Safety assessment in schools: beyond risk: the role of child psychiatrists and other mental health professionals.

This article presents an overview of a comprehensive school safety assessment approach for students whose behavior raises concern about their potential for targeted violence. Case vignettes highlight the features of 2 youngsters who exemplify those seen, the comprehensive nature of the assessment, and the kind of recommendations that enhance a student's safety, connection, well-being; engage families; and share responsibility of assessing safety with the school.

Traumatic stress and posttraumatic stress disorder in youth: recent research findings on clinical impact, assessment, and treatment.

Childhood trauma can have a profound effect on adolescent development, with a lifelong impact on physical and mental health and development. Through a review of current research on the impact of traumatic stress on adolescence, this article provides a framework for adolescent health professionals in pediatrics and primary care to understand and assess the sequelae of traumatic stress, as well as up-to-date recommendations for evidence-based treatment. We first review empirical evidence for critical windows of neurobiological impact of traumatic stress, and then we discuss the connection between these neurobiological effects and posttraumatic syndromes, including posttraumatic stress disorder, depression, aggressive behavior, and psychosis. This article concludes by considering the implications of this current research for clinical assessment and treatment in pediatric and primary care settings.

Expanding the reach of youth mentoring: partnering with youth for personal growth and social change.

The goals of youth mentoring have broadened from redressing youth problems to promoting positive youth development. Yet, many of the principles associated with contemporary conceptualizations of development found in the positive youth development (PYD) and community psychology (CP) literature have yet to be fully integrated into mentoring research and practice. These approaches place greater emphasis on youth as assets to their communities and the promotion of positive development through the cultivation of these assets, often by fostering collaborative partnerships between youth and adults to effect social change. In this paper, we examine how bringing these systemic, asset-oriented approaches more fully to bear on the youth mentoring process creates opportunities that may both extend the reach and deepen the impact of youth mentoring through the promotion of community, social, and individual change.

STAYING AT THE TABLE: BUILDING SUSTAINABLE COMMUNITY-RESEARCH PARTNERSHIPS.

In this study, the authors identify three guiding principles or relational strategies for developing successful community partnerships and building an alliance for systemic change. These principles were derived from their work over 4 years with an urban public school system, which was focused on generating a series of interventions for improving the behavioral and academic functioning of immigrant students. In their process, they developed an analysis and monitoring system of students' progress, which allowed for earlier targeted effective support.

Beyond psychopathology: assessing seriously disruptive students in school settings.

OBJECTIVE: To obtain a demographic profile of aggressive students in an urban setting and discern psychiatric diagnoses, functional impairment, and psychosocial stressors. STUDY DESIGN: Participants were 33 students in an urban public school district referred for comprehensive psychiatric evaluation by school staff because they were viewed as a threat to school safety. Evaluations included a review of records, interviews with school and mental health professionals, and student and parent interviews. RESULTS: Students were characterized by severe and untreated or undertreated psychopathology together with high levels of psychosocial stressors and learning disorders. Thirty-two students received at least one Axis I diagnosis, and the mean number of diagnoses for each student was 3; 33% had substance abuse problems, and 30% had nonpsychiatric medical conditions. CONCLUSIONS: The sample is a chronically impaired group of students confronting serious adversity in their daily lives, whose psychosocial and psychiatric needs are not met by current educational and mental health programming. Necessary interventions include prevention and early identification, substance abuse and family treatment, and appropriate psychopharmacological treatment. A comprehensive psychiatric assessment can help change the outcomes for this group of aggressive students.

An overview of juveniles and school violence.

Despite the relative rarity of school shootings, targeted violence, and school-associated violent deaths, any youth who presents with words, gestures, or actions of a threatening or violent nature in a school setting should be assessed and referred for further evaluation by a mental health professional and, if clinically indicated, a forensic evaluator.The request for a juvenile risk assessment for future dangerousness requires careful delineation of role and agency; confidentiality issues; a comprehensive diagnostic evaluation of the youth; and a detailed assessment of the youth's perceived threat or problematic behavior. Various protective and risk factors and consideration of other individual, family, school/peer, and situational factors should also be explored.There is still much information that is unknown when considering school violence or targeted school violence. There is clearly a need for additional research on the identification of at-risk youths, the contributions and significance of various protective and risk factors, the impact of peer relationships, and perceived rejection, socioeconomic status, subtypes of aggression, and developmental stages. Examples of future research direction might include difference by gender, presence of affective or psychotic disorders, substance abuse, emerging characterologic disturbances, and physiologic markers, such as cortisol or serotonin. Additional research regarding best practices and the development of clinical guidelines or practice parameters is also needed.

Developing systems interventions in a school setting: an application of community-based participatory research for mental health.

OBJECTIVES: The goal of this study was to develop systems interventions in a public school district using community-based participatory research (CBPR) methods to improve the social and academic functioning of children from racial and ethnic minority populations. DESIGN: The study used qualitative methods in the process of problem definition and intervention planning, including in-depth qualitative interviews and stakeholder dialogue groups. The study was conducted at three levels--the school system as a whole, two individual schools, and a multiple-stakeholder participatory group. SETTING: The study took place in a public school system in an urban city with a population of 101,355 and in two public schools located in this city. PARTICIPANTS: The CBPR team included two researchers, a researcher/consulting psychiatrist in the schools, the director of the special education office, her management team, four teachers, and two school-based administrators. INTERVENTIONS: The CBPR group engaged in a process of problem definition and intervention planning at all three levels of the system. In addition, both schools initiated systems interventions to target the needs of their school environments. RESULTS: The project led to system interventions at both schools, clarity about the policy constraints to effective collaboration, and increased awareness regarding the behavioral and academic needs of minority children in the schools. The process produced a series of questions to use as a framework in CBPR partnership development. CONCLUSIONS: The CBPR approach can expand the scope of mental-health services research, particularly related to services for racial and ethnic minorities.

Developmental differences in risk factors for suicide attempts between ninth and eleventh graders.

In order to identify differences in risk factors for suicide attempts throughout adolescence, this study utilized a school-based survey of ninth (n = 1,192) and eleventh graders (N = 1,055). Suicide attempts were associated with cigarette and alcohol use, family violence, and depression for ninth graders and with illicit drug use, school violence, and sexual abuse for eleventh graders, while having friends was protective for both groups. Additionally, having more than one risk factor imparted an exponential risk for suicide attempts (ninth > eleventh graders). The differences detected are consistent with developmental changes of adolescence and represent important information for identification of at-risk youth.

Case study: the internet as a developmental tool in an adolescent boy with psychosis.

The Internet has become an increasingly important part of teen culture; however, there still remains little in the medical/psychiatric literature pertaining to the impact of the Internet on adolescent development. Despite the potential problems associated with communication online, the Internet offers a variety of positive opportunities for teens. In this report, we present a case study that illustrates the Internet as a helpful tool in a 15-year-old adolescent boy with a history of chronic neurological illness accompanied by refractory psychosis. Although the case emphasizes some of the ways in which the Internet may have a positive impact on adolescent development, further research is indicated to evaluate the contexts in which the Internet serves healthy developmental processes and those in which its influence is potentially deleterious.

Recent research findings on aggressive and violent behavior in youth: implications for clinical assessment and intervention.

Assessing children and adolescents for potential violent behavior requires an organized approach that draws on clinical knowledge, a thorough diagnostic interview, and familiarity with relevant risk and protective factors. This article reviews empirical evidence on risk factors, the impact of peers, developmental pathways, physiological markers, subtyping of aggression, and differences in patterns of risk behaviors between sexes. We explore these determinants of violence in children and adolescents with attention to the underlying motivations and etiology of violence to delineate the complexity, unanswered questions, and clinical relevance of the current research. Interventions, including cognitive behavioral therapy, psychopharmacological treatment, and psychosocial treatment, are reviewed with acute recognition of the need to use multiple modalities with, and to expand research to define optimal treatment for, potentially violent children and adolescents. The information considered for this review focuses on violence as defined as physical aggression toward other individuals. Other studies are included with wider definitions of violence because of their relevance to assessing the potential for violent behavior.