ISCA - Self-injury: Identifying and responding to adolescents in the schools

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Self-injury: Identifying and responding to adolescents in the schools

Course Title

Self-injury: Identifying and responding to adolescents in the schools

Course Number

Course Overview

Self-injury in adolescents, observed in 14-18% within schools in the U.S. (Hasking et al., 2016) and 16-22% globally (Xiao et al., 2022), often emerges as a coping mechanism for psychological distress. Despite its prevalence and the fact that most school mental health professionals have encountered self-injuring students, many educators feel unprepared to intervene with students engaging in self-injury. Additionally, self-injury, a spectrum of behaviors that function to manage intense emotional responses, is increasingly noted beyond psychiatric contexts, heightening its complexity and the need for school-based intervention strategies. Importantly, research increasingly suggests that self-injury signals a significant risk for suicidal behavior, underscoring the necessity for ongoing assessment of suicidal ideation. The phenomenon of contagion, where self-injury occurs within peer groups or is influenced by online communities, further complicates management in the school setting. Experts advocate for systematic approaches, including a collaboratively designed school protocol to ensure consistent, appropriate responses within the school environment. This involves training staff, defining roles, assessing risk, and managing contagion.

This course will specifically address issues related to identification and intervention of self-injury within the school context, a systematic school protocol for self-injury, and the critical role of school mental health professionals in mitigating self-injury. Additionally, an electronic version of Coping with Self-injury, a strategy guide for use with adolescents, will be provided to participants.

ISCA Student Standards

This course will support you in providing strategies for your students to be able to:

SE A1:3 Develop self-awareness and self-management skill for mental health

SE: A1: 6 Develop healthy ways to identify, express and respond to one’s emotions

SE: A1: 9 Identify long and short-term goals

SE: B1: 3 Apply effective problem-solving and responsible decision-making skills to make safe and health choices

SE: B 1:5 Demonstrate when, where, and how to seek support for solving problems and making decisions

ASCA Professional Standards and Ethical Standards and Practices

This course is aligned to the following school counselor ASCA Ethical Standards:

A.9. Serious and Foreseeable Harm to Self and Others

School counselors:

Inform parents/guardians and school administration when

a student poses a serious and foreseeable risk of harm to

self or others. This notification is to be done after careful deliberation and consultation with appropriate professionals, such as other school counselors, the school nurse, school psychologist, school social worker, school resource officer or child protective services. Even if the danger appears relatively remote, parents/guardians must be notified. The consequence of the risk of not giving parents/guardians a chance to intervene on behalf of their child is too great.

A.1. Supporting Student Development

School counselors:

Have a primary obligation to the students, who are to be treated with dignity and respect as unique individuals.

Foster and affirm all students and their identity and psychosocial development.

Provide culturally responsive counseling to students in a brief context and support students and families/guardians in obtaining outside services if students need long-term clinical/ mental health counseling.

Provide culturally responsive instruction and appraisal and advisement to students.

Have a primary obligation to the students, who are to be treated with dignity and respect as unique individuals.

ASCA Professional Standards and Competencies

Based on the ASCA School Counselor Professional Standards & Competencies mindset, (M7: School counseling programs promote and enhance student academic, career, and social/emotional outcomes), the following Professional Foundation Behaviors apply:

B-SS 3. Provide short-term counseling in small-group and individual settings

a. Use data to identify students in need of counseling intervention

Provide support for students, including individual and small- group counseling, during times of transition, heightened stress, critical change or other situations impeding student success

Explain the difference between appropriate short-term counseling and inappropriate long-term therapy

Explain the impact of adverse childhood experiences and trauma, and demonstrate techniques to support students who have experienced trauma

Respond with appropriate intervention strategies to meet the needs of the individual, group or school community before, during and after crisis response

B-SS 4. Make referrals to appropriate school and community resources

Maintain a list of current referral resources, consistent with school and district policies, for students, staff and families to effectively address academic, career and social/emotional issues

Communicate the limits of school counseling and the continuum of mental health services

Articulate why diagnoses and long-term therapy are outside the scope of school counseling

Intended Audience

School-based mental health professionals including psychologists, school counselors, school psychologists, and social workers.

Essential Questions

How can self-injury and suicidal behavior be distinguished?
How can self-injury be assessed in the schools?
How should educators respond to self-injury?

Knowledge

Skills

Participants will have knowledge about:

Participants will be able to:

Appropriate school-based screening methods for identifying self-injury in adolescents in the schools
The role of school-based mental health professionals in initiating self-injury intervention
Current resources for increased understanding of the topic of self-injury for adults supporting adolescents who engage in self-injury

Identify self-injury behaviors in adolescents within the school setting.
Apply evidence-based methods to respond effectively to adolescent self-injury as school-based mental health professionals.
Develop and implement a research-based framework for a school protocol to mitigate self-injury.

About the Facilitator

Dr. Marina Niznik is a licensed psychologist and the President of Inlight Psychological Services PC, the private practice she founded, focused on supporting adolescent mental health. She earned her doctoral degree in School Psychology from the University of Texas at Austin and upon completing her APA-accredited internship in a large suburban school district outside of Houston, Texas, remained there for over 15 years, providing direct psychological services in a district of over 100,000 students. She is an Advisory Board member for the JED Foundation Set-To-Go High School program and has consulted with them in the development of this initiative. In collaboration with Dr. Scott Poland and Mr. Richard Lieberman, she has written articles on self-injury, suicide contagion, and suicide prevention in the context of social media and has presented for local and national conferences on these areas. She is a licensed psychologist in California and currently resides in the San Francisco Bay Area.

Dr. Scott Poland has 40+ years of experience working on crisis intervention in schools. He has assisted over thirty school communities on site after tragedies including school shootings, acts of terrorism, natural disasters and suicide clusters. He is a licensed psychologist and has authored or coauthored seven books on school crisis. He is a past president of the National Association of School Psychologists and has received many awards including the Helping Parkland Heal and the NASP Crisis Intervention Awards. He has testified about school crises before the U.S. Congress on four occasions. He previously worked full time in K-12 schools for 26 years and is currently a professor and the Director of the Suicide and Violence Prevention Office at NSU Florida.

Scott has presented many well received sessions on crisis topics for ISCA.

Dates and times of offerings

November 18, 2024 at 2:00 to 5:00PM UTC

Contact hours

3 hours, online, synchronous

Time commitment between sessions

Required Resource(s)

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References

Bubrick, K., Goodman, J., & Whitlock, J. (2010). Non-suicidal self-injury in schools: Developing and implementing school protocol [Fact Sheet] Cornell Research Program on Self-Injurious Behavior in Adolescents and Young Adults. Retrieved from http://crpsib.com/userfiles/NSSI-schools.pdf

Darosh, A.G., & Lloyd-Richardson, E.E. (2013). Exploring why students self-injure: The functions of nonsuicidal self-injury. School Psychology Forum: Research in Practice, 7 (4), 111-120.

de Neve-Enthoven, N.G.M., Ringoot, A.P., Jongerling, J., Boersma, N., Berges, L.M., Meijnckens, D., Hoogendijk, W.J.G., & Grootendorst-van Mil (2024). Adolescent nonsuicidal self-injury and suicidality: A latent class analysis and associations with clinical characteristics in an at-risk cohort. Journal of Youth and Adolescence, 53, 1197-1213.

Dickstein, D.P., Puzia, M.E., Cushman, G.K., Weissman, A.B., Wegbreit, E., Kim, K.L., Nock, M.K., & Spirito, A. (2015). Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury. Journal of Child Psychology and Psychiatry, 56 (10), 1127-1136.

Farkas, B.F., Takacs, Z.K., Kollarovics, N., & Balazs (2022). The prevalence of self-injury in adolescence: A systematic review and meta-analysis. European Child and Adolescent Psychiatry. doi.org/10.1007/s00787-023-02264-y

Glenn, C.R., Franklin, J.C., & Nock, M.K. (2015). Evidence-based psychosocial treatments for self-injurious thoughts and behaviors in youth. Journal of Clinical Child & Adolescent Psychology, 44 (1) 1-29.

Glenn, C.R., Lanzillo, E.C., Esposito, E.C., Santee, A.C., Nock, M.K., & Auerbach, R.P. (2017). Examining the course of suicidal and nonsuicidal self-injurious thoughts and behaviors in outpatient and inpatient adolescents. Journal of Child Psychology, 45, 971-983. doi 10.1007/s10802-016-0214-0

Guan, K., Fox, K.R., & Prinstein, M.J. (2012). Nonsuicidal self-injury as a time-variant predictor of adolescent suicide ideation and attempts in a diverse community sample. Journal of Consulting and Clinical Psychology, 80 (5), 842-849.

Hasking, P.A., Heath, N.L., Kaess, M., Lewis, S.P., Plener, P.L., Walsh, B.W., Whitlock, J., & Wilson, M.S. (2016). Position paper for guiding response to non-suicidal self-injury in schools. School Psychology International, 37 (6), 644-663.

Heath, N., & Lewis, S.P. (2013). Nonsuicidal self-injury in our schools, from research to practice: Introduction to the special issue (2013). School Psychology Forum: Research in Practice, 7 (4), 89-92.

Heath, N., Toste, J., & Beettam, E. (2006). “I am not well-equipped”: High school teachers’ perceptions of self-injury. Canadian Journal of School Psychology, 21, 73-92.

JED Foundation (2023). Can the metaverse be good for youth mental health? Retrieved from https://jedfoundation.org/wp-content/uploads/2023/07/Can-The-Metaverse-Be-Good-For-Youth-Mental-Health-Jed-Foundation.pdf

Lieberman, R. (2010). General guidelines for administrators intervening with self- injurious youth. Los Angeles County Youth Suicide Prevention Project http://preventsuicide.lacoe.edu

Lieberman, R.A., & Poland, S. (2006). Self-mutilation. In G.G. Bear & K.M. Minke (Eds.), Children’s Needs III: Development, prevention, and intervention (pp. 965-976). National Association of School Psychologists.

Lieberman, R.A., Poland, S., & Niznik, M. (2019). Nonsuicidal self-injury: Handout for School. In G.G. Bear and K.M. Minke (Eds). Helping Handouts: Supporting Students at School and Home (S3H10). National Association of School Psychologists.

Lieberman, R.A., Toste, J.R., & Heath, N.L. (2009). Non-suicidal self-injury in the schools: Prevention and intervention. In M.K. Nixon & N.L. Heath (Eds)., Self-injury in youth: The essential guide to assessment and intervention (pp. 195-215). Routledge.

Mahdy, J.C., & Lewis, S.P. (2013). Nonsuicidal self-injury on the internet: An overview and guide for school mental health professionals. School Psychology Forum: Research in Practice, 7 (4), 148-160.

Miller, D.N. & Brock, S.E. (2011). Identifying, assessing, and treating self-injury at school. Springer Science and Business Media.

Nock, M.K., Joiner, T.E., Gordon, K.H., Lloyd-Richardson, E., & Prinstein, M.J. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144, 65–72.

Reddy, N., Rokito, L., & Whitlock, J. (2016). What is the link? The relationship between non-suicidal self-injury and social media. Information Brief Series, Cornell Research Program on Self-Injury and Recovery, Cornell University.

Ribeiro, J.D., Franklin, J.C., Fox, K.R., Bentley, K.H., Kleinman, E.M., Chang, B.P., & Nock, M.K. (2016). Self-injurious thought and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies. Psychological Medicine, 46 (2), 225-236. doi.org.10.1017/S0033291715001804

Schatten, H.T., Morris, B.W., Wren, A.L., & Andover, M.S. (2013). Mental health issues and nonsuicidal self-injury among youth: Implications for mental health professionals in the school system. School Psychology Forum: Research in Practice, 7 (4), 136-147.

Shinn, M. M. (2023). Nonsuicidal self-injury: A brief overview [handout]. National Association of School Psychologists.

Walsh, B.W. (2012). Treating self-injury: Second edition: A practical guide. Guilford Press.

Walsh, B.W., & Muehlenkamp, J.J. (2013). Managing nonsuicidal self-injury in schools: Use of a structured protocol to manage the behavior and prevent social contagion. School Psychology Forum: Research in Practice, 7 (4), 161-171.

Whitlock, J., & Rodham, K. (2013). Understanding nonsuicidal self-injury in youth. School Psychology Forum: Research in Practice, 7 (4), 93-110.

Xiao, Q., Song, X., Juang, L., Hou, D. & Huang, X. (2022). Global prevalence and characteristics of non suicidal self-injury between 2010 and 2021 among non-clinical sample of adolescents: A meta-analysis. Frontiers in Psychiatry, 13, 912441. doi: 10.3389/fpsyt2022.912441.

International School Counselor Association