Welcome to the training on Bullying: Screening and Intervention provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and others to identify risk factors for bullying, screen children and adolescents, provide appropriate prevention and intervention strategies, and connect families with resources.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Specify the prevalence of bullying and health effects that are associated with bullying.
- Assess risk factors for being a bully or victim and conduct effective screening as part of preventive medical checkups.
- Employ recommended prevention and intervention strategies and connect families with helpful resources.
NOTE: In this module, the term “children” refers to children and adolescents, except when differentiation is needed. In addition, the term “parent” also refers to guardians and caregivers.
Please note this module expires on 8/16/2025.
This module was released on 8/16/2022.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nursing Continuing Professional Development
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center’s Commission on Accreditation.
Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hours of Nursing Continuing Professional Development.
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 hours of credit.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
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American Academy of Child and Adolescent Psychiatry. (2022). Bullying Resource Center.
American Academy of Pediatrics. Bright Futures Tool and Resource Kit, 2nd Edition.
American Academy of Pediatrics, Patient Education. (2021). Bullying: It’s Not OK.
American Psychological Association. (2022). Bullying.
Centers for Disease Control and Prevention. (2021). Violence Prevention. Fast Fact: Preventing Bullying
Committee for Children. (2022). Bullying Prevention.
Cyberbullying Research Center, Resources.
National Institute of Mental Health. Ask Suicide-Screening Questions (ASQ) Toolkit.
National Institute of Mental Health. Suicide Risk Screening Pathway: Outpatient Primary Care and Specialty Clinics.
National Institute of Mental Health. Suicide Risk Screening Tool.
Texas Child Psychiatry Access Network (CPAN). Contact CPAN at 888-901-2726 (888-901-CPAN).
Texas Education Agency. Coordinated School Health - Bullying and Cyberbullying website.
Texas Health and Human Services Commission. (2022). Children’s Medicaid and CHIP.
Texas Health and Human Services Commission. (2022). Children’s Mental Health Residential Treatment Center Project.
Texas Health and Human Services Commission. Community Resource Coordination Groups (CRCG).
Texas Health and Human Services Commission. (2022). Coronavirus (COVID-19) Provider Information.
Texas Health and Human Services Commission. (2022). Find Your Local Mental Health or Behavioral Health Authority.
Texas Health and Human Services Commission, STAR Kids.
Texas Health and Human Services Commission, STAR Medicaid.
Texas Health Steps. Anticipatory Guidance Provider Guide.
Texas Health Steps. Periodicity Schedule
Texas Health Steps, Screening Tools: Texas Health Steps links for developmental and mental health screenings:
- Pediatric Symptom Checklist (PSC-17)
- Pediatric Symptom Checklist (PSC-35)
- Pediatric Symptom Checklist for Youth (Y-PSC)
- CRAFFT (Car, Relax, Alone, Forget, Family/Friends, Trouble) Screening Questionnaire
- Patient Health Questionnaire (PHQ-9)
- Patient Health Questionnaire for Adolescents (PHQ-A) - Depression screen
- Patient Health Questionnaire for Adolescents (PHQ-A) - Anxiety, eating problem, mood problem, and substance use screen
- Rapid Assessment for Adolescent Prevention Screening (RAAPS)
Texas Medicaid & Healthcare Partnership. Online Provider Search.
Texas Medicaid & Healthcare Partnership. Texas Medicaid Provider Procedures Manual. (2022).
Thackeray, J. D., Hibbard, R., & Dowd, M. D. (2010). Intimate Partner Violence: The Role of the Pediatrician. Pediatrics, 125 (5): 1094–1100.
U.S. Department of Health and Human Services. (2021). StopBullying.gov.
U.S. Department of Health and Human Services, StopBullying.gov. (2021). Bystander Factsheet.
U.S. Department of Health and Human Services. (n.d.). Telehealth: For Providers.
U.S. Department of Health and Human Services. (2021). Texas Anti-Bullying Laws and Policies.
- Adhia, A., Gordon, A. R., Roberts, A. L., Fitzmaurice, G. M., Hemenway, D., & Austin, S. B. (2019). Longitudinal Associations Between Bullying and Intimate Partner Violence Among Adolescents and Young Adults. Violence and Victims, 34(6), 1011–1029.
- American Academy of Pediatrics, Bright Futures. (2017). Promoting Safety and Injury Prevention.
- Armitage, R. (2021). Bullying in Children: Impact on Child Health. BMJ Paediatrics Open, 5(1): e000939.
- Basile, K. C., Clayton, H. B., DeGue, S., Gilford, J. W., Vagi, K. J., Suarez, N. A., Zwald, M. L., & Lowry, R. (2020). Centers for Disease Control and Prevention. Interpersonal Violence Victimization Among High School Students — Youth Risk Behavior Survey, United States, 2019. Morbidity and Mortality Weekly Report, 69(1).
- Bass III, P. F., Scholer, S. J., Flannery, D. J., & Lichenstein, R. (2019). How to identify and treat bullying. Contemporary Pediatrics, 36(06): 30-34.
- Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance System. (2020). Youth Risk Behavior Survey 2019.
- Koyanagi, A., Oh, H., Carvalho, A. F., Smith, L., Haro, J. M., Vancampfort, D., . . . DeVylder, J. E. (2019). Bullying victimization and suicide attempt among adolescents aged 12-15 years from 48 countries. Journal of the American Academy of Child and Adolescent Psychiatry, 58(9), 907-918.
- Logan, K., Cuff, S., LaBella, C. R., Brooks, M. A., Canty, G., Diamond, A. B., Hennrikus, W., Moffatt, K., Nemeth, B. A., Pengel, K. B., Peterson, A. R., & Stricker, P. R. (2019). Organized Sports for Children, Preadolescents, and Adolescents. Pediatrics, 143(6): e20190997.
- Stephens, M. M., Cook-Fasano, H. T., & Sibbaluca, K. (2018). Childhood Bullying: Implications for Physicians. American Family Physician, 97(3):187-192.
- Toseeb, U., & Wolke, D. (2021). Sibling Bullying: A Prospective Longitudinal Study of Associations with Positive and Negative Mental Health during Adolescence. Journal of Youth and Adolescence.
- U.S. Department of Health and Human Services. StopBullying.gov.
- U.S. Department of Health and Human Services, StopBullying.gov. Fact Sheet: Teach Digital Citizenship Skills to Prevent Cyberbullying.
- U.S. Department of Health and Human Services. U.S. Surgeon General’s Advisory: Protecting Youth Mental Health. (2021).
- Wolke, D., Tippett, N., & Dantchev, S. (2015). Bullying in the Family: Sibling Bullying. The Lancet Psychiatry, 2(10):917-929.
- American Academy of Pediatrics, Patient Education. (2021). Bullying: It’s Not OK.
- Johns Hopkins Medicine, Health Encyclopedia. Bullying: Anticipatory Guidance for Parents – Pediatric.
- Nemours KidsHealth. Dealing with Bullies. (In Spanish).
- Nemours TeensHealth. Sexual Harassment and Sexual Bullying.
- PACER’s National Bullying Prevention Center. Offers a wealth of information about bullying and how to prevent it, including Bullying Prevention 101 handouts for elementary school students, middle school and high school students, and parents; a 4-part handout series with comprehensive information for students and adults about how to help someone experiencing bullying and how to address bullying in the community; a Kids Against Bullying website and a Teens Against Bullying website.
- Stomp Out Bullying, a national nonprofit dedicated to ending bullying.
- U.S. Department of Health and Human Resources. StopBullying.gov.
- U.S. Department of Health and Human Services, StopBullying.gov. “Be Someone’s Hero,” a video, in English and with Spanish subtitles, about how to be an upstander.
Screen Time Out: Managing Electronic Media Use by Children and Adolescents
Learn how to use pediatric health guidelines to inquire about child and adolescent digital media use and to counsel parents about monitoring their children’s media use and setting limits on screen time.
Addressing Adverse Childhood Experiences through Trauma-Informed Care
Integrate practices to identify, treat and reduce the effects of trauma and toxic stress among children and adolescents. Includes ethical guidelines for reporting suspected abuse or neglect and for providing culturally effective health-care services.
Adolescent Vaping: Current Trends, Research and Best Practices
Learn how to routinely screen adolescents for e-cigarette use and counsel them about the health risks and long-term consequences of vaping.
Interpersonal Youth Violence
Implement strategies to identify, intervene in and prevent behaviors such as bullying, self-injury and suicide, dating violence and sexting. Includes guidelines for ethically responding when an adolescent patient perpetrates violence.
High-Risk Behaviors In Young People: Screening and Intervention
Learn about the prevalence, signs, symptoms and interventions for substance use and other risky adolescent behaviors.