Added October 3, 2017
Self-injury is seemingly an increasing phenomenon, and school counselors are more frequently called upon to address self-injury related behaviors. Despite a need to systemically address student self-injury, only a minority of school counseling programs have a self-injury policy in place. School counselors, among other school staff members, often have uncertainty and frustration in knowing how to proceed in addressing, supporting, and intervening with students who self-injure. To address this need, an example of a protocol for student self-injury is provided in this article.
The SI protocol presented in this article aligns with the ASCA (2012) National Model and can be part of a comprehensive school counseling program. As previously indicated, school counselors assume a primarily logistical and supportive role when working with students who self-injure. School counselors can also educate other school personnel about self-injury warning signs (ASCA, 2011). Upon learning about a student who self-injures, school counselors should be ready to accurately assess the student’s needs and make appropriate referrals to outside services for treatment.
Because of a school counselor’s unique position in providing early identification, intervention, prevention, and advocacy, the school counselor is often designated as the person who responds to students who use self-injury as a coping skill. School personnel should be reminded of the warning signs, and informed that any suspected or reported student self-injury should be referred to the school counselor or other designated mental health professional (DMHP). A back-up referral person should be available for occasions when the school counselor or DMHP is unavailable; some logical choices for this position might be the school social worker or nurse. After receiving a referral, the school counselor should meet with the student within one hour of the report.
When meeting with the student, it is important that a self-injury assessment is completed. In cases in which the school counselor identifies that students pose a marked danger to themselves, their parents should be contacted and provided with resources to help facilitate their child’s safety. Provided resources may include information about hotlines, local mental health providers, and psychoeducational material on the subject of self-injury. When students engage in severe self-injury and require urgent medical attention, parents and emergency services should be contacted immediately.
For students who self-injure in non-lethal and lower-severity ways (e.g., delicate self-cutting and/or using relatively benign tools), practice proper wound care, and do not engage in other related risky behaviors (e.g., sharing self-injury tools, engaging in severe, impulsive self-injury during moments of acute distress), school counselors may choose to contact parents when appropriate. It is important to consult with relevant school administrators when working with students who use self-injury, noting that parents will likely need to be notified of the youth’s self-injury when the therapeutic relationship is strengthened. Physical wounds may be monitored by the school nurse in the meantime.
While self-injury and suicide are separate behaviors, an emerging body of literature suggests that the two co-occur with some frequency. Regardless of the severity of self-injury, school counselors should always conduct a suicide risk assessment with students who self-injure. When a student presents with high suicide risk, the school counselor should immediately contact the student’s parents. When risk is perceived to be imminent, students should be referred to emergency services. When students do not require immediate intervention by emergency services, the school counselor should intentionally work to promote continued and improved student safety. After gathering a holistic understanding of the student’s physical severity and suicide risk level, school counselors should consult with a colleague in order to ensure school policies are followed and standard of care is upheld according to the ASCA (2010) code of ethics (A.7.a.).
The personalized safety plan is the final suggested step in a self-injury school counseling protocol. School counselors can help students create a written personalized safety plan that can be shared with parents, appropriate school staff, administration, and mental health professionals. The personalized safety plan can include the school counselor’s role in supporting the student’s safety and outline the roles of other school personnel, parents, and other mental health profession. If referrals to outside professionals are provided to parents, school counselors should attempt to obtain a written release so that they might communicate with the outside mental health professionals and offer collaborative treatment.
According to student need and counselor availability, school counselors might implement time-limited mental health interventions in the school setting as part of the personalized safety plan (ASCA, 2010; 2012). Follow-up meetings with the student, parents, and outside professionals can be helpful in tracking and reviewing treatment progress, and counselors should make adjustments to the safety plans as necessary.
Nicole A. Stargell, Ph.D., is an assistant professor with the Department of Educational Leadership and Counseling at the University of North Carolina at Pembroke. Chelsey A. Zoldan, M.S.Ed., LPCC, LICDC, NCC, is a counselor and doctoral student in the School of Counseling at the University in Akron, OH. Victoria E. Kress, Ph.D., is a professor with the Department of Counseling, Special Education, and School Psychology at Youngstown State University. Laura M. Walker-Andrews is a rehabilitation counselor with the North Carolina Division of Vocational Rehabilitation Services. Julia L. Whisenhunt, PhD., LPC, NCC, is an associate professor with the Department of Communication Sciences and Professional Counseling at the University of West Georgia.
Nicole A. Stargell, Ph.D., Chelsey A. Zoldan, M.S.Ed., Victoria E. Kress, Ph.D., Laura M. Walker-Andrews, Julia L. Whisenhunt, Ph.D.
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