0
Welcome!	
  	
  
	
  
Your	
  ,me	
  is	
  very	
  valuable	
  to	
  us.	
  To	
  ensure	
  you	
  are	
  
ge8ng	
  the	
 ...
•  Private,	
  accredited,	
  therapeu,c	
  school	
  in	
  Northern,	
  New	
  Jersey	
  	
  
•  Students	
  who	
  need	...
Agenda	
  	
  
	
  
§  Defini,on	
  of	
  Self-­‐Injury	
  
§  History	
  	
  
§  Why	
  People	
  Self	
  Injure	
  	
 ...
Meet	
  The	
  Presenters	
  
Alison	
  is	
  the	
  Clinical	
  Director	
  at	
  
Sage	
  Day	
  Lower	
  &	
  Middle	
 ...
What	
  Is	
  Self-­‐Injurious	
  Behavior?	
  
v  Self	
  injury	
  is	
  the	
  inten,onal	
  harming	
  of	
  one's	
 ...
History	
  
v  Prior	
  to	
  the	
  nineteenth	
  century	
  self-­‐mu,la,on	
  was	
  understood	
  as	
  a	
  Chris,an...
Why	
  Do	
  People	
  Self	
  Injure?	
  
v  A	
  way	
  of	
  quie,ng	
  pain	
  and	
  anxiety.	
  
	
  	
  
v  Best	...
Risk	
  Factors	
  	
  
Childhood	
  sexual	
  abuse	
  and	
  or	
  
family	
  violence	
  (Dieter	
  et	
  al)	
  
Maltr...
Levels	
  of	
  Severity	
  	
  
v  To	
  determine	
  level	
  of	
  severity,	
  consider	
  how	
  frequently	
  	
  s...
Demographics:	
  Female	
  vs.	
  Male	
  
	
  9	
  percent	
  of	
  girls	
  engage	
  
	
  in	
  NSSI.	
  	
  
6.7	
  pe...
Trends	
  
Self	
  Injury	
  Trends	
  	
  	
  
Since	
  2007	
  reports	
  of	
  NSSI	
  have	
  doubled	
  
Many	
  who	...
Immediate	
  Interven,on	
  
Remain	
  calm	
  and	
  caring	
  
Administer	
  first	
  aid	
  if	
  necessary	
  
Do	
  no...
Sage	
  Day	
  Interven,on	
  Protocol	
  
CuMng,	
  Self-­‐Mu>la>on	
  or	
  other	
  Self-­‐Injurious	
  Behavior	
  Rep...
No	
  Harm	
  Contract	
  
Resources	
  	
  
Conterio,	
  K.,	
  Lader,	
  W.,	
  &	
  Bloom,	
  J.K.	
  (1998).	
  	
  Bodily	
  harm:	
  	
  The	
 ...
Resources	
  Con,nued	
  	
  
Levenkron,	
  Steven.	
  (2006).	
  Cu8ng:	
  Understanding	
  and	
  Overcoming	
  Self-­‐M...
Suggested	
  Reads	
  	
  
	
  
Kelewell,	
  Caroline.	
  (2000).	
  	
  Skin	
  Game:	
  	
  A	
  Memoir.	
  NY:	
  St.	
...
Q&A	
  	
  
“CuMng	
  may	
  be	
  a	
  way	
  to	
  reclaim	
  control	
  over	
  one’s	
  body,	
  as	
  with	
  	
  	
 ...
Final	
  Steps…	
  
Thank	
  you	
  for	
  your	
  >me	
  this	
  a[ernoon.	
  We	
  hope	
  that	
  you	
  gained	
  
som...
Disclaimer:	
  
The	
  informa>on	
  and	
  interven>ons	
  discussed	
  today	
  are	
  supported	
  
by	
  research.	
  ...
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Non Suicidal Self-Injury Webinar Slides

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Why do children and young adolescents self injure? View our webinar presentation led by Sage Day's top Clinical Directors .

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  • Transcript of "Non Suicidal Self-Injury Webinar Slides"

    1. 1. Welcome!       Your  ,me  is  very  valuable  to  us.  To  ensure  you  are   ge8ng  the  most  out  of  this  Webinar  we  would  like   you  to  submit  a  ques,on  before  we  begin  our   presenta,on  on  Non-­‐Suicidal  Self-­‐Injury,    so  we   can  answer  your  specific  ques,ons  during  our  Q&A   por,on.  Please  type  your  ques,on  in  the  comment   box  on  the  right  hand  side  of  your  screen  at  this   ,me  or  at  any  point  throughout  the  presenta,on   and  we  will  do  our  best  to  address  it  at  the  end.       We  will  begin  shortly.  
    2. 2. •  Private,  accredited,  therapeu,c  school  in  Northern,  New  Jersey     •  Students  who  need  a  small,  personalized  environment   •  Strong  academics  based  on  the  Common  Core  Standards     •  Intensive  individual,  group  and  family  therapy     •  Provide  NJ  state  approved  In-­‐District  therapeu,c  services     •  Three  campuses:  Sage  Day  Lower  and  Middle  School  in  Mahwah,     Sage  Day  High  School  in  Boonton  and  Sage  Day  High  School  in  Rochelle   Park.     •  For  more  informa,on,  visit  us  at  www.sageday.com.      
    3. 3. Agenda       §  Defini,on  of  Self-­‐Injury   §  History     §  Why  People  Self  Injure     §  Risk  Factors     §  Levels  of  Severity     §  Demographics   §  Trends   §  Immediate  Interven,on     §  Case  Studies   §  Resources   §  Q  &  A    
    4. 4. Meet  The  Presenters   Alison  is  the  Clinical  Director  at   Sage  Day  Lower  &  Middle  School  in   Mahwah,  NJ.   Gail  is  the  Clinical  Director  at  Sage   Day  Boonton  High  School.   Janet  is  the  Clinical  Director  at  Sage   Day  Rochelle  Park  High  School.     Chris  Leonard    is  the  Director  of   Opera,ons  at  Sage  Day  School.  
    5. 5. What  Is  Self-­‐Injurious  Behavior?   v  Self  injury  is  the  inten,onal  harming  of  one's  own  body  in  order   to  relieve  emo,onal  pain  or  stress.  It  is  not  typically  meant  to   end  one's  life.       v  Self  Injury  isn’t  a  modern  adolescent  issue.  It  is  an  ancient   disorder,  which  is  best  understood  as  an  aempt  to  relieve   pain.          
    6. 6. History   v  Prior  to  the  nineteenth  century  self-­‐mu,la,on  was  understood  as  a  Chris,an   concept  of  “mor,fica,on  of  the  flesh”.     v  First  began  to  appear  in  psychological  literature  in  the  mid  19th  century.            Modern  understanding  of  self-­‐injury  was  made  by  Karl  Menninger.            1930  –  The  Human  Mind            1938  –  Man  Against  Himself     v  Menninger  believed  that  “self  injury  was  a  fascina,ng  kind  of  compromise  in   an  ongoing  war  between  aggressive  impulses  and  the  survival  ins,nct."            1960  –  Graff  and  Mallin:    Described  a  “typical  cuer  as  a  young,  highly                      intelligent  woman  who  is  prone  to  alcohol  and  drug  abuse  and  has  great                  difficulty  in  rela,onships.”              1980’s  –  Landmark  books  :    Self-­‐Mu5la5on  by  Barent  Walsh  and  Paul  Rosen                  and  Bodies  Under  Siege  by  Armando  Favazza.                Many  Late  20th  Century  studies  linked  self-­‐injurious  behavior  with                      dissocia,on.  
    7. 7. Why  Do  People  Self  Injure?   v  A  way  of  quie,ng  pain  and  anxiety.       v  Best  described  as  a  form  of  self-­‐help  for  people  whose  emo,ons  are  hyper-­‐ reac,ve  or  for  those  raised  in  an  emo,onally  chao,c  environment.   v  Not  always  a  manifesta,on  of  mental  illness  or  suicidal  idea,on.           v  There  is  a  high  correla,on  between  cu8ng  and  childhood  sexual  abuse.    
    8. 8. Risk  Factors     Childhood  sexual  abuse  and  or   family  violence  (Dieter  et  al)   Maltreatment  during  childhood   People  who  experience   dissocia>on     Those  who  have  experienced     childhood  trauma   People  who  suffer  from  other   mental  health  issues  (impulse   control,  ea>ng  disorders)   Excessive  alcohol  or  drug  abuse   Loss  of  a  parent  or  separa>on   from  a  caregiver  in  childhood       There  are  many  factors     that  may  contribute  to  self   injury     Difficulty  expressing  strong  nega>ve     emo>ons  such  as:  pain,  hurt  and   anger  
    9. 9. Levels  of  Severity     v  To  determine  level  of  severity,  consider  how  frequently    self-­‐harming  occurs,   the  number  of  methods  one  u>lizes  and  the  loca>on  on  the  body  that  is   injured.     v  Most  olen  those  who  self-­‐injure  do  not  wish  to  expose  their  wounds.         v  The  most  common  areas  of  the  body  on  which  self-­‐harming  is  performed  are:   the  arms,  wrists  and  legs.  Other  areas  may  include:  the  breasts,  thighs,   stomach  and  genitals.  (Conterio  et  al,  1998)       v  Typically  those  who  self-­‐harm  private  areas  of  the  body  do  so  out  of  shame.        
    10. 10. Demographics:  Female  vs.  Male    9  percent  of  girls  engage    in  NSSI.     6.7  percent  of  boys  engage      in  NSSI.   Primary  behavior  for   females  is  cu8ng.     Primary  behaviors  for    males  is  burning  or      self-­‐hi8ng.       cu8ng  is  viewed  as                        “feminine.”   17-­‐28%  of  teens   report  having  par,cipated     In  NSSI.     Nearly  50%  of  those  who   engage  in  NSSI  have  been     sexually  abused.     NSSI  behaviors  for  all   genders  typically    begin   between    11-­‐15.     When  treated,  most  NSSI   resolves  by  the  ,me  both   males  and  females  begin   young  adulthood..       Untreated,  NSSI  can   con,nue  throughout     adulthood  especially  in   Females.    
    11. 11. Trends   Self  Injury  Trends       Since  2007  reports  of  NSSI  have  doubled   Many  who  self  injure  report  learning  how  to  do  so    are  from  friends  or  pro  self-­‐injury  websites.   NSSI  is  frequent  in  high  income  countries.     NSSI  behaviors  by  males  are  increasing.   Self  harm  is  a  risk  factor  for  suicide  although     suicide  is  a  rare  effect.     Brain  research  indicates  that  there  an  incomplete    connec,on  between  the    cortex  and  amygdala     contribute  to  the  deregula,on  of  mood.       Approximately  2  million  cases  are  reported  annually  in  the  US.     Collec,on  of  data  remains  difficult  as  behaviors  go  unreported.    
    12. 12. Immediate  Interven,on   Remain  calm  and  caring   Administer  first  aid  if  necessary   Do  not  be  cri>cal  or  judgmental  even  if  you  disagree  with  behavior   Listen  with  compassion   Do  not  overreact,  show  shock  or  fear   Do  not  use  threats  to  stop  behavior     Follow  school/clinic  procedures  to  no,fy  administra,on/clinical  team         Note:  Students  and  staff  may  be  the  “first  responders”  to  NSSI.  
    13. 13. Sage  Day  Interven,on  Protocol   CuMng,  Self-­‐Mu>la>on  or  other  Self-­‐Injurious  Behavior  Reported  Outside  of  Therapy       Teachers:   v  If  a  student  discusses  or  reveals  cu8ng  during  class  they  must  be  accompanied  to  the  office.   v  Inform  Clinical  Director  and  Therapist.       Administrators:   v  Check  and  administer  first  aid  if  needed.   v  Access  immediacy  of  risk.   v  Based  on  assessment  retrieve  all  student  possessions.    Have  student  empty  out  belongs  and  confiscate     any  items  that  could  be  used  to  self-­‐harm.   v  If  student  refuses,  contact  parent.    Call  police  if  student  aempts  to  leave.  The  student  should  not   return  to  school  un,l  a  follow  up  mee,ng  with  parents  (and  district)  is  held  and  safety  plan  is  in  place.   Review  policy  with  student   Consider  No-­‐  Harm  Contract   Consider  suspension  of  privileges   Inform  parents   Inform  therapist     Inform  teachers         When  we  [Sage  Day]  make  a  decision  to  refer  a  student  for  evalua,on  for  hospitaliza,on    
    14. 14. No  Harm  Contract  
    15. 15. Resources     Conterio,  K.,  Lader,  W.,  &  Bloom,  J.K.  (1998).    Bodily  harm:    The  breakthrough  healing  program     for  self  injurers.    New  York:    Hyperion.         Deiter,  P.J.  Nicholls,  S.S.,  &  Pearlman,  L.A.  (2000).    Self  injury  and  self-­‐capaci,es:    Assis,ng  an  individual    in  crisis.    Journal  of  Clinical  Psychology,56,1173-­‐1191.       Levenkron,  S.  (1998).    Cu8ng:    Understanding  and  Overcoming  Self-­‐Mu,la,on.    New  York:       W.  W.  Norton  &  Company.         American  Psychiatric  Associa,on.  (1994).  Diagnos,c  and  Sta,s,cal  Manual  of  Mental  Disorders,  Fourth     Edi,on(DSM-­‐IV)  Washington,  DC:  American  Psychiatric  Associa,on.       Gluck,  Samantha  (2012).  Self  Injury,  Self  Harm  Sta,s,cs  and  Facts.  Retrieved  from:   hp://healthyplace.com/abuse/self-­‐injury/self-­‐harm.       Claassen,  Cindy  and  M.  Kasner.  (2012).  Self  Harm  in  the  United  States:  What  We  Can  Learn  from     Na,onal  and  State-­‐Level  Medical  Datasets.  Washington,  DC:  Na,onal  Center  for  Health     Sta,s,cs.     Interna,onal  Associa,on  for  Child  and  Adolescent  Psychiatry  and  Mental  Health.    (2012).  IACCP       Textbook    of    Child  and  Adolescent  Mental  Health.  Belgium:  Interna,onal  Associa,on  for  Child     and  Adolescent  Psychiatry  and  Mental  Health.  
    16. 16. Resources  Con,nued     Levenkron,  Steven.  (2006).  Cu8ng:  Understanding  and  Overcoming  Self-­‐Mu,la,on.  New  York:     W.W.  Norton.       Favazza,  A.R.    1996.  Bodies  Under  Siege,  Self-­‐Mu3la3on  and  Body  Modifica3on  In  Culture  and  Psychology.      Bal,more:  The  John  Hopkins  University  Press.       Graff,  Harold  and  Mallin,  Richard.  1967.  The  Syndrome  of  the  Wrist  Cuer.     American  Journal  of  Psychiatry,      124  :  36-­‐42.       Levenkron,  Steven.  2006.  CuAng:  Understanding  and  Overcoming  Self-­‐Mu3la3on.    New  York/London  ,     W.W.  Norton  and  Company.       Menninger,  K.A.  1938.    Man  Against  Himself.  New  York,  Harcourt,  Brace  and  World,.       Strong,  Marilee.  1999.  The  Bright  Red  Scream:  self-­‐mu3la3on  and  the  language  of  pain.    New  York,     Penguin  Putnam  Books.       Walsh,  B.W.,  Rosen,  P.  1988,  Self  Mu,la,on:  Theory,  Research  and  Treatment.    New  York,     The  Guilford  Press.       Levenkron,  S.  CuAng,  Understanding  and  Overcoming  Self-­‐Mul3la3on.    New  York/London:1998    
    17. 17. Suggested  Reads       Kelewell,  Caroline.  (2000).    Skin  Game:    A  Memoir.  NY:  St.  Mar,n's  Press.     Leatham,  Victoria.  (2004).  Bloodle8ng:  A  Memoir  of  Secrets,  Self-­‐Harm  and  Survival.  Australia:   Allen  &  Urwin.     Strong,  Marilee.  (1998).  A  Bright  Red  Scream:  Self-­‐Mu,la,ons  and  a  Language  of  Pain.  NY:   Penguin  Group  
    18. 18. Q&A     “CuMng  may  be  a  way  to  reclaim  control  over  one’s  body,  as  with                anorexia  and  bulimia.  Or  it  may  allow  the  tortured  individual  to            play  out  the  roles  of  vic>m,  perpetrator,  and  finally  loving            caretaker,  soothing  self-­‐inflicted  wounds  and  watching  them  heal.              For  others,  the  sight  of  blood,  is  literal  proof  that  they  are  alive,          drawing  them  out  of  terrifying  dissocia>ve  states.”   -­‐Marlee  Strong-­‐    
    19. 19. Final  Steps…   Thank  you  for  your  >me  this  a[ernoon.  We  hope  that  you  gained   some  new  knowledge  on  the  topic  of  Non-­‐Suicidal  Self-­‐Injurious   Behavior  and  that  we  answered  all  of  your  ques>ons.  You  can   now  refer  to  the  link  in  the  comment  box  that  will  direct  you  to   our  brief  survey.  Once  you  have  completed  the  survey,  you  will  be   redirected  to  a  Sage  Day  web  page  where  you  can  print  out  your   cer>ficate.     Survey  Link:  https://www.surveymonkey.com/s/K9NGXJC     If  you  have  any  further  ques>ons,  feel  free  to  visit  us  at   www.sageday.com  If  you  have  specific  ques>ons  geared  towards   one  of  our  presenters  today,  you  can  contact  them  via  email:   Alison  Hipscher-­‐  ahipscher@sageday.com   Gail  D’Aurelio  –  gdaurelio@sageday.com   Janet  Bertelli  –  jbertelli@sageday.com    
    20. 20. Disclaimer:   The  informa>on  and  interven>ons  discussed  today  are  supported   by  research.  However  abendees  are  urged  to  inves>gate  provided   resources  and  their  own  resources  to  confirm  research  findings.  
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