Deliberate Self Harm in Children and Adolescents

Abstract

This study compared children and adolescents who had deliberately selfharmed (DSH) with those who had not using data routinely collected during assessment at a Child and Adolescent Mental Health Service (CAMHS). The DSH group consisted of 64 boys and 194 girls aged between 7 to 18 years. The control group consisted of 175 boys and 181 girls aged between 11 and 18.As in previous studies, there was a substantially higher proportion of girls who self-harmed or who had depressive symptoms when compared to boys. The study investigated the effectiveness of HoNOSCA as an assessment tool for DSH and compared it with other measures of seriousness of self-harm (BDI, PATHOS, clinician-based risk rating or previous episodes of self-harm). Comparisons of HoNOSCA-rated 'self injury' with other assessment tools showed advantages of the latter in detecting individuals at risk.The study also investigated whether DSH was linked to changes in family living and explored trigger or risk factors. The HoNOSCA item 'Problems with family life and relationships' was linked to self-harm as expected. However, there were no substantial differences between the groups for measures of family living.Analyses of risk factors showed background issues concerning breakdown of relationships and self esteem were relevant to DSH.

Cognitive therapy compared with CBT for social anxiety disorder in adolescents: a feasibility study

“…Previous studies have identified a range of barriers including increased time demands on therapists and administrative staff, a lack of therapist training on how to integrate measures into practice, a lack of data management systems with which to record, review and audit the data, and a perceived lack of clinically useful information, 60 for example if they did not include items to assess suicidal risk. 61 The qualitative interviews that were conducted within this study indicated that therapists recognised the value of sessional measures that accurately captured the problem and helped guide treatment, but they expressed worries about the measures' acceptability to young people. Notably, in addition to the social anxiety and intervention process measures, we added a further depression measure to the one that is used within the CYP IAPT data set (RCADS) to ensure that we routinely asked about suicidal risk (via the PHQ-9).…”

Implementation of routine outcome measurement in child and adolescent mental health services in the United Kingdom: a critical perspective

“…Additional barriers are related to limitations of the available outcome measures, for example, the fact that generic outcome measures do not typically assess self-harm behaviour and suicidal risk [ 30 ], or are not sensitive to symptom change in some clinical presentations [ 31 ].…”

“…Johnston and Gowers [ 3 ] found that clinicians who did not regularly use quantitative clinical measurements were more likely to be sceptical about the value of the quantitative ‘medical’ approach. Additional concerns relate to ‘ labelling’ patients [ 30 ], confidentiality [ 23 ], and the risk of data being used by managers and commissioners to unfairly compare services that deal with different levels of case complexity [ 23 , 24 , 32 ]. Despite these reservations, most studies [ 2 , 24 , 36 ] report a range of clinicians’ views, with a substantial number of clinicians showing a positive attitude towards the implementation of ROM.…”