Nonsuicidal Self-Injury in the Schools: A Tiered Prevention Approach for Reducing Social Contagion

Added December 29, 2017

Rates of nonsuicidal self-injury have been increasing among youth and young adult populations. In schools, this is a concern generally; however, an increasing concern is how nonsuicidal self-injury can spread among youth through social contagion. This means that when one person engages in self-injury another person can pick up the behavior through social connections and social modeling. While it is understood and known that social contagion occurs, very little has been provided in terms of intervention and prevention strategies.

The authors of this article combine the Multi-Tiered System of Support with the tiered response intervention model (primary, secondary, and tertiary prevention) to provide strategies for school counselors to prevent and decrease social contagion of nonsuicidal self-injury. Specifically at the primary prevention level, which typically occurs at both Tier 1 support level, school counselors can engage in creating or altering school wide policies and procedures in terms of how schools respond to nonsuicidal self-injury. This can include trainings for teachers, who are more likely to be immediate first responders in the classroom, as well as what to do and who to include when self-injury is determined. Interventions at this primary prevention stage also include classroom guidance that focuses mostly on emotion regulation and coping skills – thus, not focusing on self-injury specifically, but more so on adaptive coping methods, and how to implement them to effectively regulate emotions.

Primary prevention would occur predominantly at the larger school level. Secondary prevention however, which can occur within Tier 1, 2, and 3 levels of support, includes a combination of classroom guidance aimed more specifically at discussing self-harm and physical wound care. This classroom guidance is based on the Signs of Self-Injury Program developed by Muehlenkamp and colleagues. At the Tier 2 level of support, small group interventions that are primarily focused on coping skills and emotion regulation become important. This is after specific students have been identified, and school counselors can walk through and provide these individual students more hands on coping skills and walk through how to effectively use these skills individually.

Once self-injury is identified and occurring, social contagion is already a risk within the school, thus identifying the social networks that students are in can help in decreasing the contagion within the social group. This can result in targeted interventions with specific members of the social group to decrease how self-injury might spread within that group.

Finally, at Tier 3 level of support, secondary prevention can include individual meetings with specific students that results in referrals for more tertiary care, while the school counselor will continue to check in on the student throughout the services they may receive outside of the school setting. Finally tertiary care, which is most often mental health services provided outside of the school setting, is more at the Tier 3 level of support and includes more long term care of the student to help minimize and decrease self-injurious behaviors. These intervention strategies at the various levels of support can decrease or prevent nonsuicidal self-injurious behaviors among students, which in turn decreases the social contagion of the behavior.

Kelly L. Wester, PhD, University of North Carolina, Greensboro; Carrie Wachter Morris, PhD, University of North Carolina; Breton Williams, University of North Carolina.