- D Johnson, K Ferguson and J Copley
- Clinical Child Psychology and Psychiatry (2017)
Self-harm in residential care
Self-harm is an intentional act of self-injury regardless of the motivation or degree of suicidal intent. Research suggests that children in local authority care are at a heightened risk of self-harm compared to non-looked after children. There is also evidence that the prevalence of self-harm within residential settings is higher than in other care settings.
There is a myriad of complex reasons for the high prevalence of self-harm among these young people. It is thought to arise from the high levels of adversity, trauma and difficult attachment relationships that many of these children have experienced. These experiences can lead to difficulties in regulating and coping with strong emotions, which can trigger self-harm.
Consequences of self-harm
Young people who self-harm experience immediate and potentially long-term physical injury. Strong negative emotions (e.g. shame and regret) can also be triggered and perpetuate a cycle of self-harm. The consequences of self-harm can also result in distress for family members, friends and staff supporting the young person. There is also an association between exposure to the self-harm of others and adolescent self-harm.
It is important that young people who self-harm receive support that is helpful to them. Fortune et al (2008) and McAndrew and Warne (2014) define helpful support as including being listened to; not being judged; confidentiality; trust; and having opportunities to talk to someone independent of family, friends or school. A study by Piggot et al (2004) of young people who had previously lived in residential care found that "good relationships" and empathic listening were crucial for helpful support. Being listened to and having a non-judgmental attitude increases the chances of young people engaging with support services.
The study findings
This study used purposive sampling to select young people who had self-harmed in residential settings. Seven young people aged 14-16 were interviewed (three boys and four girls). Five of the young people were in secure care and two were in residential care and all had been in the care setting for over six months.
Analysis identified the following key themes:
- Safety: young people were clear of the duty of staff to keep them safe from harm. Safety was achieved primarily through removal of potentially harmful objects and increased observations or checks.
- Care: young people also identified the duty of staff to provide support. They noted that staff were able and willing to do this.
The study also identified the following sub-themes:
- Staff responses: young people accepted that staff needed to check on them while they were in their bedrooms, and that this was helpful to keep them safe. They also suggested that some improvements could be made to reduce unhelpful consequences (for example, shutting the viewing panel quietly and checking at random times).
- Removal of means: removal of potentially harmful objects was viewed as helpful. However, it could also increase distress and trigger further self-harm. The young people suggested that some items could be returned after they had calmed down.
- Extra support: young people discussed how helpful it was to have increased support from staff following self-harm. They emphasised the need for staff to help them calm down before exploring any issues with them. One negative consequence of them having additional support was that staff may have less time to spend with other young people.
Implications for practice
Although the small sample size limits the findings of this study, they are consistent with the findings of other studies.
Implications for practice include:
- Observations of young people should be discrete and sensitive and done at random times. Constant observation may be more effective when a trusted person engages with the child.
- If items are removed, some of these (such as photographs, soft toys) should be returned as quickly as possible as they can be a source of comfort.
- Emotional support should focus on calming the young person before exploring the trigger of self-harm. Positive peer support may also be helpful.
- Where young people are receiving additional support following self-harm it may be useful to have additional staff present to minimise disruption to other young people.
- Supporting adolescents on the edge of care: The role of short term stays in residential care. An evidence scope. Jo Dixon, Jenny Lee, Sarah Ellison, Leslie Hicks, Action for Children and NSPCC, April 2015
- The Place of Residential Care in the English Child Welfare System. Research report. Di Hart, Ivana La Valle, University of East London, and Lisa Holmes, Loughborough University, June 2015
- Therapeutic approaches to social work in residential child care settings. Literature review. Geraldine Macdonald and Dr Sharon Millen, Institute of Child Care Research, Queens University Belfast. May 2012
- "They helped me, they supported me" Achieving outcomes and value for money in secure children's homes. Justice Studio. April 2014
- Our Lives Our Care: Looked after children's views on their well-being. Professor Julie Selwyn and Linda Briheim-Crookall, Univesrity of Bristol and Coram Voice, 2017
Related resources by Research in Practice:
- Analysis and critical thinking in assessment 2nd Edition: Handbook
- Reflective supervision: Change Project pilot resources
- Regarding the use of practice observation methods as part of the assessment of social work practice: Evidence Scope
- That difficult age: Developing a more effective response to risks in adolescence
- Promoting resilience in children young people and families Frontline Briefing
- Young person centred approaches in CSE: Promoting participation and building self efficacy: Frontline Briefing
- Risk taking adolescents and child protection: Strategic Briefing
- Children and young people missing from care and vulnerable to sexual exploitation: Strategic Briefing
- RiP runs bespoke training workshops for residential children's home managers and practitioners. For more details contact firstname.lastname@example.org
The research section for this special report is based on a selection of academic studies which have been explored and summarised by Research in Practice, part of the Dartington Hall Trust.