Mental health is commonly defined as the emotional and psychological well-being needed in order to function and participate in daily life (World Health Organization, 2011). In this sense, mental health is characterized by the well-being of individuals within social groups. To function effectively in society, individuals need to interact in positive ways with others including helping, sharing, cooperating and demonstrating empathy to others. Thus, prosocial behavior is one aspect of mental health that schools specifically try to foster in children.

Bullying is an example of a negative social interaction that is unfortunately common in schools and is a threat to students' mental health. Bullying affects millions of children in American schools each year and is a "hot topic" in current educational research and popular media particularly because of the negative effects it can have on students' mental health and academic performance (Skiba & Fontanini, 2000). In 2001, the American Medical Association estimated that more than 3.2 million sixth through tenth grade students are victims of moderate or serious bullying each year. The definition of bullying can vary but one common definition "…is aggressive behavior marked by an imbalance of power occurring repetitively with intent to harm and can be either physical (e.g., fighting, pushing) or relational (e.g., social exclusion, spreading rumors) (Bauer, Lozano, & Rivara, 2007, p. 266). Being a victim to bullying can lead to low self-esteem, depression and/or anxiety among students (Blood & Blood, 2004; Didden et al., 2009). Bully victimization is also associated with school truancy, declined academic performance and lower feelings of self-worth (Hirschstein & Frey, 2006). Chronic bullying victimization can lead to aggression, anxiety, depression and self-inflicted violence (Hirschstein & Frey, 2006).

Due to the potential negative effects on students' mental health, recent research has focused on how to best address bullying in the schools with prevention and intervention programming. Previously schools had focused on discipline enforcement to handle bullying, but the developers of prevention programs of the past two decades have worked to also include interpersonal skill instruction in order to prevent problems from occurring (Hazler & Carney, 2006). More and more programs are being developed to tackle school bullying, but only a small number of these programs have been evaluated through research (Hazler & Carney, 2006). Two such programs are the Olweus Bullying Prevention Program (OBPP), formerly known as the Bully/Victim Program, and Steps to Respect (STR).

Dr. Olweus, the primary author and developer of the OBPP defines a bullying victim as someone who "…is exposed, repeatedly and over time, to negative actions on the part of one or more other persons, and he or she has difficulty defending himself or herself" (Hazelden Foundation, 2011, "Frequently Asked Questions," para. 1). Questionnaires developed as assessments as part of the OBPP ask questions about both direct (i.e., verbal, physical, racial, and sexual bullying and having things taken or damaged) and indirect forms (i.e., social exclusion or isolation, lies or false rumors, and cyberbullying) of bullying (Hazelden Foundation, 2011). STR defines bullying similarly as a repeated activity done with the intent to harm that involves a power imbalance in which the person doing the bullying has more power. Bullying includes physical aggression, verbal insults, rumors or gossip, and threats of exclusion (Committee for Children, 2012). Hirschstein and Frey (2006) in their discussion of STR indicate that the program defines bullying to children as "unfair and one-sided. It happens when someone keeps hurting, frightening, threatening or leaving someone out on purpose" (Hirschstein & Frey, 2006, p. 311).

Bullying students with disabilities

Although many students in schools aroundthe United States and the rest of the world experience bullying, some subgroups of students have been identified as being particularly vulnerable to bullying. One specific group includes students with disabilities, although the prevalence rates of bullying experienced by this group differ depending on the source (Doren, Bullis, & Benz, 1996; Holmquist, 2011; Rose, Espelage, Aragon, & Elliott, 2011). Like students without disabilities, students with disabilities need appropriate social behavior to engage with others in their daily lives. Bullying is one threat to the development of prosocial behavior for students with and without disabilities. It has been noted in research that students with disabilities both experience bullying as victims and engage in bullying as bullies (Estell et al., 2009).

Students with disabilities are more frequently placed in general education classrooms and interact more with general education peers than in the past, to ensure they receive education in the "least restrictive environment" as defined by the Education for All Handicapped Children Act (1975) and Individuals with Disabilities Improvement Act (2004; Carter & Spencer, 2006). While general education classroom participation can be beneficial to students with disabilities seeking to develop academic and social skills, these settings can also provide opportunities for comparison between students with and without disabilities, which may lead to bullying (Schoen & Schoen, 2010).

For students with and without disabilities, bullying can be related to a student's race/ethnicity, weight, religion, gender, sexual orientation or other characteristics (National Association of School Psychologists, 2012). Students with disabilities may also frequently be bullied for having disabilities (Whitney, Smith & Thompson, 1994). These students experience a wide range of bullying behavior including social exclusion, verbal abuse and physical aggression (Carter & Spencer, 2006; Raskauskas & Modell, 2011).

Students with disabilities can potentially experience the same negative effects on mental health as students without disabilities when they are bullied. Students with intellectual disabilities who were bullied online reported high levels of emotional and interpersonal problems (Didden et al., 2009). Some studies indicate that students with disabilities are at an even greater risk than general education peers. For example, adolescents with learning disabilities are at a greater risk of emotional distress compared to peers without disabilities and females with learning disabilities are more likely to attempt suicide (Svetaz, Ireland, & Blum, 2000).

Bullying prevention programs: Goals and methods

Schools have been encouraged to adopt antibullying policies and utilize bullying prevention programs to avoid the negative effects that bullying can have on students with and without disabilities (Limber & Small, 2003). Hazler and Carney (2006) identified several common components of effective bullying programs. Programs focus on universally addressing bullying or targeting specific groups of students who are at-risk for being bullies or victims (Hazler & Carney, 2006). Successful programs also attempt to reduce the isolation of individuals and build empathic awareness (Hazler & Carney, 2006). This is in order to limit the number of opportunities for students to be alone, but also to build opportunities for inclusion and create emotional connections between people (Hazler & Carney, 2006). Typically these programs are implemented in stages: awareness building, policy development, skill development, continuing involvement and assessment with adjustment (Hazler & Carney, 2006). The research on bullying prevention programs is still fairly recent, but two programs that might be classified as "successful" are the Olweus Bullying Prevention Program and Steps to Respect.

The Olweus Bullying Prevention Program (OBPP) is, according to their website, the "most researched and best-known bullying prevention program available today" (Hazelden Foundation, 2011, para. 1). It was first developed and evaluated in Norway (Limber, 2006). The program is designed to reduce existing bullying problems, prevent new bullying problems, and improve peer relations (Hazelden Foundation, 2011). Instead of just implementing a classroom curriculum to meet these goals, the OBPP is a schoolwide program to address the issue on all levels by focusing on the known risk factors for bullying behavior and building upon protective factors (Limber, 2006; Hazelden Foundation, 2011). Although it has been adapted for use in high schools, OBPP is designed for elementary, middle, or junior high schools with students 5 to 15 years old (Hazelden Foundation, 2011). The program was identified as "effective" by the U.S. Department of Justice's Office of Juvenile and Delinquency Prevention and was classified as a "Model Program" by the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration and the University of Colorado's Center for the Study and Prevention of Violence Institute of Behavioral Science (Hazelden Foundation, 2011).

In order to achieve these goals, OBPP includes components at four different levels: school, classroom, individual and community. At the school level, the program involves the development of a committee, staff training, school-wide data collection, introduction of school rules against bullying and refinement of the school's supervision system (Hazelden Foundation, 2011). Classrooms, as part of the program, must post and enforce school rules, and hold regular meetings as a class to discuss the subject (Hazelden Foundation, 2011). On an individual level, student activities must be supervised and staff must intervene immediately when bullying occurs (Hazelden Foundation, 2011). In addition, meetings are held with students involved in bullying and individual intervention plans can be developed (Hazelden Foundation, 2011). Finally, the OBPP stresses the involvement of the community as part of the committee and to develop partnership with community members to help support and spread the school's program (Hazelden Foundation, 2011). Although not identified as core components, it is highly desirable to also hold meetings with staff and parents (Olweus, Limber, & Mihalic, 1999).

Individual intervention approaches have limited success in reducing the aggressive behavior of individuals; therefore, the OBPP takes a school-wide approach (Olweus et al., 1999). The implementation of a schoolwide program allows for restructuring of the school's entire social environment to reduce bullying opportunities and consistently reward positive behavior in order to redirect behavior to be more prosocial (Limber, 2006; Olweus et al., 1999). The school environment must be structured in order that adults become authority figures who provide firm limits for behavior and negative consequences to rule violations while also serving as positive role models who are warm, positive and involved (Olweus et al., 1999).

Steps to Respect (STR) is also a school-wide program to address bullying and the program developers' goal of fostering "…the social and emotional development, safety, and wellbeing of children" (Committee for Children, 2012, "Our mission," para. 1). Similar to OBPP, STR is a universal program designed to tackle bullying programs on multiple levels however it is designed for elementary schools only (i.e., grades three through six) and emphasizes classroom instruction (Hirschstein & Frey, 2006). Once the school works to assess bullying problems and train all adults how to respond to bullying situations, the classroom lessons focus on teaching students to make friends, recognize feelings, and recognize, refuse and report bullying (Committee for Children, 2012). This format not only increases staff awareness of and responsiveness to bullying problems, but it also fosters social responsibility among students and teaches students specific skills to solve these problems (Hirschstein & Frey, 2006). The program was identified by CASEL (2013) as an "effective" social-emotional program because, while it is designed specifically for bullying prevention, it promotes the acquisition of more general socioemotional competence among students (Hirschstein & Frey, 2006).

To meet the previously discussed goals, the STR program is implemented in three phases. In the first phase the school administrators must use surveys to gather baseline data and examine current bullying policies and procedures (Committee for Children, 2012). The second phase involves training all of the adults in the school to recognize and handle bullying (Committee for Children, 2012). Finally, in the third phase classroom lessons are used to foster the development of general socioemotional skills such as making friends and understanding and recognizing feelings and also to build students' specific skills in handling bullying (Committee for Children, 2012). There are 11 lessons on three different levels. The topics covered by the lessons also attempt to address the students' beliefs and peer-group norms related to bullying (Hirschstein & Frey, 2006).

The goals of both the OBPP and STR programs, although established as general goals for all children in a school, are still applicable to students with disabilities as a specific sub-group. In order to maintain the mental health of these students at school, students with disabilities can benefit from the reduction or prevention of bullying problems and improved peer relations. The social and emotional development, and general safety and well-being is an important goal for all students including those with disabilities.

Research on bullying programs

OBPP has been examined through research for over 35 years on the program's implementation around the world. There have been six comprehensive studies of the program in Norway in addition to the replication studies that have been conducted in Canada, Germany, and the United Kingdom (Limber, 2006). The original study of OBPP in Norway involved 2500 students in 42 schools (Olweus, 1994). Results indicated a 50 percent reduction in student bullying behavior after two years of program implementation (Olweus, 1994). The program has also been studied in the United States but the results are more mixed. These research studies all examine the effectiveness of the program in the context of "real-world" school implementation.

OBPP was first evaluated systematically in the United States after being implemented in 18 middle schools in South Carolina in the mid-1990s (Limber et al., 2004). The program was implemented over the course of one year and evaluated by examining student reports of bully behavior, victimization, social isolation, and attitudes about bullying (Limber et al., 2004). The researchers found significant decreases in boys' and girls' reports of bullying behavior and also significant decreases in boys' reports of being bully victims and feeling socially isolated (Limber et al., 2004). These additional decreases were not found among girls' reports and there were no significant changes in students' attitudes (Limber et al., 2004). The program was also evaluated after being implemented in 12 elementary schools in Philadelphia (Black, 2003). Significant decreases in students' reports of bullying and victimization and adults' observations of bullying were found in the schools that implemented OBPP with moderate fidelity (Black, 2003). These initial studies highlighted the potential positive effects of the program.

More recent research has found less positive results. For example, one study examined the effects of implementing OBPP in middle schools in Seattle (Bauer, Lozano, & Rivara, 2007). Seven intervention schools were compared to three schools that chose to prevent bullying less formally. Program effectiveness was evaluated using student-reported victimization frequency (four items on questionnaire about relational and physical bullying), student attitudes towards bullying (one item on questionnaire) and perceptions of others' willingness to intervene (two items on questionnaire about teachers/adults and other students), and improving the general school environment (nine yes or no items on questionnaire about perceptions of safety, support, and engagement). Questionnaires were administered pre-implementation in spring 2003 and then again in spring 2005 after one academic year of OBPP implementation. Results indicated that there was no overall effect on student-reported victimization, although when stratified by ethnicity/race, White students reported less victimization after implementation. Students in the intervention schools perceived other students to be active in intervening in bullying incidents compared to students in the control schools, but no other significant differences were found.

In another recent study of six schools in a large urban U.S. school district, student bullying behavior was directly observed to calculate bullying incident density pre- and post-implementation of OBPP (Black & Jackson, 2007). The program was implemented over four years. In addition to these observations, student reported data on the program's Bully-Victim Questionnaire was collected. Changes in bullying incident density from pre- to post-implementation ranged from no change to a 65 percent decrease with an average of a 45 percent decrease. Changes in student-reported bullying on the questionnaire ranged from an increase of 7 percent to a decrease of 10 percent with an average of a 5 percent decrease. The range in the effects among the different schools does not lend itself to clear interpretation of the results regarding the program's effectiveness.

As a newer program, there is less research on the STR program in general. One study examined playground bullying and prosocial beliefs in elementary students in the Pacific Northwest (Frey et al., 2005). The STR program was implemented in three schools for one year compared to three matched control schools. The schools implementing STR did not see the increases in playground bullying across the school year that were found in the control schools. Although the differences were not significant, there were trends indicating that bystander encouragement of bullying declined in intervention schools and students' in intervention schools self-reported less victimization, but not less bullying, compared to students in control schools. Teachers did not indicate any difference in student interpersonal skills in their ratings but observations showed a decrease in argumentative interactions and increased agreeable interactions among students in the schools implementing STR. With regards to student beliefs, students in intervention schools reported a stronger sense of responsibility to intervene as bystanders, less tolerance of bullying, and more adult responsiveness to bullying problems compared to students in control schools.

A larger and more recent study examined the outcomes of implementing STR in California elementary schools (Brown, Low, Smith, & Haggerty, 2011). The 33 schools were randomly assigned to intervention or waitlist control groups. The researchers sought to examine the following research questions: "(a) What are the effects of the STR program on the social-ecological context of the school? (b) What are the effects of the STR program on teacher perceptions of student behavior? (c) What are the effects of the STR program on student perceptions of school climate, staff/teachers and connectedness with their school?" (Brown et al., 2011, p. 427). Results using survey data indicated that the STR program had significant positive effects on the school environment, specifically school antibullying policies and strategies, student and staff climate, and school bullying problems. In addition, there were significant increases in teacher assessments of student social competency and decreases in teacher assessments of physical bullying perpetration. Student surveys indicated that students also noticed the improvements in student and teacher bullying intervention, positive bystander behavior and student climate.

While the literature on school bullying, risk factors and bullying prevention programs is growing, there are still gaps in the research. One glaring gap is that while students with disabilities have been identified as one subgroup that is potentially at a higher risk for engaging in bullying and experiencing bullying, bullying prevention programs have not been developed for use with this specific population. The more widely used bullying prevention programs such as OBPP and STR do not explicitly discuss any modifications or adjustments to address the needs of students with disabilities (Flynt & Morton, 2007). The published research on these programs has examined differences among grades, ages, genders, and racial/ethnic groups but has ignored students with disabilities as a subgroup of interest.

Use of bullying prevention programs with students with disabilities

Although bullying prevention programs have not been directly studied with students with disabilities and the existing programs do not outline considerations for this population, students with disabilities may still benefit from programs such as OBPP and STR. These programs address the issue of bullying using a school-wide approach. If students with disabilities are bullied by students without disabilities, the prevention programs may reduce the bullying behavior of the general student population and therefore reduce the victimization rates of students with disabilities. In addition, the focus on staff training and clear policies and procedures may help raise the awareness of the adults and help them recognize and address bullying when it occurs at school. The adults can intervene when students with disabilities are being bullied. Still, special consideration of students with disabilities is needed when implementing bullying prevention programs. In particular, school environment and structures, assessment and instruction may need to be modified or adapted in order to make them applicable for these students. In addition, research that specifically examines the effects of these modified programs on the bullying of students with disabilities will be needed to evaluate these adaptations.

School environment & structures

A major component of prevention programs designed to address bullying on a schoolwide level is the establishment of consistent policies and procedures to handle bullying in the schools. It will be important for schools to include clauses in these policies that are specifically related to the bullying of students with disabilities, which may be classified as disability harassment (NJ Coalition for Bullying Awareness and Prevention, 2012). In addition, schools must decide if there should be different consequences or procedures for students with disabilities who engage in bullying other students. For example, zero tolerance policies may not be appropriate for students whose behavior is related to their disabilities (Parker-Roerden, Rudewick, & Gorton, 2007). Some schools may set up anonymous reporting procedures to encourage students to share incidents of bullying. Students with disabilities may not understand the concept of anonymous reporting (Flynt & Morton, 2007) and may need alternative reporting procedures (NJ Coalition for Bullying Awareness and Prevention, 2012; Raskauskas & Modell, 2011). Connecting these students with a caring adult in the building who they can report incidents to may be more appropriate for some students who do not understand or reporting procedures established for general education students.

Hazler and Carney (2006) indicated that successful bullying prevention/intervention programs attempt to reduce the isolation of individuals to limit the opportunities for students to be targeted by bullies. Bullying programs often have adults encourage students to include students in school activities. Although many students with disabilities are "mainstreamed" and included in general education classes as much as possible, students with disabilities may still spend part of the day in special education or resource room classrooms. Changes in placement during the school day may limit the number of opportunities for students to be included in social activities with general education peers. In addition, their disabilities may hinder their ability to fully participate in some general education activities (Flynt & Morton, 2007). Teachers and students without disabilities may need direct instruction in how to best include students with disabilities in their classrooms and activities. Supplemental social skills groups or afterschool clubs that connect students with disabilities with general education "buddies" may be beneficial for both groups of students (NJ Coalition for Bullying Awareness and Prevention, 2012; Parker-Roerden, Rudewick, & Gorton, 2007).

Assessment

Both the OBPP and STR programs utilize student surveys to collect data regarding school bullying problems. These survey assessments, such as the Bully-Victim Questionnaire created by Dr. Olweus, are used to assess the extent of the students' initial bullying behavior and provide data to support the adoption and implementation of a prevention or intervention program. These surveys are then used after one or more years of implementation to examine the effects of the intervention and help guide any adjustments. These same assessments are frequently used in the published research on the bullying prevention programs to measure intervention effects. The challenge of using these surveys with students with disabilities is that they require a certain reading level. Some students with disabilities (e.g., cognitive impairment or specific learning disability in reading) may not have the basic reading or comprehension skills needed to fill out the survey (Flynt & Morton, 2007). For some students this issue could be addressed by having teachers read survey items to the students, but some students may still not understand the item contents like general education peers do or may need alternate ways to respond to survey items if they cannot write or speak (Raskauskas & Modell, 2011). The key is to adapt and modify the assessments in order to include these students, rather than to exclude them from assessments. This will lead to the development of more effective programs for these populations (NJ Coalition for Bullying Awareness and Prevention, 2012).

Instruction

A major component of the STR program is the classroom curriculum. The instruction provided in these lessons is one of the major mechanisms to change student behavior because it is designed to teach students how to make friends, understand and recognize feelings, and appropriately handle bullying situations. Some students with disabilities have deficits related to social skills and could benefit from the lessons offered as part of bullying programs. The severity of a student's deficits may require more intensive instruction than what is offered through a bullying program with classroom lessons. The lesson may need to be repeated several times for students with disabilities to gain the necessary skills (Raskauskas & Modell, 2011). Students with disabilities typically receive special education services or general education accommodations to help them access or benefit from academic instruction. Students with visual or hearing impairments would not be able to benefit from the STR classroom curriculum as it currently stands because the classroom lessons utilize posters, pictures on overhead projectors, videos and classroom discussions. The materials may need to be adapted so they are accessible for all students (Raskauskas & Modell, 2011). In addition to curricula modifications to make sure students with disabilities can access the instruction (Flynt & Morton, 2007; NJ Coalition for Bullying Awareness and Prevention, 2012), the bullying examples used in the lessons could be adapted to include the common forms and types of bullying that these students experience including namecalling or exclusion related to their disabilities.

Conclusion

The negative effects that bullying can have on students' mental health make it an important issue to address with prevention or intervention programs in schools. Students with disabilities form a subgroup of the student population that should be specially considered, as they are particularly vulnerable to bully victimization. Bullying prevention programs such as the Olweus Bullying Prevention Program and Steps to Respect program have some preliminary evidence of their effectiveness in reducing bullying problems in schools. These programs both address the issue on a schoolwide level, incorporating staff training and involvement and the development of students' social responsibility. Steps to Respect places more emphasis on direct classroom instruction on general social-emotional skills and handling bullying. Neither program has been researched with students with disabilities and neither program's guidelines include information on how to adapt or modify the program to make is more accessible for these populations. Adaptations or modifications may be necessary to make the school's environment and structure (e.g., policies and procedures and opportunities for inclusion), assessments of bullying problems and instruction more appropriate for this population. Depending on the extent of these modification, it could greatly affect the validity of the prevention programs and research on these adapted versions would be an important addition. Despite these adaptation considerations, there is still reason to expect that students with disabilities could benefit from prevention programs such as Olweus Bullying Prevention Program and Steps to Respect program as they currently stand. Both programs attempt to build a positive school climate built on acceptance and social responsibility. Teachers and other school staff play an important role in this school climate and can help protect and respond to student with disabilities who experience bullying (NJ Coalition for Bullying Awareness and Prevention, 2012). Schoolwide bullying programs may also lead to opportunities to provide disability awareness education to teachers and students on visible and nonvisible disabilities to promote empathy, acceptance, and support for students with disabilities throughout the building (Parker-Roerden, Rudewick, & Gorton, 2007; Raskauskas & Modell, 2011). Students with and without disabilities can benefit from opportunities to interact and build friendships to feel less isolated.

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About the author

Kristen Girard is a fourth-year doctoral candidate in school psychology at Michigan State University.