Assessing and Intervening in Childhood Bullying: What Do Current Pediatric Primary Care Providers Do?

Purpose: Bullying in childhood has been found to severely affect short and long-term physical and emotional health (Bottino, Bottino, Regina, Correia, & Ribeiro, 2015; Holt et al., 2015; Moore et al., 2017). Much has been done to drive public awareness of the negative effects of bullying, but more work should be done in developing standardized and universally approved tools for screening and treating these youth. For instance, current recommendations state that youth victims of bullying who subsequently develop physical and emotional health problems should visit a healthcare provider to obtain effective treatment (Lamb, Pepler, & Craig, 2009; stopbullying.gov, 2017). Moreover, multiple national and international pediatric organizations include policy statements or reports on bullying, such as the National Association of School Nurses (NASN), American Academy of Pediatrics (AAP), American Medical Association (AMA), World Health Organization (WHO) and Society for Adolescent Health and Medicine (SAHM), however these statements do not discuss specific screening tools to identify youth who have been involved with bullying and in general, their recommendations for interventions are vague (Committee on Injury, 2009; DeSisto & Smith, 2014; Eisenberg & Aalsma, 2005; World Health Organization, 2015; Wright, 2002). Additionally, no surveys have been done to see if pediatric primary care providers (PCPs) are actually screening and intervening with patients who have been involved in bullying. The purpose of this study is to identify current practices of healthcare providers regarding bullying among their patients.

Methods: To address this gap in the literature, a survey, an adapted version of the Hensley’s Healthcare Provider’s Practices, Attitudes, Self-Confidence, & Knowledge Regarding Bullying Questionnaire (HCP-PACK) was sent out to pediatric PCPs in the state of Ohio in the United States in 2017. This survey assessed the Pediatric PCPs (1) screening practices related to bullying among their patients, (2) associated symptomology of their patients who have been involved with bullying and (3) interventions used when they discover their patients have been involved with bullying, among other factors.

Results: About 1 in 2 Pediatric PCPs screened their patients for bullying (52.9%). When these PCPs discovered their patients experienced bullying, they observed physical symptoms such as stomachaches (80%), difficulty sleeping (79%), headaches (75%), and fatigue (49%). Emotional symptoms noted in victims of bullying included depressed mood (84%), anxiety (80%), irritability/anger (69%), poor concentration (59%), isolation (54%), aggressive behavior (48%), and suicidal ideation (47%). When these PCPs suspected bullying to be a problem, about 2/3 implemented interventions. The most frequent interventions included counseling (91.3%), referral to a mental health professional (95%), and making documentation in the patient’s chart (97%); followed by contacting the child’s school guidance counselor (30%) and providing reading materials to the patient and family regarding bullying (35%). Qualitative data showed that pediatric PCPs implemented other interventions such as advising the family to look up bullying laws, instructing the parent to contact the school/school board, active listening, and screening for depression and suicidality.

Conclusion: The results of this survey need to be interpreted within a geographic lens, however the results point to a need to address youth bullying victimization in primary care as pediatric PCPs reported seeing and treating the mental and physical consequences of bullying. The results of this survey also supported that there is a gap between current literature on interventions and the actual interventions that PCPs are using in practice. Knowledge of the interventions currently used should be utilized to tailor interventions in primary care that are feasible and scalable for pediatric PCPs. Ultimately, treating pediatric patients who have been involved with bullying could decrease the adverse short and long-term physical and emotional health outcomes that are associated with bullying.