Guidelines and Procedure to Support Young People Who Are Self-Harming
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Design: www.haiwyre.com Design: Emergency Supports It is inevitable that, at some point, a young person or their family will be looking for help or advice late on a Friday or just before a holiday period. Guidelines and procedure to support At these times, sources of help include: Psychiatric Liaison Nurses Emergency Social Work Services young people who are self-harming Monklands Hospital, Airdrie We deal with emergencies which Telephone: 01236 748 748 are too urgent to await action by the or engaging in suicide behaviours social work locality office on the next Wishaw General Hospital working day. Telephone: 01698 361 100 in Lanarkshire Service operates outwith office hours Childline and at weekends. Telephone: 0800 1111 www.childline.org.uk Who we are The team is made up of experienced Breathing Space and qualified social work staff. Telephone: 0800 83 85 87 www.breathingspacescotland.co.uk What sort of emergencies can we help with? Samaritans – Child protection Telephone: 08457 909 090 www.samaritans.org – Adult protection – Older people who are at risk Cruse or need immediate help Telephone: 01698 303 099 – Mental health assessments www.crusescotland.org.uk – Major incidents (civil emergencies) NHS 24 North Lanarkshire contact details Telephone: 08454 24 24 24 Freephone: 0800 121 4114 www.nhs24.com South Lanarkshire contact details Parentline Plus Freephone: 0800 678 3282 Telephone: 0800 800 2222 www.parentlineplus.org.uk Dial 999 in emergency situations South Lanarkshire Lifelines intervention flowchart This flowchart should be used in conjunction with the supporting Lifelines Guidelines. In the case of Child Protection, please use your agency’s guidance. This flow chart assumes that all users will be trained on ASIST and Supporting young people who are self-harming. Concerns identified – Through discussion with young – See young person in private – Senior management informed and person, observation of behaviour co-ordinator arranged for support or reports from others, e.g. peers worker to support young person Nature and level of concern – Provide basic first aid, if required – Check if the young person – Support worker will support young – Discuss and agree level of concern is looked after or looked after person’s peers, as required with other members of the support – Check if the young person is away from home team or colleagues from other agencies known to the social work – Support worker will liaise with department or other services – Support worker will explore co-ordinator – These consultations will be recorded the nature and level of concern – Be alert to changes in level of concern (suicide and deliberate self harm) Low level Medium level High level Emergency – Any act of self-harm – Any act of self-harm – Any act of self-harm – Evidence of serious suicide attempt – Unlikely to cause serious – Self-harm could cause – Immediate risk of accidental death – Serious laceration/self-injury harm or death accidental death – Intent to complete suicide – Ingestion/overdose of drugs – No thoughts of suicide – Thoughts of suicide – Clear suicide plan – No suicide plan – No suicide plan – Previous suicide attempt See checklist page 32 – History of alcohol or drug misuse – History of alcohol or drug misuse See checklist page 33 See checklist page 34 Action Action Action Action – No immediate action required – Do not send home alone – Access emergency medical – Dial 999 attention, if required – Provide and secure advice on – Provide and secure advice on – Access immediate medical appropriate care of any injury appropriate care of any injury – Do not send home alone intervention – Link with most appropriate – Involve appropriate external – Do not leave alone agency for further assessment agencies e.g. GP, CAMHS, A&E – Inform parents/carers e.g. GP, CAMHS, A&E – Liaise with Social Work – Liaise with Social Work – Liaise with Social Work – Decide with Social Work on informing parents/carers Reporting Reporting – Agree Safe Plan with young – Agreed action made to monitor – Provide information leaflets – Referral to supporting agency, person (Page 31) young person and by whom and contact cards where appropriate – Record all actions fully – Agree multi-agency Support Plan with – Referral to supporting agencies, – Record all actions fully relevant sta! (Page 15), as required where appropriate – Report findings to co-ordinator – Report findings to co-ordinator who will inform relevant agencies – Complete Record of Meeting – Inform parents/carers with who will inform relevant agencies, – Agree multi-agency Support Plan form (Page 29), as required young person’s permission as required – Attend multi-agency review (Page 24) – Refer to Lanarkshire Assessment and Treatment Pathway (page 13) Follow up – Maintain contact with young – Liaise with other agencies involved – If there are changes in Levels of – Follow up on commitment to person during this period Concern work through Flowchart again multi-agency support plan, – Be alert to changes in as required – Maintain contact with parents/carers, Levels of Concern – Young person and support worker as appropriate follow up commitment to Safe Plan – Multi-agency reviews, as required Remember – Try to make them feel safe – Listen and take their – Remember self-harming is – Don’t make them promise concerns seriously usually a coping mechanism not to do it again – Try to be calm and reassuring 1 3–Foreword 4–How to use Lifelines 5–Self-harm and Suicide 6–Initial assumptions 9–Intervention 10 – Support Strategies 11 – Role and training of Support Staff 12 – Intervention Flowchart 13 – Lanarkshire Suicide Assessment 14 – Supporting Young People and Staff 15 – Support Plan 16 – Emergency Contacts 19 – Monitoring of Young People 20 – Concern, Consent and Confidentiality 22 – Involvement of Parents 24 – “Please don’t tell my Mum!” 27 – Use of Record forms 29 – Recording of meeting with Young Person 31 – My Safe Plan 32 – Checklists of Action 37 – Looking after Ourselves and Others 38 – The ABCs of Self Care 39 – Services Available 51 – Training 52 – ASIST Training 53 – SafeTALK 55 – Contacts 58 – Legal Issues chooselife Foreword How to use Lifelines Self-harm and Suicide Initial Assumptions 3 Foreword Lifelines arose from discussions with staff supporting young people, engaging in self-harm or suicide behaviours, who explained that there was very little guidance available. Staff reported this shortfall as a primary There are unique versions of the –All members of the staff know to source of personal and professional protocol for North and South take immediate action when risk anxiety and a fundamental barrier to Lanarkshire due to services often is identified. effective joint working. being specific for either locality. –Decisions about young people ‘at risk’ are made by teams, not It is felt the Lifelines will improve the Key Aims individuals. support given to young people, their families and peers. In addition it will –To assume a shared responsibility –Case conferences and ‘Safe Plans’ enhance the skills and knowledge for the care of those ‘at risk’ of are the means by which support is organised and reflect the assessed base of staff, resulting in improving self-harm or suicide. needs of the young person and the support they provide. –To work together to provide a level of risk. person-centred caring environment North Lanarkshire’s Choose Life –Staff are supported if monitoring Implementation Group had discussed based on individual assessed need, of a young person is necessary, these concerns of staff regarding where young people who are in recognising also that a young self-harm and the need to develop distress can ask for help to avert person with self-harm or suicidal guidelines. The working group’s a crisis. behaviour may unsettle others. membership drew on a number of –To identify and offer assistance in –It is essential to generate an key agencies and the joint work has advance, during and after a crisis. understanding amongst young resulted in the creation of Lifelines. people, which involves them and their families in responses. Lifelines have been piloted with staff, Key Objectives giving comments and feedback to –Care is central to everything we do –To develop a community approach the working group ensuring that the and can only be achieved through is recommended, which enables guidelines are user friendly. effective partnerships with children, everyone, including young people, young people, parents, guardians, to work together to identify Early in 2009, discussions took and other agencies. self-harm, share information and place to extend the availability of the –Since assessment techniques alone encourage those “at risk” to accept guidelines to South Lanarkshire staff. are not enough to reduce suicides, help and support. Through a series of meetings it has the aim is to create an environment proven possible to integrate South where young people feel safe and Lanarkshire’s protocol with Lifelines confident to ask for help. thus creating a pan Lanarkshire –Multi-disciplinary working and approach to supporting young sharing of information are people engaging in self-harm or recognised as essential. suicide behaviours. chooselife 4 How to use Lifelines This document is for all staff in statutory and voluntary agencies who are working and supporting young people, e.g. educational psychologists, group workers, home school partnership officers, public health nurses, pupil support staff in schools, social workers and youth counsellors. Lifelines supports practitioners in Lifelines must be used with the person Please remember these forms and identifying their concern of self-harm who is self-harming. A Safe Plan form checklists are a guide and prompt only, and suicide and so enables them to is available for the young person to it is not essential they are completed work together on shared approaches complete and keep. at a set time, so long as you have a and protocols. The Lifelines Flowchart, clear record of your contact and agreed Lifelines may be used to support your record forms and guidance are provided actions. It may be that you chose to write own professional judgement and to facilitate this multi-agency collaboration this up after the young person has left.