final%20 submission%20of%20non suicidal%20self-injury%20project

Prevention of Adolescent Non-Suicidal Self-Injury

ANDREW JAMES PANNETON

Non-Suicidal Self-Injury (NSSI) Defined

What is Non-Suicidal Self-Injury?

Non-Suicidal Self-Injury (NNSI) is the deliberate, self-inflicted injury of body tissue, resulting in immediate tissue damage, performed without conscious suicidal intent and for purposes not socially sanctioned.

NSSI was originally conceptualized as a behavior which occurred exclusively among psychiatric or clinical samples. However, the emergence of new research evidencing NSSI among adolescents in community settings has sparked renewed interest and concern into the phenomenon.

Swahn, Ali, Bossarte, Dulmen, Crosby, Jones & Schinka, 2012

DSM-5: Non-Suicidal Self-Injury (NSSI)• The essential feature of Non-Suicidal Self-Injury is that the

individual repeatedly inflicts shallow, yet painful injuries to the surface of his or her body.

• The purpose of NSSI is to reduce negative emotions, such as tension, anxiety, and self-reproach, and/or to resolve an interpersonal conflict.

• In some cases, the injury is conceived of as a deserved self-punishment, however, the individual engaging in NSSI will often report an immediate sensation of relief that occurs during the process.

• When the behavior occurs frequently, it might be associated with a sense of urgency and craving, with the resultant behavioral pattern resembling an addiction. Thus, the inflicted wounds can become deeper and more numerous.

American Psychiatric Association, 2013

• NSSI is a “social epidemic” that primarily affects adolescents and young adults.

• Prevalence rates of NSSI continue to rise every year.

• Research shows that NSSI is a major risk factor for suicide. 70% of adolescents engaging in NSSI also attempt suicide.

• 25% of those who successfully commit suicide have attended a hospital for a NSSI in the 12 months immediately preceding their death.

• In 2007, 77,024 individuals sought treatment for NSSI in U.S. emergency departments, however the majority of adolescents engaging in NSSI do not seek treatment.

• Thus, the true prevalence rates are estimated to be much higher than reported.

Non-Suicidal Self-Injury: What’s the big deal?

Cook, Clancy, & Sanderson, 2004; Swahn et al, 2012

Prevalence and Incidence: NSSI

• Research estimates the lifetime prevalence of NSSI ranges between 13.0% and 23.2%, however, some studies have reported lifetime prevalence rates as high as 46.5%.

• In a 2012 cross-sectional study of adolescents, the 12-month prevalence rates were reported as follows:• Total prevalence: 20.3%• Prevalence for girls: 23.9%• Prevalence for boys: 16.4%

• According to single item assessments the 12-month prevalence of NSSI is 9.6%.

• According to self-report inventories the 12-month prevalence of NSSI is 28.4%.

• The average 12-month prevalence for NSSI is 19.0%, with a 1-year incidence rate of 3.6%

• Lifetime prevalence is significantly higher in the U.S. as compared to Japan, Canada, and Hungary.

Larsson & Sund, 2008; Swahn et al, 2012

Prevalence/Incidence Rates for Non-Suicidal Self-Injury

Study N-size Age Range M (SD)* Assessment Lifetime

Prevalence %12-Month

Prevalence %6-Month

Prevalence % Country

Csorba et al. (2005) 470 14-18 Ottawa Self-Injury

Inventory 5.5 Hungary

Laye-Gindhu & SchonertReichl (2005)

424 15.34 (1.06) Single Itemb - Yes/No 13.2 Canada

Izutsu et al. (2006) 477 14.2 Single Item - Yes/No 8.4 Japan

Muehlenkamp & Gutierrez (2007) 540 15.53 (1.42) SHBQ 23.2 USA

Lloyd-Richardson et al. (2007) 633 15.5 (1.18) FASM 28 USA

Yates et al. (2008) 1,036 Grade 9-12 FASM 37.2 USA

Matsumoto et al. (2008) 1,726 14.5 (1.4) Single Item - Yes/No 9.6 Japan

Hilt et al. (2008) 508 Grade 6-8 Single Item - Yes/No 7.5 USA

Sample of Prevalence Estimates of NSSI in Adolescents by Year of Publication for Larsson and Sund (2008)Note: * Standard Deviations and mean ages were not always reported within sample descriptions. a SHBQ = Self-Harm Behavior Questionnaire, FASM = Functional Assessment of Self-Mutilation; b The most common single item wording was: "Have you ever intentionally hurt yourself on purpose (e.g, cut, burn) without wanting to die" or "Have you every hurt yourself on purpose without suicidal intent?"

Larsson & Sund, 2008

Risk Factors for Non-Suicidal Self-InjuryIn a 2012 cross-sectional study by Swahn, Ali, Bossarte, Dulmen, Crosby, Jones, & Schinka, results revealed that among those individuals who engaged in NSSI were certain shared “risk” factors. These “risk factors” include:

• CONTEXTUAL FACTORS• Low SES• Negative familial environment

• PERSONAL FACTORS• Depression and Behavioral Problems• Impulsivity• Somatic Problems and Thought Problems• Eating Disorders• Delinquency• Substance Use and Abuse

• INTERPERSONAL FACTORS• Aggression toward others• Social Binge Drinking• Poor Student-Teacher relationships


Protective Factors for Non-Suicidal Self-Injury

Adolescent participants who had not engaged in NSSI shared certain “protective” factors: factors that may help to protect an individual from engaging in NSSI. They include:

• CONTEXTUAL FACTORS• Higher SES• Family Involvement• Parental Support• Parental Monitoring

• PERSONAL FACTORS• Effective Coping Strategies• High levels of Cognitive Functioning• History of “Help-Seeking”• High levels of Self-Efficacy

• INTERPERSONAL FACTORS• Social Support and Interaction• Effective Communication Strategies with Caregivers


Importance of Prevention for NSSI• Research has consistently demonstrated an increase in prevalence for NSSI behavior among adolescents.

• There is a growing body of literature suggesting that lifetime rates of at least one act of NSSI within adolescents approximates 23% of the population.

• Those who engage in NSSI are at increased risk for suicide.

• The majority of adolescents who engage in NSSI do not seek help for their problems.

• Adolescents who do not seek help for NSSI have similar levels of psychopathology as those who do seek formal treatment, thus adolescents who are engaging in NSSI are likely to benefit from some type of early intervention.

• Intervening early with prevention programs can not only help adolescents avoid serious physical injury, but also can help adolescents avert a potential pathway to suicidal behavior.

Need for Prevention: NSSI

Muehlenkamp, Walsh, McDade, 2009

Signs of Self-Injury (SOSI) Prevention Program

The Signs of Self-Injury program offers prevention training that addresses many of the prevention features identified by adolescents as important to preventing NSSI as well as meeting school personnel needs.

SOSI Program Objectives

• Increase KNOWLEDGE of NSSI including warning signs and symptoms.

• Improve ATTITUDES and perceived capability to respond and help refer students, or peers, who engage in NSSI.

• Increase HELP-SEEKING behaviors for NSSI for peers and self.

• Decrease acts of NSSI among adolescents.


SOSI Program Setting• Five large urban schools in Massachusetts.• Classroom Setting.

Program Content and Structure• The SOSI program is divided into two general modules: one for faculty/staff and one for students. • The module designed for school staff/personnel provides psychoeducational material about NSSI which is

presented along with a set of potential warning signs for the behavior, and suggested ways to respond if a student discloses NSSI.

• The module designed for students provides basic information regarding NSSI, its signs, and symptoms.



Program Implementation Schedule

• The student module is designed to be implemented in one class period and uses a multimedia DVD to share basic information about NSSI, its signs, and symptoms.

• Students are encouraged to respond to peer NSSI by using the ACT model: – ACKNOWLEDGING the signs of NSSI.– Demonstrating CARE for the person and a desire to offer help, and to…– TELL a trusted adult.



Target Population• Total of 274 (n = 274) students.• Ethnicity: predominantly Caucasian students (73%).• Gender: 51.5% of the students were female and 48.5% of the students were male.• Ages: 14-18 years with a mean age of 16.07 years.

Hypotheses– Knowledge of NSSI signs/symptoms will significantly increase from pre- to post- program

implementation.– Perceived comfort with NSSI and openness to helping peers (e.g. attitudes) will significantly increase

from pre- to post-implementation.– Increase in self-reported help-seeking behaviors will be observed.– One month incidence of the frequency and intensity of NSSI thoughts and behaviors would

significantly decrease from pre- to post-program implementation.

Signs of Self-Injury (SOSI) Evaluation


Preventing Non-Suicidal Self-Injury in Adolescents: The Signs of Self-Injury ProgramJennifer J. Muehlenkamp – Barent W. Walsh – Moira McDade

Study Findings and Evaluation of SOSI• The results of the current study by Muehlenkamp, Walsh, and McDade (2009) revealed that the Signs of

Self-Injury (SOSI) school-based program may indeed have promise for being an effective prevention program.

• Adolescents self-reported knowledge of NSSI increased from pre- to post-implementation of SOSI.• Increased openness to seeking help for their peers, or self, for NSSI behavior also increased from pre- to

post-implementation of SOSI.• This finding, of the increase in openness to seeking help for peers or for one’s self, is particularly

promising as research has shown that friends are the primary source of support and help regarding self-harm and NSSI.

Signs of Self-Injury (SOSI) Evaluation


ORYGEN Research Centre (ORC) MHCP

The ORYGEN Research Centre’s Mental Health Consultation Program is a program designed designed specifically for the recognition and management of deliberate self-harm in adolescent subjects.

ORC MHCP Objectives

• Provide a better understanding of NSSI and mental illness.

• Improve ability to recognize risk and mental illness associated with NSSI.

• Improve levels of confidence and perceived skill in identifying and managing NSSI.

• Improve attitudes of participants towards young people engaging in NSSI.

Robinson, Gook, Yuen, McGorry, & Yung, 2008

ORC MHCP Program Setting• Melbourne, Geelong, and Warrnambool regions of Victoria.• Classroom Setting.

Program Content and Structure

• Skills Training on Risk Management (STORM) and further training in mental health first aid focusing on the ability to recognize mental illness associated with deliberate self-harm and NSSI.

• Program designed to assist school welfare coordinators improve their ability to provide support to adolescents engaging in deliberate self-harm and NSSI.



Program Implementation Schedule• The training course was delivered over two days and participants opted to attend either day 1 or day 1 and day 2.• Day 1 included 5 sessions:

– Session 1 involved a presentation providing up to date information on the epidemiology of DSJ and its relationship to suicide and up to date evidence regarding interventions used in school settings.

– Session 2 involved a small group activity using case vignettes during which participants were given the opportunity to explore their attitudes towards deliberate self-harm and NSSI, followed by a group discussion.

– Session 3 focused on the recognition and assessment of deliberate self-harm risk where participants worked in small groups and using vignettes were asked to consider the individual’s level of risk. They were then given some templates of risk assessment tools and asked to role-play conducting a risk assessment. Finally, participants were shown a DVD of a risk assessment scenario and a group discussion followed.

– Session 4 focused upon risk management planning and began with a presentation, followed by the participants working in small groups to complete a management-planning template for a case vignette. This was followed by a group discussion.

– Session 5 involved a discussion of the benefits and challenges of working with families and took the form of a group discussion followed by a group activity.



Program Implementation Schedule Continued• Day 2 included 5 sessions:

– Session 1 involved a presentation providing up to date evidence on the different type of individual interventions employed when working with adolescents who engage in NSSI.

– Session 2 provided some basic information about different types of mental disorders associated with NSSI and the signs and symptoms to look out for.

– Session 3 drew upon some of the therapeutic techniques that have been shown to be useful when working with adolescents who self-harm. The session began with a presentation followed by participants working in small groups with a case scenario. The group work brought together all of the information delivered in previous sessions and involved identifying levels of risk, conducting a risk assessment, devising a management plan, and outlining types of interventions that may be considered in different scenarios.

– Session 4 provided an opportunity for participants to discuss the policies and procedures they had in their schools for managing NSSI behavior in adolescents and to consider how these might be improved Examples of Evidence Based Practices were shared and discussed.

– Session 5 focused upon working with specialist services and took the form of a question and answer session between intervention participants and representatives from local services..



Managing Deliberate Self-Harm in Young People: An evaluation of a training program developed for school welfare staff using a longitudinal research design

Jo Robinson - Sara Gook - Hok Pan Yuen - Patrick D. McGorry - Alison R. Yung

Study Findings and Evaluation of ORC MHCP• Overall there was a positive change in terms of confidence and perceived skill in dealing with NSSI related

mental illness and self harm following the training course (see Table 4).• In comparison to pre-intervention and training results, the majority of participants showed improvement in

both confidence and skill in dealing with self-harm and NSSI.



• Future prevention programs aimed at eliminating NSSI in adolescents should be informed by the research available on evidence based prevention programs, however, as there are very few empirically supported and validated prevention approaches for the prevention of NSSI behavior, a new approach and perspective is needed.

• Although there are many existing approaches that focus on identifying risk and protective factors, or identifying clear warning signs of NSSI behavior etc., one of the biggest issues facing the prevention of such self-directed harm is a lack of information, awareness, and knowledge of the true prevalence and importance of this issue. This is evidenced by the overall lack of research literature on the subject, specifically evidence based prevention programs.

• Moving into the future, prevention programs should be more comprehensive, considering all relevant aspects of this social epidemic, with a clear emphasis being placed on destigmatizing NSSI behavior in adolescents.

Next Steps for Prevention of NSSI behavior

C.A.R.E. Prevention Program ApproachAn Ecologically Informed and Curriculum Based Educational Approach to Prevention of Adolescent Non-

Suicidal Self-Injury which utilizes Universal and Selective Targeting Strategies for the Identification of At-Risk Adolescent Populations with a clear emphasis on Community Involvement and Collaboration.

Target Population• Community Awareness Presentation (CAP): Students, Prevention Program Gatekeepers (PPGs), and

Community Program Participants (CPPs)• NSSI Recognition and Response Training (RRT): Prevention Program Gatekeepers (PPGs) and

Community Program Participants (CPPs)• Initial NSSI Student Education Program (SEP): Adolescent Students in Grade 6, 7, 8, 9, & 10.• Advanced SEP – Community Concerns Module (SEP-CCM): Students in Grades 11 & 12.• RRT & CCM Program Planning Sessions: Prevention Program Gatekeepers (PPGs) and Community

Program Participants (CPPs)

CARE: Create-Address-Respond-Establish

C.A.R.E. Program Objectives• Raise awareness and understanding of the importance of preventing self-harming behaviors (NSSI).

• Provide information to educators, students, and parents regarding the risk and protective factors of NSSI among adolescents and create a network of support including outside of school resources and treatment options.

• Emphasize the true prevalence and incidence of NSSI and the importance of destigmatizing such behavior.

• Place emphasis on the extreme importance of parents and educator’s initial reactions NSSI behavior: these initial interactions can have a lasting impact and effect on adolescent’s decisions to engage in future self-directed harmful behavior.

• Explain the relationship between NSSI and suicide and its implications for practice and assessment.

• Provide information on the complex nature of NSSI related behavior.


C.A.R.E: Main Areas of Interest

• NSSI Education and Recognition and Response Training (RRT).

• NSSI Student Education Programs (SEPs).

• Identification of Contextual, Personal, and Interpersonal Protective Factors.

• Behavioral Modification and Effective Coping Strategies.

• Early Identification Practices and Training.

• Provision of External Resources and Available “out-of-school” Treatment Options.


C.A.R.E. Program Components

• Community Awareness Presentations (CAPs) on Effective NSSI Recognition, Reaction, and Response.

• NSSI Recognition and Response Training (RRT) for Prevention Program Gatekeepers (PPGs).

• NSSI Student Education Program (SEP) for adolescent students in grades 6 through 10.

• Student Education Program Community Concerns Modules (SEP-CCMs) for students in grades 11 and 12.

• Recognition and Response Training (RRT) and Community Concerns Modules (CCMs) Program Planning Sessions: Community Feedback, Identification of Future CCM Topics, and Continuing Program Evaluation.


C.A.R.E. Program Setting: PPGs, CPPs, & At-Risk Adolescents

• Community Awareness Presentation: (CAP): Students, Prevention Program Gatekeepers (PPGs), and

Community Program Participants (CPPs)

• NSSI Recognition and Response Training: (RRT): Prevention Program Gatekeepers (PPGs) and

Community Program Participants (CPPs)

• Initial NSSI Student Education Program: (SEP): Adolescent Students in Grade 6, 7, 8, 9, & 10.

• Advanced SEP – Community Concerns Module: (SEP-CCM): Students in Grades 11 & 12.

• RRT & CCM Program Planning Sessions: Prevention Program Gatekeepers (PPGs) and Community

Program Participants (CPPs)


C.A.R.E. Dosage and Implementation Schedule

• Community Awareness Presentations (CAP)

– C.A.R.E. Implementation C.A.P. - Monday, Week 1 at 7:00 PM: 60 minute presentation followed by Q&A Session.

– C.A.R.E. Progress, Feedback, and Continued Evaluation C.A.P. – Monday, Weeks 3 & 6 at 7:00 PM: 60 minute Evaluation & Feedback Presentation followed by a Roundtable Discussion to facilitate community involvement and participation (Formative/Process Evaluation Meetings).

– C.A.R.E. Program Efficacy and Final Evaluation C.A.P. – Monday, Week 8 at 7:00 PM: 90 minute Evaluation Presentation providing Program Evaluation Results, Outcome, Program Revisions and Directions for Future Program Modification (Outcome/Summative Evaluation Meeting).



• Initial NSSI Student Education Program (SEP)

– C.A.R.E. Student Education Program for Students Grades 6 through 10 in Health and Physical Education Class: 40-45 minute class sessions - 8 weeks.

• Advanced SEP – Community Concerns Module (SEP-CCM)

– C.A.R.E. Student Education Program for Students Grades 11 & 12 in First Block (Homeroom): 20 minute daily modules - 8 weeks.



• NSSI RRT & CCM Program Planning Sessions

– C.A.R.E. RRT & CCM Planning Meetings (Week 1-7) for Prevention Program Directors (PPDs) and Gatekeepers (PPG) - 30 minutes.

• NSSI Recognition and Response Training (RRT)

– C.A.R.E. Implementation NSSI Recognition and Response Training (RRT) - Wednesday, Week 1 at 7:00 PM: 90 minutes.

– C.A.R.E. Weekly Meetings (Week 1-7) NSSI-RRT - Wednesdays at 7:00 PM.


C.A.R.E. Program Evaluation Plan

• There are only a few existing evidence based prevention programs for NSSI and they are not comprehensive in nature as they utilize either universal, selective, or indicated targeting practices rather than a combination of targeting strategies.

• The C.A.R.E. Prevention Program represents a new approach to intervention in that it will attempt to comprehensively target universal and selective populations through the utilization of targeted and uniquely specialized educational programs for gatekeepers, community members as a whole, and adolescent students,

CARE: Evaluation Plan

C.A.R.E. Program Evaluation Plan (Process & Summative)

• A comprehensive evaluation is necessary to ensure all stakeholders’ needs are met, and that future program implementation is informed by evidence based results and program feedback.

• A process evaluation is necessary to maintain both program fidelity and fit, and will consider program context, appropriateness, adequacy, efficiency, and effort expended. The process evaluation will be conducted during the C.A.P. “Progress, Feedback, and Continued Evaluation” meetings held Mondays at 7:00 PM: Week 3 & Week 6.

• A summative evaluation will be completed to consider local effects of the program including considerations regarding incidence reduction, program sustainability, replication and transferability, and dissemination. The summative evaluation will be conducted during the C.A.R.E. Program Efficacy and Final Evaluation C.A.P. Meeting on Monday of Week 8 at 7:00 PM.


C.A.R.E. Program Evaluation PlanOverviewThe goal of the present study is to conduct an initial evaluation of the effectiveness and feasibility of the C.A.R.E. Prevention Program in achieving the following goals.

• Increasing student and community awareness of NSSI.

• Increasing knowledge of NSSI risk and protective factors.

• Increasing help-seeking behavior among the adolescent student population.

• Improving student and gatekeepers’ openness to, and attitudes towards, adolescents engaging in NSSI behavior.


C.A.R.E. Program Evaluation PlanHypotheses1. Student and Gatekeeper knowledge of NSSI indicators/signs and symptoms will significantly increase

from pre-program implementation to post-program implementation

2. Individual’s perceived comfort with, and openness to, proactively helping and providing support to those engaging in NSSI will significantly increase from pre-program implementation to post-program implementation, i.e. attitudinal response.

3. Help-seeking behaviors, such as visiting the school psychologist, will increase by 35% as determined through self-report measures.

4. One-month and one-year incidence rates of NSSI thoughts and behaviors will decrease by 25% and 50% respectively.


C.A.R.E. Program Evaluation PlanResearch Design• Initially a “One-Group Pretest-Posttest” Design was considered, however, this design does not allow for a

comparison with a control/comparison group, thus it is not possible to conclude that any change from pretest to posttest is due to the intervention and not extraneous variables such as environmental events, maturation threat, and carryover effects.

• Therefore, C.A.R.E. will utilize a “Wait-List Comparison-Group” Design.

• With the “Wait-List Comparison-Group” design, all the program participants in each non-randomized cohort, i.e. students in grade 6 through 10 (SEP) and students in grades 11 and 12 (CCM) will be randomly assigned to one of two groups, both of which will eventually receive the treatment.

• Half of the participants in each testing group will be placed on a waiting list. These participants will be assessed immediately before the initial intervention, and twice more later on: once after the eight weeks of the initial intervention (C.A.R.E.) and again after receiving the intervention themselves.


C.A.R.E. Program Evaluation PlanResearch Design ContinuedAs the C.A.R.E. Prevention Program is a preventative intervention designed for both universal and selective targeting, but not indicated targeting, it is both practical and ethical for the “wait-listed” potential program participants to wait 8 weeks for the opportunity to receive the intervention. All participants will be given an opportunity to receive immediate help for NSSI if requested (c.f. Procedures and Methods).

Wait-List Comparison-Group Design

Immediate Intervention Group: [O1 X O2]Wait-List Group: [O1 ~XO2 X O3]


C.A.R.E. Program Evaluation PlanSample Description• The current study will include 16 participating schools (6 high schools and 10 middle schools) who

responded to the C.A.R.E. Prevention Program Pilot Study Invitation. • The study will sample adolescent students age 11 – 18 (grade 6 through 12) who will be participating in a

wait-list comparison-group design study. • Non-random assignment into the SEP and CCM cohorts via grade determination.• Student Education Program (SEP) cohorts will include adolescent students in grades 6 through 10.• Community Concern Module (CCM) cohorts will include students in grades 11 and 12.• Upon completion of non-random assignment into experimental groups, random assignment of students

will occur for all students.• Half of the randomly assigned students will be placed into the initial intervention while the other half of

the randomly assigned student will be placed into the wait-list intervention so as to allow for a control/comparison group for Program Evaluation and Analysis.

• The study will include all races, ethnicities and genders.


C.A.R.E. Program Evaluation PlanMeasures• The SITTBI-R-ES pre- and post-test surveys will be presented as a 25-item self-response

questionnaire assessing individuals’ knowledge of NSSI indicators/signs and symptoms, openness to helping and providing support for peers engaging in NSSI, help seeking behaviors, and self-reported one-month/one-year incidence rates of NSSI.

• Questions regarding frequency, openness, and help seeking behaviors will be formatted in dichotomous “yes” or “no” response pattern, where upon answering “yes” a Likert Scale is provided asking for the intensity/frequency of the indicated answer (Very Weak = 1 to Very Strong = 5).

• All survey questions regarding NSSI behavior were adapted from Nock, Holmberg, Photos, and Michel’s (2007) Self-Injurious Thoughts and Behavior Inventory (SITBI).

• All survey questions regarding actual NSSI behavior, openness to helping others engaging in NSSI, and attitudes towards help-seeking behavior were adapted from Aseltine and DeMartino’s (2004) evaluative survey of the Signs of Suicide program.



C.A.R.E. Program Evaluation PlanProcedures and Methods All schools participating in the C.A.R.E. Prevention Program implementation and evaluation will conduct their own pre-set

and pre-determined method and procedure for obtaining consent for both the program itself, and the program evaluation. In order to insure confidentiality, all student participants will be given a random identification number and only the Head

Program Administrator will have access to the codes.

It will be insured that no school personnel or program participants will gain access to students’ SITTBI-R-ES (Self-Injurious Thoughts and Behaviors Inventory – Revised – Evaluation Survey) responses.

The “pretest” administration will be conducted for all program participants during the last period of the school day (Friday) immediately preceding program implementation. All program participants will have 75 minutes to complete the SITTBI-R-ES.

Program Administrators will insure proper assignment into each testing group for survey administration as well as provide identical classroom settings for all four testing groups: intervention SEP group, immediate intervention CCM group, wait-list SEP group, and wait-list CCM group. Survey administration will occur in separate classroom settings for each of the four testing groups.


C.A.R.E. Program Evaluation PlanProcedures and Methods Continued Program Administrators will simultaneously administer the “pretest” survey (SITTBI-R-ES) to all

program participants in the immediate intervention and wait-list groups for both study cohorts, i.e. SEP (adolescent students grade 6 through 10) and CCM (students grade 11 & 12).

In order to insure best practices and ethical practices, during the reading of the survey administration instructions, the following statement will be made: “Prior to beginning the survey, you may write either ‘I do not need help for self-injury’ or ‘I do need help for self-injury’ so as to insure help is provided for any student who requests it.”

The C.A.R.E. Program will then be implemented each week via CAPs, Initial SEPs and CCMs as outlined in the C.A.R.E. Dosage and Implementation Schedule.

Following the first eight week implementation of the C.A.R.E. NSSI Prevention Program, the SITTBI-R-ES will be administered again for the immediate intervention SEP and CCM groups (which will serve as the posttest evaluation) and the wait-list SEP and CCM groups (which will serve as the pretest survey).

Upon completion of the second implementation of C.A.R.E. NSSI Prevention Program, the SITTBI-R-ES will be administered one final time to the wait-list SEP and CCM groups as the posttest evaluation.


References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

Cook, S., Clancy, C., & Sanderson, S. (2004). Self-harm and suicide: Care, interventions and policy. Nursing Standard, 18(43), 43-52.

Heath, N. L., Toste, J. R., & Beettam, E. L. (2006). “I am not well-equipped”: High schools teachers’ perceptions of self-injury. Canadian Journal of School Psychology,

21, 73-92.

Jacobson, C., & Gould, M. (2007). The Epidemiology and Phenomenology of Non-Suicidal Self-Injurious Behavior Among Adolescents: A Critical Review of the

Literature. Archives of Suicide Research, 11, 129-147.

Larsson, B., & Sund, A. (2008). Prevalence, Course, Incidence, and 1-Year Prediction of Deliberate Self-Harm and Suicide Attempts in Early Norwegian School

Adolescents. Suicide and Life-Threatening Behavior, 38(2), 152-165. doi: 10.1521/suli.2008.38.2.152.

References

Muehlenkamp, J., Walsh, B., & Mcdade, M. (2009). Preventing Non-Suicidal Self-Injury in Adolescents: The signs of self-injury program. Journal of Youth and

Adolescence, 306-314.

Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007) The self-injurious thoughts and behaviors interview. Development, reliability, and validity of a new

measure. Psychological Assessment, 19, 309-317.

Robinson, J., Gook, S., Yuen, H., Mcgorry, P., & Yung, A. (2008). Managing Deliberate Self-Harm in Young People: An evaluation of a training program developed for

school welfare staff using a longitudinal research design. BMC Psychiatry, 75-75.

Swahn, M., Ali, B., Bossarte, R., Dulmen, M., Crosby, A., Jones, A., & Schinka, K. (2012). Self-Harm and Suicide Attempts among High-Risk, Urban Youth in the U.S.:

Shared and Unique Risk and Protective Factors. International Journal of Environmental Research and Public Health, 9, 178-191.

final%20 submission%20of%20non suicidal%20self-injury%20project

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