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Table 3 Table of the factors affecting the reporting or recording of self-harm within a school setting

From: The barriers and facilitators to the reporting and recording of self-harm in young people aged 18 and under: a systematic review

Study

Country

Aim

Type of Study

Participants

Setting

Facilitators to Reporting/Recording

Barriers to Reporting/Recording

Quality Assessment

Berger et al., 2014 [50]

Australia

To validate a measure of attitudes towards NSSI and examine the knowledge,

attitudes, and confidence of staff towards NSSI

Quantitative- Questionnaire

501 secondary school staff- 261 teachers; 106 MH workers, counsellors,

psychologists and welfare coordinators; 82 school leaders and 52 admin and support staff

86 Secondary schools

REPORTING (i) Helpful Staff- Willingness to help YP by resolving education needs and helping them manage emotions

RECORDING (i) Younger staff were more knowledgeable and had higher self-perceived knowledge of NSSI than older colleagues

REPORTING (i) Lack of knowledge and confidence to assess and refer. (ii) Education- Need more around helping YP to seek help

RECORDING (i) Length of professional experience-senior staff had poorer knowledge around identifying NSSI (ii) Females reported greater confidence and NSSI knowledge

(iii) Experienced staff were more confident and had higher knowledge, understanding and more positive attitudes

LOW RISK

Dowling & Doyle, 2017 [58]

Ireland

To explore post-primary school guidance counsellors’ and teachers’

experiences of and responses to self-harm among students

Qualitative- Interviews

6 participants (all female) from 4 schools. 3 were guidance

counsellors and 3 were teachers including a year head and a principal

All school types (i.e., all-boys, all girls

and mixed) in areas of both high and low social deprivation

REPORTING- (i) Being able to Identify SH- Noticing subtle behaviour changes or being told about SH by YP or friends/ family. (ii) Different ways of Reporting- Disclosure to English teachers happened through essays and PE teachers noticed a YP’s refusal to change or wearing bandages to hide injuries. (iii) Not knowing a YP well made it easier for staff to cope with. (iv) Staff Debrief-To manage their own emotions staff drew upon colleague support, family and other self-care strategies

REPORTING- (i) Hard to identify- YP used ‘jumpers’, ‘uniforms’ or ‘bandages’ to cover up. (ii) Staff felt panicked by SH reporting, but this reduced with experience. (iii) Hard to Deal With- SH described as ‘difficult’, ‘horrible’, ‘disturbing’. (iv) Confidentiality

(v) Negative Perceptions- Staff were less tolerant for advantaged YP and perceived them as ‘attention seeking’ (vi) Larger class sizes and fewer, busier teachers resulted in less time for SH reporting (vii) Inexperienced staff struggled, felt out of their depth, overwhelmed and anxious

LOW RISK

Evans et al., 2005 [25]

UK

To explore whether YP who deliberately harmed themselves or

had thoughts of SH differed from others in terms of help-seeking, and coping strategies

Quantitative- Questionnaire

6020 15–16 year old school pupils, were surveyed using an anonymous self-report questionnaire

41 schools (35 comprehensive, 4 independent and 2 grammar) from 3 areas in

England

REPORTING (i) YP were most likely able to talk to a friend (84.7%), followed by mothers (67.0%) and YP with a single episode of SH were more able to talk to relatives and friends than YP with multiple DSH episodes (ii) Females were more likely to reach out for help

REPORTING (i) YP did not feel comfortable to their teachers with only 20.8% reporting they would be able to talk to them. (ii) Ability to identify SH as an issue- Quarter of the YP did not feel they had a problem with SH

LOW RISK

Evans et al., 2019 [51]

UK

To understand school context-existing provision, barriers to implementation, & acceptability of different approaches

Quantitative- Questionnaire

222 schools in England and Wales were invited to participate 68.9% (n = 153) responded

Secondary schools

 

REPORTING (i) Lack of training was only identified as being moderate

(ii) Limited Time/ Resources

MEDIUM RISK

Heath et al., 2010 [52]

Canada

To examine YPs reports of willingness to access

school based NSSI support

Quantitative- Questionnaire

7,126 middle and high school students

Schools from 11 school districts in Greater Kansas City metro area

REPORTING

(i) No significant difference between females and males

 

LOW RISK

Nearchou et al., 2018 [53]

Ireland

To determine predictors of YP help-seeking intentions for symptoms of depression/ anxiety and SH

Quantitative- Questionnaire

722 Participants (n = 368 girls)

3 cohorts of secondary schools

 

REPORTING (i) Older YP were less willing to report SH. (ii) Boys were more likely to report SH than girls

(iii) YP's beliefs about other people's stigma towards SH was a stronger predictor of help-seeking intentions

LOW RISK

Roberts-Dobie & Donatelle, 2007 [54]

US

To examine the experience, knowledge and needs of school counsellors in relation to students’ self-injurious behaviours

Quantitative- Questionnaire

443 school counsellors

Membership list of the American School Counsellor Association (ASCA)

REPORTING (i) Important for everyone to be educated around SH due to different individuals being involved in discovery

(ii) Counsellors reported that they were the most appropriate contact (75%) and the most likely (77%). (iii) Specific facilitators to reporting- training, school policy, education, community connections, tangible support, and cooperation. (iv) Need for staff to build knowledge and skills. (iv) Cooperation from different organisations

REPORTING (i) School counsellors did not self-report high levels of knowledge on SH. (ii) Counsellors felt they didn’t know outside therapists enough for referrals. (iii)Lack of Time, Money, and Staff- School counsellors were asked to do more tasks in less time today and counsellors reported that they would need more time or more support staff

LOW RISK

Roberts, 2013 [59]

US

To develop knowledge by investigating experiences and practices of school counsellors working with YP who SH

Qualitative- Interviews

6 men, 6 women, aged between 30–64 years with 3–35 years of experience

Public and private schools in a South Eastern US state

RECORDING (i) Enlisting help to make referrals was important

REPORTING (i) Feeling uncomfortable/ uncertain- Some staff reported feeling uncomfortable and that it wasn't part of their role. (ii) Untrained or unwilling

MEDIUM RISK

Tillman et al., 2018 [60]

US

To understand the lived experiences of middle school girls who have engaged in NSSI and who have received help

Qualitative- Interviews using IPA

16 girls- mean age 13.8 years, 8th grade

Middle schools across the US

REPORTING- (i) YP valued being listened to, supported, and shown love. (ii) YP wanted to feel comfortable and have open and honest conversations about confidentiality, including what would be shared with guardians. (iii) YP wanted their staff to try to understand the reasons why they are engaging in self-injurious behaviours without judgement

REPORTING- (i)YP felt unsupported and unable/ reluctant to share. (ii) YP were afraid to seek help from the fear that their struggles would be dismissed. (iii) YP felt uncomfortable disclosing SH and were angry about how professionals addressed SH- feeling dismissed, misunderstood, or as if they were overreacting

(iv) YP found it difficult to be honest and direct

(v) Money- A barrier to YP disclosing was lacking health insurance

LOW RISK