Research In Action

I recently came across a New York Times blog from a pediatrician whose patient was uncharacteristically acting out at school. In the course of her visit with this family, Dr. Tsai ascertained that her patient was being bullied at school, something his parents were shocked to hear. Unfortunately, this is not an uncommon story; aggression and bullying in schools affects 20 to 30 percent of students, while up to 70 percent of these youth are bystanders to bullying.

Fortunately, there are multiple touchpoints at which intervention is possible, including at schools, at home, and – as articulated in Dr. Tsai’s blog – through visits to the pediatrician’s office. Here at CHOP, we have instituted a network-wide bullying screen as part of our Electronic Health Record (EHR), making asking about bullying a standard part of the care that many of our patients receive.

In order to put the bullying screen in place, a template of questions was developed and made available in CHOP’s EHR. Additionally, the questions were customized for several departments and incorporated into each of their individualized workflows within the EHR. Our bullying prevention research team then monitored provider use of the developed tools and met with these departments to receive feedback and to provide additional education on utilization.

In the event of a positive screen, six resource lists and handouts for providers were developed to give to patients and families. Since the bullying screen was implemented in April 2015, close to 99,000 patients from 7 to 20 years of age have been screened. This data has revealed that, for patients seen at CHOP, the highest rates of reported victimization were to 7- to 10-year-olds and to patients being treated by CHOP’s Healthy Weight program.

Importantly, CHOP providers have anecdotally reported an increase in their awareness of bullying due to having the screening questions embedded within their work templates. This falls in line with what Dr. Tsai writes in her blog post: “During my clinic visits, I am incredibly pressed for time. I check in on past medical history, family history updates, current medications, diet, sleep, exercise, vaccination records and more. But after meeting my young patient and hearing his story of being bullied, I now make it a point to ask my patients if they are being made fun of or bullied at school.”

Embedding a bullying screen into the EHR and providing brief follow-up questions to better understand the nature of the bullying, and resources for providers to offer to patient families can be a crucial first step to identifying if bullying is the underlying cause for a child’s other health issues. It is also important for hospitals and local schools where bullying often takes place to collaborate and communicate. If pediatricians, parents, and schools work together, we can help ensure the safety and well-being of our children.

For more information on bullying in schools, click here.

For local and national bullying prevention resources, click here.