Educational professionals' experiences of self‐harm in primary school children: ‘You don't really believe, unless you see it’

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  Educational professionals' experiences of self‐harm in primary school children: ‘You don't really believe, unless you see it’
  This article was downloaded by: [Lancaster University Library]On: 31 March 2015, At: 08:51Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Oxford Review of Education Publication details, including instructions for authors andsubscription information: Educational professionals' experiencesof self ‐ harm in primary school children:‘You don't really believe, unless yousee it’ Rebecca Simm a  , Katrina Roen a  & Anna Daiches aa  Lancaster University , UKPublished online: 17 Mar 2008. To cite this article:  Rebecca Simm , Katrina Roen & Anna Daiches (2008) Educational professionals'experiences of self ‐ harm in primary school children: ‘You don't really believe, unless you see it’,Oxford Review of Education, 34:2, 253-269, DOI: 10.1080/03054980701663967 To link to this article: PLEASE SCROLL DOWN FOR ARTICLETaylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. 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Terms &Conditions of access and use can be found at  Oxford Review of EducationVol. 34, No. 2, April 2008, pp. 253–269  ISSN 0305-4985 (print)/ISSN 1465-3915 (online)/08/020253–17© 2008 Taylor & FrancisDOI: 10.1080/03054980701663967 Educational professionals’ experiences of self-harm in primary school children: ‘You don’t really believe, unless yousee it’ Rebecca Simm, Katrina Roen *  and Anna Daiches Lancaster University, UK  TaylorandFrancisLtd CORE_A_266239.sgm10.1080/03054980701663967OxfordReviewofEducation0305-4985(print)/1465-3915(online)OriginalArticle2007Taylor&  This paper reports on an empirical study concerning educational professionals’ understandings of self-harm in primary school children. There is little research available about self-harm in primary-school aged children, and literature searches for the current study have revealed no research onprimary school professionals’ understandings of self-harm in their pupils. This is remarkable giventhe role that such professionals play in pastoral care. The present qualitative research involved inter-viewing 15 staff members of six schools in the North of England and analysing transcribed datausing Interpretative Phenomenological Analysis. The findings of this exploratory study suggest acyclical relationship between the experience, understanding and awareness of self-harm asdescribed by primary school professionals. This research is presented as a springboard for improvingunderstandings of how self-harm is experienced and managed in primary schools. It is hoped thatthe findings might contribute to a long term goal of working with school communities to developsystem-level interventions that cultivate existing resources for addressing self-harm in children. Introduction Rates of self-harm in the UK have increased over the past 10 years and are among thehighest in Europe (National Institute for Health and Clinical Excellence, 2004). Theincidence of self-harm appears to be rising among young people (Fortune & Hawton,2005), with evidence to suggest that it is beginning earlier in the childhood andadolescent years, thus prevalence rates within younger age groups are rising (Darche,1990; Conterio et al. , 1998; DiClemente et al. , cited in White Kress et al. , 2004). Upto 20% of people who are referred to Child and Adolescent Mental Health Servicespresent following self-harm (Audit Commission, 1999). * Corresponding author: Institute for Health Research, Lancaster University, LA1 4YT, UK.Email:    D  o  w  n   l  o  a   d  e   d   b  y   [   L  a  n  c  a  s   t  e  r   U  n   i  v  e  r  s   i   t  y   L   i   b  r  a  r  y   ]  a   t   0   8  :   5   1   3   1   M  a  r  c   h   2   0   1   5  254 R. Simm et al.In the UK, approximately 25,000 young people present to hospital Accident andEmergency departments with self-harm, but it is becoming apparent that such figuresare merely the ‘tip of the iceberg’. Recent school-based research in the UK andAustralia suggests that much more self-harm in children and adolescents occurs in thecommunity and does not come to medical attention (Hawton et al. , 2002; De Leo &Heller, 2004; Hawton et al. , 2006).This paper reports findings from research concerned with educational profession-als’ understanding of self-harming behaviour among primary-school aged children. Of particular interest are (i) what is considered to count as self-harm, (ii) what evidencethere is for the occurrence of self-harm among primary-school aged children, and (iii)what is known about educational professionals’ responses to such behaviour. Thepresent paper goes some way to addressing each of these points both in the literaturereview and reporting the empirical study.There is generally a lack of consensus about how to define self-harm. A key issuein the definition of self-harm is whether this should include ‘indirect’ behaviourssuch as reckless driving as well as ‘direct’ behaviours, such as cutting. In addition,definitions of self-harm often attempt to clarify the relationship between thesebehaviours and suicidal actions. The intent behind potential self-harming behaviouris central to both these issues. A typical definition is offered by the National Chil-dren’s Bureau: ‘Self-harm is when someone deliberately hurts or injures themselves.This can take a number of forms: cutting or burning—the most common forms of self-harm, taking overdoses of tablets or medicines, punching themselves, throwingtheir bodies against something, pulling out their hair or eyelashes, scratching, pick-ing or tearing at their skin causing sores and scarring, inhaling or sniffing harmfulsubstances, swallowing things that are not edible, inserting objects into their bodies’(NCB, 2005).No literature seems to be available on how children define self-harm, althoughsome studies have addressed adolescents’ definitions of self-harm. Laye-Gindhu andSchonert-Reichl (2005), for instance, explored what adolescents aged 13–18perceived to be ‘self-harming behaviour’ and found that participants not onlyreported behaviours identified in previous research (Patton et al. , 1997; Ross &Heath, 2002; Rodham et al. , 2004; all cited in Laye-Gindhu & Schonert-Reichl,2005) but some also considered eating disorders and non-suicidal pill-abuse toconstitute self-harm. Laye-Gindhu and Schonert-Reichl (2005) suggest that theirfindings highlight the importance of attending to the viewpoints of adolescents as theviews of adult researchers in isolation may not accurately reflect the actual experi-ences and perceptions of young people.Little research has been found which focuses on primary-school aged children andself-harm, so the literature reviewed here includes: (i) studies providing some data onchildren and self-harm and (ii) research with adolescents and young adults thatprovides retrospective evidence of self-harm earlier in childhood.Literature searches have identified four studies involving children aged 11 andunder as participants (Nadkarni et al. , 2000; Meltzer et al. , 2001; Ayton et al. , 2003;Dow, 2004). Of these four, two are hospital-based studies that used Accident and    D  o  w  n   l  o  a   d  e   d   b  y   [   L  a  n  c  a  s   t  e  r   U  n   i  v  e  r  s   i   t  y   L   i   b  r  a  r  y   ]  a   t   0   8  :   5   1   3   1   M  a  r  c   h   2   0   1   5  Self-harm in primary school children 255Emergency (A&E) Department records to ascertain the prevalence of young peoplepresenting with self-harm. The findings of these two studies suggest that childrenunder the age of 11 rarely present to A&E departments with deliberate self-harm(Nadkarni et al. , 2000; Ayton et al. , 2003). Findings from these two studies givelimited information on the age group of interest here. This may be for a variety of reasons, not least of all because Nadkarni et al. , for example, explicitly excluded allchildren under the age of 10, since no intention to deliberately self-harm was includedin the case notes. It is reasonable to assume that primary-school aged children whopresent to A&E will not be perceived, or recorded, as self-harming if the adultsconcerned do not consider the possibility of self-harm in children. This issue of theperception and visibility of self-harm in primary-school aged children is central to thepresent study.The other two papers identified in the search for literature on children and self-harm reported on community based studies (Meltzer et al. , 2001; Dow, 2004).Meltzer et al.  (2001) surveyed 10,438 children and adolescents in England,Scotland and Wales to establish the prevalence rates of deliberate self-harm amongthose aged 5–15 outside a hospital setting. These researchers sought to interviewyoung people aged 11–15 years about self-harm but, in relation to children under 11years of age, they interviewed only the parents. This study found that according to their  parents , 1.3 % of 5–10 year olds had at some point tried to harm, hurt or killthemselves. In the 11–15 year old age group, information was collected from both theyoung person and the parent. Comparison of this parent and child data suggests thatthere was a low degree of concurrence between the two reports. Of 4249 11–15 yearolds, 248 reported trying to harm themselves, while 78 parents reported that theirchild had tried to harm themselves. There was agreement in 38 cases (i.e., bothparties said that they or their child had harmed themselves). Among the 4001children who said they had not tried to harm themselves, 1% of their parents said theyhad, whereas of the 4171 children whose parents said they had not tried to harmthemselves, 5% of children said they had done so. Factors such as the perceivedstigma around self-harm (Fox & Hawton, 2004) may have influenced participants’decision to disclose self-harm to the researcher.Dow (2004) reports a community based study drawing data from written recordsof phone conversations conducted by ChildLine. This study found that, of those chil-dren and young people who talked to ChildLine about self-harm and gave their age,2% were 5–11 yrs old.Qualitative studies involving adolescents or adults provide retrospective evidenceto suggest that self-harm can start in primary-school aged children (Spandler, 1996;Sutton, 1999; Len & Kortum, 2004). Spandler (1996) conducted a qualitative studyexploring the views of 15 people aged 15–25 who had experience of repeated self-harm. As illustrated by the following excerpt from Spandler’s data, this study providesevidence of self-harm in children: [The] first time I harmed myself—I was about four—stabbed myself in the arm with a fork,seeing blood—and thinking afterwards, god this feels good … when I was about eight Istarted using razor blades. (Spandler, 1996, p. 43)    D  o  w  n   l  o  a   d  e   d   b  y   [   L  a  n  c  a  s   t  e  r   U  n   i  v  e  r  s   i   t  y   L   i   b  r  a  r  y   ]  a   t   0   8  :   5   1   3   1   M  a  r  c   h   2   0   1   5  256 R. Simm et al.Spandler further found that, many of the young people expressed some confusion and uncertainty … [sometimesrealising] that their self-harm had begun earlier than they had previously envisaged ….Thus some of the young people recalled banging their head as a young child or eatingharmful substances such as glass, and queried, ‘does that count?’. (Spandler, 1996,pp. 43–44) This study suggests that younger children who self-harm do not realise they are self-harming, or that this behaviour is not perceived as such by others. The study alsosuggests that forms of self-harm may change or evolve as children become older,which may mean that self-harm in younger children takes a different form to self-harm in older children and adolescents.The insights offered by both Spandler and Meltzer et al. ’s studies are important forthe present study. Both found clear evidence that children do self-harm. Meltzer et al. highlighted the discrepancies between adults’ perceptions of whether or not childrenself-harm, and children’s own reports. Further, Spandler’s retrospective work withadolescents suggests that the ability to recall and recount stories of self-harm hingeson the research participant’s evolving understanding of what counts as self-harm.These issues are taken up in detail in the course of this paper as we consider howadults who work with children talk about what counts as self-harm and whether ornot children’s self-harm is visible to adults. Educational professionals’ understandings of self-harm in their pupils Given the time children spend in school, arguably, schools cannot avoid exerting asubstantial influence on children’s personal and social development (Galloway,1990). It has been suggested that schools may influence self-harming behaviour inchildren (Meltzer et al. , 2001; Dow, 2004).While school staff are ‘in a unique position to identify and respond to pupils’personal, social, emotional and behavioural needs’ (Best, 2004, p. 3), there isclear evidence that, with regard to self-harm, schools are often failing to do so(Best, 2004). A review of government strategies aimed at promoting well-beingfor all children across educational settings shows that, in the UK, the strategieswere generic with little to no focus on the specific issue of self-harm (YoungPeople and Self-harm National Inquiry, 2005). Young people involved in theinquiry felt that self-harm should be tackled in schools and that comprehensivetraining was essential for teachers to know how to talk about self-harm, and todetect the signs of self-harm. Findings from this inquiry resonate with the presentstudy in noting concerns over time constraints faced by teachers and queryingwhether teachers would be given adequate resources to deal with the issue of self-harm.The findings of the inquiry raise the issue of how educational professionals under-stand self-harm. However, it seems there is limited research exploring professionals’understandings and responses to self-harm in pupils. The one study identified (Best,    D  o  w  n   l  o  a   d  e   d   b  y   [   L  a  n  c  a  s   t  e  r   U  n   i  v  e  r  s   i   t  y   L   i   b  r  a  r  y   ]  a   t   0   8  :   5   1   3   1   M  a  r  c   h   2   0   1   5
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