Most children and young people in residential care have experienced significant trauma in their lives and are often highly vulnerable. It is likely that these children will sometimes have multiple and complex needs and significant behavioural and emotional difficulties, which can lead to acting in ways that place themselves in situations of high risk.

2. Why do children and young people self-harm?

It is not uncommon for children and young people who reside in residential care to have experienced some form of trauma in their lives. However, there are many reasons that children and young people turn to self-harm. Below is a list of reasons provided by the NSPCC (though not limited to):

Experiencing depression, anxiety or eating problems;
Having low-self-esteem or feeling like they’re not good enough (or loved);
Being bullied or feeling alone;
Experiencing emotional, physical or sexual abuse or neglect;
Feeling angry, numb or like they can’t control their own lives.

3. Signs of self-harm in children and young people

Recognising the signs of self-harm can be very difficult, especially as many children and young people hide their efforts/intentions. However, some signs that you could look out for include:

Covering up (e.g. more than usual or dressing inappropriately for the weather/climate);
Unexplained bruising, cuts, burns or bite-marks on their body;
Blood stains on clothing or finding tissues discarded with blood on them;
Becoming withdrawn and spending a lot more time alone in their room;
Avoiding social interaction;
Feeling down, low self-esteem or blaming themselves for things;
Outbursts of anger or risk-taking behaviour, such as drinking alcohol or taking drugs.

4. Planning and Prevention

As part of placement planning, relevant information should be gathered and appropriate risk assessments put in place, alongside relevant intervention strategies. The risk assessment should take in to consideration the impact of an incident of self-harm or suicide on the staff and other young people in the Home. The risk assessment will be part of the child’s Placement Plan and should be regularly reviewed and monitored.

All reasonable measures should be taken to reduce or prevent continuation of the behaviour. Support strategies should be agreed with input from the child’s Social Worker and family (where appropriate).

This may include providing additional supervision, confiscation of materials that may be used to self-harm or, as a last resort, use of physical intervention or calling for assistance from the emergency services.

The child’s Social Worker should be notified of concerns that the child may be self-harming or has made attempts/expresses ideation of committing suicide.

If necessary, specialist advice or support should be sought.

Serious or persistent self-harming or attempted suicide must be notified immediately to the Home's Registered Manager and the relevant Social Worker within 1 working day. The Social Worker should be consulted and consideration given to whether a Child Protection Referral should be made, if so, see Safeguarding Children and Young People and Referring Safeguarding Concerns Procedure.

The Registered Manager will consider whether the incident is a Notifiable Event, see Notification of Serious Events Procedure.

5.3 Recording and Review

All self-harming must be recorded in the Home's Daily Log and relevant child's Daily Record.

An Incident Report must also be completed.

If First Aid is administered, details must be recorded.

The child's Placement Plan and any relevant risk assessments should be reviewed with a view to incorporating strategies to reduce or prevent future incidents.