8.4.4 Responding to a Group of Children and Young People Aged Under 18 Who Are at Risk of or Engaging in Self-harm Behaviour Together

1. Definition

The term ‘self-harm group’ describes a situation in which young people (children under the age of 18) are engaging in self-harm behaviour collectively.

It is difficult to precisely define a self-harm group. A self-harm group could include 3 or more young people; however, 2 young people engaging in self-harm occurring in a specific community or setting (for example a school) in a short time period should also be taken very seriously in terms of possible links and impacts.  This should also be the case even if the young people are apparently unconnected, particularly in the case of young people. It is important to establish at a very early stage if there are connections between young people who engage in self-harm behaviours.

It is also important to recognise that there do not have to be clear connections for multiple young people who are engaging in self-harming behaviours to constitute a self-harm group. Multiple unconnected self-harm behaviours in a community can have similar consequences to a group in which links between young people who self-harm are apparent, such as media response, heightened local concerns and speculation, and influence on methods used for self-harm. One of the challenges of identifying a self-harm group, especially in the early stages, is that they may present as single events of self-harm.

It is important that professionals use their judgement and professional curiosity to consider what constitutes a self-harm group and consider the safeguarding concerns, risk reduction and impact of contagion, considering both individual risk and risk for multiple individuals or group/s.

2. General Principles

Following the identification of a possible self-harm group there is the need for significant specialist input and a dynamic multi-agency response to identify and assess a considerable number of young people who may be at increased risk due to the self-harm group to reduce the risk of contagion and support those young people at risk.

Responding to a potential self-harm group requires a time-critical response.  Safeguarding partners have committed to provide the resource required if a response is required, including the formation of dedicated teams of professionals from Children’s Services, specialist mental health services, Police, Education, Early Help and other third sector organisations, for example, Mind etc.

A self-harm group is different to responding to self-harm.  There are established processes already in place that outline the initial response to self-harm behaviour. These processes should continue to be followed.  See chapter on Self-harm, Suicidal Behaviour and Suicide.

This policy outlines when a multi-agency response is required.

3. Response

If there is a concern about a possible self-harm group a Multi-Agency Response Group – (Scoping) meeting should be held to identify risk, cross referencing and multi-agency information sharing and to agree shared management of risk and safety planning across the individual/s.

Agency requests for a Multi-Agency Response Group (Scoping) meeting should be made via the Local Authority’s Integrated Front Door (IFD) / MASH, in line with local safeguarding referral processes. The IFD will then consider the information provided, liaise with safeguarding partners, and coordinate the convening of the Scoping meeting.

Agencies should raise the concern through a child safeguarding referral, clearly identifying the suspected group dynamic, and request that a Multi-Agency Response Group (Scoping) meeting be initiated.

During the risk assessment process, professionals may identify a number of young people who are vulnerable and at increased risk of self-harm or who have expressed feelings of suicidality in the past.

In addition to considering the individual young person who has self-harmed, and where there is a concern this is influenced through a group it is vital that consideration is given to identifying individuals involved in the social networks of those young people.  This would be consideration of connections, both in real life and in the virtual world, of other young people, in order to provide specific support and undertake risk assessments where there are concerns.

A Multi-Agency Response Group scoping meeting can be initiated at any stage in the process of responding to a self-harm group.  This is in view of the potential for situations to rapidly change and knowing that assessments are dynamic.

4. Multi-Agency Response Group – Scoping Meeting

A Multi-Agency Response Group – Scoping meeting should be held to identify risk, cross referencing and Multi-Agency information sharing and action.

Required attendees at the meeting:

• Children’s Services – Head of Children’s Safeguarding or delegate (Chair);
• Children’s Social Care;
• CAMHS (Suicide Prevention lead and/or appropriate manager);
• Police representative;
• Head of Safeguarding ICB;
• Public health consultant;
• Head of Safeguarding or Named Nurse from acute provider;
• If Looked After, Children in Care Specialist Nurse;
• Local authority education lead/ Educational Psychologist, Wellbeing lead officer, include Elective Home Education/Children Missing Education lead if appropriate;
• Education –(include previous school if recent change – consider both primary / secondary and links to sibling schools);
• Local authority communications lead;
• District / Borough Council representative if relevant;
• Mental Health Adults Services;
• Additional membership may be required dependent on the circumstances e.g. digital safety team, in-patient clinical ward representation.

The scoping meeting must:

• Assess the information known to date;
• Decide what further information is required at this stage;
• Arrange for its gathering;
• Undertake an initial mapping exercise to determine the scale of the response and possible young people requiring specific support. Consider risks relating to contagion;
• Consider any immediate protective action required and if a separate S47 enquiry should take place for individual children;
• Identify a response plan including a review mechanism;
• Feedback the outcome of the scoping strategy meeting including resource implications, if a self-harm group is identified to the Multi Agency Response Group;
• Agree a review date to ensure all children identified have been assessed;
• Communication including communication with parents / carer.

The purpose will be to discuss reason why there is possibly a self-harm group, the risks and response to mitigate risks.

The meeting needs to take account of the likely impact the self-harm group may have on young people, the and identify action to reduce any identified risks.

The Multi-Agency Response Group scoping meeting will then determine if a full Multi-Agency Response is required.

This can constitute;

Multi-Agency Response Group – (Strategic)

Multi-Agency Response Group – (Operational)

4.1 Multi-Agency Response Group – (Strategic)

The Multi-Agency Response Group- (Strategic) will build upon the scoping meeting.  Considering the likely impact the self-harm group may have on young people and identify action to reduce any identified risks.

Attendees:

Professionals attending will need to be of a relevant position in their organisation to, where necessary, be expected to contribute resources from their agency to support the young person and manage risk.

• Children’s Services – Head of Children’s Safeguarding or delegate (Chair);
• Children’s Social Care;
• CAMHS (Suicide Prevention lead and/or appropriate manager);
• Police representative;
• Head of Safeguarding ICB;
• Public health consultant;
• Head of Safeguarding or Named Nurse from acute provider;
• If Looked After, Children in Care Specialist Nurse;
• Local authority education lead/ Educational Psychologist, Wellbeing lead officer, include Elective Home Education/Children Missing Education lead if appropriate;
• Education –(include previous school if recent change – consider both primary / secondary and links to sibling schools);
• Local authority communications lead;
• District / Borough Council representative if relevant;
• Mental Health Adults Services;
• Additional membership may be required dependent on the circumstances e.g. digital safety team in-patient clinical ward representation.

In selecting staff, consideration should be given to requirements arising from the individual needs of the relevant child(ren) – e.g., gender, culture, race, language, and where relevant, disability.

The meeting must consider a wide range of issues and agree a plan that includes:

• A decision on the scale of the response and if additional agency representation is required to support;
• The focus of the response – online harm / in person;
• Any cross-boundary issues and planning of appropriate liaison and sharing of resources;
• Identification of staff to manage the intelligence gathering from social media / live time surveillance;
• Sufficient support, supervision and debriefing of staff involved;
• Availability of expert advice where necessary;
• Liaison arrangements for inter-agency working;
• Time scales for the stages of the response;
• Allocation of specific tasks to personnel involved in the response together with line management responsibilities;
• Management of public relations and media interest;
• Management of political arena;
• Confidentiality / need to know arrangements;
• Exit strategy.

The Multi-Agency Response Group (Strategic) must ensure that any current risks to children are acted upon immediately, whenever they emerge during the investigation and should consider developing a risk management protocol.

The Multi-Agency Response Group (Strategic) must decide to convene regularly during the response to:

• Monitor the progress of the response;
• Ensure alignment with other governance structures involved in the response;
• Review risk indicators for the children involved;
• Consider resource requirements;
• Consider the appropriate timing of the termination of the response;
• Plan a de-brief meeting with the response management group to identify lessons learnt;
• Take forward actions from lessons learnt with clear plans in place.

Structures and processes should be in place to ensure timely debrief and support for staff involved in the response around their mental and emotional wellbeing.

4.2 Multi-Agency Response Group (Operational)

To support the plans identified at the Multi-Agency Response Group (Strategic) an operational group may be required.  It should take place and be attended by relevant operational professionals who know the detail of the young people to ensure a robust response and identification of risks.

Attendees could be, but not limited to:

• Children’s Services – Service Manager;
• Children’s Social Care;
• CAMHS (Suicide Prevention lead and/or appropriate manager);
• Police representative;
• Head of Safeguarding or Named Nurse from acute provider;
• If Looked After, Children in Care Specialist Nurse;
• Local authority education lead/ Educational Psychologist, Wellbeing lead officer, include Elective Home Education/Children Missing Education lead if appropriate;
• Education –(include previous school if recent change – consider both primary / secondary and links to sibling schools);
• District / Borough Council representative if relevant;
• Mental Health Adults Services;
• Additional membership may be required dependent on the circumstances e.g. digital safety team, in-patient clinical ward representation.

In selecting staff, consideration should be given to requirements arising from the individual needs of the relevant child(ren) – e.g., gender, culture, race, language, and where relevant, disability.

The operational group will provide feedback at a strategic level to the Multi-Agency Response Group (strategic).

The Multi-Agency Response Group (Operational) must ensure that any current risks to children are acted upon immediately, whenever they emerge during the investigation and should consider developing a risk management protocol.

The Multi-Agency Response Group must make arrangements to convene regularly during the response to:

• Scoping of young people at risk – more often, schools will be the agency who undertakes the risk assessments and identifies those most at risk;
• Identify individual response plans for the identified young people;
• Identify parental responses needed (e.g. communication/working with/education);
• Monitor the progress of the response;
• Ensure alignment with other governance structures involved in the response;
• Review risk indicators for the children involved;
• Consider resource requirements;
• Consider the appropriate timing of the termination of the response;
• Plan a debrief meeting with the response management group to identify lessons learned;
• Ensure that staff support structures and processes are in place and utilised.

Structures and processes should be in place to ensure timely debrief and support for staff involved in the response around their mental and emotional wellbeing.

5. Information Sharing

See also Information Sharing chapter.

Normal information sharing protocols will remain in place for any self-harm group response.

Where staff are utilised within schools to meet with specific young people, protocols for informing parents / carers ahead of any such meeting will be generated ahead of the meeting.

Where staff are deployed to schools as a means of ‘drop in’ support it is anticipated schools will inform parents / carers of this support before the first session takes place.

6. Crossing Geographical and Operational Boundaries

It may be recognised at the outset, or during the response, that there are young people requiring support in more than one geographical area – for example, online friends or friends who have recently moved out of the area. In such cases the responsibility of responding to risk and providing support should be agreed by Children’s Services and Police.

7. Closure

There must be a clearly defined exit strategy not only in relation to the closure of the response but also regarding the young people who have been supported. Clear safety plans will be drawn up for all those young people together with the agency(ies) who will support the young person moving forward.

Staff involved directly in the response need to be thoroughly debriefed at the conclusion.

At the conclusion of the response each agency should undertake a review, with a view to identifying any changes to policy or practice that may be necessary / beneficial. Such a review will complement any safeguarding practice review that may be concurrent or have been completed. Actions to be clearly taken forward.

The Multi-Agency Response Group should have a final meeting where concluding information and debriefing can be shared. An overview report should be compiled and presented to the safeguarding partnership.