Stopping the attacks Preventing targeted gun violence in our schools For years, stories of gun violence in schools have dominated the headlines. MSUCOM seeks to address and put an end to this brutality. Feb. 1, 2023WednesdayFebruary 2023 issue Alyse Ley, DO, Frank Straub, PhD, and Jed Magen, DO, MS Contact Dr. Ley Facebook Twitter LinkedIn Email Topics gun violence Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA. All too often, schools are added to the list: Columbine High School, Sandy Hook Elementary, Marjory Stoneman Douglas Elementary, Robb Elementary and Oxford High School; a list that encompasses tragedy, evokes terror and generates wide-ranging responses from those who share the common goal of protecting our children. This is a list no community wishes to join and yet there is no end in sight. History of mass violence in schools Mass violence in schools dates as far back as May 18, 1927, when one of the deadliest school attacks in U.S. history took place in the rural community of Bath, Mich. Among the victims, 45 were killed and another 58 were injured, leaving a community grieving, rebuilding and healing for more than 94 years. Although there were several targeted attacks in schools after 1927, it was the 1999 Columbine High School mass shooting that was the turning point in our country’s awareness of mass violence in our schools. According to the Naval Postgraduate School’s Center for Homeland Security and Defense, since Columbine, there have been over 392 fatal school shootings and 1,119 persons injured in K-12 school buildings in the United States. As we try to make sense of these deadly attacks, groups divide to address what they see as the most viable solution. Some emphasize targeting access to weapons, others focus on addressing mental health issues or placing more security measures in schools. Targeted attacks in schools continue to rise despite gun restriction debates, increased security measures and efforts to raise mental health awareness and access to care. Guns continue to end up in the hands of those who intend to do great harm, schools are not impenetrable fortresses and teachers are not trained in tactical measures. Increased mental health awareness, although needed, will not solve this issue as most perpetrators do not have a psychiatric disorder. Finally, examination of completed attacks to establish a shooter profile as a means of prevention have proven fruitless. Furthermore, siloed mental health, education or law enforcement efforts fail to reach the high-risk/high-need adolescents who are “falling through the cracks” of our disconnected systems. If we cannot prevent at-risk adolescents from obtaining a gun, there is no consistent plotter profile and security in schools has not prevented attacks, what are we to do? Preventing school attacks demands a whole community response. To reduce risk among adolescents, we must be prepared to offer mental health treatment, evaluate criminogenic risk factors and address social environmental factors that affect adolescents’ quality of life. We must recognize dangerous behavior and address it immediately. We believe specially-trained interdisciplinary teams of community-based professionals must take responsibility for helping high-risk/high-need adolescents address the challenges that lead to criminal acts and destructive behavior patterns. MSUCOM’s new violence prevention program In 2022, the Adolescent Targeted Violence Prevention Program (ATVPP) was established through an appropriation from the State of Michigan to the Department of Psychiatry, a jointly-administered department of the Michigan State University College of Osteopathic Medicine (MSUCOM) and College of Human Medicine. We are partnering with Frank Straub, PhD, a nationally recognized expert in the field of targeted violence prevention and founder of the Averted School Violence Database to create and implement the ATVPP in Michigan. The ATVPP will work with Michigan educators, mental health practitioners, law enforcement officials and community stakeholders to establish intensive support teams (IST). ISTs will work with high-risk/high-need adolescents identified by schools and communities and their caregivers to create individualized care plans that ensure connection to community-based intervention, treatment, and support. The ATVPP model emphasizes cross-system collaboration and intervention to prevent violence and support rehabilitation in a community context. These efforts are informed by research, the national Averted School Violence database and a network of national and international subject matter experts. Over the next five years, we will pilot what we hope will become a national model for addressing violence in our school systems. About averted attacks Although examination of completed attacks can yield valuable information regarding the specific event in question, we must examine both completed and averted attacks to gain a true understanding of how to prevent targeted violence in our schools. The number of averted attacks far outnumbers completed attacks. Studying averted attacks helps answer the question, “How can this be stopped?” While it is impossible to quantify the exact number of averted attacks with the number of lives saved, every documented averted attack provides vital information to inform prevention. The U.S. Department of Justice, Office of Community Oriented Policing Services (COPS) funded the Averted School Violence (ASV) database, which is a collection of reports dating back to the 1999 attack on Columbine High School. In 2021, the COPS Office published a report on 171 averted cases that provides critical information to guide the creation of prevention and intervention measures. Most individuals who planned attacks were male (93%), under 18 (61%), plotted alone (77%, or 132/171) and planned to use a firearm (81%, or 139/171). Most were students, either currently or recently enrolled in the school (64%, or 110/171). Importantly, no consistent profiles were identified, but several characteristics (impaired socialization, depressed mood, agitation, social withdrawal, isolation, disgust with authority and lack of empathy) were common among those planning an attack. Often, a traumatic event proceeded the planned event. Motivation for the premeditated attacks included themes of hate, revenge, resentment, paranoia, bullying and rivalry. Analysis of the ASV database highlights the fact that many events can be averted, and targeted violence in schools is often preventable. In many cases, prevention is possible because the plotters disclose their plan to peers, family members or on social media. Community member intervention provided the opportunity to identify these high-risk adolescents, intervene and ultimately save lives. We believe early identification and coordination of community treatment services can address the needs of these high-risk adolescents and thereby decrease their risk of violence. Developing alternate paths wherein at-risk adolescents gain a sense of companionship, competence, positive contribution and connectedness to the community can change the trajectory of their life and prevent acts of targeted violence. Related reading: Under the gun: The physician response to gun violence in America More in Advocacy AOA Annual Report charts successes of past year Highlights include public policy advocacy efforts to decrease regulatory burdens for physicians and expand the impact of the profession at the federal and state policymaking levels. Advocacy win: Ontario recognizes AOA board certification and residency training The College of Physicians and Surgeons of Ontario voted to amend its bylaws to recognize AOA board certification during a recent meeting. Previous articleEagles fan is saved by DO during home game, Rowan-SOM presents award Next articleMedical media elective: Exploring one DO’s time in the ABC News Medical Unit
AOA Annual Report charts successes of past year Highlights include public policy advocacy efforts to decrease regulatory burdens for physicians and expand the impact of the profession at the federal and state policymaking levels.
Advocacy win: Ontario recognizes AOA board certification and residency training The College of Physicians and Surgeons of Ontario voted to amend its bylaws to recognize AOA board certification during a recent meeting.