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  3. 10. General
  4. 10.8 Responding to self-harming behaviour
  5. Key steps
  6. 2. Respond to the child with a self-harm alert

2. Respond to the child with a self-harm alert

2.1 Record the self-harm alert in ICMS within 24 hours

When a child discloses or displays self-harming behaviour or when it is assessed that the child meets the criteria for self-harm risk, a self-harm alert must be recorded in ICMS within 24 hours by staff of the CSSC, RIS or CSAHSC regarding the incident, disclosure or assessment.

2.2 Develop a self-harm risk management plan

After recording the self-harm alert, the CSSC develops a self-harm risk management plan with, where possible, the child, their parents, carers and other significant people. The complexity, number and extent of actions in the self-harm risk management plan vary and depend on:

  • the point at which the plan is instigated - either:
    • at intake or during an investigation and assessment, the parent or the notifier may be the only person responsible for implementing the self-harm risk management plan actions (for example, removing available means of self-harm, not leaving the child alone and seeking help from a general practitioner)
    • during ongoing intervention, a range of people may be undertaking actions with the child (for example, child protection and youth justice staff, recognised entity staff, carers, health workers).
  • the nature and significance of the information prompting the self-harm alert - if a child is physically injured or hospitalised as a result of their self-harming risk or behaviour, the self-harm risk management plan actions may be undertaken by a range of people relevant to the child's current situation and context (for example, general practitioner or other health provider, parent, youth worker or other identified support person)
  • the child's circumstance - the number, extent and persons responsible for implementing the self-harm risk actions will depend on:
    • the child's characteristics and individual circumstances (for example, the child's ethnicity, behaviour, health or special needs, child's relationships with others) and
    • the characteristics of the persons able and willing to undertake actions to protect and support the child (for example, an Aboriginal child subject to youth justice and child protection interventions may have child protection, youth justice and recognised entity staff responsible for certain actions within the self-harm risk management plan).

The purpose of the self-harm risk management plan is to document the immediate and ongoing actions and interventions aimed at preventing or reducing the future risk of self-harm to the child. These may include:

  • strategies to increase the knowledge and understanding of all parties about self-harm and suicide risk
  • practical strategies that can be put into action. These may include for example:
    • not leaving the child alone
    • removing or safely securing any available means of self-harm or suicide, for example, weapons, medications, alcohol and other drugs, access to a car
    • encouraging the child to talk with and seek help from a general practitioner or other provider
    • information and advice about alternative sources of support that may assist the child and their family, including community based health (for example, a general practitioner) and/or mental health services (for example, Queensland Health, Child and Youth Mental Health Services), wider family networks and other local community resources
    • referrals to a support or intervention service
    • strategies for how and when the self-harm risk management plan will be monitored and reviewed
    • any other matters discussed or actions to be taken, and the response of all parties.

Record the self-harm risk management plan in ICMS in a ‘Case discussion/decision’ case note titled, ‘Self-harm Risk Management Plan’, and include the team leader’s verbal approval of the self-harm risk management plan, in the case note.

Self-harm risk management plans for children at intake or during an investigation and assessment

When a self-harm alert is recorded at intake by the RIS or CSAHSC (for example, an intake enquiry or child concern report) or during an investigation and assessment by the CSSC and the child is not subject to ongoing intervention, record the actions the notifier or parent agrees to undertake in the self-harm risk management plan. Where the notifier or parent (if the notifier) does not agree to undertake actions:

  • consider whether the parents lack of commitment to the actions in the plan, would require a more intrusive response, for example, recording a notification or providing ongoing intervention
  • record the notifier or parent's response and the rationale for the decision made.

As the department does not have an ongoing role in providing intervention to children unless they are subject to an ongoing intervention case, it is critical that the intake or investigation and assessment response clearly explores (with relevant people and agencies, including where applicable, the notifier) all available options for securing the child's immediate physical safety.

For further information about resolving doubt about whether a child is at risk of self-harm, refer to 1.3 Consult with the team leader to decide whether a self-harm alert is required.

Consider referrals to services

Children who display self-harming behaviour or who are at risk of self-harm, may already have involvement with other services that have expertise to offer in addressing or reducing such behaviours.

If a child is not involved with professional service providers, consider making referrals to relevant services or consulting with them for information, resources and assistance.

2.3 Inform relevant people

After recording a self-harm alert and completing a self-harm risk management plan, inform relevant people about the alert and associated risk plan, as follows:

  • at intake - inform the notifier
  • during an investigation and assessment - inform the child, parents, and other relevant people (for example carers, medical staff, education staff, recognised entity staff)
  • for a child subject to ongoing intervention- inform the child, parents, carers and other relevant people about the self-harm alert and the particulars of the self-harm risk management plan (for example, medical staff, education staff, recognised entity staff).

Note: because the department does not have an ongoing role in providing intervention to children or young people unless they are subject to an ongoing intervention case, it is critical that the intake or investigation and assessment response includes exploring with relevant people (including where applicable, the notifier) all available options for ensuring the child's immediate physical safety.

Critical incident reporting

Where a child's self-harming episode requires medical treatment or hospitalisation, complete a critical incident report in accordance with the Critical incident reporting policy.

2.4 Respond to a child with multiple self-harm alerts

A subsequent self-harm alert must be completed whenever the child demonstrates or engages in a new episode of self-harming behaviour.

Where a child subject to a self-harm alert repeatedly engages in self-harming behaviour, consult with the team leader to consider whether the recurring self-harming behaviour:

  • signifies an escalation or intensification in the pattern or severity of the child's self-harming behaviour or risk of self-harm
  • is being adequately addressed by actions in the self-harm risk management plan.

When deciding whether to record a subsequent self-harm alert, consider whether actions in the current self-harm risk management plan are relevant and effective in addressing the repeated self-harming behaviour.

When a subsequent self-harm alert is recorded for a child, consider whether the previous self-harm risk management plan contains actions, interventions and supports that are relevant to the child's pattern of self-harming behaviour or risk and their situation and what progress has been made. The self-harm risk management plan may repeat the strategies of the previous plan if the new episode is to be responded to and managed in the same way.

Consider whether a suicide risk alert is required

Where a child is subject to multiple current or previous self-harm alerts and recording another self-harm alert is being considered, consult with the team leader about whether a suicide risk alert is required instead of a self-harm alert. In making this assessment, consider factors associated with cumulative harm, and the possibility that a pattern of, or escalation in self-harming behaviour may constitute risk of suicide. Where a suicide risk alert is required, refer to Chapter 10.9 Responding to suicide risk behaviour.