Self-Injurious Behavior: Assessment and Intervention
Presented by: Dr. Sharon Van Sell, RN,PHAM and Ms. Pat Shull, RN of Texas Women’s University School of Nursing
Dr. VanSell and Ms. Shull presented an assessment tool they are using in the Grand Prairie School District on self-injurious behavior. These ladies, along with Dr. Sandra De La Cruz, Director of Pupil Personnel Services in the Grand Prairie School District and several other women from the University have also co-authored an article for RN Magazine on self-injurious behaviors.
Dr. Van Sell and Ms. Shull began their presentation by describingmyths around self-injurious behavior. Some of the myths described were: self-injurious behavior is a failed attempt at suicide, a way of seeking attention, a manipulative act, and it is often done by females. The presenters went on to tell us that self-injurious behavior is on the increase and it is being seen in younger and younger students.
School nurses play a very important role when evaluating students who demonstrate self-injurious behavior. The first line of defense is to do an assessment and ask a series of questions to try and determine the reasons a student may be doing this kind of behavior. During the assessment one should consider asking questions around: sexuality, sexual identity, sexual abuse, academic achievement, problems with friendships, problems with family or friend relationships, low self-esteem and impulsive behaviors. Forty to fifty percent of students have a history o self-injurious behavior.
The final part of the presentation was to administer the HEEADSS Assessment, which can be found in the School Nurse Handbook.
HEEADSSS stands for:
H = Home
- Who lives with you
- Do you have your own cell phone, TV, bedroom (try to determine if the student spends a lot of time alone or apart from family and friends
- Who do you talk to at home
- Is there any physical violence at home?
E=Education and Employment
- What is your favorite subject?
- How are your grades
- Do you get along with others at school?
E=Eating
- Who do you eat with?
- Do you eat at home or in a restaurant?
- Do you take dietary supplements?
A=Activities
- What extra curricular activities are you involved in?
- What are your favorite websites?
- Do you play video games? What’s your favorite? Check to see if the games are violent or not.
D=Drugs
- Do any of your friends use tobacco, alcohol or other drugs?
- Has anyone ever showed you how to use drugs?
- Any history of drug abuse in your family?
S=Sexuality
- Do you have a boyfriend/ girlfriend?
- Are you in a serious relationship?
- Anyone pressing you to have sex
S=Suicide and Depression
- Do you feel sad or down more than usual?
- Have you ever considered suicide? Do you feel that way now?
- Have you ever self-injured yourself?
S=Safety (savagery)
- Are you bullied at school?
- Do you carry a weapon to be safe or feel safe?
- Have you ever been in an accident?
Ms. Shull did a role-play with an audience member around interviewing a student using this assessment process. At the conclusion of the presentation, the presenters answered questions.