School Violence Prevention Requires Comprehensive Social Effort

From the WebMD Archives

Oct. 11, 1999 (Washington) -- A comprehensive social effort will be required to reduce school violence, according to U.S. Attorney General Janet Reno, speaking here at the 69th Annual Meeting of the American Academy of Pediatrics. "School violence can't be thought of outside the whole [culture]," she says. "We need a national and community alliance ... to end the culture of violence."

Such an alliance will have to involve "parents, educators, physicians, and [the juvenile justice system]," says Reno. One of the goals of such a coalition would be to identify and treat children at risk of becoming violent before tragedies such as the recent school and church shootings occur, she says, speaking as part of a panel.

Adding more metal detectors in schools and applying harsher sentences to juvenile offenders are simplistic solutions to a complex social problem, panel member Paul Melinkovich, MD, tells WebMD. "We need to look at the broader society. Homicide is the second most common cause of death for adolescents. However, it's a mistake to focus only on schools, because school shootings are relatively rare. They account for less than 1% of child homicides," he says. "We need to avoid the temptation to apply simple solutions to a complex problem. There's no one answer."

Melinkovich directs school-based health care in the Denver Public Schools, and he helped coordinate actions taken by the medical community in Denver after the school shootings last April in Littleton, Colo. He and colleagues developed a rapid response team to attend to the immediate crisis and identified community resources for students and their families.

"A school shooting in our community caused people to ask, 'What's wrong with our community, our schools, these students?'" says panel member Warren Skaug, MD, a pediatrician in Jonesboro, Ark. "These are the wrong questions. These events can't be understood apart from the broader epidemic of youth violence." He and colleagues have incorporated questions about domestic violence and guns in the home into routine examinations, along with the usual questions about seat belts.

Children who live with domestic violence and other forms of distress can be more likely to become violent because they live with a high, ongoing level of anxiety. For example, they can have an unacceptably high pulse even when they are at rest, says panel member Bruce D. Perry, MD, PhD. If they can be identified, they can be helped before they, in turn, become violent. A psychiatrist at Baylor College of Medicine in Houston, Perry treated several of the children who were released from the Branch Davidian compound in Waco prior to the fatal explosion.

"Dr. Perry's information about traumatized children is particularly helpful," Eugenia Marcus, MD, tells WebMD in an independent interview. "It's also helpful to know how to screen for violence risks, [as discussed by Skaug]. In my practice, we routinely ask not only about guns in the home, but how they are used. It's important for parents to store guns and their corresponding ammunition separately," she says. Marcus is a pediatrician in Newton, Mass., and president of the Massachusetts chapter of the American Academy of Pediatrics.