· Emotional health
· Self harm
· Low Mood
· Protective factors
Version: / 1
Adopted by:
Date Adopted:
Name of originator/author: / Sarah Fenwick
Alison Barlow
Louise Lester
Alex Yeomanson
Name of responsible committee: / Patient Safety
Date issued for publication:
Review date:
Expiry date:
Target audience: / Public health Nursing
Type of Procedure (tick appropriate box) / ü
Contents
Contents page...... 2
Appendices…………………………………………………………………... 3
Version control ...... 4
Definitions that apply to this procedure...... 4
The Procedure
1.0 Purpose of the procedure ...... 5
2.0 Summary of the procedure ………………………………………... 5
3.0 Introduction...... 5
4.0 Responsibility of all staff …………………….……………………. 6
5.0 Training needs ...... 6
6. etc.
15.0 References and bibliography ……………………………………... 24
16.0 Equality Statement……………………………………………… 25
17.0 Duties within the organisation…...... 26
18.0 Monitoring compliance and effectiveness ………………… 27
19.0 Standards/performance indicators…………………………… 28
Appendices
Version control and summary of changes
Versionnumber / Date / Comments
(description change and amendments)
Definitions that apply to this procedure
Framework for the Assessment of Children in Need and their Families (The Assessment Framework) / The Assessment Framework is a systematic way for professionals to assess a child’s needs and whether s/he is suffering or likely to suffer significant harm, what actions must be taken and which services would best meet the needs of the child and family. All professionals should be competent to contribute to the assessment which is usually led by Local Authority Children’s Social Care under the Children Act 1989.Gillick or Fraser Competence / Following the case of Gillick-v-West Norfolk and Wisbech AHA [1986] AC 112, the Courts have held that children who have sufficient understanding and intelligence to enable them to understand fully what is involved in a proposed intervention will also have the capacity to consent to that intervention. This is
LSCB / Statutory body established under the Children Act (2004) to co-ordinate, maintain and review safeguarding activity within the area of its remit.
1.0. Purpose of the guidance
The purpose of this guidance is to support School Nurses to feel confident in knowing when, and how to assess risk when seeing children and young people with emotional health needs.
Principles Underpinning the Guidance
In line with the code of conduct nurses have a duty to assess risk at all times (NMC 2015). School Nurses are often the first contact for a child or young person and therefore assessing the level of risk in any situation is a crucial part of any assessment.
Risk itself does not cause mental health problems however risk is cumulative and does predispose children and young people to poorer outcomes and it is essential that this is considered on assessment.
It may not be possible to remove the risk itself, but often an awareness of the presence of risk will change the way we understand a child’s needs and how we respond to them so ensuring that risk is assessed at assessment is essential .Assessment or risk factors are not, nor can they ever be tools for prediction. They are only valid for the moment they are undertaken
The Aims of this Guidance
The aim of this guidance is to support School Nurses to feel confident in knowing when and how to assess risk when seeing children and young people with emotional health needs.
2.0 Summary and key points
School Nurses are required to assess risk when they complete an assessment on any child and must complete the template on Systm one to evidence this
Staff must complete each section of the risk assessment and must complete an analysis of risk level at the end of the assessment
· Harm to self
· Harm From others
· Harm to Others.
3.0 Introduction
This is a guidance document for School Nurses working with children and young people with emotional health issues such as low mood, suicidal behaviour and self-harm. It does not replace the assessment framework which is a fundamental tool in school nursing assessments. Neither does it replace the care pathways for self-harm or emotional health and well-being. It is an additional guidance to support school nurses in assessing the level of risk of harm to a young person.
Self-harm, low mood and suicidal behaviour among children and young people are major public health issues that school nurses work with every day. In the UK evidence shows that self-harm affects 1 in 15 young people (Truth Hurts, 2006). Alongside this One in Four (26%) young people in the UK experience suicidal thoughts at some point (Young minds 2016) and among teenagers, rates of depression and anxiety have increased by 70% in the past 25 years, particularly since the mid 1980’s.
School Nurses have a vital role to play in assessing levels of risk when they assess emotional health and wellbeing as they may be the first health professional a child or young person comes into contact with and be the first person that they disclose low mood or harming behaviour to. An early baseline health assessment is essential to aid the child or young person to receive timely and appropriate advice and support.
The NMC is clear in the code that all nurses have a responsibility to assess risk within daily practice (NMC 2015). School Nurses are not expected to complete a full mental health assessment, however they are expected to complete a baseline health assessment including a holistic emotional health assessment within their sphere of competence. Assessing the level of risk to the child or young person is a fundamental part of that process with referral onto other appropriate health professionals where the risk is deemed to be higher than the tier 1 or 2 public health work that they undertake. Referral to social care and other relevant agencies must take place if safeguarding concerns are disclosed in line with Leicestershire Partnership NHS Trusts safeguarding policy and guidance.
4.0 Responsibility of all staff
All School nurses are required to be familiar with this guidance and ensure
5.0 Training needs
There is a need for training identified within this policy. In accordance with the classification of training outlined in the Trust Learning and Development Strategy this training has been identified as role specific training with mandatory training supporting the underpinning policies and procedures (section 2.0).
Role specific training will be provided in relation to completing baseline health assessments, assessing and documenting risk and must be completed by practitioners prior to assessing risk in emotional wellbeing as a lone practitioner,
Mandatory training - The course directory e-source identifies who the training applies to, delivery method, the update frequency, learning outcomes and a list of available dates to access the training.
A record of the training will be recorded on uLearn
6.0 Assessing Risk
Risk and Protective Influencing Factors
The following list should be used as a guide as part of the school nurse holistic assessment, and in conjunction with the School Nurse Risk Assessment Tool. This is not a diagnostic tool, it is a guide that is not prescriptive. It lists situations and behaviours which can indicate increased risk of emotional harm
Remember that risk factors are not, nor can they ever be, tools for prediction. Any risk assessment is only valid for the moment at which it is undertaken.
Risk Factors / Protective FactorsFeatures of immediate risk/Access to / § Access to means of self-harm
§ Social Isolation/exclusion
§ Alcohol and drugs / § Access to social support
§ Social Inclusion
Child/Young person’s Characteristics / § Low self esteem
§ Age (increase risk around time of puberty)
§ Poor coping skills
§ Poor communication skills
§ Changes to normal temperament eg anger, guilt
§ Mental distress or illness eg anxiety/depression
§ Previous self-harm attempts
§ School or friendship worries
§ Feeling stressed
§ Feeling isolated
§ Recent bereavement
§ Alcohol or substance misuse
§ Sexuality
§ Gender issues / § Positive Self Esteem
§ Higher achievement or accomplishment
§ Future plans
§ Good coping strategies
§ Positive school experiences
§ Positive friendships
§ Secure attachment
§ Emotional resilience
§ Knowledge and ability of where to seek help and advice
School/College/Peer Group / § Arguments with friends
§ Bullying
§ Friends who self-harm
§ Pressure from school to perform well
§ Poor school ethos
§ Exam stress/failure / § Stable and secure friendships
§ Supportive adults
§ Supportive school ethos
§ Schools commitment to mental health promotion/PSHE
§ Peer supportive systems eg bullying clubs; nurture groups
Family Factors / § Family members who self harm
§ Family members with mental /physical ill health
§ Young carer
§ Family conflict/domestic abuse
§ Parent separation or divorce
§ Poverty/low socio economic status
§ Sexual/Physical abuse
§ Pressure from family / § Supportive adult
§ Harmonious family relationship
§ Good role model within the family
§ Included within the family
§ Good communication between family members and child/young person
§ Parental awareness of protective factors
Environment and Community / § Issues in relation to race, religion or culture
§ Issues regarding sexual orientation, identity or gender
§ Accessing media portraying positive image of self-harming / § Access to GP and School Nurse
§ Access to social support
§
Assessing risk to self
(please can you insert the flow chart from pg 4 of my document)
Actions to Take
Low Risk / Action· Suicidal thoughts are fleeting and soon diminished
· No plan to end life
· Few or no signs of depression
· Current situation felt to be painful but bearable
· Self-harm is superficial / · Ease distress as far as possible
· Consider what may be done to resolve difficulties (using problem – solving approach)
· Empathetic listening
· Discuss harm reduction
· Advise on safety. Where necessary use safety plan (See attached safety plan). Discuss harm reduction strategies
· Make use of other support resources
· Consider support from others eg parents/school/peers
· Review and assess at agreed intervals
· Make use of line management or supervision to discuss cases and concerns
Raised Risk / Action
· Previous, especially recent, suicide attempt
· Suicidal thoughts are frequent but still fleeting
· No specific plan or intent to end life
· Current self-harm is frequent and distressing
· Situation felt to be painful, but no immediate crisis
· Drug or alcohol use, binge drinking
· Evidence of current mental health issues eg anxiety, depression / · Ease distress as far as possible
· Empathetic listening
· Use/review safety plan (See attached safety plan). Discuss harm reduction strategies
· Joint problem solving to resolve difficulties
· Consider safety of young person, including possible discussion with parents/carers/other significant figures (consider consent issues)
· Discuss with Professional Advice Service (PAS 0116 295 5048)
· Make use of other support resources
· Review and assess at agreed intervals – see sooner than if risk is low
· Make use of line management or supervision to discuss cases and concerns
High Risk / Action
· Frequent suicidal thoughts which are not easily dismissed
· Specific plans with access to potentially lethal means eg tablets, knife, ligatures
· Increasing self-harm, either increase in frequency, potential lethality or both
· Situation felt to be causing unbearable pain or distress
· No reason identified not to go ahead with plan
· Evidence of current diagnosed mental illness
· Significant drug and alcohol use / · Ease distress as far as possible
· Empathetic listening
· Contact and discuss with parents/carers/significant others
· Contact and involve GP immediately and seek CAMHs referral
· Send to A & E if GP or CAMHs not available
· If remains high risk discharge to care of CAMHS
Medical Emergency / Action
· Suicide attempt
· Any act of self-poisoning, laceration or other injury / · Dial 999
· Access immediate medical intervention
· Do NOT leave alone
· Inform parents/carers/other significant figures
References and Bibliography
NMC (2015)The Code
16.0 Equality statement
Leicestershire Partnership NHS Trust (LPT) aims to design and implement policy documents that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others.
It takes into account the provisions of the Equality Act 2010 and promotes equal opportunities for all.
This document has been assessed to ensure that no one receives less favourable treatment on the protected characteristics of their age, disability, sex (gender), gender reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity.
In carrying out its functions, LPT must have due regard to the different needs of different protected equality groups in their area.
This applies to all the activities for which LPT is responsible, including policy development and review.
1 Duties within the organisation
17.1 The Trust Board has a legalresponsibilityfor Trustpoliciesand forensuring that theyarecarriedouteffectively.
17.2 Trust Board Sub-committees have the responsibility for ratifying policies and protocols.
17.3 Divisional Directors and Heads of Service are responsible for:
Ø Ensuring that comprehensive arrangements are in place regarding adherence to this guideline and how policies and procedures are managed within their own Department or Service in line with the guidance in this guideline.
Ø Ensuring that team managers and other management staff are given clear instructions about guideline arrangements so that they in turn can instruct staff under their direction. These arrangements will include:
Ø Receiving policies/procedures/guidelines from the author.
Ø Distributing information about new policies, guidelines and procedures in a timely manner throughout the Division or Service to a distribution list will be agreed in advance with local managers.
Ø Ensuring that all staff have access to up to date policies and guidelines through the internet.
Ø Maintain a system for recording that policies, guidelines and procedures have been distributed to and received by staff within the Department / Service and for having these records available for inspection upon request for audit purposes.