Understanding the Experience and Needs of School Counsellors When Working with Young People Who Engage in Self-Harm

Identifying high-risk subgroups for self-harm in adolescents and young adults: A longitudinal latent class analysis of risk factors

BACKGROUND

Self-harm is a major public health concern in young people and is governed by a complex interaction of different risk factors. While many studies have identified these risk factors, less is known about how they tend to co-occur together.

METHODS

A latent class analysis was conducted using risk factors for self-harm from two waves at ages 13 and 17 from the Growing Up in Ireland (GUI) study their associations with self-harm were examined longitudinally at ages 17 and 20, respectively.

RESULTS

At age 13, there was a 'peer problems' group with higher probabilities of bullying, being unpopular and internalising problems and a 'school and substance use problems' group with higher probabilities of substance use, truancy or excessive absence from school and violence. Both of these two groups had over a two-fold risk of self-harm at age 17 in comparison to the low risk factor group. At age 17, there was a group with depression that was diagnosed by a medical professional with the highest relative risk (RR:13.9 (95 % CI 10.2-19.0)) of self-harm at age 20. Two other groups with undiagnosed depression had high probabilities of being bullied, and either high or low probabilities of substance use that had a 9.4 (95 % CI 6.8-13.1) and 7.4 (95 % CI 5.5-10.0) relative risk of self-harm at age 20, respectively.

CONCLUSIONS

Identifying hidden sub-groups using risk factors for self-harm in young people can inform potential public health interventions by clinicians and other professionals who work with young people.

Practice-based insights from specialized clinicians into youth suicide risk assessment and psychotherapy: A qualitative study

Objective: The experience of frontline clinicians is an underutilized source of knowledge about improving youth suicide intervention. This qualitative study explored the perspectives of highly experienced, specialized mental health clinicians on the practical application of risk assessment, stabilization, and treatment and their experience of working in this practice area.Method: Data were collected from seven focus groups with 28 clinicians and analyzed using consensual qualitative research methods.Results: Four domains emerged, describing 1) youth suicide intervention as relationally focused and attachment-informed, 2) the need for flexible and tailored care balancing individual and family intervention in the context of family complexity and fractured relationships, 3) a nuanced, therapeutic approach to managing the complexity and uncertainty of adolescent suicide risk, and 4) working in youth suicide intervention as emotionally demanding and facilitated or hampered by the organizational and systems context.Conclusion: The importance of harnessing family systems and attachment-informed approaches to alliance, risk assessment, and treatment was emphasized, along with the parallel need for systemic clinician support and consideration of the potential negative consequences of administrative and risk management protocols.

Development of guidelines for school staff on supporting students who self-harm: a Delphi study

OBJECTIVE

Self-harm is a major public health issue that significantly impacts communities, making early intervention and prevention paramount in addressing this public health issue. This study aimed to develop evidence-based, culturally responsive, safe, and practical guidelines to assist school staff in effectively supporting students who self-harm.

METHODS

This Delphi study comprised of a five-step process, oversighted by a Rōpū Mātanga Māori (Māori clinical and cultural governance group), and drawing on the expertise and knowledge gained from existing literature, interviews with stakeholders, and two panels of experts (youth and stakeholders). The Rōpū Mātanga Māori ensured accountability to the principles of Te Tiriti o Waitangi (Treaty of Waitangi) and kept Māori processes central to the research aims. The panels completed two rounds of questionnaires, rating their endorsement of each statement. Statements rated as important or essential by 80% or more of both panels and Māori participants were included in the final guidelines. The Rōpū Mātanga Māori reviewed any remaining statements to determine inclusion.

RESULTS

Following the five-step process, 305 statements were included in the guidelines. These statements provided guiding actions that endorsed communication, collaborative responsibility, and wellbeing and a student-centred approach.

CONCLUSION

The guidelines provide guidance to all school staff that is culturally responsive and safe, consensus-based, and evidence-based. It is informed by the voices and experiences of young people and those who support them.

Young people and adult stakeholders' reflections on how school staff should support students who self-harm: A qualitative study

INTRODUCTION

Self-harm is a significant public health issue affecting school communities, students, and families. The school is an ideal environment for early intervention and prevention. This study aimed to explore the views of young people and stakeholders on how school staff should support students who self-harm in the context of developing accessible and acceptable guidelines.

METHODS

The study was nested within a larger Delphi study conducted in New Zealand. Two panels were asked to provide reflection in open text boxes in two questionnaires on how school staff can support students who self-harm. The youth panel included 22 participants between 16 and 25 years, and 81.8% identified as female and 18.3% as male. The stakeholder panel (e.g., school staff) included 27 participants over 25 years, and 63.0% identified as female, and 37.0% as male. The data were analyzed using thematic analysis to identify key themes.

RESULTS

Eight themes were identified; (1) an approach that prioritizes trust, (2) an approach that recognizes students' agency, (3) an individually tailored approach, (4) a whole-school approach, (5) an approach that recognizes role boundaries, (6) an approach that prioritizes safety, (7) a nonpunitive approach, and (8) an appropriately-resourced approach.

CONCLUSION

The eight themes identified highlighted ineffective practices in response to self-harm in schools. The eight themes provide solutions to these practices. Our findings highlighted four recommendations that address ineffective management approaches in response to students who self-harm. These recommendations included using a student-centered approach, a whole-school approach, avoiding punitive approaches, and providing adequate resourcing to schools.