Outline of Presentation

Self-Injury Interventions for

School Psychologists Part One: Introduction
i. Prevalance/Myths
ii. Warning Signs/Risk Factors

Part Two: Referral

MISTY BONTA i. Increasing Awareness
SHERRY JANKANS ii. Response to students/School Psychologist Role
LIANA LOPES
Part Three: Assessment
DELIA VILLASENOR
i. Assessing for High/Low risk/Immediate Risk
ii. Contacting Parents/Outside Referrals

Part Four: Intervention

i. School-Based/Non-School Based Treatments
ii. Individual/Group Counseling

Part Five: Prolonged Care for the Student

i. School Accommodations

Introduction Prevalance

y Terms used for Self-Injury : cutting, self-harm, self- y 15-20% of adolescents admitted to engaging in SI at
mutilation & non-suicidal self-injury (NSSI) least once
y Todays presentation will use the term Self-Injury y When students were provided with a checklist of
(SI) behaviors, 30% indicated that they have cut, carved,
y SI can take many forms: The most common is burned, or hit themselves on purpose
cutting the skin followed closely by burning and
y SI is prevalent in all cultures and races and cuts
hitting oneself.
across SES
y Other forms: scratching the skin, biting, preventing
y Age of onset: (59% grades 7-8) (24.6% in grade 6 or
wounds from healing, pulling out clumps of hair,
lower)
placing objects under the skin, and head banging

Gaining Knowledge by Dispelling Myths Gaining Knowledge by Dispelling Myths

y Myth #1All youth who self-injure are suicidal. y Myth #2Students who self-injure are attention-
y Students who self-injure are doing so in an attempt seeking
to make themselves feel better whereas the suicidal y Researchers have actually found that the function of
students wants to end all feelings SI is one or combination of the following:
y Out of 208 participants who engage in SI, 11% of 1. Feeling concrete pain when physic pain is too much
them also exhibited high risk of suicide. 2. Communicating, expressing, or attempting to control
y Many students who engage in SI may suffer from emotions
an underlying mental health disorder: 3. Reducing tension or numbness, promoting a sense of
y Depression, Anxiety, Border Personality Disorder
feeling real.
4. Self-punishing
 Gaining Knowledge by Dispelling Myths Warning Signs of Self-Injury

y Myth #3All youth who self-injure have been y Unexplained frequent injury including cuts and
sexually or physically abused. burns
y Risk Factors: y Wearing long pants and sleeves in warm weather
y losing a parent, being sexually and/or physically y Low self-esteem, difficulty handling feelings, &
abused, having a sibling and/or parent who SI, relationship problems
and/or witnessing family violence y Poor school functioning
y Research conducted on clinical populations. We y Secretive behaviors such as spending unusual
recommend that you allow students to tell their amounts of time in student bathroom or isolated
own stories areas

Warning Signs Cutting

y Possession of sharp implements (i.e., razor blades) y Cutting is the most prevalent, look for cuts on
y Expression of self-injury via art and or/writing arms, wrists, abdomen, legs
samples
y Risk taking behavior
y Substance and/or alcohol abuse
y General signs of depression, social-emotional
isolation and disconnectedness

Pictures Taken from: Myspace (Self-Injury Awareness)

Increasing Awareness

y Crisis team- should have a well developed response protocol

Part Two: Referral that allows for appropriate and rapid response that addresses
the following.
y -When should school personnel report suspected self injury?
y -Who does the teacher report to?
y -What is the role of the school nurse and school psychologist?
i. Increasing Awareness
y -What is the policy on notifying and involving parents?
y Update mental health resources on a regular basis. Make sure
ii. Response to students/School Psychologist Role crisis team is knowledgeable of the characteristics of self
injury.
y In service days to educate staff.
 Working With Students Who Self-Injure Responding to Student Self-Disclosure

y Be aware of your own reactions and feelings. y Students may disclose if they can find an adult who they
trust.
y Monitor and manage reactions.
y Initial response will play critical role in future help seeking
y Assess your comfort in working with students who behavior and participation in intervention.
SI. y -Build supportive and trusting relationship with youth.
y If there is discomfort, immediately refer student to y -Show respect and willingness to listen in a non-judgmental
another mental health professional and provide fashion.
resources to the student. y -Do not express shock, revulsion, or discomfort.
y Only work with a few students who SI at a time. y -Do not show too much concern- it can alienate youth or
y Share with colleagues, seek collaborative support damage trust.
from crisis team, and guidance from your supervisor. y -Do not show too much interest in the behavior itself.

Responding to Student Disclosure

y Use the students own language.

y Avoid using suicide terminology.
Part Three: Assessment
y Do not tell the student to just stop!
y Do not pretend to know how they feel.
y Reassure student that there is nothing to be ashamed of
i. Assessing for High/Low risk/Immediate Risk
and that they are not in trouble.
y Emphasize hope. ii. Contacting Parents/Outside Referrals
y Dont assume trauma or abuse is present.
y Supervise at all times until risk has been assessed.
y Create a safe and caring place for the student to talk.

The Primary Role of School Psychologist Assessing for Immediate Risk

Assessing for immediate risk Individuals should be assessed for immediate

Communicating with parents (if necessary)
risk of suicide and other mental health issues.
Risk is considered high when:
Providing appropriate community and/or Adolescent is at risk for suicide
district mental health resources There is a comorbid mental health issue
There is abuse or trauma, substance abuse, and/or an eating
disorder
There is severe tissue damage or indication of infection
(involve school nurse)

Adapted from Lieberman et al. (2004) Adapted from Lieberman et al. (2004)
 Responding to Assessment Contacting Parents

High Risk adolescents y Contacting parents about their childs self-

Treatment should begin with care of the wound for both risk levels
Confidentiality must be broken and parents contacted immediately if
injurious behavior must be done with patience,
adolescent is at risk for harm to self or others tolerance, and cultural sensitivity
Referrals should be made immediately for appropriate treatment (i.e.
medical attention and/or mental health services) y Advise student that parents must be notified for
their own safety (when necessary)
Low Risk adolescents y Notify the parents while the student is present
Provide appropriate interventions in school setting (i.e., counseling,
no harm agreements, etc.) y Be supportive
Risk level should be reassessed periodically (may change)
Contacting students parents may or may not be required (may differ
y Facilitate positive communication between
depending on the schools SI protocol) adolescent and parent

Outside Referrals

y Referrals should be conducted in a sensitive manner to

increase likelihood that adolescent will utilize services and Part Four: Intervention
so adolescent does not feel unsupported by adult he or she
confided in.
y Adolescents considered at high risk should be referred to i. School-Based/Non-School Based Treatments
outside services to receive the most effective treatment
(requires more intense and individualized treatment).
y Obtain a release of information to monitor students ii. Individual/Group Counseling
progress and be involved in facilitating communication
between the adolescent, school, parents, and community
mental health agencies.

Intervention in the School Setting Intervention in the School Setting

y Individual Counseling y Individual Counseling

{ Communication Skill Building { Cognitive Restructuring
Encourage student to use communication to express emotions Explore the students cognitions and help him or her
Use journals to express emotions through writing challenge the maladaptive thoughts that are
Trigger Log student tracks each time he or she engages in SI and maintaining the SI
the events leading up to it
{ No Harm Agreement
{ Behavioral Interventions The student and school psychologist make an
Stress Management and Tension Release
agreement that the student will choose alternative
Diaphragmatic and Controlled breathing
behaviors that he or she will do instead of SI
Meditation and Visualization
It is not a contract, it develops as the student learns the
Exercise, specifically aerobic
alternative behaviors
 Intervention in the School Setting Non-school Based Intervention

y Counseling Groups y Cognitive Behavior Therapy (CBT)

{ Based on the premise that cognitions influence mood and behavior
{ Groups should focus on developing problem-solving
and targets both the faulty cognitions of the adolescent and the
techniques, adaptive coping strategies, self-esteem maladaptive behaviors that result
building, communication and social skills, not on SI Dialectical Behavior Therapy (DBT)
behavior due to contagion effect | Goal is to reduce self-destructive behavior, learn adaptive
coping and problem-solving skills, and to accept self while
changing
{ Solution Focused Therapy
Problem-Solving Therapy (PST)
Selekmans Stress Busters Leadership Program
| Goal is to identify and resolve problems and teach coping and
| Specifically designed to work with self harming problem-solving skills
adolescents in a group setting Manual Assisted Cognitive Behavior Therapy (MACT)
o Short-term problem-solving intervention that teaches how to
manage negative thoughts and emotions

Non-school Based Intervention Non-school Based Intervention

{ Group Therapy y Medication

Helps the student learn problem-solving skills { Antidepressants
Enhances peer relationships and communication skills
Selective Serotonin Reuptake Inhibitors (SSRI)
{ Family Therapy | For example: Prozac, Celexa, Zoloft
Provides the student with family support
y Hospitalization
Family learns about SI and helps the family cope
Not likely to be effective alone { This is discouraged and only used during extreme cases
Partial hospitalization, usually 6 to 12 hours a day
y A combination of cognitive behavioral therapy,
Inpatient hospitalization
assertiveness training, and modeling and practicing
adaptive ways of expressing negative feelings has been
found to be most effective.

Care for Adolescent Who Engages in SI

y Treatment for the adolescent who self-injures will

Part Five: likely be a difficult time for them and our role as
Prolonged Care for the Student School Psychologists is to help them while they are at
school
y We should let them know that they could come to
i. School Accommodations
our office or the counselors office when they need to
talk and we must provide them with empathy,
caring, unconditional acceptance, trust, and rapport
among other things already mentioned (Bowman &
Randall, 2006).
 Care for Adolescent Who Engages in SI Care for Adolescent Who Engages in SI

y As School Psychologists, we must keep in contact y School Psychologists should make sure that the
with their outside mental health worker (i.e., crisis team is aware of this and create flexibility in
therapist, counselor) to be aware of where they are in their protocol for how to accommodate the student
their treatment and be notified of any changes in during their treatment.
their level of risk y The needs of the student must be monitored and
y The student will be trying to balance therapy with the crisis team should consider 504
everyday challenges of being a teenager. Maintaining accommodations if the SI is impacting their
a routine around therapy interventions and academic achievement.
schoolwork may seem impossible for the student.

Care for Adolescent Who Engages in SI Questions?

y Keep up with local resources and mental health

professionals that specifically help Self-Injurious Youth or yThank You for your time, do
that specialize in the type of therapies we recognized as
being most successful with this population. The following you have any questions?
are some helpful online resources:
y http://www.selfinjury.org/
y http://www.safe-alternatives.com/
y http://www.palace.net/~llama/psych/fself.html
y http://www.recoveryyourlife.com
y http://www.selfinjury.net
y http://coolnurse.com/self-injury.htm
y HOTLINE: 1-800-DONT-CUT

References References

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Youth Light inc. youth: The essential guide to assessment and intervention. Routledge.
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