Development of Schools Self-Harm Pathway Buckinghamshire Team







Full text


• Dal Sahota- Clinical Commissioning Director,

Maternity & Children’s Services. Chiltern CCG

• Kerry Allen- Clinical Team Manager OSCA

• Daniela Raffio- Paediatric Urgent Care Project


Development of Schools Self-Harm

Pathway Buckinghamshire Team


Self-Harm: The Facts

• Self-harm statistics (Stallard et al 2013)

27% of 12-16 year olds sampled had thought about self-harming  15% of 12-16 year olds had self-harmed over the last year

• Self harm is an important signal of distress and increases the

likelihood that person will die by suicide between 50-100 fold above the rest of the population. ( Hawton et al 2012)


Bucks Picture

• The Young Foundation Report, 2012 ‘Being Seen, Being Heard

Report- researching emotional resilience in Bucks


lack of support to universal settings e.g. schools

YP tell a friend or care provider e.g. Teacher not necessarily GP

• Multi-disciplinary events across Bucks showed a lack of support

and training for school staff and school nurses

• Last two years a number of serious case reviews in Bucks

involving self-harm


What we wanted to do?

• Provide support and training to school staff

• Improve the self harm urgent care pathway

• Work with all partners

• Simplifying systems and processes

• Raise the profile of emotional resilience in schools


How we did it?

• Interested ST4 GP- Nick Smith with a project for health and

education integration.

• He received mentorship with Kerry Allen (CAMHS)

• The project was managed by jointly chaired Overview Group

including representation for schools, health, LA

• Nick had access to senior leadership and was able to

influence at appropriate Board level


Nick Smith

CAMHS Project Management Chiltern CCG Schools Public Health


Loosing the driver


The work continues...

• Excellent handover

• Momentum had been built- Communications Strategy & Plan

• Timeline developed

• Dedicated Project Management

• Clear commitment from relevant agencies: Wycombe High

Deputy Head- Sally Jarrett, CAMHS (Oxford Health)- Kerry Allen, Public Health- Jen Beer, CCG’s Clinician’s- Dal Sahota & Steven Murphy and Project Management- Daniela Raffio



Preventing Self-Harm (PH) Emotional Resilience Project Managing self-harm better in universal settings

Schools Self Harm Working Group

Improving urgent care

Secondary Care Pathways Group

Multi-agency Self Harm Overview Group jointly chaired by a secondary school and the Chiltern Clinical Commissioning Group


A day in the life….

Schools Self Harm Working Group

• Getting everyone around the table e.g. meeting within a

school at lunchtime

• Giving real life examples- Lucy & Sam

• Not reinventing the wheel- does it already exist?

• Hearing the patients experience

• Pushing & Persuasion

• Being flexible and inclusive - adapted model to include

school nurses

• Sense checking tools (Self-harm guidelines, e-learning)

• Schools offered free locations- and it included schools into a


Tools to support


Guidelines and resources

for schools, may also be

appropriate for other


Developed by a

multi-agency working group.

Chaired by Wycombe High


Schools Self-Harm

Resource Pack

Basic information about self harm e.g. what it

is, why CYP self-harm, do’s and don’ts

Flow diagram for dealing with self harm in


Appendices to support flow diagram e.g. circle

of support, list of support agencies, leaflets

that can be given out to help young people

that self harm, friends and family etc


‘The Plan’

The self-harm pack was piloted with 9 secondary

schools with excellent feedback-Summer 2014

It was rolled out to all secondary schools including

school nurses Autumn 2014-Dec 2015

To date only three secondary schools including


Training Agenda

Item Time Subject Speaker

1. 1.15-1.30pm Arrival, Registration and Refreshments 2. 1.30-


Welcome, Introduction and Case Studies

Sally Jarrett Dal Sahota

3. 1.45-2.30pm An Overview of Self-Harm Kerry Allen 4. 2.30-


Part 1: Self-Harm Schools’ Resource Pack and Group Activities

Sally Jarrett

5. 3.15-3.30pm Break

6. 3.30-4.15pm Part 2: Self-Harm Schools’ Resource

Pack and Group Activities

Sally Jarrett

7. 4.15-4.30pm Role of CAMHS & A&E Pathway Kerry Allen

8. 4.30-4.50pm Building Emotional Resilience Jen Beer, Public Health Practitioner 9. 4.50-5.00pm Conclusion and Training Evaluation All


Who we trained


School/ Community



Lead Counsellor School SEN Safeguarding Head of Year

33 29 13 14 18 21

Total Trained:

Pilot: 10 school staff



To date

Pilot feedback- helped us to develop the full


Training feedback- 100% excellent or good

Next steps

Impact evaluation from both staff and young


The missing link…Improved

process/pathway in A&E:

• In response to feedback from young people and an SCR, part of the self-harm pathway work

was to look at the experience of the YP if they attend A+E following any form of self harm

• In conjunction with the paediatric staff team, A+E and CAMHS created a clear pathway and

guidance for triage, assessment and follow up of any YP attending

• This is in line with NICE guidance around admittance and liaising with other agencies • It links in clearly with the protocol of jointly assessing with social care where the young

person is known to them, and alerting them if not, thus safeguarding is considered immediately.

• A Triage form was designed for use of staff to aid initial assessment and experience of the

young person

• As part of this, training on mental health screening and young people who self- harm has

been offered to SMH A+E and paediatric staff by Bucks CAMHS. Better trained staff helps to reduce ‘stigma of self-harm’ and thus the experience of the patient.


Next Steps

Evaluate impact of training and urgent care pathway

on practice through both school staff and young


Develop Primary School programme

Develop Special School Programme

CAMHS Link Worker into every secondary school.

Sharing our learning with others

Raising the profile within primary care (GP’s,


Any Questions?

Dal Sahota

Kerry Allen CAMHS

Daniela Raffio (Project Manager)