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 AE
  departments
• Assess on day of referral unless discharged by
  AE, 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 AE 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

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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
AE Audit

• 86 Presentations over 10 week period to 4 AE
  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