Professional Documents
Culture Documents
For Real Final Paper
For Real Final Paper
Amber Blankenship
An eight year old boy sits eating lunch at a table full of his peers. The children play and
talk over food with great enthusiasm. Topics shift from recent movies, sports, and Xbox games;
each child one-upping the other in their passion and wonder. The chatter grows more intense
and the boy cannot contain his excitement any longer. The need to vent off the excitement
compels the boy to stand, his banana in hand. Giggling through a big smile he points the fruit at
his peers and calls bang, bang bang, bang! The cafeteria monitors immediately came
forward with a firm voice to enforce the schools zero tolerance rule - no pretend play with
violent weapons of any kind, especially gun play. The boy, deflated and ashamed, is escorted to
the principals office where his parents are called and threatened with his banishment from eating
In the case above, a shooting at a local mall prompted the school to introduce its zero
tolerance policy. As school systems react to the increase of gun violence in our society,
predicaments like those suffered by the boy are not outliers. News articles write of children as
young as five being suspended from school for gun play. Historically, gun play has been a game
enacted by growing children; it often entails visions of military soldiers and use of their nerf
guns as props in their theatrical renditions. Thoughtful consideration must be practiced when
implementing zero tolerance rules. Educating children on the inappropriateness of violent play is
important; however, suspending or alienating a child for something they do not understand is
counterproductive and can lead to exactly what the educators are trying to avoid social
isolation.
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Isolating or shaming a child can lead to insecurities and create a sense of separation
within the childs school community. Studies have shown that these emotions can fester within a
child and lead to violence. What can school administrators, parents, and medical providers do to
combat the fear of imminent violence within schools and communities? There is a need to move
focus from simple gun play to identifying children who are truly at risk for violence and thus
take action. Implementing Mental Health screenings for youth will improve access to treatment
and improve long term outcomes for the students, decrease violence in schools, as a result
Search Process
I began my research on the relationship of gun play and violence using gun play as my
initial search query. I extended my search using Google Scholar and OneSearch and began
looking into the process of how children are screened for mental health issues; for this I used the
phrase pediatric mental health screenings. I found a book which discussed early childhood and
adolescent development. I proceeded to use both Google Scholar and Western Washington
University library services to retrieve articles pertaining to causes of youth violence via terms
violence and youth. I then reviewed government and Centers for Disease control (CDC)
websites for facts regarding US policies and costs of violence to the communities. I researched
how to implement mental health screenings for pediatric patients and identified a gap in
knowledge base. Most mental health screenings and studies pertained to adolescents aged 12 and
older. There is a clear shortage of articles pertaining to the younger pediatric population.
cause of death in those aged 10-14, and the second leading cause of death in those aged 15-34.
Males are four times more likely to take their lives; whereas females were more likely to have
suicidal ideation. In fact, 60% of high school students had suicidal ideation or action. In 2010,
784 juveniles under 18 years of age were arrested for murder, 2198 for forcible rape, and 35,001
for aggravated assault. These numbers validate concerns that parents have as they contemplate
There is a known link between youth violence and milieu ailments such as poverty,
victimization, and poor parental habits; thus, it is important for us to view violence as symptom
destructive force or energy used to harm or damage self, others, or property (para 1). The
environment in which people live will have a major influence on their mood and behavior.
Children spend most of their days within school and at home, and as a result, these environments
are chief contributors to a childs developing personality. Likewise, a childs parents are
primary character models; consequently, their daily actions make deep impressions; conflict
within the household, like domestic violence, substance abuse, and symptoms of a parents
mental illnesses can have a profound impact. If the child is exposed to frequent hostilities in the
home, it is reasonable to believe they would begin to view violence as acceptable behavior.
Eisenbraun (2007) has cited that students who grow up in these settings, where structure
is poor, have an increased likelihood of becoming bullies. Neglect or isolation can create feelings
of fear and anxiety. In order to dominate or gain attention, bullies will harness their anxiety and
externalize terroristic behaviors towards others. Young people who become involved with
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violence are vulnerable, have limited opportunities for gaining status in more pro-social ways
and do not see education as a route to self-advancement. (Mcara & Mcvie, 2016, p.76)
Victimization of a child from parental abuse or bullying has been shown to create an increase
likelihood of committing future violence themselves relative to the development of anxiety and
decreased self-esteem. Eisenbraun (2007) also cited a study that found that 16% of girls and
Genetics have been reported to have a direct influence on behavior. Children born from
parents who have been diagnosed with antisocial personality disorder have an elevated risk for
developing conduct disorders and aggression (Copelan, 2006). Impulsive aggression, the failure
to control mood and aggressive impulses, is thought to be a trait which anticipates violent and
criminal behaviors and has been shown to be predisposed to genetics (Copelan, 2006). As cited
by Seo, Patrick, & Kennealy (2008), studies have made connections between low serotonin
levels, a chemical in the brain that is known to regulate mood, and criminal behavior.
When is the best time to intervene? Research has not fully supported mental health
assessments in children prior to age 12, depicting that children younger than this are too difficult
to assess. Conversely, Galehouse & Foley (2012) argue that early identification of risk factors
and assessment of childs temperament and self-regulation can help direct interventions and
safeguard better outcomes for the child and family. Further, they suggest that the development of
evolving, adapting to the childs environment during the first year of life. Scholars have
associated temperament to physical, emotional, and social outcomes for children and have made
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connections with a number of mental health disorders such as attention deficit hyperactive
disorder (ADHD), anxiety, and depression. Extreme temperaments, in children, are thought to be
associated with oppositional defiant disorder, antisocial behavior disorders and other behavioral
Self-regulation is cited by Galehouse & Foley (2012) as the interactions of the childs
imperative for a child to learn the ability to manage these emotions and reactions in order to
adapt well within society. Unlike temperament, the ability to self-regulate behavior and
emotions develops in tandem with the childs brain until hardwiring is completed at about eight
years old. (Galehouse & Foley, 2012, p.22) Frequent exposure to stressful atmospheres, cause
struggles in self-regulation, known to scholars as dysregulation. This can be later associated with
Children who are good self-regulators have a natural ability for attention or focus and
have higher levels of achievement. Research has shown that the ability of blocking distracting
information from the focus of attention, known to scholars as executive attention, shows
improvement from ages 2 through 7, whereas studies of older children and adolescents found
little change in skill from eight to adulthood. This suggests that there is a tight margin of
opportunity where interventions have the most likelihood of success. Regulating behavior
requires the ability to suppress a more dominant response in favor of non-dominant one.
Galehouse & Foley (2012) continue to detail how inability to cope and manage behavior as a
child is a prediction of poor adjustment to school and challenges with peers. Shy temperament
has been shown to be affiliated with internalizing emotions such as negative self-talk which often
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leads to depression. It is important to assess a childs temperament and behaviors to provide the
best tools to help the child to manage and cope with challenging moments and thus improve their
One in five children and adolescents have some form of mental health issue and 70% of
adolescents with mental health problems do not receive care. (Napolitano.house.gov, n.d.
para. 1) Accordingly, it is necessary to create opportunity to screen for mental health and
behavioral problems and provide needed care to these minors. Two opportunities for such
screenings have been identified. As children and adolescents spend a large quantity of time at
school, it is thought to be the best place to implement a screening process. Primary care visits
present a second opportunity for physicians and nurses to assess risk factors. Many of these risk
factors are recognizable during interactions between family members or with staff. Once
identified, primary care providers (PCP) can direct care for the patient and make needed referrals
to appropriate liaisons.
Berger-Jenkins, McCord, Gallagher, & Olfson (2008) completed a study analyzing the
use of a mental health screening tool within a primary care office. This tool, known as the
Pediatric Symptom Checklist (PSC-17), was presented to parents upon arrival. They were
externalizing, and attention difficulties. Outcomes illustrated that parents given the checklist
were eight times more likely to disclose concerns for mental health struggles. These outcomes
also showed that primary care providers were more likely to inquire about these ailments, were
three times more apt to diagnose a problem, and ten times more likely to arbitrate.
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A concern was voiced of over burdening mental health referral services. However, this
study provided evidence against such a claim as practitioners were less likely to make referrals
which implied that this screening was able to direct practitioners focus of care (Berger-Jenkins et
al., 2012). Primary care physicians can best manage care and have the ability to prescribe
medications; yet, have less opportunity for interaction with the student. To best address this
A study by Essex, Kraemer, Slattery, Burk, Boyce, Woodward, & Kupfer (2009) assessed
develop a 15-minute questionnaire to be filled by parents at the start of the academic year. This
tool would be used to help identify students who were most at risk. Symptoms were found to be
either variable or consistent within different groups. Isolated events were found in particular
groups, however, the group who displayed secondary symptoms of either internalizing or
externalizing behaviors, exhibited these consistently over the four years of study. These children
were accurately recognized in first grade. This study further supports the importance of early
universal mental health screenings for the early identification of children in need. When
appropriately identified, tailoring of suitable interventions improves the overall health of the
minor and decreases the risk violence within the school and community (Essex et al., 2009).
Screening all school children for mental health disorders and identifying those who are at
risk for violent behavior is a complex and challenging process. Several screening tools have
been developed to help identify students at risk for emotional and behavioral disability.
However, the accuracy, speed, and ease of use are important characteristics when considering
their implementation. The Emotional and Behavioral Screener (EBS) is clear, concise and
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requires only a minimal expense of educator time. In this tool there are ten questions requiring
the educator to score the student on a scale from 0 (no problem) to 3 (severe problem). These are
then added together to grade the EBS score. The student is considered at risk if they score at 80
percent or greater.
There are several ways to implement the EBS. A three-tiered model appears to be the
most useful and less biased model. As Pierce, Nordness, Epstein, & Cullinan (2016) cited,
students fall into one of three levels of risk: 80% will fall into a low risk category, 15% in a
moderate risk, and 5% will fall into a high risk category. This three-tiered model includes
assessing and grouping students into these three risk categories as well as implement three levels
of prevention. The primary level of prevention, otherwise known as Universal, is for all
students. It allows for structured classroom time and working through morals and pro-social
behaviors. The secondary level, known as Selective or Targeted, is for students requiring more
aid and educator time. The tertiary level, Indicated, is for students who were unsuccessful during
school which trialed this tool over one year expressed feeling more cognisant about their
students behavioral needs and were able to make adjustments to classroom structure
accordingly. They described improvements in the mood of their classrooms and reported
sending fewer students to the principals office for disciplinary actions (Pierce et al., 2016).
School Based Health Centers (SBHC), consists of both medical and mental health
providers and help to improve student access to health care. These are located on school grounds
and are operated or affiliated with an outside community health agency or hospital. It was
reported that adolescents were 10-21 times more likely to use an SBHC for mental health
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services than a local community health center (Carroll, Kilcoyne, & Galehouse, 2012). SBHC
support the success of students by following medication regiments and assisting with health plan
and education development. These centers typically employ Advanced Practice Nurses (APN)
and at times will employ both APNs and school RNs (Carroll et al., 2012).
The Mental Health in Schools Act of 2015 is a bill to amend the Public Health Service
Act and extend projects related to children and violence and improve access to school based
mental health screenings and programs. This will provide funding of up to $200,000,000 in
competitive grants and be distributed by the Substance Abuse and Mental Health Services
Administration (SAMHSA). These funds will be used to train volunteers, families, and other
Youths of the ages 12-22 cost the US more than 10 million dollars, or a minimum of $45,472 an
individual. This figure includes costs of police work, court appearances, property damage,
Education is a vital piece of implementing such courses within the educational system.
Educating staff regarding emotional and behavioral disabilities and other mental health needs is
imperative for the recognition and support to these students. Developing an educational platform
for youth themselves can help with recognition of bullying, victimization and assist with
prevention of further violence. It can further be used to teach about emotional disorders such as
anxiety and depression, how to avoid them, and their long term outcomes. Teaching coping skills
to manage stress throughout life would also be a focus. Above all, educating both the students
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and community as a whole will combat the stigmatization of such disorders and help to alleviate
Conclusion
Although there is correlation between violent behavior and mental disability, not all
mentally ill children will grow to be violent. If the United States is having this influx of mass
shootings, is there an influx in mental disabilities? It would also be interesting to compare the
statistics of mental illness verses number of shootings in the United States against those of other
countries. Data gathered from this research could assist in investigating further into the cause of
Current research supports the importance of implementing screenings for mental health
within the school platform. However, few touch on the importance of adding such screenings for
children under 12. Yet, children ages 5 through 8 are at an ideal age for intervention due to the
dynamic state of self-regulation in this period (Galehouse & Foley, 2012). Screenings as early as
kindergarten can identify internal and externalization temperaments which may lead to comorbid
Implementation of early mental health screenings in schools and clinics for children as
young as five identifies those suffering early enough to intervene while temperament and self-
regulation habits continue to form. Tailored interventions are then able to grant children the
ability to develop the skills needed to manage stress, promote positive lifestyle, and feelings of
belonging toward their family and their community. If these interventions are successful,
children will be more likely to triumph throughout life and be less likely to turn to violent,
aggressive behaviors. Additionally, increased welfare for schools provides educators with the
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ability to deliberate on scholarly teachings and governments the ability to allocate saved funds to
Educators and primary care providers must look past the distractions of gun play and
focus on the roots of violence. It is imperative that clinicians begin to look further upstream to
identify the social and genetic determinants of mental health. A preventative stance must be
taken to provide better opportunity of success for our youth and thereby protect the safety of our
communities.
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References
Berger-Jenkins, E., Mccord, M., Gallagher, T., & Olfson, M. (2012). Effect of Routine Mental
Carroll, E., Kilcoyne, A., & Galehouse, P. (2012). Advanced practice nurses interfacing with the
school system. In E. Yearwood, G. Pearson, & J. Newland (Eds.), Child and adolescent
Centers for Disease Control and Prevention.(2012). Youth violence: facts at a glance.
Copelan, R. (2006). Assessing the potential for violent behavior in children and adolescents.
https://doi.org/10.1016/j.avb.2006.09.008
Essex, M. J., Kraemer, H. C., Slattery, M. J., Burk, L. R., Boyce, W. T., Woodward, H. R., &
Kupfer, D. J. (2009). Screening for Childhood Mental Health Problems: Outcomes and
Early Identification. Journal of Child Psychology and Psychiatry, and Allied Disciplines,
& J. Newland (Eds.), Child and Adolescent behavior health (pp. 22-36).
doi:10.1002/9781118704660
House of Representatives. (March 03, 2015). Mental health in schools act of 2015. Retrieved
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from https://www.congress.gov/bill/114th-congress/house-bill/1211/all-info
Mcara, L., & Mcvie, S. (2016). Understanding youth violence: The mediating effects of gender,
https://doi.org/10.1016/j.jcrimjus.2016.02.011
webster.com/dictionary/violence
https://napolitano.house.gov/resources/additional-resources/mental-health-schools-
act/facts-mental-health-schools-act
Pierce, C. D., Nordness, P. D., Epstein, M. H., & Cullinan, D. (2016). Applied Examples of
Seo, D., Patrick, C. J., & Kennealy, P. J. (2008). Role of Serotonin and Dopamine System
Interactions in the Neurobiology of Impulsive Aggression and its Comorbidity with other
https://doi.org/10.1016/j.avb.2008.06.003