Sadly, self-harm and suicidality occurs throughout society, and is a common feature amongst children in care, due to the psychological trauma that they have often experienced.
QPC recognises the importance of developing sound risk assessments that involve the identification and evaluation of the sources of potential harm and the management of the identified risks. This process is multi-disciplinary and often involves education, health, and social care.
At QPC, we have developed both a short-term and longer-term management pathway for self-harm and suicidality that is grounded in the NICE (National Institute for Clinical Excellence) guidelines 2018 and government legislation (Children’s Act, 2004; Safeguarding Vulnerable Groups Act, 2006; and Lost in Care: Learning the Lessons, 2000).
Staff are familiar with the principles of confidentiality with regards to the information about the young person’s care and are aware of the circumstances in which disclosure of confidential information may be appropriate and necessary.
QPC Ltd has commissioned Applied Suicide Intervention Skills Training (ASIST) training for a range of staff including residential staff, home managers, teachers and members of the clinical team. QPC already use a range of approaches to inform risk assessments and management, such as STORM and multi-disciplinary consultation with agencies such as CAMHS, Local Authorities, and the Police.
The Clinical Team within QPC have been involved in formulating risk assessments with the local CAMHS team and have looked after a number of children with immigrant backgrounds, whose first language was not English. We are aware of how robust risk assessments need to incorporate both the child’s native language and culture.
The QPC Clinical Team offer a risk assessment that balances the need to look at each episode of self-harm in its own right (with the person’s reasons for self-harm varying from episode to episode) and the consideration of important background information, such as: skills and coping strategies; mental / physical health difficulties; and social circumstances and life difficulties.
Whilst all risk assessments are based on the unique needs of the young person, at QPC we strive to achieve consistency in our approach to risk and use the following framework:
- Identify the activity that creates potential risks; e.g. substance misuse, bullying, or going missing from care.
- Identify Risks / Hazards that place the young person at risk, e.g. emotional distress, personal safety, previous episodes of self-harm or suicidality.
- Identify Resources that protect the young person from self-harm/suicidality; e.g. psychological therapy, the provision of nurturing relationships, techniques, such as mindfulness, distraction, and self-soothing.
- Identify who is at risk: carer, young person, or other.
- Control Measures to reduce the levels of risk, e.g. specific pieces of work by different agencies, referrals to specialist services (e.g. CAMHS), adequate agreed levels of supervision, training for carers and staff, calling an ambulance, training staff to develop their risk management skills.
- Are these controls adequate to keep the young person safe? If not, then further actions will be required. The control measures must be monitored at regular intervals to ensure that they are being adhered to and working efficiently. If they are not being adhered to, then appropriate measures need to be taken:
- All risk assessments must be reviewed quarterly or earlier if there are any changes in the risk or control measures to be taken. Young people coming towards the end of their placement, e.g. transitioning into adult services, will require their risk management plans to be reviewed with the professionals who are taking over their care.
- All risk assessments must be recorded, signed and dated.