Dissociative Identity Disorder in Schools Part II

Dissociation is a well-established outcome of early life trauma, but school nurses may not be aware of resources and recommendations available to support students who experience it. If dissociation or behaviors consistent with dissociation are present, trauma-informed care (TIC) principles can guide individualized care of the student. Part I of this two-part article provided a pertinent background on dissociation, dissociative identity disorder (DID), the effects of social media, and TIC. Part II offers specific recommendations for implementing these principles in school nursing practice and follows the student vignette through the school year. Due to their holistic approach to care and long-standing leadership in providing TIC, nurses can significantly affect health, safety, and access to learning for students expressing dissociative experiences at school.

Dissociative Identity Disorder in Schools Part I

Dissociation is a normal life adaptation that can become pronounced and disruptive in the setting of repeated or extreme exposure to trauma. Children and adolescents may experience dissociation due to a trauma or stressor-related disorder, anxiety, or depressive disorders. Children and adolescents also may mimic behavior they see online as a way of expressing internally painful and intolerable experiences. Myth and misinformation surround the diagnosis of dissociative identity disorder (DID), formerly multiple personality disorder. The purpose of this article is to provide school nurses with evidence-based information on DID and resources for practice regarding how to provide a secure, consistent approach to students who are being traumatized, misunderstood, or excluded at home or at school. Part 1 of this two-part series describes DID foundations and DID in school-aged children, reviews controversy spurred by social media representation, and presents the Trauma-Informed Care (TIC) model. TIC offers useful perspectives regardless of a student's presentation or diagnostic status. Part 2 will discuss recommendations for managing dissociative presentations using a team-based approach, focusing on the school nurse's roles and responsibilities.

Capitalizing on Federal Agencies' Intentions To Protect Youth Working in Agriculture

Nearly 750,000 youth work on farms across the United States. The U.S. Department of Labor's (U.S. DOL) Fair Labor Standards Act (FLSA) Hazardous Occupations Orders for Agriculture (HOOA) applies to approximately 37% of these youth. The HOOA regulations had not been updated since their inception in the late 1960s and the early 1970s. An attempt by U.S. DOL to update the regulations in 2011 was met with fierce opposition by the agricultural community, and the proposed updated regulations were withdrawn. One impactful outcome of these two events was a rededication by USDA and the farm community to address agricultural youth farm safety through education rather than through regulation. An agriculturally based National Steering Committee has developed consensus Belief Statements and Guiding Principles to proactively influence agricultural youth safety. In this case, USDA was clearly a 'sphere of influence' for youth agricultural safety.

Age- and Gender-Based Patterns in Youth All-Terrain Vehicle (ATV) Riding Behaviors

Injuries to youth on all-terrain vehicles (ATVs) have been increasing exponentially in recent years. Youth under age 16 years are 4 times more likely to require emergency room treatments. This study explored the relationships and differences in ATV risk and safety behaviors based on age, gender, and age at ATV driving/riding initiation. Data were collected from 180 farm youth between 10 and 19 years of age. The study brought to light an important factor that influences risky ATV behaviors of youth, namely, their age at ATV driving and riding initiation. The sooner that youth (boys and girls) were exposed to ATVs, including riding with their family or friends, the sooner they started driving ATVs themselves, and the more likely they were to indulge in several ATV risk behaviors when older. This effect was more pronounced for boys than girls. Overall, girls in this study were equally likely to engage in many of the risky ATV behaviors, such as taking and giving rides on single-seat ATVs, driving adult-sized ATVs, driving ATVs on public roads, and driving ATVs really fast. However, they were less likely to wear protective attire, leaving them more vulnerable to injuries and fatalities during crashes. Implications of the findings and future directions are discussed.

Which "broken windows" matter? School, neighborhood, and family characteristics associated with youths' feelings of unsafety

Young people's fears of victimization and feelings of unsafety constitute a serious and pervasive public health problem and appear to be associated with different factors than actual victimization. Our analysis of a population-based telephone survey of youths aged 10-18 years in five economically distressed cities and their suburbs reveals that a substantial minority of youths feel unsafe on any given day, and that an even greater number feel unsafe in school. While some traditional predictors of victimization (such as low socioeconomic status) were associated with feeling unsafe, perceived school disorder was the major factor associated with such feelings. Disorderliness may thus be the school's version of "broken windows," which serve to signal to students a lack of consistent adult concern and oversight that can leave them feeling unsafe. We suggest that fixing the broken windows of school disorderliness may have a significant, positive impact on adolescents' feelings of safety.