North Yorkshire Pathway of Support for Children and Young People with Self Harming Behaviour And/Or Suicidal Ideation

North Yorkshire Pathway of support for children and young people with self harming behaviour and/or suicidal ideation Click to enter North Yorkshire Pathway of support for children and young people with self harming behaviour and/or suicidal ideation Who is the document for? What does self-harm mean? What does crisis mean? This document and pathway is primarily for frontline staff This pathway will use the definition as defined A crisis is any situation in which a person feels they need working with children and young people who: by the National Institute of Clinical Excellence urgent help. For example, they might feel in crisis if: • Identify themselves as using self (NICE) https://www.nice.org.uk/guidance/ • they are having suicidal thoughts and feelings harm as a coping strategy qs34/chapter/Introduction-and-overview as self-harm being ‘self-poisoning or self-injury, • they are having thoughts about harming • Require support as a result of disclosing self-harm, irrespective of the apparent purpose of the act’. them self or someone else suicidal ideation and or previous suicide attempt • they have seriously hurt them self What does suicidal ideation mean? The pathway contributes to delivering the priority outcomes of the North Yorkshire Children and Young Suicidal ideation, also known as suicidal thoughts, is People’s Emotional and Mental Health Strategy thinking about or having an unusual preoccupation and Young in Yorkshire 2 which is overseen by the with suicide. The range of suicidal ideation varies North Yorkshire Health and Wellbeing Board and greatly from fleeting thoughts, to extensive thoughts, associated children’s partnership arrangements and to detailed planning, role playing, and incomplete the North Yorkshire Safeguarding Childrens’ Board attempts, which may be deliberately constructed to (safeguardingchildren.co.uk) and the Childrens Trust not complete or to be discovered, or may be fully Board (cyps.northyorks.gov.uk/childrenstrust). intended to result in death, but the individual survives. 2 North Yorkshire Pathway of support for children and young people with self harming behaviour and/or suicidal ideation North Yorkshire Pathway of support for children and young people with self harming behaviour and/or suicidal ideation Why have a pathway? Severity and the risk and/ The purpose of the pathway is to improve the Improvements will be evidenced by: or impact of self-harming referral processes, and the co-ordination of • A decrease in the number of reported The severity and impact of the self- harming behaviour information, advice, support and treatment that incidents of self-harm on the safety and emotional wellbeing of the child/young is provided to children and young people who person should inform decisions about the support or • A decrease in the seriousness of the self-harm and/or experience suicidal ideation. treatment that is provided. self-harm that is reported. If this is achieved the benefits experienced by children, • A decrease in the numbers of presentations This document should form a guide for practitioners young people and their families will be evidenced as a result of self-harm at Accident but should always be used alongside any previous by them reporting a high level of satisfaction with: and Emergency departments. knowledge and information available to inform the decision process. • The speed in obtaining a response to their concerns. • A decrease in the number of repeat referrals. • The appropriateness of the information, advice, • A reduction in the numbers of requests for The pathway makes clear where children and young support or treatment that is provided. home tuition or alternative educational provision people and/or families and practitioners can access • The positive changes to the child/ young person’s as a result of mental health problems. advice and support as concerns about the severity and/ or impact associated with self-harming increases. self-harming behaviour and emotional wellbeing. • A decrease in the number of deaths as a result of self-inflicted injuries. Consent issues If a child or young person is deemed to need support from other professionals the worker supporting the individual will: • Seek consent from the child, young person and or parental guardian to share information 3 North Yorkshire Pathway of support for children and young people with self harming behaviour and/or suicidal ideation Definitions of severity and impact THRIVE model The person supporting Coping/Getting help Getting more help Getting risk support the child or young Goa ment ls foc person should take age use • Superficial harm e.g. • No specific plan or intent • Frequent suicide an t outcom d e m tac es vi into consideration lf- n fo de e co c n wounds that do not thoughts which are S f us c protective factors: • Suicide thoughts are , of e e g d i n e n require medical attention not easily dismissed i n in f frequent but fleeting t o t o s e r o d r m p n v e e • No specific plan or intent • Specific plans in n a Having close n d • Previous or recent g i t i a S o place and access n friends n • Has ongoing support suicide attempt Prevention d to lethal means • Suicidal thoughts and Supportive family The self harming behaviour • Increasing self-harm are fleeting and promotion involvement is linked to other risk R either frequency, potential is a t easily dismissed n k n factors or behaviours which d m e lethality or both c a r n tm could affect the severity is a a School factors; The behaviour is related is ge re r m t feels school is of the self harming, for The self harming is part of a es en ve to personal and social po t si ns ten a supportive circumstances which example linked to alcohol complex mix of behaviours e Ex environment might include peer or substance misuse. which increase the risk to and has good pressure to conform. the child/young person. The self-harming is routine friendship group The ‘self-harm’ behaviour and has been taking place The child/young person over a period of time may (but not in every Get Permanent is not routine. ng tin irrespective of the severity instance) have a clinical pi g home base o H of the self-harming. diagnosis of mental health C e There is no accompanying l risk taking behaviour or illness or condition. p Access to leisure concerns about the safety The behaviour is being and other social to themselves or others. used regularly as a There is evidence that THRIVE amenities coping mechanism. without specialist and/ G e The impact on daily or clinical intervention t p Low fear of crime t l The impact on daily i e life is minimal. the severity of the self n life is moderate. g H harming will escalate. R e Low level of i r sk o drug use in the The impact on daily S M up ing community life is high. port Gett www.implementingthrive.org/wp-content/uploads/2016/03/Thrive.pdf Key providers in delivering the pathway (Click the buttons below to open each area guide as a PDF) 4 North Yorkshire Pathway of support for children and young people with self harming behaviour and/or suicidal ideation Determining current vulnerability for self harm and/or suicidal ideation This is a guide at one point in time and needs to be revisited with the child/young person - THIS DOES NOT REPLACE ORGANISATIONAL RISK ASSESSMENTS Individual presents with actual self harm Individual presents with ideas of self-harm or suicidal ideation BE ALERT Do you have safeguarding or child protection concerns? Follow local Safeguarding procedures. at every intervention Are you concerned that there is an immediate risk to the child or young person’s physical health? Call an ambulance (999) or take the child/young person to the nearest A&E department. CHECK! Are you concerned that there is an immediate risk that the child or young person will harm themselves or others? Do not leave the child unaccompanied. Call the Police (999). If you are worried about a child or a young person under the age of 18: Telephone 01609 780 780 www.safeguardingchildren.co.uk/professionals/forms-for-professionals yes no no yes no yes yes no no yes Use the main pathway document to look at ways you can provide ongoing support to the child/young person and their family. 5 North Yorkshire Pathway of support for children and young people with self harming behaviour and/or suicidal ideation North Yorkshire Guidance on Self Harming behaviours for Schools and Pupil Referral Services North Yorkshire Guidance on developing a policy on self harming behaviours for schools and Pupil Referral Services. The purpose of this document is to enable your school to develop and agree an effective policy on self harming behaviours. 6 North Yorkshire Guidance on Self Harming behaviours for Schools and Pupil Referral Services Contents Safeguarding . 8 Worried about a child? . 8 Introduction . 9 Self-injury . 9 Self-harm . 9 How to respond . 10 Suicide . 11 Next steps . 11 Principles for working with children/young people . 12 Key messages . 13 Residential settings . 15 Roles and responsibilities . 16 Training and awareness . 20 Appendix 1: . 21 Appendix 2: . 22 Appendix 3: . 23 Appendix 4: . 28 Appendix 5: . 30 7 North Yorkshire Guidance on Self Harming behaviours for Schools and Pupil Referral Services Safeguarding Worried about a child? This guidance is not intended for Anyone can make a referral if you are worried about any Outside Office Hours child and think they may be a victim of neglect or abuse, use in circumstances where there is Emergency Duty Team (for evenings, weekends and whether as a member of the public or as a professional.

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