Study | Country | Aim | Type of Study | Participants | Setting | Facilitators to Reporting/Recording | Barriers to Reporting/Recording | Quality Assessment |
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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 |