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Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
Trauma, Bullying, and Violence
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Trauma, Bullying, and Violence

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Trauma can interfere with the development of healthy coping skills. This can prevent children from interacting in an appropriate way with peers, teachers, and family. Those that have been bullied …

Trauma can interfere with the development of healthy coping skills. This can prevent children from interacting in an appropriate way with peers, teachers, and family. Those that have been bullied can also become bullies because of the same principal.

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  • In the days of dinosaurs this reaction to stress was a survival strategy
  • Transcript

    • 1. Second Annual Bullying Prevention Conference December 14, 2012 Presented by LSU Baton Rouge
    • 2. CARE for the Roots and the Tree Will Bloom
    • 3. Effective Steps to Counteract Trauma, Bullying and Violence
    • 4. k.seifert@espsmd.com http://preventbullyingnow.info http://drkathyseifert.com Dr. Kathryn Seifert
    • 5. • Bullies have been bullied or traumatized • They have learned to be bullies from a role model. To change a bully, change the role model (teachers, parents, & School climate) • Multi-disciplinary Teams for the most difficult cases include teachers, mental health, counselors administrators, and law enforcement Major Concepts
    • 6. • Primary Prevention – everyone • School Climate – Respect for all and talking through conflicts • Less Severe Problems - Teachers • Teaching Social Skills – Olweus, character counts • Moderate Problems - Behavior Coaches • Setting limits, positive reinforcement, Behavior management • PBIS • Severe Problems – Mental Health Referral • Very Severe Problems - Law Enforcement and/or mental health Interventions Depend on the Severity of Problems
    • 7. • Some bullies have rather moderate problems that are fairly easily remedied with traditional methods. • Some Bullies have very serious problems that are much more difficult to resolve • Identification, assessment and treatment for these two groups are different. There are little b bullies and There are BIG B Bullies.
    • 8. The Severity of the Problems of a Youth that Bullies Relate to: • Severity and age at which they experienced trauma • Prior Bullying • Level of Aggression • Family and school experiences • Types of interventions
    • 9. Let’s Start at the Beginning
    • 10. Babies Are Born Innocent and Helpless and Need Adults to Take Care of Them
    • 11. But, what if they grow up in  Violent, abusive, or neglectful homes?
    • 12. Trauma Fight/Flight /Freeze Numb – unable to act Frontal Cortex Not in Use New Stressor - High Arousal - Excitability Hyper- Vigilant – Poor executive function In the days of dinosaurs this reaction to stress was a survival strategy. And led to safety.
    • 13. Traumatized children may fight  Be angry, hostile, defiant and aggressive
    • 14. The Under-Achiever Or they may become good at Fleeing – Running Away from their Problems:
    • 15. What do they learn?  To withdraw, hide or make themselves small (Freeze)
    • 16. Development of coping skills may be so focused on fight, flight, or freeze, • That development of more complex skills do not progress as well, such as: • Problem solving • Developing trust, perspective taking, and relating well to others • Emotional regulation • Brain development • Self-soothing and calming down • Self monitoring to change behavior.
    • 17. Trauma also affects the brain and brain/body communication
    • 18. • Brain still developing throughout childhood. • Make a fist with thumb sticking down – Thumb is brain stem, inside of fist is limbic system (emotions), fingers are cerebral cortex or thinking part of brain. • The brain develops from most primitive to most complex. • Over proliferation followed by use it or loose it trimming. • Amygdala – emotional regulation – may be smaller and less effective • Brain development may be delayed • Cortisol may be in over abundance causing a constant state of arousal Problems caused by trauma
    • 19. This attachment may be damaged by early trauma Attachment is the heart to heart connection between infants and their caregivers
    • 20. Close proximity of caregiver for protection and meeting needs of child (Bowlby) Supports healthy development in every area Is the basis for developing trust, reciprocity, and healthy relationships throughout the lifespan Supports healthy brain development Teaches self-soothing and how to build relationships through attunement Is the basis for moral development (Kohlberg, 1969) Creates safe haven for exploring the world(Mary Ainsworth) Necessary for the development of the amygdala and limbic system for emotional regulation and for the development of mirror neurons to create empathy 8 Vital Functions of Secure Attachment
    • 21. Secure Attachment Baby has needs Baby cries to get Mom’s attention Mom attends to his needs He feels safe, relaxed, & happy He is good, his mom is good, the world is good. arousal satisfaction
    • 22. • Positive view of self, others and the world • Development of skills is appropriate for age and IQ • Emotions well modulated after age 5 Secure attachment = Positive Development of self
    • 23. • Effective coping skills and improved behavioral regulation by age 7 • Able to form trusting reciprocal relationships after age 10 • Loving and respectful relationships with parents and others • Has empathy and compassion after age 10 (A chronic bully before and after age 10, may not have developed empathy for others.) • Is academically successful in school to the best of his ability and is behaviorally well adapted. Look for bullies among those frequently suspended from school across grades.. Healthy Attachment
    • 24. Disrupted Attachment – disorganized/Dismissive/Disinhibited Type Baby has needs Baby Cries to get Mom’s Attention Mom rarely comes or attends to his needs He cries & cries until he stops crying No one can be trusted I must take care of myself I must have Power
    • 25. • Behavior problems that begin in adolescence, often end in adolescence if routine interventions are used. (Easier to solve) • Chronic Behavior problems that begin in elementary school may signal a life long trajectory of aggression toward others and need a different type, intensity, and length of intervention. Trauma and attachment Problems at ages 0 – 3 can result in a Life-Long Trajectory of Interpersonal Aggression
    • 26. Why is that?
    • 27. • Recognizing that an individual has a mind and that others have a mind, each with a point of view, which can differ. • Basis for perspective taking, interpreting intention of others, and empathy. • Certain brain functions and social experiences are necessary for an individual to develop a theory of mind. • Autistic and children maltreated in early childhood either do not have or have a poorly developed or distorted theory of mind. • This does not allow the adequate development of empathy, perspective taking, understanding another’s intentions, or reciprocity. Theory of Mind
    • 28. • Toddlers do not have the social skills to get what they want through negotiation. • They take what they want • They can be quite physically aggressive – pushing, pulling hair, grabbing • Tremblay et al. Ages 2 ½ to 3 ½
    • 29. • For those that have adults teach them other ways to get their needs met, aggression goes down to zero and stays there throughout the school years. • For those that do not have adults teach them other ways to get their needs met, aggression remains – sometimes for a lifetime 3 ½ to 5
    • 30. • Skill Development • Interpersonal Relatedness • Self Concept • Self Management • Theory of Mind • Emotional Regulation • Development of Pro-social values • Brain Development • Family Cohesiveness and relationships Additionally, When Attachment Bonds are disrupted, There can be problems with
    • 31. • Negative view of self, others and the world • Development of skills lags behind age and IQ • Emotions not well regulated after age 5 • Learning Problems Disrupted attachment patterns - self
    • 32. Complex PTSD (Courtois)/Developmental Trauma Disorder (Van der Kolk) • The victim is psychologically and physically immature and dependent on others. • His or her development is often seriously compromised by repetitive abuse and inadequate response at the hands of family members or others on whom he or she relies for safety and protection. • Symptoms include dysregulation, severe problems with interpersonal relatedness, and ineffective general functioning
    • 33. 3 Major Outcomes for Early Trauma • Building strengths from overcoming the trauma • When an adult helps a child overcome trauma and teaches skills • Becoming bullies or a violent individual • When no one attempts to help child overcome trauma and teach skills Becoming withdrawn, anxious and depressed. When no one helps the child recover from trauma All maltreated children should be assessed for family therapy and skill building
    • 34. DISORDERS OF DYSREGULATION IN CHILDHOOD AND THEIR RELATIONSHIP TO TRAUMA  Conduct Disorder  Aggression  Destroys property  Deceitfulness  Violates rules  Oppositional Defiant Disorder  Angry/irritable  Defiant  Vindictive  Trauma is the likely the major source of the above disorders (Seifert, 2012; Greewald, 2002; Frick & Silverthorn, 2001; Rhee et al., 2001; van den Oord, Verhulst, & Boomsma, 1996; Waldman et al., 1998 and http://www.aacap.org/cs/root/facts_for_families/conduct_disord er
    • 35. RELATIONSHIP HEALTH Severely Disturbed Attachment Patterns Primarily Highly Conflicted Relationships Primarily Positive Interpersonal Relationships Altruistic Relationships
    • 36. BULLYING
    • 37. Types of Bullies Bully • Sadistic, Narcissistic – Purposeful. Lacks empathy & needs to feel omnipotent. Deep seated problem requiring intensive services – Needs thorough Assessment and intensive treatment (BIG B Bully) • Very Serious Problems
    • 38. • Follower. Responds to overall culture of the group with whom he is surrounded. Needs supportive counseling, guidance and social skills. Can be led toward or away from Bullying – Olweus Bullying Program (Adolescents trying to fit into a group. Has to do with VALUES) Imitative Bully
    • 39. • Reacts to the situation. Difficulty restraining himself. May have been bullied. Evaluate for Trauma, family problems, ADHD and treat (Could be a culture/Values Issue) Impulsive bully
    • 40. • Watches and enjoys bullying and encourages the bully. Needs assessment for treatment options (May be a BIG B Bully) Bully by proxy
    • 41. • Bystander – stands by does nothing to help victim either because of fear, uncertainty, or mixed feelings (Universal Bystander
    • 42. Any Type of Bully Can be An Outgrowth of Past Trauma, but most likely the Sadistic and Impulsive Types (Big B) • child abuse and neglect • Exposure to domestic violence • failure to teach alternative ways to get one’s needs met • violent role models
    • 43. • Prevents Victim from becoming a bully • Yellowribbon.org – It’s OK to ask for Help • Mental Health Referral Help the Victim
    • 44. Important Bullying Facts Bullying is serious and should never be ignored. Bullying is not a normal part of growing up. Suspension is not an adequate answer. Bullying is an adult problem to solve. Children cannot solve a bullying problem alone. Parents of the bully need to be involved in solving the problem. Stopping some types of bullying is about teaching respect for diversity and teaching social skills. Some bullies have deep-seated problems that will take significant treatment, some do not. teachers and counselors need to know which is which because interventions will be different. Most school shooters felt they were bullied and ostracized by another group of youth. Their attacks were often retribution toward the group that bullied them.
    • 45. Bullying Approaches For those that do not have severe ,deep seated problems Olweus Bullying Program - http://www.violencepreventionwork s.org/public/olweus_bullying_preve ntion_program.page Operation Respect - http://operationrespect.org/ Character Counts - http://charactercounts.org/ School based mental health http://yellowribbon.org When you are not sure : Assessment of severity of problems, dangerousness and appropriate interventions
    • 46. • Severe problems • chronic problems • multiple problems • Past aggression • Problems began in elementary school When is the problem more serious?
    • 47. Warning Signs Youth at Risk for Chronic Violence have multiple problems, but may be different for girls and boys More Problems = Greater Risk for Chronic Aggression Boys Past assaults on others between the ages of 5 an 12 Chronic School Behavior Problems Oppositional to authority Not doing well in school Fire setting Childhood maltreatment by a caregiver Lacks remorse Anger management problems
    • 48. Violence & School Shooters
    • 49. From Bullying to Violence in Schools Bullying can lead to violence in our schools and School Shootings Most school shooters felt they were bullied by others Which youth are at high risk for extreme violence? What are the warning signs? Which ones need intensive interventions to prevent future violence?
    • 50. Warning Signs for Girls Who are Violent Past Assaults Harms animals Delinquency Childhood maltreatment Substance Abuse (teens only) Anger management problems Lacks remorse Poor problem solving skills Bullying Behavior Delinquent peer group Chronic School Behavior Problems
    • 51. Assessments to Determine the Best Intervention
    • 52. One Size Does Not Fit All
    • 53. • Problems and Strengths • Complexity or severity of problems • Levels and types of interventions needed • Developmental level of coping skills • Functioning of family What an Assessment Should Tell You
    • 54. Problems and Strengths
    • 55. Problems & Strengths • Problems • School difficulties • Bullying • History of aggressive acting out • Problems began before adolescence • Parents not supportive of working with school to find solution • Strengths • Does well in school • Gets along well wit peers • Respectful of authority • Corrects behavior when requested • No past aggression • No past delinquency • Talented in ________
    • 56. Charles Manson (Disinhibited/ disorganized/dismissive attachment type and below average relationship health) • Mother was a teenager and an alcoholic • She severely neglected Charles. He ran the streets from a very young age • She once sold him for a pitcher of beer • He was delinquent and a bully • Spent most of his teenage years in institutions • Raped a boy in one of the institutions • Drug user, never held a job • “Family” responsible for Tate & LaBianca Murders
    • 57. Mother Teresa (Secure Attachment type and above average relationship health) • Agnes was born in Albania (Bosnia). • Father was in Albania independence movement. Likely poisoned by opposition political group when Agnes was 8 yo. • Parents very supportive of children, deeply religious, gave to the poor • Financially and emotionally devastated when father died. • Agnes was good student, active in church, and no behavioral problems. • She was neither a bully, nor bullied • Mother became entrepreneur and support family. Still gave to the poor and devoted to children. • Agnes became a nun when she was 18 years old.
    • 58. Nelson Mandela • His nickname as a child was troublemaker • Lost his father when he was 9 • Regent Jongintaba became his guardian • He was very good in school • Was bullied as a teen in Boarding School • Led ANC’s 1952 Defiance Campaign against apartheid • Led the ANC’s Bombing and sabotage campaign • Imprisoned for 27 years • Became first elected president of the new Republic of South Africa in 1995
    • 59. 0 1 2 3 4 5 6 Non Violent Altruistic Violent Violent All 3 groups had losses & trauma.
    • 60. Violent Group Non-Violent and Altruistic Groups had nurturing families, positive school experience and activities and helped others
    • 61. Complexity or severity of problems
    • 62. • Mild • Less than 4 months duration & easily corrected. Counseling or skill group 1 a week or every other week, 6 months or less. • Moderate • A year in duration & at risk for negative consequences. Weekly, may need to bring in family, skill groups • Severe and Chronic • Lasting more than a year, started before age 13, multiple problems, few resources, at risk for placement, need to involve family Severity and Complexity
    • 63. Levels and types of interventions needed
    • 64. Both Bullies and those being Bullied Need Assessment for Services
    • 65. • Mild • Counseling or skill group 1 a week or every other week, 6 months or less. Supportive or relationship counseling I likely to be sufficient. • Moderate • Supportive counseling not sufficient. Weekly, may need to bring in family, skill groups for 1 year. Developmental approaches may be needed for some. • Severe and Chronic • Supportive counseling not sufficient. Individual, family and group; intensive (multiple times per week); need to involve family; placement may be needed. Services needed for more than 1 year. Developmental approaches likely are needed. Levels of Intervention
    • 66. CARE2 Problem Complexity Score o Uses all items on the CARE2 o Clinical, historical, dynamic, and those that predict violence o Gives a score that can track progress o Gives EBP Treatment plan o Allows agency to use more expensive treatment for most chronic and severe cases o Can also use Strengths score o Can change treatment plan if youth is not improving
    • 67. CARE2 – Violence o 4 NORMS o Male/female o Pre-teen/Teen o Mark all that apply (Clinical and Risk Items) o Items with scores are added and resiliency scores subtracted o risk scale are statistically derived on a sample of 1000+ youth and studies of subsets o Evidence based intervention plans
    • 68. Skill Development
    • 69. • Clinical Judgment no better than Chance • SAVRY – Randy Borum – U. of S. FL., primarily for violence. Excellent tool. • LS-CMI – Andrews. Case management tool primarily for delinquency. Found no gender differences. • PCL-YV. Adelle Forth & Robert Hare. Measures Psychopathy. Do not use for girls Violence Risk Assessments
    • 70. Trauma Negatively Affects Moral Development, Kohlberg, 1969 Can be blocked by Trauma Can be blocked by Trauma Can be blocked by Trauma
    • 71. Development of Childhood Aggression All children below the age of 3 are aggressive When parents teach children alternative ways to get their needs met, they stop being aggressive when they enter kindergarten or 1st grade When no one takes on the job of teaching alternatives to aggression, the children remain aggressive after they enter school. This is a red flag that family intervention is needed.
    • 72. More in depth assessments and interventions are needed for any school age aggressive child if any of the following are true • Low level of coping skills? • Child’s behavior not appropriate in multiple settings • Parents do not respond to requests from school or therapist to help problem solve. • The child appears to be physically neglected? • The Child appears to be hyperactive, depressed, irritable, or unable to focus most of the time?
    • 73. The Marshmallow Experiment
    • 74. Behavioral Objective Sequence Sheldon Braaten
    • 75. The Behavioral Objective Sequence • By Sheldon Braatan • A developmentally sequenced group of skills in 6 Domains. • Age is not the determiner of skill level • Youth must learn skills in appropriate developmental sequence. • Find out at what level they have mastered skills (can do it 90% of the time without prompting)
    • 76. Adaptive Skills Responds in a developmentally appropriate manner to rules and expectations AND Changes those responses as the circumstances change Example I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy, the youth is able to adapt to the different format and relate to peers in the group, not just counselor.
    • 77. Adaptive: Responds appropriately to routine and new expectations respond independently to materials for amusement appear alert and able to focus attention bring no weapons to school use amusement materials appropriately wait for turn without physical intervention use and return equipment without abuse accept positive physical contact touch others in appropriate ways refrain from stealing respond when angry without hitting recognize and show regard for possessions accept verbal cue for removal from a situation respond when angry without abuse of property respond appropriately to substitute respond when angry without threats walk to timeout without being moved by an adult work or play without disrupting others refrain from inappropriate behavior when others lose control respond to provocation with self-control respond when angry with self-removal
    • 78. Self-Management Skills Responds appropriately to challenging experiences with self-control in order to achieve success Example Gets upset with brother because he broke something that belonged to client. Client is able to use alternative strategies to manage self and situation and not harm brother, ie. ask for help
    • 79. Communication • Ability to share with and receive information from other people to meet a need or affect another person in a positive way. • Example: • You need to turn in your book report by Friday • Tell him you would like a turn with the _______.
    • 80. Interpersonal Behaviors • Interacting with others in social and task situations in ways that meet personal and interdependence needs and contribute to a sense of belonging • Example: • Can participate in group • Can give and accept positive or negative feedback
    • 81. Task Behaviors • Student engages in task or activity with or without assistance • Example: • Finish a homework independently • Can set the table without assistance
    • 82. Personal Behaviors • Student engages in a counseling dialogue with a helping person, permitting adult to help resolve issues or solve problems or build self esteem. • Example: • Can ask for help from an adult when stressed • Can discuss problems with counselor and generate possible solutions
    • 83. Level 3 (skills typically mastered during preschool years): Focus: Self; Significance; Success Issues: Trust; Pleasure; Security; Support Interventions: Routines; Repetitions; Modeling; Rewards; Limit Setting; Consistent and Planned Consequences; Continuous Supervision Adult Role: “Benevolent Dictator”
    • 84. Level 2 (skills typically mastered during elementary years): Focus: Group membership; Competence; Sensitivity to Others; Awareness of Values; Communication Skills Issues: Applying Skills in Groups; Balancing Personal and Group Needs; Responding to New Settings and People; Managing Movement Interventions: Routines; Repetitions; Verbal Rewards; Limit Setting with Expanded Choices; Consistency with Group Consequences; Natural and Logical Consequences Adult Role: “Group Leader”
    • 85. Level 1 (skills typically mastered during adolescence and early adulthood): Focus: Belonging; Cooperation; Personal “Power,” Individuation Issues: Applying Skills in New Situations; Expanding and Reinforcing Competencies; Transitions to New Environments Interventions: “Normal” Expectations; Social Rewards; Expanded Choices; Group Problem Solving; Self Selected Goals Adult Role: “Guide/Facilitator”
    • 86. Functioning of family
    • 87. • Parenting Skills • Communication Skills • Conflict Resolution Skills • Acceptance of Diversity • Mental Illness • Substance Abuse • Homelessness Assess Family Functioning
    • 88. Interventions
    • 89. General Interventions Try correcting the behavior first. Use behavior management and contracts. Teach the method to parents to use, as well. Teach respect for differences If children respond, it is likely not a deep seated problem.
    • 90. • School wide education campaign • It’s OK to Ask for Help http://Yelllowribbon.org
    • 91. Severe Behavior Problems Remain If child is still: Frequently Assaultive Has chronic, moderate to severe behavior problems Has history of childhood maltreatment His/her behavior is out of control and cannot be corrected Child lacks respect for authority Assessment is needed to determine severity of problems and treatment and if it is a family problem. Refer for Mental Health Evaluation
    • 92. Assess Youth For: • Level of strengths and problems • Developmental Level • Types of interventions needed • Family Functioning
    • 93. • Right Intervention for Right Youth • Interventions for needs of youth and family • More structure • Parent education and therapy • Behavioral Objective Sequence • More intensive services • Services for years, rather than months • Case Management • Coordination of multiple agencies School Based Mental Health
    • 94. • Early childhood trauma can interfere with the development of important skills • Those that receive appropriate support and assistance can grow up to be healthy • Those that do not receive what they need can become bullies and violent • Appropriate treatment can change behavior and skill developmental level • Adolescence specific and life long trajectory aggression toward others are very different and require different treatment. • School wide skill building programs are only appropriate for less severe forms of bullying and aggression • More severe and complex problems require more intensive and a broader spectrum of services. Summary
    • 95. Elephant Story

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