Childhood bullying affects over 25% of today’s youth and causes up to 160,000 missed school days per year. Bullying causes short and long term adverse effects to both mental and physical health. Many organizations encourage healthcare providers to take an active role in bullying prevention. However, there has been little research into the role of primary healthcare providers regarding childhood bullying and the effectiveness of different approaches to screening and management. Therefore the purposes of this dissertation were to a) explore childhood bullying and the role of the healthcare provider in bullying prevention, b) develop and evaluate the psychometric properties of Hensley’s Healthcare Provider’s Practices, Attitudes, Self-confidence, & Knowledge Regarding Bullying Questionnaire. Pediatric healthcare providers were asked to participate in this study if they conducted well-child exams on a weekly basis. Information on the provider’s current bullying assessment practices, attitudes, self-confidence, and knowledge regarding bullying was gathered. Results indicated that approximately one-half (46.6%, n=55) of the healthcare providers reported assessing their patients for bullying behaviors during well-child exams. The strongest predictor of positively assessing for bullying was attitudes, recording an odds ratio of 1.24. This indicated for every one-unit increase in attitudes score, the odds of assessing for bullying will be 24% higher. The odds ratio of self-efficacy or self-confidence was 1.18, indicating that for every one-unit increase in self-efficacy score, the odds of assessing for bullying will be 18% higher.

Childhood bullying can lead to adverse physical and mental health outcomes for both the victim and the bully. Risk factors for bullying can be related to gender, race, sexual preference, and having any type of disability. A pediatric primary care clinic in a large, metropolitan area, the focus for this project, did not have an evidenced-based clinical practice guideline (CPG) for providers to facilitate the management of children who presented with reported bullying. The project, guided by the Tanner'€™s integrated model of clinical judgement, addressed the question whether a CPG would facilitate the early recognition and treatment of bullying in the pediatric clinical site. Using a literature search, a CPG was developed with evidence that included 6 recommendations ranging from clinical assessment and screening to advocacy. The CPG was then evaluated by 4 expert panelists using the AGREE II tool. Panelists included 2 pediatric medical doctors, 1 pediatric school nurse, and 1 mental health nurse practitioner. The panel evaluation results revealed a score of 81 out of a possible 100, where a score of 71 was the standard for acceptable results for the 6 recommendations. Results from the expert panel were used to modify the CPG, after which the guideline was presented to the panel for final approval. One final recommendation of the panel was to include a provision for referral and follow up for children identified with bullying. The finalized CPG was presented to the medical director of the pediatric clinic for implementation. The implications of the project for positive social change include decreased variations in clinical practice, early detection and intervention of bullying, improved effectiveness and quality of care, and decreased costly and preventable adverse events.

Guided by Premack and Woodruff's theory of the mind and Bandura's social learning theory, this qualitative study examined the issue of bullying at school, and whether teachers' childhood experiences of bullying had effects on how they, as adults, handled bullying situations in their classrooms. Convenience sampling was used to administer the Bauman, Rigby, and Hoppa Handling Bullying Questionnaire to 22 middle school educators with three or more years of teaching experience at the participating school, to determine their responses to bullying scenarios. Twelve educators completed the questionnaire. Data collected from the questionnaire were analyzed for frequencies of responses. Teachers' responses to how they might handle bullying appeared similar across the sample for most items, indicating that they would intervene and communicate the concern. Six of the 12 educators voluntarily agreed to be interviewed to gain a deeper understanding of how they manage bullying situations at school and whether they thought bullying incidents experienced as a child affected their responses as teachers. Interview data were transcribed and analyzed using open and selective coding to identify common themes. Two of the participants reported being bullied as children; however, they did not report an effect of that childhood bullying on their current handling of bullying at school. Interview participants also reported the need for training related to protocols for addressing bullying at school. The findings led to the development of a professional development series, Recognize, Respond, and Reduce, which can create positive social change by equipping teachers to handle bullying in their classrooms. By preparing teachers to respond to bullying, school leaders may create a safer learning environment for students, teachers, and the community as a whole.