The same care planning principles and processes that apply for all youth AOD clients should be used with clients planning who also self-injure. Residential units or day programs, where young people are likely to spend large amounts of unstructured time, will often develop specific support plans (sometimes known as a management plan) with a young person regarding self-injury.
Support plans are commonly based on an understanding of the young person’s past and recent self-injuring behaviour (eg: function, intent, type, implements used, severity, first aid / medical care required) and assessment of the risk. Support plans clarify how a service can:
- Support a young person to increase control over their self-injury while participating in a program
- Respond to self-injury in a way that is ethical, professional and effective for the young person
Support plans should not require the young person to sign a contract stating that they will not self-injure while involved in a program. This is counterproductive in that:
- it minimises the likelihood that a young person who is feeling like self-injuring will turn to practitioners for help
- where self-injury occurs it is likely to be hidden even when first aid is required
- young people who ‘break the contract’ are likely to feel shame and a sense of failure (this might reinforce negative self-beliefs and can engender despondency and a sense of helplessness)
The ‘Self-injury Functional Analysis Questionnaire’ can be useful in creating a care plan with the client. Practitioners should always be guided by organisational policy and procedures but for reference a guide to self-injury care planning is attached which builds on the information gathered using the Self-injury Functional Analysis Questionnaire.
The following elements drawn from Solutions Focused Therapy and Dialectical Behaviour Therapy might assist practitioners in forming care pans with their clients.
B3. Exception seeking & B7. Competence-seeking / looking for strengths
These SFT concepts can be useful in gently seeking out behaviours or strengths the young person has utilised in the past to assist them in coping without self-injuring. Any discoveries made could provide valuable information for the care plan.G5iii. Reducing physical vulnerability to overwhelming emotions
Including self-care basics, such as sleep, nutrition and activity scheduling, can be a great baseline for building up a care plan. This element will provide a rationale to the young person for including self-care strategies.
Important: Careful consideration should be given to whether the young person could benefit from specialist psychological treatment.
