NHS figures obtained by BBC Newsbeat
show a 20% rise in the number of 10 to 19 year olds admitted to hospital
because of self-harm injuries across England, Wales and Northern Ireland
(Whitworth, 2015). This demonstrates the increasing incidence of self-harm in
secondary-school aged children, and is the primary focus of our intervention –
which is centred around the issue of self-harm. The current UK estimate of
hospital attendance caused by self-harm is around 400 per 100,000 people
(Hawton et al., 1997); which highlights what a nation-wide issue this has
become; if self-harm can be tackled, then these rates can be reduced. Deliberate
self-harm behaviour is a major concern for UK health systems (Timson et al.,
2012) but of main concern is that suicide can follow on from non-fatal
self-harming – as suicide occurs in 1 in 10,000 people a year, and reducing the
population’s suicide rates is a difficult challenge (Owens et al., 2002). From
present efforts, it is possible that interventions currently provided by mental
health services do much to limit the likelihood of suicide as a consequence of
self-harming (US Department of Health and Human Services, 2001). However, it
remains clear that self-harming itself is still a very apparent issue; in-fact
self-harm in adolescence is an extremely common phenomenon and is considered to
be one of the most significant social and healthcare problems for young people
(Hawton et al., 2006). Many of those people who self-harm, are of school age
and it is to be expected that schools and their teachers are aware of the
problem, as well as how to respond appropriately as part of their provision of
pastoral care (Best, 2006). Viewing this identified problem in a certain way
can now allow us to develop the most effective intervention, and justifications
can be laid out as to why our intervention is designed and structured in the
way that it is. Before providing explanations for the
structure of our intervention – we had to assess the problem. Using the
Development Practice-Centred Approach, we considered the goals of the society,
the individual and the institution, and it became apparent that as well as
reproducing social norms, and receiving a relevant education, having good
emotional and physical health was a core component in each of these
environments. The Development and Practiced Centred Approach can be “applied in
a variety of practical situations that arise for schools and/or children,
including support for families and schools” (Hedegaard and Chaiklin, 2011,
P.87). Best (2006) drew attention to the fact that judgmental reactions towards
self-harm are understandable given the attitudes held in society towards
individual well-being. This assessment highlighted the need for an intervention
focused on those whose who self-harm, and Lewis et al., (1997) estimated that
additional interventions following self-harm might reduce the rate of subsequent
suicide by 25%. The World Health Organisation has also announced that reducing
the rate of suicidal behaviour is actually a national service priority in
Britain and in many other countries (DfHealth, 2002 and WHO, 2002); and that the
prevention of suicide is now included in health policy initiatives in several
countries, and reduction in suicidal behaviour both fatal and non-fatal, is
part of the Health for All targets of the World Health Organisation (Hawton et
al., 1998). The experiences that people have in their early years – including
through their primary schooling, are crucial and beyond the control of those
working in secondary schools – but once within the secondary school, it is
possible to work to prevent such issues (Best, 2006). This is why the
Development and Practice Centred Approach is so useful because “plans for
interventions draw explicitly on an analysis of the children’s social situation
and the practices in which the child participates” (Hedegaard and Chaiklin,
2011, P.91).  With
the focus of our intervention identified, we considered the scale. Clearly,
self-harm and its subsequent impacts, are a global issue; but for the sake of
this intervention, focus has been given to the issue in the Coventry and
Warwickshire area in the Midlands, England. This way, if the proposed
intervention were found to be successful, it can be replicated on a larger scale
and the benefits experienced by more people. Previous research has highlighted
the importance of staff attitudes towards adults who engage in self-harm
behaviour (Timons et al., 2012) and consequently, given the context and scale
of the proposed intervention plan, the reason for teachers being the focus of
the intervention can be justified. In an extensive report by the Samaritans
(2005), “it was argued that since the vast majority of pupils who self-harm, do
not go to hospital, prevention may need to take place in the community, ideally
within schools” (Timons et al., 2012, P.1308). Therefore, having used the
Development and Practice Centred Approach to assess the identified issue of
self-harm for adolescents – the ‘Success Goals’ for our intervention were
developed – bearing in mind the location of a school. Firstly, they included
‘making teacher’s more aware and able to spot the symptoms of self-harm’.
Secondly, we aimed to make ‘teachers to feel more confident in dealing with
self-harming students, and be more familiar with the procedure to support and
report the issue’. Our final goal was ‘to provide support to teachers dealing
with self-harming students’. By addressing teachers’ awareness and ability to
deal with self-harm, the likelihood of meeting the goals of the society, the
individual and the institution can be increased; rather than reducing the
prevalence of self-harm itself – which would likely only immediately impact the
individual. Previously,
the government has asked experts to examine how to tackle self-harming and the related issues in schools; and according to the National
Association of Head Teachers and the Association of Teachers and Lecturers,
spending cuts to local services have left schools without as much expert medical
help as in the past (Whitworth, 2015). Consequently, the intervention we
decided to develop is focused in schools because teachers and other members of
school staff are often the only professionals that self-harming adolescents
have regular
contact with, and are in an ideal position to respond to
students’ distress (Dowling and Doyle, 2016). A review of literature
revealed that previous research about how schools work with students who self-harm is severely limited, and often
undertaken using quantitative research methods (Ibid, 2016); and at present, there is a distinct lack of evidence to
indicate the most effective forms of treatment for patients who deliberately
self-harm (Hawton et al., 1998). This is of major concern due to the fact that
the size of the population at risk is so large and so susceptible to the
associated risks of harming themselves, including suicide (Ibid, 1998). Some
studies conducted in schools, identified that while 1 in 10 young people
engages in self-harm, only a small minority seek professional help (Dowling and
Doyle, 2016), and that in some cases, school teachers could be the only adults
who may be aware of a young person’s self-harm (Ibid, 2016). This is the reasoning
as to why we selected teachers; but this could be contested, by making other
actors the centre of the intervention plan. It
could be argued for example, that individual families might have been more
appropriate groups to work with, however, we felt that educating teachers and
improving their confidence was more important given their roles in pastoral
care, and that this would make our intervention more efficient in terms of
reaching as many people in need as possible. It also became continuously
apparent that teachers often feel unsuitably equipped to respond effectively to
students experiencing self-harm (Dowling and Doyle, 2016). In addition, we
decided that using teachers as the focus also made the intervention easier to
evaluate in a summative way – as a school provides an environment where all
teachers come together, where-as very rarely are all family members in the same
place as other families. Due to this, the distribution of the questionnaires –
our chosen method of evaluation – would be more efficient and economical, and
it can help to provide a greater indication as to whether the intervention has
been successful or not.  We decided that an intervention focused
solely on reducing the prevalence of self-harm would be unrealistic and
unachievable. Subsequently, in addition to the above justifications, it was
decided that using teachers would provide the most effective intervention, and
that improving teacher confidence in dealing with self-harming students was
crucial. Despite the fact that school counsellors and teachers are in regular
contact with adolescents who self-harm, it appears they may not be adequately
resourced to respond effectively, and additionally, even though teachers show a
willingness to help, it has been reported that they often feel ill-informed
about how to best respond and a need for further education and training to
increase their confidence has been identified (Dowling and Doyle, 2016). Best
(2006) also found that it has been indicated that many teachers have ‘patchy’
awareness of self-harm and reactions of ‘shock, panic and anxiety’ when faced
with it. Subsequently, our intervention consists of a training morning, run by
mental health workers from RISE – and is based at North Leamington School in the
Coventry and Warwickshire area for all teachers in the school. Among other
things, the morning includes a ‘Question and Answer’ session with two
ambassadors from a school in Cheltenham – Trevor Allinson and Helen Hooper who
provide an insight into how to recognise self-harm and how teachers can help
students who are going through it. If increased teacher awareness is not
accompanied by increased levels of training then more harm than good may be
done (Best, 2006). This is another reason why teachers were selected as the
focus, because they are able to emphasize and relate to the guest speakers in a
more appropriate manner.It was clear that the lack of provision
of training on self-harm and professional supervision for teachers further
hampers their ability to respond effectively to self-harming students (Dowling
and Doyle, 2016); hence why the intervention decided on is focused on such
matters. In-fact Dowling and Doyle (2016), even go as far as to say that
“training teachers to respond to self-harm within the school setting will allow
for more helpful and supportive responses from schools by increasing
understanding, offering earlier detection of self-harm and supporting timely
referral to appropriate mental health services” (P.591). With a range of prevalence
among adolescents, it remains important that all schools are not only aware of
self-harming problems, but also equipped to cope with them (Best, 2006). The
aspect of the intervention where teachers are offered support by the
Deputy-Head of North Leamington School is especially important because little
is known about how supporting students impacts the teachers themselves, or the
best ways to help teachers who respond to distressed students (Ibid, 2016). We
also felt that this was a way in which our intervention could prove to be more
successful than other previous interventions because teachers are frequently
left unsupported.

In conclusion, it is clear that there
are a variety of justifications that can be made in order to explain why the
intervention we developed was structured around improving teacher confidence
when dealing with self-harming students. Self-harm is a complex issue, but when
examined using the Development and Practice Centred Approach, it can be broken
down and it is possible to form a small-scale intervention plan that helps to
meet all of the goals of the society, the individual and the institution.
Teachers are accessible, congregate in one place, and are often the adults in a
prime position to intervene with adolescents in distress. There are obviously additional
aspects and developments to an intervention that could be considered, however,
this intervention plan is manageable, and likely to meet the original success
goals formed.


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