Developing and Running a Nurse Led Self Harm Service –

1. Developing and Running a Nurse Led Self Harm Service – Adolescent Self Harm Service Glasgow 2008

2. Glasgow Adolescent Self Harm Service • Pilot from October1999-May 2002 • Statutory Service since May2002 • Staff – 6 senior nurses • Area City of Glasgow • Service – Assessment, Treatment (various & flexible), Follow-up. Continuity of same member of staff from assessment to discharge.

3. Clinical Service Provision • Nurse-led, City Wide Community Service • 1 Clinical Nurse Specialist, 6 Nurse Therapists • PRIORITY – 5 District General Hospitals • 1 Paediatric Hospital • 7 Day/week service 9.30-5.30 • Medical/surgical receiving ward and A&E departments • Assess on day of referral unless discharged by A&E, written referrals assessed within 7 days • Routine Referrals – CAMHS Teams • Primary problem – Any act of DSH • 5 Day/week service • Assess within 14 days

4. Service Provision • Therapist identified as on duty daily • Identified daily ward referrals • Quick response to A&E departments • Quick response to enquiries • Ensures staff safety on a daily basis • Supervision Structures • Individual • Group – Case Discussions • Mobile telephone contact with on-duty person • Weekend 2nd on call nurse

5. Treatment • Home Based Family Intervention • Kerfoot et al 1993 (1st episode DSH O/D) • Psychosocial risk assessment • Family understanding of episode/Crisis planning • Communication styles • Problem Solving • Adolescence • Review process – 3, 6, 12 months

6. Individual Intervention • Full psychosocial risk assessment and crisis contacts • Crisis planning • CBT – thoughts, feelings and actions • Negative/faulty thinking , challenge beliefs assumptions. • Solution focussed – problem solving, promoting adaptive coping mechanisms • Communication/adolescence

7. Review Process 3, 6, 12mths • BDI, ISE • Further acts • Further thoughts • Feelings • Coping/problem solving • Activities • Social contacts • Drugs/alcohol • Any other issues, e.g. life events

8. Why It Works • Prevention • Crisis cards/Emergency contact details given • Review process • Flexibility of intervention/location • Education – in schools, statutory/voluntary agencies, other health professionals • Working with other agencies/establishing supportive networks Service/User Evaluation

9. Current/Future Developments • Current • Survival Skills Training (DBT) • Development of an out of hours service • Seeking funding for a research assistant to update the statistical database • Assist trainers • Future • Full statistical analysis • Research

10. Key Challenges In Practice • Maintaining a robust service/staffing levels (competing demands of the job) • Maintaining service delivery whilst implementing new practice • Identifying impact of care/service delivery on youth suicide rates through statistical data collection and comparing with national trends

11. A&E Audit • 86 Presentations over 10 week period to 4 A&E Departments. • 38% male, 62% female • 73% overdose, 20% self cutting • 68% no previous DSH episodes (59) • 52 admitted to ward. 44 referred to service • 24 not admitted. 4 referred to service • 48 YP referred to ADSH service (56%) • 10% in social work care at time of incident • Admission was a determining factor for referral to the service