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Pediatric Nonsuicidal Self-Injury

A Call to Action for Inpatient Staff Training


Journal of Psychiatric Practice®: September 2019 - Volume 25 - Issue 5 - p 395–401
doi: 10.1097/PRA.0000000000000417
Practitioner's Corner

The rising prevalence of nonsuicidal self-injury (NSSI) in pediatric populations along with the recent inclusion of NSSI as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have increased the focus on the assessment and treatment of NSSI among youth. Despite the frequent occurrence of NSSI in inpatient psychiatric treatment settings, there are no empirically based assessment protocols to guide clinical staff. This article presents findings from a needs assessment conducted with staff at a state-run child and adolescent inpatient treatment facility. The purpose was to assess the need for formalized NSSI training among staff. A questionnaire was developed to evaluate whether staff had received formal training in NSSI assessment and treatment as well as typical practice responses to patients engaging in NSSI behaviors. The questionnaire also evaluated staff comfort and confidence in their knowledge and skills concerning the assessment and treatment of NSSI among children and adolescents. Respondents were 126 clinical staff, most of whom were nursing staff. Only a minority of staff reported having received formal NSSI training, and a third of respondents indicated that they do not typically assess for NSSI at all. Although a substantial percentage of clinical staff self-reported comfort and confidence with assessing and treating NSSI, fewer than 10% demonstrated accurate skill. Formal training in NSSI is associated with positive outcomes for both patients and staff in general healthcare settings. These findings suggest that similar training for staff on pediatric inpatient psychiatric units will likely foster comfort, confidence, and accuracy, thereby improving outcomes for children and adolescents engaging in NSSI behaviors.

PLUHAR, FREIZINGER: Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital; and Department of Psychiatry, Harvard Medical School, Boston, MA

NIKOLOV: Yale Child Study Center, Yale School of Medicine, New Haven, CT; and Albert J. Solnit Children’s Center, Middletown, CT

BURTON: Department of Pediatrics, University of Tennessee Health Science Center; and Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, TN

The authors declare no conflicts of interest.

Please send correspondence to: E. Thomaseo Burton, PhD, MPH, Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, 452R, Memphis, TN 38103 (e-mail:

Online date: September 6, 2019

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