October is National Bullying Prevention Month, and with good reason. Being bullied is linked to many mental illnesses including depression, anxiety, substance abuse and even suicide. Cardinal signs of school bullying include school avoidance, academic difficulties, changes in sleep patterns and health problems. The impact can last a lifetime. Relational aggression, a close relative to bullying, involves deliberate exclusion or covert aggression and can be just as damaging — we will use the term bullying for both.

To better understand bullying, we advocate the “Victim-Bully-Bystander” paradigm, and recognize that there are psychological implications for everyone involved. More is commonly known about what happens to victims, so let’s examine the potential long-term impact on the bullies and bystanders. Bullies are more likely to have been exposed to aggression in the home or community, engage in risky behaviors such as early sexual activity, and are at risk for drug and alcohol abuse. There are strong associations between bullying and bipolar disorder, conduct disorder, personality disorders, among others. Bystanders or witnesses to verbal or physical aggression and intimidation have demonstrated increased vulnerability to substance use disorders, mental health problems, and academic difficulties.

Bullying doesn’t happen in a vacuum. Bullying reflects aggressive behavior that is tolerated — or even applauded. Bullying is a primal instinct seen in multiple contexts and is based on an effort to better one’s own station at the expense of others. It happens at work, on the playground, on the basketball court, and at home. Cyber-bullying amps up the stakes even more and, in the age of Snapchat and other vanishing message apps, can be harder to prevent and prosecute.

Here at Silver Hill, parents often ask me what they can do about bullying, from both sides of the equation. While I would like to hope that bullying could be eradicated, I encourage kids and parents to be realistic. We must accept that bullying in our society isn’t going anywhere. It is too pervasive and too closely woven into the fabric of societal function and human nature. Bullying is a complex social and cultural phenomenon that is going to require many levels of change.

When working with families, I use a metaphor: The “Backbone Family.” This is a respectful, embracing home environment where love is unconditional and children feel, respected, safe and secure — no matter what their own particular situation may be. Unfortunately, many families are “Brick-Wall Families,” where parents have absolute authority, enforce their will through humiliation or violence, encourage family competition and fear, and teaches “what to think” vs. “how to think.” Another equally problematic family constellation is what I call the “Jellyfish Family.” This family relies on bribes and rewards, has arbitrary second changes and the provision of love his highly conditional. Each of these can lead to the development of a bully or a bystander.

So let’s give our kids tool kits to cope with the inevitable. If your child is prone to being bullied, teach them patiently how to handle difficult, challenging situations. If they bully, consider psychological or psychiatric treatment to help them better manage their aggressive tendencies before they hurt someone, and maybe even themselves. And if they are the bystander, help them understand that they can neutralize the situation and provide a safer environment for everyone by speaking up.

Here are a few tool kits the bullied, the bullies and the bystander. You can find out more at stopbullying.gov.

1. Parent Toolkit for kids who are bullying victims

Know the risk factors

Children who are at risk for bullying are often perceived as different from other kids. Differences include kids who are overweight, underweight, anxious, in the sexual minority, new to school or less affluent. These are just some examples of kids who may be targets.

Do not dismiss what they are saying

Listen and respect your child when they are talking. Acknowledge and validate the difficulty of the situation.

Develop a strategy, together

First explore selective ignoring — sometimes the best reaction is no reaction at all.

Empower your kids to express their discomfort by verbalizing some form of “no” and simply walking away.

Empower your kids to consider using humor selectively and help them practice how they might do that — humor can deflect a difficult situation and help your child can control — without retaliating.

Empower your kids by taking initiative to talk to the school. School systems and individual schools, principals, and teachers have varying levels of tolerance for bullying. Without expressing your concerns, there will be no record and without a paper trail, bullies can go on bullying without consequences.

Avoid engaging with the parents of the other child. It might be tempting to call the family and have a heart to heart with the parents of the identified bully, but you may be stepping into uncharted territory where the consequences for your child as well as the bully are unknown. Best to keep the communication through official channels. If these efforts to advocate for your child are ineffective, it may be necessary to contact the police — but only after every other avenue has been explored.

Encourage your child to be in good physical shape

Martial arts, weight lifting, any kind of athletic development — even if it’s not a team sport, may be protective not only as a deterrent but also as a means of bolstering your child’s self-confidence. Bullies are less likely to target children with a solid sense of self and self-esteem.

Tell your kids to buddy-up if they can

Bullying is less likely to occur if your child is not alone.

If need be, enlist the help of a professional counselor.

Your pediatrician, clergy, and the authorities are all great places to start when confronting bullying situations.

2. Parent Toolkit for kids who are the bullies

Find out why if your child is indeed bullying

Inquire first, in a nonjudgmental and neutral way, if your child has engaged in activity that may be construed as bullying

Inquire about the circumstances that may have led up to the incident(s)

Learn why your child is bullying

Their answers may surprise you. Kids bully for all kinds of reasons: insecurity, anger, frustration.

Often, kids bully because they have themselves been victimized and starting there may be a good way to help kids take ownership of their behavior and then perhaps change it

Develop effective anger management strategies, together

Some bullies demonstrate “hot aggression” — they become angry quickly and act out. Mindfulness, breathing, and walking away are all effective coping mechanisms your child needs to learn.

Alternatively, some bullies demonstrate “cold aggression” meaning they enact premeditated acts of aggression in order to shame or humiliate others. This is more concerning and warrants an immediate referral to a qualified mental health provider.

Provide education about bullying

Many bullies do not recognize the implications of their behavior. By simply educating them about bullying and the power of verbal and or physical aggression, some bullies will immediately feel remorseful. Encourage these kids to make repairs with their victims by writing apology notes or verbally expressing apology

On the other hand, some bullies know full well what they are doing and will deny wrongdoing. This is very hard for a parent because it threatens parent/child trust. Sometimes it takes a hard line, especially with bullies who demonstrate cold aggression, to keep them in line and in conjunction with mental health experts, a behavior modification program is required to change the behavior.

Take an inventory of every adult in their lives and determine what needs to be changed

Is your child modeling aggressive behavior that is acceptable elsewhere? Are they the recipient of harsh criticisms? Do they witness yelling and putdowns? For example, some coaches are gruff on the football field and while that may be acceptable in that context, it is unacceptable elsewhere. That point may need clarification for your child.

Instill a sense of empathy

Whether or not empathy can be taught is a hotly debated topic in psychology, however those kids who are at risk for lacking empathy profit from demonstrating empathy at home. Take a few extra minutes to check in with your child emotionally. Express how you are feeling internally. All people have emotions but how they are expressed is culturally and individually determined.

One way to help instill a sense of empathy is providing service for others — as part of reparations, you may offer to take your child to volunteer with those less fortunate.

Encourage good behavior

Positive reinforcement can work wonders. If you child has managed to hold their tongue or not negatively engage with someone, notice it and praise appropriately.

Get professional help

Many kids who bully have not yet learned to manage conflict, their own sense of self-esteem, or their emotions. It is very important for their growth as individuals that they learn and practice better coping skills now, while they are still at home. Bullying behavior will not go away on its own.

3. Toolkit for the bystander

Bystanders are impacted by bullying

Ask your kids who the bullies are at the playground. Find out who is aggressive and who is a victim.

Ask your kids how it feels to observe bullying behavior and listen empathically. Many kids will feel uncomfortable and validating this is important.

Educate your kids about the “Bully-victim-bystander” model — it may help them understand what is going on and how to best protect themselves and perhaps others.

Bystanders may be able to help neutralize bullying situations

Safety first: no bystander ought to risk their own well-being to manage a bullying situation. Concerned bystanders should alert the school authorities anonymously.

Bystanders can express their dissatisfaction with bullying by ignoring the behavior and walking away. Bullies thrive when they have an audience. If their “friends” abandon their behavior it may help to extinguish it.

How to be an upstander

Some kids want to be protective and transition from a bystander to an upstander. Educate your child about the risks of standing up to a bully — they may become the next target. However, upstanding may be a value in your home. If so, arm your children with knowledge. When safe, upstanders can use humor, encourage the victim to walk away, or redirect the bully to another activity.

Dr. Aaron Krasner is chief of the Adolescent Transitional Living Program at Silver Hill Hospital in New Canaan.