you are aware of anyone who have talked to the panels or appears friends of those who have committed

suicide and who were also bullied to gain insight about the other factors you're talking about here? >> i can speak to, i personally have experienced -- suicide. i lost my brother in 2004, and he was bullied on line before he took his life so i have a very deep personal connection to this issue and i completely empathize with people who are also in that situation. it is very very difficult to look at the person that you loved and were so close to and not think that the thing that happened to them right before they died was the reason why they took their life. my brother's case specifically he actually indicated in his notes that this other individual who was bullying him was the reason so looking at that in the mix of all your confiscated grief and your guilt in your shame and all of that come it's really really hard to say that

wasn't the only reason why he left us. empathize with these folks and it's taken me a long time to come to you at their site and really start looking at it in that vigor context and what else is going on with greg and why was it when he was humiliated that he ended up taking his life whereas most kids who are in this situation don't. it's very very difficult. you can get there with a lot of support and a lot of research and talking to people and starting to change the conversation i think. >> perfect, thank you and michelle were you able to contact the family through that study where the adults ask as well or was it just a youth between the ages of 13 and 18? >> no, we talked to the youth and because we want young people to feel free to be honest about what is going on and we asked a multitude of questions, we ensure the confidentiality and their privacy and in this

particular save a we ask questions that were sensitive enough that we actually, we don't have that name and we have no way to contact them. for that reason we really wanted to protect them. >> i think i receive are going to add one thing but i know it's very different in the native communities where the family is such a strong net bond, so can you speak a little bit about that? >> actually just last week, you know we had a murder suicide in two very prominent families and in our culture, it's very important to involve the elders in everything that exists in the community and i was just sitting here thinking about even saying the word suicide is a cultural taboo for many traditional communities because they believe that word holds a spirit that you don't want to a attracts to yourself, so that you have to find ways to communicate things that allow you to be able to

engage people, but that word in and of itself is really you know, it's charged with a lot of energy, and so the healing has to come from within the family, and being able to involve older people in the community, you know that have those life experiences are critical to the work that we do. >> thank you, iris. >> thank you to the panel. they have been a fantastic panel and thank you for your questions and your attention. [applause] ♪ [inaudible conversations]

[inaudible conversations] [inaudible conversations] >> the education department today hosting its third annual bullying summit in washington. some focusing on assuring anti-bullying efforts are based on the best available research. live coverage when the summit resumes at noon eastern. speakers will include senior advisers valerie jarrett and cynthia germanotta, -- lady gag.

>> now if i'm advising this, who is not necessarily, he's not going to win because of this

site, let's not worded that way. i would look for someone who did bring assignment. sarah palin did bring excitement to john mccain. chris christie would bring excitement to mitt romney. i doubt that happens but that is where i would lean. >> the barack obama campaign generated over 200 million people on the electric just from people going door to door. all of that is housed in the democratic voter base and becomes the foundation for which the campaign than can go back and coordinated outreach program for 2012. >> during this break in the bullying summit taking place in washington we will show you an earlier discussion on how to

support sub-- bullies so they can change their behavior. >> good morning everyone. i am a social science analyst at the national institute of justice, and i think i will be joined momentarily with mike cho moderator valerie maholmes. we are both very excited to have this panel today, the panel will be joining us shortly. we are still getting the mics up but val and i are on the federal partners and bullying prevention workers specifically on the research subcommittee. where is valerie? and we are very excited actually for this panel today. this panel really grew out of a recognition in the last couple of summits that we have been

understandably focusing on youth who are victims of bullying but as we have heard some already at this year's summit, we note that bullying occurs within a much broader context and in order to ensure that our schools are safe and supportive places for all students we really need to understand what factors may be used up her ticket paid -- participate in bullying behavior to support this youth as well. is a heard about yesterday many of the current strategies such as zero tolerance ultimately are not particularly helpful. the research shows for these years and we really want to understand more about youth who bully for many reasons but one reason actually there are a good number, a small but critical number of youth are involved in both the hay fears as bullies as well as victims and we want to make sure we can really understand those experiences and find ways to support on cute. i'm really excited for our panel

today who will be presenting some of the research and intervention that will be supported to help us explore these issues. so, are they ready? okay. have them all come out and i will briefly introduce them. [inaudible conversations] >> i will briefly introduce her speakers who have their full bios in your books. i don't want to take any more time away from their presentations. we will start with dr. dorothy espelage who is a professor in the department of educational psychology at the university of illinois at urbana-champaign and she has been conducting research on bullying, sexual harassment

and gay violence for the last years. she will review the receptors associated risk factors associated with aggression and set tree and how bullying is's length with gender-based aggression. >> thank you very much. good morning, good morning. we have about 12 minutes to take you through 20 years of research so hopefully you had your coffee. what a first want to do is to, because we have about 12 minutes i first want to talk to you about what we know from a perspective so if we were to take the cook study and look at, essentially they looked at 153 studies to say what do we know about this those kids who bully others? if we look at this analysis, it across 153 studies, some cross-sectional study so a snapshot if you look at a child that bullies have a high rate what do we see that occurs? what we find at the university

of washington found these kids had significant externalizing behavior, increased, decreased social confidence academic challenges, negative attitudes towards others and a family characterized by conflict. however if you look close at the meta-analysis you will see the same types of outcomes really were moderated by -- meaning as the kids age they became or popular within the context of their peer groups and you will hear more about that from dr. faris. if we want to think about moving forward from cross-sectional studies and you have heard already from the department of justice that there is an apparent assumed link between subthree and criminality. if we look at the criminal behavior and mental health and if you dig deep into those studies you ultimately find that those kids that are engaged in bullying across analysis are at risk for criminal involvement, alcohol and drug use, challenges

within their occupations but the reality is that the best that they can conclude is there might be associations because once they control for all of these other risk factors within their environment, that association between bullying and criminality was reduced so we are really at a point where there might be some kids that bully others that may have his criminal trajectory but that may not be the entire story for all kids. so the bottom line is there is a limited number of longitudinal studies that on pat mechanism and the contextual variable that explains why kids bully others. there a few longitudinal studies that consider how bullying is related to these negative outcomes and what the mechanisms are underlying these processes. what i want to do is show you some research funded at a center for disease control and i want to appreciate my projects officer kathleen and the late merle who was instrumental in

funding -- what do we know about the kids that bully others and what we do see here and i want to show you a sample and a quick demonstration of some of the research that is the tip of the iceberg to understand what are these kids like to bully others? we are looking at about 1105th or eighth-graders and retract them from fifth to eighth grade over a two-year period and i'm going to show you some of our findings. now you may not be impressed by this beautiful longitudinal structure but i am and my team is. this builds on those cross-sectional research to understand the nuance mechanisms of how it is that kids begin to bully others. what i'm going to walk you through our three waves of data from fifth grade through seventh grade and in what this shows is, this is the boy model, boys that are in homes where there are high rates of family violence and aggression, they are more likely to bully others longitudinally and if you look

at the arrows from one to two, you see that is not the complete picture it and in fact engaging in bullying they are at at risk for outgoing druggies. .. at the same time those that bully others may be at particular risk for using

substances. now, i want to draw, i'm trying to tell a story in a short amount of time. we're seeing complex associations with bullying in sexual violence in home to homophobic perpetration. it it's not kids bully others. milieu lead them to engage in other forms of bullying. could be homophobic teasings and if kids are in schools in which there is a promotion of masculinity and endorsement of heated sexual norm. they may have to demonstrate it in engaging in sexual violence other over time. we have talked about this as a potential bully sexual violence pathway. we have done a number of series of studies looking at bullying homophobic content in which they engage in a homophobic banter to others. we also have three engaged sexual violence literature to say what is actually happening

within the context of early adolescence is bullying perpetration a training ground in some ways for homophobic bander and kids feel the need to demonstrate their heterosexuality by harassing another publicly. the high pot is is -- casually linked i i did stay casually linked. i feel comfortable about it. i want to high hypothesize that teasing perpetration would beon set of sexual violence perpetration. let's take it to a point where we might be able to intervene. this is the idea that bullying perpetration in the association with sexual harassment or sexual violence may be the strongest for those kids that adhere to a traditional masculinity. that boys need to be boys. like we heard yesterday from the boy that he had to man up.

we demonstrated why he engaged in bullying perpetration. i want you to recognize, first, when yes look at the middle school sample and we look at those kids engaging in high rates of bullying we find equal numbers between males and females. 12%. more alarming is the finding we continue to see since 2000 and the number of kids that engage in homophobic banter toward others 34% of the boys are engaging in behaviors at high right at 20% of the girls are engaging at high rates. there's a suggestion that perhaps wul bullying perpetration is common 12 percent. perhaps homophobic banderring directedded toward others may be common. let's take it yet to another beautiful, yet i know at 9:00 in the morning. this is a casual transactional model between those kids that bully others and those that direct it to homophobic

bantering. the words we think are innocent actually play a major socialization role and they stem from bullying perpetration in earlied adolescence. it if you're bully prevention program is not addressing homophobic panterring the use of the language, it is probably going to be ineffective given the strong longitudinal links. it's present in illinois, it's not in the state of illinois, we're finding it in other states. we have a casual link we feel strongly about. and replicating in multiple studies. we finded that bullying prevention programs should include that discussion. around the language that marginalized not just lgbt youth any boy or girl that is not no longer wants to sit on the gender box and marrallized because they are gender noncon

forming. not only is bully and homophobic bully linked we show in a series of studies that bullying homophobic is linked to sexual violence over time. that's what the circles show in a longitudinal analysis. one from wave five two year different. strong longitudinal association among bullying homophobic banter and sexual sarsment perpetration. rather than showing you another beautiful diagram that has more circles. i want to tell you about the moderating analysis. the bottom line what it shows. longitudinally, that if kids -- kids when they bully others, in fifth or sixth grade, they will have a high propensity to engage in sexual violence perpetration if they endorse a traditional masculinity ideology inspect is for boys and girls. if boys and girls both believe

boys should be stoic and not express their emotions. there will be an increase from bullying two sexual violins perpetration. we should remember -- we're not talking about sexual assault, we are talking about commentary and sexual rumors they be may be precure corp.s so other tomorrows of violence as they transition to high school. we must consider as we think about who are these kids that bully others? there's great complexity in what they bring to the table. whether it's violence in the home, whether it a siblings aggress where thar model the behavior. i chosen to focus on something that is amenable. that is the use of homophobic banter and the compression of sexual violence that seems to stem longitudinally from bullying. we must address this in our bullying prevention program. it's one area with we can, people are starting to do this, and we must, must address

homophobic bantering and the sways that sexual violence is expressed in order to promote heteronormivity in our schools. thank you. [applause] >> thank you dorothy dara blachman-demner davis the his research focuses on social networking and how they are structured, how they structure in by conflict and aggression. he will talk about social networking drivers and aggression in bullying. >> thank thank you very much for having me. i appreciate the opportunity to talk to kind of a new community of people that i'm not usuallying talking to. is the microphone okay? okay. i'm going have to come compress a lot of research into a few slides. well, about twenty slides. that's also too many. i'm going gloss over a lot of the details here. but all of my research lately

has focused on two and a half questions. the first, one and a half questions are, who victimizes whom and why? and say it's one and a half questions the answers to both the questions are linked. the motivation, it turns out, drives the targeting. and the second question, is what happens to them as a result of their involvement in aggression? so the data i use come from two very different communities. the first is a large study of adolescence in nbc who typically small town, and somewhat rural areas of north carolina. the second study is a wealthy suburb of new york city on long island. a different community. the kids are in age 12th grade. we follow them over a period of time. different periods of time of time. it allows us to again, disentangle some of the casual relationships here.

so one of the things eye focus on in the research is social networking able sis which is a fancy way of saying i study relationships, between people and how those relationships are linked in larger webs. a lot of social networking analysis is focused on positive relationships like friendships. we have collected the friendship relation of the kids. we can create social mass of the school. on top of that, we also collected data on who is picking on whom. who is bullying whom. who is victimizes whom? that adds a new layer of questions question focus on. we also know what they're doing. physical violence, os schism and so on? and how frequently it occurs. and the idea of social networking analysis is best illustrated in pictures, here we have, this is an image of hypothetical school with the to thes represent student and the lines between them are friendships. and this probably looks like

something like a birds nest. there there important ideas in here. there's clustering in the school networks. kids don't aggravate together equally. they cluster together. there are denser regions of the diagram and more upstairs regions. there are kids who vary in centrality in the networks. and that might have implications for their involvement in pulleying. one possible pattern we might observe will look like this. where we see kids who are the margins of the social networks are picks on other kids who are marginal. there are lot of reasons that might occur. what we find in the data is the opposite. so we find that actually as kids become more central in the social networks, their involvement in aggression both as a perpetrator and as a victim increases. the rates of their aggression increase as they climb the

social hierarchy. that begins to tamper off once they approach the top. so -- in these terms once they reach the sort of around the four or five level of centrality. you don't have to worry about what it means. they are very central. there's the hub of social in the school. at that point, their aggression and victimization rates tend to tamper off. what tear finding is the bulk of aggression is occurring within the hub, the center of the nervings, rather than the outside. there is one exception, there are kids who we call isolates who do not receive any friendship nomination. they are elevated risk of being picked on by the classmates. with that exception, most of it is occurredded at the center. this is -- you can look at die yatic level. this is an illustration of the rates aggression at the i did yatic level between pairs of

kids. what it dells us is the highest rates of aggression are occurs when both kids are relatively high status. relativity central. that's the orange area on the top right of the graph. so we're seeing a lot of occurring between high status kids who are targettings other high status kids. it's also finding that a lot -- most aggression is occurring within sociodemgraphic areas. on the left side we see rates of aggression are highest within racial groups rather than across. it has at african-american are more likely to target other african-americans and caulk -- caucasian the same. with gender it's slightly different. you see somewhat more crossing gender lines. the last group that we looked at is sexual categories, and we see

higher rates of involvement in aggression among lgbt youth but i want to interpret those numbers cautiously because we have those relatively small number of kids who self-identical with identify with the categories. we also see that bullying aggression tends to occur within a relatively short social distances. we see more occurring within friendship groups rather than across the school networking. it so it's not like kids are picking opennen complete strangers. they are picking on kids who are friends of friends. that's the rate of aggression declines the farther apart they are. again, it's consistent with a notion that there's a lot of targeting of rivals and this is a process of trying to climb social hierarchy. there's narrative evidence this is occurring within friendship groups. i'm not going read it out loud. i think so you printouts of the slides. these stories come from kids who

reported their experiences on a website called bullying.org. a few of -- they're talking about how the friends turn on them and the friendship groups involve a lot torment. okay. this is actually what we see. so again, this is caps lates everything i've been targeting. kids in the middle are targeting other kids in the middle. this is coded by gender. this is the same. this is the long island school. you see the same pattern it's coded by race, excuse me grade in school. you see most of the aggression occurring witness the dense cores of these networks. so why do they do it? we find that status motivations are driving them. the more kids care about being popular, the more likely they are to become a bully. more over, the more their friends care about being popular, the more likely they are to become aggressive.

so they're getting -- there's a pure influence process that is a driving -- this is a game in which kids are using aggression to climb the social hire hierarchy. the last question what happens to them as a result of their involvement? we find for victims this is very standard in our data we find that the number of times, number of classmates that pick on you can associated with sub stand increases in anxiety, depression and anger levels. we find they become marginalized socially. victims lose social networks centrality. they also become less attached to the school. these are standard effects that we see in other data as well. but what we found is these effects are actually worse for high status victims. i can talk about that later on in the q and a. if there are questions about that. for the aggressive side, the one question of the i prose or ideas i propose these are ways in

which kids climb hierarchies. one of the questions whether it works. are the kids aggressive, do they actually gain in status. to address the question, my colleague and i, gathered information from the high school yearbook which is have great indicators who is a high stot cuss kid. and so we identified elites in the school. and we looked a who their friends were using tour social networking data. we tried to predict aggression predicted their status two years later. what we found is, yes, aggression kids who are more aggressive are more likely to reach one of these elite social circles it depended on who their victims. sop who they targeted matter for the status perspectives. but it also comes to the psychology call price. they were increases in anxiety and depression, and losing attachment to school somewhat

paradoxly. i want to leave this -- actually leave it with a question rather than a summation. i want to recap to find two patted earns that work here. vulnerable kids getting harassed and targeted adds we might expect. we see process of high status kids jostling with social position. and damaging consequences across the board. i think one of the questions i'd like to propose is toss out there, what are the implications or if this is something that the kids are using to climb social hiker i cans and if it actually works, how can we reach prevention programs to address the process. if it's working and being reward. what are prevention programs going do about? how can they change that dynamic? thank you. [applause] next we have dr. joseph wright.

he is the senior vice president and head of the child healthed a have casey substitute which is the new center of excellence. at the national center children as well as professor and vice chairman of pediatrics and emergency medicine policy at george washington school of medicine and public health. he's going talk about mental and physical impacts on engaging in bullying behavior. >> thank you. good morning, everyone. i'd like to shift gears here. i have nothing to disclose other than i am a card carrying member of the american academy of pediatrics. one question i want to ask you to think about as we move through any presentation for those who are parents in the audience, have you had an fund to think about your pediatrician your child's pediatrician as a player with regard to bullying

prevention? the other long that i'm coming from as a 20-year member of the department of emergency medicine which is one of the busiest pediatric emergency in the department with over 100,000 visits. i mention that because this is where i got my clinical introduction to the issue of bullying and frames my remarks this morning. not only do we have a children's national a great deal of exposure through our emergency department, but also my colleague dr. george strap seen manages a clinic for health-related problems associated with bullying. not surprisingly most of his patients in the clinic are victims and not identified at bullies.

so you are familiar with this epidemiology. i show it to point out that the small percentage of children who are bully victims is an important category to be cognizant of. we will come back to that with regard to practical approaches in the clinical environment. this is the question that i get most often from my colleagues, so joe, what's the fuss? isn't this just kids being kids? and the answer that i've come give is that the issue of concern is really the association with the development of more serious behaviors assault toward behavior down the line, and also, health consequences that clearly may not be evident in the acute care situation. so the question is bully really the tip of the intentional injury iceberg? is it concern from a clinical

stand point that we need to pay attention to? certainly from the standpoint of the literature as recently as a decade ago, this comes from an editorial in the journal of the american medical association, there was not a great cancel -- deal of the evidence at all that showed a relationship of bullying or being bullied with the risk for more serious violence down stream. over the last of the decade, of course, there's been a great deal of work, and i'm sure most of you are familiar with the work out of the national substitute of child health and human development tonya's group that demonstrated that there is not only an association, but also an association that is greater for bullies with regard to weapon carriage, with regard to frequented threat fightings

and bring to my attention in the emergency department. these associations are stronger for bullies than their targets. and we've heard from all of the speakers so far this morning the -- top likelihood of a number of other behaviors down stream. you see substance abuse, academic reform, and truant sei and crime conviction down the line. now, one of the issues that we were concerned about in our clinical environment is that of retaliation. i mention to you that the small percentage of children who are bully victims may represent in my practice a large percentage of the kids who present in the clinical space, and so we conducted a study that was supported in part by funding for the health resources and service administration emergency medical service for children's program

to take a look at the children who were presenting to us as assault victims at our emergency department and trauma center, and asked several questions of that group. and i have interesting findings that i wanted to share with you. 64% of them disagreement with the statement that i believe revenge is a great thing. however, when we ask the question if someone hit you and you hit them back 77% endorsed the statement. and this is a little bit confusing to us, but what we learned is that thed adolescence perception of the parent's attitude toward fighting has the single greatest impact on the response to the survey. and it really poses a bit of a con dumb rum as we activate young people to be actors and be advocates and participate in the prevention of bullying.

one of the challenges what are the attitudes of their parents in their house hold? it's really at the cross roads, and something that i think for me, certainly, as a pediatrician who has counsel in the office space parents and children at the same time, a real challenge as to how to do that. and this actually speaks to what we all are well aware of, there in the yellow, the meta-analysis from the u.s. secret service looked at incidents following columbine going back to look at the cases of mass casualty shootings in two-thirds of the cases, the analysis revealed that the attacker who felt persecuted or injured before the incident. again, make the point that the bully victim dynamic very much is a an important factor to

consider. now, here's at bottom line for me, what is it that a pediatrician can do? a clin niches who is dealing with family and children's and parents all in the space of either an office visit in the emergency department or a community-based health clinic? what is it that clinic nicheses can offer? the first thing that i tell my colleagues is obviously, awareness in advocacy around the issue is critical. there is so much misinformation, and lack of information that parents have it is critical, particularly for pediatrician who have many more contact opportunities with parents of young children than other clay nicheses. but in terms of at the individual level, with a is it that we can actually incorporate into the practice as part of anticipate story guidance as part of the way that you

actually get information and talk to young people in the office space, what is that pediatrician can do? three years ago, the american academy of pediatrics got on board with this in a big way, and published this policy statement around the pediatrician and youth violence prevention with a big focus on bullying and i want to take a moment just to share with you, and, by the way, what i'm going to show you was supported in part by work from founding from doj and the ojjdp to fund a curriculum that the american academy of pediatricses has published called connected kids and made available to all the members. let's see if the technology will work here. this is a pediatrician with a bully victim. >> the other kid has a black eye. that's a good question. no one in here wants to be

here. i totally understand why you don't feel like being here. but i asked your mom to wait outside so i could talk to you by yourself. because i think when stuff like this is going on, it's much easier to have the conversation one on one. so i understand you're having trouble at school? >> nobody -- in the fourth grade was me getting kicked around. now all of a sudden everybody is concerned. >> and you probably feel like that isn't fair? and you're right, it isn't really fair. they should have cared when it was you. and i care now, and i care both for the kids that you're given a hard time, and i care for you. because what you're doing is actually bullying. and it's not okay. we need help you figure out another way to resolve your conflicts besides bullying the kids that are getting on your nerves. >> they just bother me.

they think they're better than everyone else just like -- i just want to keep them in line. >> but you know that it's not your job to keep them in line, right? your job to keep yourself in line, not to keep anybody else in line. do you think these kids are scared of you? >> they better be. >> okay. so this is a fax similarly of an office visit that points out a couple of very fundamental approaches that may not be evident to the pediatrician the the simple approach of open-ended questioning. be able to allow the young person to tell a story and sometimes it's tough to do in the pressured confines of an office visit. the other thing is, obviously,

separation from the parent. we can talk about the value or the importance of that. , but again i wanted to share with you this morning from a clinic clinical perspective what it is and how it presents in the clinical space and how we fight -- might activate pediatricians to participate. thank you. [applause] and now we'll have nancy riestenberg join us who will be talking about restored of other strategies for students that bully. she has over twenty five years in the field of child abuse prevention and sexual abuse prevention. she's a school specialist for the minnesota department of education. let's give her a round of