Nathan is a bright kid, but two years ago he failed the seventh grade--not because of a learning disability, but because crises in his personal life had severely affected his school attendance. An honor student throughout elementary school, Nathan was facing the breakup of his parents and a transfer to Will C. Wood Middle School in the Sacramento City Unified School District, where he had recently moved with his mother. Progressing from elementary to middle school can be traumatic enough for some kids. Suddenly their bodies are going through a roller-coaster ride of physical and emotional changes, they're surrounded by older teens, and often they're bombarded with peer pressure to experiment with alcohol, sex and drugs. In addition to these adolescent changes, Nathan (whose name has been changed to protect his privacy) was experiencing an emotionally strained relationship withhis father and dealing with an unstable mother. But instead of falling through the cracks, Nathan got help from the Healthy Start program located on the Will C. Wood campus. Funded by the state Department of Educationsince 1991, Healthy Start is a referral program to a collaboration of school and community agencies that deliver integrated health, mental health, social, educational and other support services to kids and their families, primarily in poor urban areas. In Nathan's case, two Healthy Start staff members and the school nurse established tougher guidelines to curb his attendance problem and also advised Nathan's mother to stop excusing his absences, which only supported his self-destructive behavior. Through counseling, they also helped allay Nathan's apprehensions about facing a new school situation where he was fearful and shy. As a result of these interventions and Nathan's willingness to cooperate, his attendance, grades and citizenship improved so dramatically that he received special recognition from the Healthy Start "Incentives Club" and was also honored as Student of the Month for November 1998. His grade point averagejumped from a 1.83 at the end of the 1997-98 school year to a cumulative 3.73 at the end of 1998-99. Yvette Dearring-Dixon, a family advocate for Healthy Start, says although Nathan's attendance still isn't perfect, she has seen him make great strides in the past year. But, she said, "these changes don't happen overnight. Interventions work as much as a person wants them to work." She credits the Healthy Start program for its success in reaching out to troubled, at-risk kids--a success that she says is due to a holistic approach in dealing with their problems. Their needs may range from mental health counseling, tutoring and recreational after-school activities to basic necessities such as housing, food and clothing. "Some kids manifest problems much more openly than others," Dearring-Dixon says. "Others aren't open with problems unless asked directly. This program helps flush out those students so they can get the help they need." * The benefits of programs like Healthy Start go far beyond the assistance they provide to individuals, points out UC Davis education professor Jon Sandoval. They play an important role in ensuring the safetyof a school environment--of increasing public concern since the tragic mass homicides in Jonesboro, Ark., and Littleton, Colo. Although Nathan's personal crises did not lead to violent behavior, Sandoval says that children may ultimately exhibit violent or socially deviant behaviors when they are unable to deal with their problems. "We could argue that a lot of violence results from people feeling hopeless to solve a problem," says Sandoval, who also serves as the principal investigator for the Healthy Start field office based at the Cooperative Research and Extension Services for Schools office at UC Davis. "We can't separate the mental health of a student from his or her success in learning skills and acquiring knowledge." Daily pressures and crises can overwhelm children. Feelings of isolation, peer pressure to use drugs and alcohol, hormones going haywire--all of these factors combined at a key developmental period in young lives can form a ticking time bomb for adolescents if the warning signs are not detected and addressed, Sandoval warns. "Lack of intervention comes at a huge cost to society," Sandoval says. "Kids who resort to acts of physical violence as adolescents are often the same people who end up in the nation's criminal system as adults." * Sandoval is quick to note that most cases of juvenile angst don't lead to murder, and that juvenile violence is not on the rise, though the recent media attention to the problem gives a contrary impression. Charles Scott, a child forensic psychiatrist and expert on juvenile violence at the UC Davis Medical Center, agrees. "In reality, incidents of juvenile violence both on and off the school campus are down," says Scott, who provides educational and training workshops for schools and mental health providers on assessing risks and developingintervention plans for juvenile violence. He also directs the forensic psychiatry training program at UC Davis, providing instruction to other psychiatrists on issues related to juvenile violence. According to the Bureau of Justice Statistics' National Crime Victimization Survey, juveniles were victims of serious violent crime at the rate of 27 crimes per 1,000 in 1997, down from 44 per 1,000 in 1993. Serious violent crimes include rape, robbery,aggravated assault and homicides. As perpetrators of these crimes, juveniles accounted for 31 per 1,000 in 1997, down from a high of 52 per 1,000 in 1993, the lowest rate since 1986. Nationwide, crimes committed by juveniles account for about 1 in 4 of all violent crimes. After the Columbine High School shootings in Colorado, television and newspaper reports began to refer to recent incidents of school violence as a growing trend, but statistics from the National School Safety Center show the 1992-93 school year to be twice as deadly as 1998-99 with 54 campus deaths compared to 24 this year. According to Sandoval, the inordinate amount of attention paid to the tragedy may have led to a few copycat incidents but mostly just fed children's and parents' fears. Scott notes that campus killings account for less than 1 percent of all homicides of children. What remains troubling, he says, is that although there has been no significant increase overall in school deaths in the past two years, mass homicides have reportedly increased. In looking at the most recent cases, Scott points out some similarities: The perpetrators felt rejected or isolated from their peers, they had made previous threats of harm and had access to weapons. But he adds that it is premature to speculateon whether incidents involving multiple deaths are a trend or aberration. Both experts agree that the decrease in school violence does not dilute the need for programs to avert not only the few yet devastating mass homicides but the more prevalent occurrences of assault and suicide. * In the aftermath of the Columbine shootings this past spring, public sentiment called for stricter gun control, the installation of metal detectors at schools and a halt to the stream of violent media images in television shows, movies and video games. Scott doesn't rule out the possibility that media violence may have an influence over children's behaviors, but he believes that we can't with any certainty state that gun availability and the exposure to violent video games and movies are the primary cause of the problem. "It's likely that we will start looking at violent video games and movies carefully to screen other events in a child's life," he says. But he joins with educators and school psychologists nationwide in asserting that these steps alone are not adequate to curb juvenile violence. "It's not something you can do with a metal detector," said Kevin Dwyer with the National Association for School Psychologists in Bethesda, Md. "We as a community have to teach kids to stop and think and respect one another." Building a relationship among schools, families and communities is exactly what Sandoval hopes intervention programs like Healthy Start will accomplish--reaching troubled kids before they resort to serious violence. Identification of those students at risk of employing impulsive, violent behavior is one of the best ways to prevent a crisis. And the sooner they can be identified as needing help, the better, he says. "The 'acting up' kids get the lion's share of attention, while others remain hidden in the first several grades because they aren't the squeaky wheel in the classroom," Sandoval says. "It's often the quiet ones who are sinking into destructive patterns." He applauds the reduction in class size that the state has implemented in first through third grades and says it may be a significant step toward identifying, early on, kids who need extra help in their social or mental development. From his experiences, Sandoval says "fringe" kids often have learning disabilities such as attention deficit disorder or they may suffer from depression. These situations can be treated with a combination of medication, if needed, and behavioral modification techniques. "We encourage teachers to experiment with classroom structure and provide more opportunities for periods of physical activity to get rid of tension," he says. "Teaching social problem-solving skills at an early age can also help kids feel in greater control of their emotions." Peer education is another important tool. Kids of all ages need to feel comfortable reporting concerns about their classmates, Sandoval says. They need to feel free to talk with a counselor or trusted adult who can take their concerns to the appropriate source--a teacher, parent or law enforcement official. * Unfortunately, the unthinkable and unexpected can always occur and Sandoval's early experiences as a psychologist in Richmond elementary schools and later work with the Lodi Unified School District have made one thing clear--if crises are bound to happen, being prepared to deal with them helps immensely. Ten years ago, two of Sandoval's colleagues, Sharon Lewis and Stephen Brock, were helping the Lodi district form a crisis intervention team. No one realized how soon their expertise would be needed. On Jan. 17, 1989, a gunman stepped onto the schoolyard at Cleveland Elementary School in nearby Stockton and killed five students, injuring another 29 students and one teacher. The day after the shootings, Lewis and Brock met with the Stockton Unified School District to help develop a crisis team. Their experiences in counseling children and staff, dealing with parents and talking to reporters evolved into a manual. The following year, Sandoval, Lewis and Brock expanded the manual into a workshop titled "The School Psychologists' Role in Developing and Implementing a Crisis Intervention Plan," which they presented at the annual Convention of School Psychologists. The overwhelmingly positive response they received at the meeting prompted them to collaborate on a book, Preparing for Crises in the Schools: A Manual for Building School Crisis Response Teams. The book offers guidelines for developing an intervention plan, crisis counseling and security procedures, as well as methods to evaluate the effectiveness of the crisis response team. Sandoval refers to it as a roadmap for people to create a meaningful plan for their own school. "The goal in dealing with a crisis is to help students and staff handle what is happening and deal with it sufficiently to move on with life," Sandoval says. "The curriculum we're developing is designed to help people learn how to do that. "We can never really eliminate the chances of juvenile violence happening, although we hope prevention at least lowers the probabilityof these occurrences," Sandoval says. "But there will always be deranged people who fall outside the patterns."