- Email: [email protected]
School Violence: Assessment, Management, Prevention
BOOK REVIEWS
parental work patterns are transforming family life. In addition to addressing family problems, society must improve the quality of child care available in the United States today. • Programs that combine child-focused educational activities with explicit attention to parent–child interaction patterns and relationship-building appear to have the greatest impact. The elements of early intervention programs that enhance social and emotional development are just as important as the components that enhance linguistic and cognitive competence. There is an urgent need to ensure access to these intervention programs for working parents. Listed below are a few of the report’s ambitious recommendations (excerpted from the Executive Summary): • In addition to the focus on literacy and mathematics skills, resources should be dedicated to fostering development in social-emotional skills and self-regulation. Substantial new investments should be made to address the nation’s seriously inadequate capacity for addressing young children’s mental health needs. • The Family and Medical Leave Act should provide expanded coverage to all working parents. • Major investments need to be made to improve the skills, status, and compensation of early childhood caregivers and educators. • The President should establish a joint federal-state-local task force charged with reviewing the entire portfolio of public investments in child care and early education. Priorities must include meeting children’s needs through sustained relationships with quality caregivers, addressing the special needs of children with developmental disabilities or chronic health problems, and ensuring safe and stimulating child care environments. Effective coordinated infrastructures must be designed to reduce the long-standing fragmentation of early childhood policies and programs. • Increased integration between basic and applied science in the areas of development and early childhood intervention need to occur, as well as increased outcome research regarding interventions. Since publication, there has been significant effort at national follow-up. For example, Zero-to-Three has received foundation support to assist the news media with their coverage of From Neurons to Neighborhoods, is collaborating with the American Academy of Pediatrics on a brochure for parents, and is developing a briefing paper for local, state, and national policymakers that can also be used by child and family organizations in education and advocacy efforts. As a former child and adolescent psychiatry training director, with significant ongoing interest in infant mental health training, the question naturally occurs to me: “How can this book be used in training?” Although the report was not intended as a textbook, I think it would make a wonderful core review text for an infant and early childhood mental health fellow626
ship. It would also prove useful as a reference in any child and adolescent psychiatry fellowship. A few concerns about using it as a textbook: the chapters vary in readability, and some require stamina to wade through. An adaptation of the text using adult learning principles to make it more student-friendly would improve it as a training tool. However, these points should not dissuade the instructor from selecting From Neurons to Neighborhoods. Not only does it pack a mega-wallop in terms of a compact review of the current literature (the references number 117 pages); the authors also take the next step in challenging the student to consider his or her role as an advocate for policy change. Armed with a solid understanding of this document, perhaps some of our trainees will go forward to make a difference at a societal, as well as individual, level. Geri Fox, M.D. Department of Psychiatry University of Illinois at Chicago Institute for Juvenile Research
School Violence: Assessment, Management, Prevention. Edited by Mohammad Shafii, M.D., and Sharon Lee Shafii, R.N., B.S.N. Washington, DC: American Psychiatric Publishing, 2001, 352 pp., $49.95 (softcover). Recent incidents of school shootings across the country have awakened us all to the potential dangers of school violence. Today, violence affecting children and youth in our communities and schools is recognized as a major public health problem. It is difficult to imagine a more appropriate book for mental health practitioners so often confronted with these complex phenomena than Shafii and Shafii’s School Violence. The book provides an eclectic approach to understanding school violence, with 15 chapters, each 10 to 31 pages, contributed by researchers, attorneys, prevention researchers, mental health clinicians, and psychiatrists. The volume provides a remarkable synthesis of significant research about violence, but also first-hand commentaries by clinicians who responded to school tragedies in urban sites such as Chicago, as well as the more recent “heartland” events in Pearl, Mississippi, and Littleton, Colorado. The coupling of relevant science with the honest reactions of those confronted with school violence makes this collection attractive to a broad readership. In part 1, “Contributing Factors,” Garbarino discusses school violence from a sociological perspective, and those familiar with his work will recognize content from his seminal book Lost Boys. Garbarino highlights the risk factors predictive of serious violent behavior, emphasizing the importance of the accumulation of these risk factors. Flaherty examines variables relevant to the school environment, and readers new to this field will appreciate the descriptions of zero-tolerance policies, school curricula
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 1 : 5 , M AY 2 0 0 2
BOOK REVIEWS
that are helpful in reducing violence, and changes in the way adolescents regard confidentiality in the face of recent violence. Kettl summarizes the biological and cultural causes of violence, including male sex, serotonin dysregulation, and also the contributions of television, video games, and gun access. Fisher concludes this section by examining the evolution of trends over recent decades, including the actual decreases in school murder rates over the past decade, the characteristics of the adolescent subgroups who have become more violent, and the preliminary effects of media coverage on school shootings. In part 2, “Assessment and Management,” Shafii and Shafii discuss the diagnosis, management, and treatment of youths who have the potential for school violence. They use an approach similar to that used to analyze youth suicide and provide guidelines for conducting interviews with these patients. Readers new to this area, or those who must assess students at risk for violence, will find this succinct chapter most helpful, as evaluation instruments are briefly described and treatment guidelines are provided, with overviews of specific pharmacotherapy recommendations, which will be of use for those familiar with prescribing psychotropics. Becky Rowan, M.Ed., a counselor at Pearl High School in Pearl, Mississippi, gives a first-hand account of a school shooting experience and of the effects on the community in the days thereafter. Her honest sharing of her own personal reactions are most moving, especially her account of her frantic efforts to stop her sons from speaking to anyone, as everyone became a suspect after the event. Weintraub, Hall, and Pynoos well describe the response of the psychiatric community to the school shooting in Littleton, Colorado. This chapter provides a template for responding to such a disaster; it includes immediate organizational steps, management of the media, and directions for long-term follow-up as well as acute management. It is a remarkably candid description of what really occurs among people with a variety of agendas in such an event, and Weintraub poignantly points out how, despite the efforts of the community to move forward, “Columbine” remains a disparaging term to describe potential violence everywhere. Layne, Pynoos, and Cardenas describe an effective school-based group psychotherapy program for adolescents dealing with trauma. They detail how the very disturbing and traumatic experiences of the participants can be dealt with through a group experience and examine the importance of sensitivity to group members’ diverse backgrounds and histories. In part 3, “Legal Aspects,” Breen, a plaintiff attorney, eloquently discusses the Tarasoff case and its ramifications with regard to the clinician’s duty to warn and to protect. This chapter sensitizes clinicians to the balance between patient confidentiality and social responsibility. Simon reviews the Tarasoff case and this duty from a psychiatrist’s perspective. This chapter is an excellent companion to the preceding chapter. In part 4, “Prevention,” the editors provide an introduction to several contemporary prevention programs. Cohen describes
a public health perspective on the epidemic of firearm injuries and its tragic consequences, focusing on gun control issues. Fink, in Philadelphia, and Bell, Gamm, Valas, and Jackson, in Chicago, discuss community programs aimed at preventing youth violence in the school and the community. They detail how investment by community members in actions in different layers of the community, combined with clinical work, is necessary to achieve prevention goals. Twemlow, Fonagy, and Sacco describe a systemic, dynamic approach to understanding school violence. Their innovative prevention program addresses bullying by examining the “power dynamics” between the bully, the victim, and also the bystanders. This attention to everyone’s role in the problem represents a significant advance for all future prevention programs. Arnow examines multiculturalism and diversity as a major tool in conflict resolution opportunities to prevent youth violence. Child and adolescent psychiatrists are often asked, in the most varied contexts, to provide answers about school violence. This book effectively integrates diverse perspectives, which prepare the clinician to participate, both with individual patients as well as with community systems, to reduce school violence. The chapters are uniformly well written, insightful, and captivating. The redundancy inherent in any book with multiple authors is not distracting; indeed, the chapters stand alone well, and many deserve to be required reading for anyone training in mental health. Indeed, because of the respect for the perspectives of many different professionals thinking about school violence, it would be an excellent text for education, sociology, criminology, or psychology seminars or courses addressing juvenile violence. This book is not a reference work on all nuances of school violence. Instead it provides the core information about youth violence, what really happens for clinicians after a violent episode, and familiarity with emerging prevention practices. The Shafiis have succeeded in providing a concise, fundamental, useful, and engaging book. All child and adolescent psychiatrists will benefit from reading this book, and most will find it captivating.
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 1 : 5 , M AY 2 0 0 2
627
Hector J. Parada, M.D. Jeff Q. Bostic, M.D., Ed.D. Massachusetts General Hospital Harvard Medical School Boston
Out East of Aline: An Adoption Memoir. By Rex L. Wilson. Rapid City, SD: The Uncommon Buffalo Press, 2000, 378 pp., $14.95 (softcover). Out East of Aline is the story of Billy Joe, a young boy who was left in an orphanage at age four and a half without explanation and adopted at age five and a half by a childless farm
parental work patterns are transforming family life. In addition to addressing family problems, society must improve the quality of child care available in the United States today. • Programs that combine child-focused educational activities with explicit attention to parent–child interaction patterns and relationship-building appear to have the greatest impact. The elements of early intervention programs that enhance social and emotional development are just as important as the components that enhance linguistic and cognitive competence. There is an urgent need to ensure access to these intervention programs for working parents. Listed below are a few of the report’s ambitious recommendations (excerpted from the Executive Summary): • In addition to the focus on literacy and mathematics skills, resources should be dedicated to fostering development in social-emotional skills and self-regulation. Substantial new investments should be made to address the nation’s seriously inadequate capacity for addressing young children’s mental health needs. • The Family and Medical Leave Act should provide expanded coverage to all working parents. • Major investments need to be made to improve the skills, status, and compensation of early childhood caregivers and educators. • The President should establish a joint federal-state-local task force charged with reviewing the entire portfolio of public investments in child care and early education. Priorities must include meeting children’s needs through sustained relationships with quality caregivers, addressing the special needs of children with developmental disabilities or chronic health problems, and ensuring safe and stimulating child care environments. Effective coordinated infrastructures must be designed to reduce the long-standing fragmentation of early childhood policies and programs. • Increased integration between basic and applied science in the areas of development and early childhood intervention need to occur, as well as increased outcome research regarding interventions. Since publication, there has been significant effort at national follow-up. For example, Zero-to-Three has received foundation support to assist the news media with their coverage of From Neurons to Neighborhoods, is collaborating with the American Academy of Pediatrics on a brochure for parents, and is developing a briefing paper for local, state, and national policymakers that can also be used by child and family organizations in education and advocacy efforts. As a former child and adolescent psychiatry training director, with significant ongoing interest in infant mental health training, the question naturally occurs to me: “How can this book be used in training?” Although the report was not intended as a textbook, I think it would make a wonderful core review text for an infant and early childhood mental health fellow626
ship. It would also prove useful as a reference in any child and adolescent psychiatry fellowship. A few concerns about using it as a textbook: the chapters vary in readability, and some require stamina to wade through. An adaptation of the text using adult learning principles to make it more student-friendly would improve it as a training tool. However, these points should not dissuade the instructor from selecting From Neurons to Neighborhoods. Not only does it pack a mega-wallop in terms of a compact review of the current literature (the references number 117 pages); the authors also take the next step in challenging the student to consider his or her role as an advocate for policy change. Armed with a solid understanding of this document, perhaps some of our trainees will go forward to make a difference at a societal, as well as individual, level. Geri Fox, M.D. Department of Psychiatry University of Illinois at Chicago Institute for Juvenile Research
School Violence: Assessment, Management, Prevention. Edited by Mohammad Shafii, M.D., and Sharon Lee Shafii, R.N., B.S.N. Washington, DC: American Psychiatric Publishing, 2001, 352 pp., $49.95 (softcover). Recent incidents of school shootings across the country have awakened us all to the potential dangers of school violence. Today, violence affecting children and youth in our communities and schools is recognized as a major public health problem. It is difficult to imagine a more appropriate book for mental health practitioners so often confronted with these complex phenomena than Shafii and Shafii’s School Violence. The book provides an eclectic approach to understanding school violence, with 15 chapters, each 10 to 31 pages, contributed by researchers, attorneys, prevention researchers, mental health clinicians, and psychiatrists. The volume provides a remarkable synthesis of significant research about violence, but also first-hand commentaries by clinicians who responded to school tragedies in urban sites such as Chicago, as well as the more recent “heartland” events in Pearl, Mississippi, and Littleton, Colorado. The coupling of relevant science with the honest reactions of those confronted with school violence makes this collection attractive to a broad readership. In part 1, “Contributing Factors,” Garbarino discusses school violence from a sociological perspective, and those familiar with his work will recognize content from his seminal book Lost Boys. Garbarino highlights the risk factors predictive of serious violent behavior, emphasizing the importance of the accumulation of these risk factors. Flaherty examines variables relevant to the school environment, and readers new to this field will appreciate the descriptions of zero-tolerance policies, school curricula
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 1 : 5 , M AY 2 0 0 2
BOOK REVIEWS
that are helpful in reducing violence, and changes in the way adolescents regard confidentiality in the face of recent violence. Kettl summarizes the biological and cultural causes of violence, including male sex, serotonin dysregulation, and also the contributions of television, video games, and gun access. Fisher concludes this section by examining the evolution of trends over recent decades, including the actual decreases in school murder rates over the past decade, the characteristics of the adolescent subgroups who have become more violent, and the preliminary effects of media coverage on school shootings. In part 2, “Assessment and Management,” Shafii and Shafii discuss the diagnosis, management, and treatment of youths who have the potential for school violence. They use an approach similar to that used to analyze youth suicide and provide guidelines for conducting interviews with these patients. Readers new to this area, or those who must assess students at risk for violence, will find this succinct chapter most helpful, as evaluation instruments are briefly described and treatment guidelines are provided, with overviews of specific pharmacotherapy recommendations, which will be of use for those familiar with prescribing psychotropics. Becky Rowan, M.Ed., a counselor at Pearl High School in Pearl, Mississippi, gives a first-hand account of a school shooting experience and of the effects on the community in the days thereafter. Her honest sharing of her own personal reactions are most moving, especially her account of her frantic efforts to stop her sons from speaking to anyone, as everyone became a suspect after the event. Weintraub, Hall, and Pynoos well describe the response of the psychiatric community to the school shooting in Littleton, Colorado. This chapter provides a template for responding to such a disaster; it includes immediate organizational steps, management of the media, and directions for long-term follow-up as well as acute management. It is a remarkably candid description of what really occurs among people with a variety of agendas in such an event, and Weintraub poignantly points out how, despite the efforts of the community to move forward, “Columbine” remains a disparaging term to describe potential violence everywhere. Layne, Pynoos, and Cardenas describe an effective school-based group psychotherapy program for adolescents dealing with trauma. They detail how the very disturbing and traumatic experiences of the participants can be dealt with through a group experience and examine the importance of sensitivity to group members’ diverse backgrounds and histories. In part 3, “Legal Aspects,” Breen, a plaintiff attorney, eloquently discusses the Tarasoff case and its ramifications with regard to the clinician’s duty to warn and to protect. This chapter sensitizes clinicians to the balance between patient confidentiality and social responsibility. Simon reviews the Tarasoff case and this duty from a psychiatrist’s perspective. This chapter is an excellent companion to the preceding chapter. In part 4, “Prevention,” the editors provide an introduction to several contemporary prevention programs. Cohen describes
a public health perspective on the epidemic of firearm injuries and its tragic consequences, focusing on gun control issues. Fink, in Philadelphia, and Bell, Gamm, Valas, and Jackson, in Chicago, discuss community programs aimed at preventing youth violence in the school and the community. They detail how investment by community members in actions in different layers of the community, combined with clinical work, is necessary to achieve prevention goals. Twemlow, Fonagy, and Sacco describe a systemic, dynamic approach to understanding school violence. Their innovative prevention program addresses bullying by examining the “power dynamics” between the bully, the victim, and also the bystanders. This attention to everyone’s role in the problem represents a significant advance for all future prevention programs. Arnow examines multiculturalism and diversity as a major tool in conflict resolution opportunities to prevent youth violence. Child and adolescent psychiatrists are often asked, in the most varied contexts, to provide answers about school violence. This book effectively integrates diverse perspectives, which prepare the clinician to participate, both with individual patients as well as with community systems, to reduce school violence. The chapters are uniformly well written, insightful, and captivating. The redundancy inherent in any book with multiple authors is not distracting; indeed, the chapters stand alone well, and many deserve to be required reading for anyone training in mental health. Indeed, because of the respect for the perspectives of many different professionals thinking about school violence, it would be an excellent text for education, sociology, criminology, or psychology seminars or courses addressing juvenile violence. This book is not a reference work on all nuances of school violence. Instead it provides the core information about youth violence, what really happens for clinicians after a violent episode, and familiarity with emerging prevention practices. The Shafiis have succeeded in providing a concise, fundamental, useful, and engaging book. All child and adolescent psychiatrists will benefit from reading this book, and most will find it captivating.
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 1 : 5 , M AY 2 0 0 2
627
Hector J. Parada, M.D. Jeff Q. Bostic, M.D., Ed.D. Massachusetts General Hospital Harvard Medical School Boston
Out East of Aline: An Adoption Memoir. By Rex L. Wilson. Rapid City, SD: The Uncommon Buffalo Press, 2000, 378 pp., $14.95 (softcover). Out East of Aline is the story of Billy Joe, a young boy who was left in an orphanage at age four and a half without explanation and adopted at age five and a half by a childless farm