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Kids Who Cut

Evidence-informed programs for understanding and responding

Flickr/Creative Commons
Source: Flickr/Creative Commons

co-authored by Angelica Cullo

It’s no secret: American youth are stressed. Contemporary children are born and raised in a culture that expects and even prides itself in overcommitment. In the last decade tweens and teens have begun to report levels of stress that are on par with adults. They and the adults around them have tended to underestimate both the presence and impact of this stress. Although a growing public health focus on the deleterious health effects of stress has raised awareness of and attention to the stress that youth experience, levels of depression and anxiety in youth remain high and adults remain uncertain about how to best respond

Non-suicidal self-injury is one of the more contemporary responses to stress that happens at notably higher rates among adolescents and young adults than any other group. Because it can look and feel so much like a suicide attempt, professionals and the parents they may work with are often at a loss to understand how this form of self-injury can actually reduce stress and anxiety - at least in the short term.

US studies find that lifetime prevalence of self-injury without the intent of suicide (also called non-suicidal self-injury; NSSI for short) ranges from 12 percent to 37.2 percent in secondary school populations, and 12 percent to 20 percent in young adult populations, with an average age of onset between 11-15 years. Although it is impossible to know whether rates of self-injury have actually increased over time, it is clear that the number of youth and young adults (and even adults) who use their body as a canvas for both self expression and seeking physical relief, is remarkably high. It is also clear that most adults who work with them are at a loss to respond.

School administrators, teachers, nurses and counseling staff are poised to play a critical role in the early detection of self injury behaviors, but many of these professionals lack the knowledge needed to recognize warning signs. Detecting self-injury behavior is also complicated by the subtlety with which the symptoms present themselves. Research and clinical evidence suggest that many individuals who are self injuring fly under the radar because they are not suicidal and do not meet criteria for a diagnosable DSM-V psychological or personality disorder (other than NSSI Disorder, now part of the DSM-V).

Is your school ready to notice & respond? Are your staff trained?

Prevention, intervention and treatment require families, peers, and systems to work collectively to put programs and practices in place that bolster the community’s ability to identify and screen higher risk youth but also to prevent and intervene when warning signs are noticed in any students. Programs for helping adults who work with at risk youth respond effectively are few, but are growing in number and sophistication, though it remains rare to find programs targeting NSSI in particular.

For example, screening for Mental Health, Inc. provides training to help educators identify the signs and symptoms of depression, suicidal thoughts and behaviors, and self-injury in themselves and their peers. The SOS Signs of Suicide® High School Prevention Program is currently the only school-based suicide prevention program listed on SAMSHA’s National Registry of Evidence-Based Programs and Practices that addresses depression, suicidal thoughts and behaviors, and self injury while reducing suicide attempts and in a randomized controlled study, the SOS program showed a reduction in self-reported suicide attempts by 40 percent.

While programs like this are absolutely essential and can sometimes complement self-injury treatment and prevention programs, this and most trainings focus on suicidal thoughts and behaviors, which can often overlook or even exclude NSSI. There’s a great need for professionals who work with youth to better understand non-suicidal self-injury and to promote strategies for preventing and intervening. As a result, producing evidence-based practices in settings where youth are found is a high priority for self injury researchers. Screening for Mental Health also offers the Signs of Self-Injury Prevention Program which is focused on helping peers recognize and respond to NSSI by effectively linking their self-injurious peer with an adult in the school system.

For professionals, the Self-Injury Recovery, Research and Research (SIRRR) program, based at Cornell University, offers a suite of psychoeducational, evidence-informed web-based trainings in non-suicidal self-injury for youth-serving professionals. These brief 1.5 - 2.0 hour version and in-depth 8-11 hour courses focus on equipping teachers and other youth serving professionals, such as school mental health workers, clinicians in private practice, and anyone who works with youth, to notice, respond, and effectively intervene. The brief course is ideal for teachers, youth workers, and other individuals who want to know what self injury is and how to most effectively respond. The longer course, which can be taken as a self-paced or instructor-led course and for credit, is designed for individuals who need to know significantly more about what self injury is, where it comes from, what is clinically associated with, how to respond individually and institutionally, and best practices in intervention and prevention. A version for parents is forthcoming (interested parents can click here to be notified when this program is available).

We fully anticipate that there will be more evidence-based and informed intervention programs available for professionals, parents, and individuals who injure in time. And, as they arrive, we will sound the bugle here for those of you who have been waiting for a way to reach across the divide of generations, pain, and wounds, old and new. If you want to stay in touch with what we know and learn, please feel free to visit us at Self-Injury Recovery, Research and Research (SIRRR).