RLO: Effective communication with children and young people following self-harm admission: Effective communication and engagement

Effective communication and engagement

As a health professional working with children, you will already know the importance of good communication. For those children and young people admitted with self-harm, there is typically feelings of shame which can be heightened when being on a ward. This can be worsened by the actions of people caring for them, but equally it can be made easier.

While there are many subtleties to communication with children and young people, you may find the following strategies helpful to become a more confident and effective communicator.

	When communicating with the child or young person, use open-ended questions. These often start with words such as 'what', 'when', 'how' or 'where'.
	For children and young people with communication impairment (i.e. they have hearing difficulty), work with parents or carers to establish the most suitable methods to communicate.
	Avoid using 'why' questions as these can appear judgemental. For example, instead of asking, "why do you self-harm?", use a question like "what is it about self-harming that helps?"
	Avoid the term "deliberate self-harm". It has negative connotations and is no longer recognised or used by health professionals.
	Use active listening (let the person know you have listened to what has been said by paraphrasing the key points of the conversation).
	Use information you have read in the nursing/medical notes and at handovers. For example, "I heard you are feeling a bit better now than before you came into hospital" or "I heard you’re still finding things really difficult at home/school".
	Don’t jump to conclusions about what has been said. Recognise your own feelings and make sure they are not a barrier to effective communication.

	Let the child or young person know the process, who they will see and why, what this means and what is involved. Ensure they have a written CAMHS information leaflet such as the one entitled 'Your self-harm assessment' available from your hospital trust.
	Tell them about the CAMHS assessment (i.e. this will involve finding out about you and your life, as well as what happened before you came in to hospital). They will use this to make an assessment and plan what support you may need going forward.
	If you are asked a question to which you don’t know the answer to then inform the child or young person that you will find out and get back to them.
	Work collaboratively with the child or young person and state you would like to learn from them to develop a short-term care plan.
	When you are at the end of your shift let the child or young person know you will be talking to the health professional who will be replacing you. This will enable the new person to continue care from where you left off. If possible, include the child or young person during this handover, to build a collaborative and open approach to care.

	Providing the child or young person something to do will alleviate boredom and also act as a distraction technique to further self-harm. This may also help reduce any anxiety/worry about the CAMHS assessment.
	It is important to ask the child or young person what they would like to do; you may want to ask about their interests at home.
	If the child or young person is shy or does not want to talk, you could suggest they use a post it note to let you know what they would like to do. This can then be looked at later together.
	Some activities you may want to consider offering the child or young person include colouring, drawing, watching films, reading books, video games and visiting the 'teen room' or youth service (if available).

	The child or young person may not know that they can call upon you should they feel the need – so let them know.
	Be clear that you are not a therapist but that you are a good listener. Speak to the child or young person about their feelings - don’t simply see this as the CAMHS role.
	If they want to talk then spend time with them. If they look distressed, be proactive and ask them if they would like to talk.

	This strategy can work if the child or young person is less communicative. It works by simply asking them to rate on a scale of 1-10 (with 10 being really bad and 1 being pretty good) how they are feeling at the moment? You can then follow this up by saying "What can we/I do for you to feel one 1 point higher?"
	You can also try asking the child or young person to rate themselves and putting the answer on a post it on note which can be stuck on the end of their bed. This allows them to tell you how they are feeling without having to announce it verbally.
	Don’t be afraid to challenge or ask if you are concerned or worried about the rating. You can ask, for example, "I have noticed that you seem really distressed, and maybe more so since this morning, what could I do make you feel even a little better?"

	Offering the child or young person support and justification for being in hospital can lessen the shame the child or young person feels having been admitted on to a ward. This can be achieved by saying some non-judgemental phrases such as: - "We do take this seriously, and that is why you have to stay here because we just need to make sure you are safe and getting any help you need." - "You did the right thing coming to ED (or telling your parents)." - "It’s important to us you spend some time here to try and relax. Feel free to talk to us when you are able."
	Don’t avoid talking to the child or young person for fear of saying something wrong. This can reinforce the stigma felt by child or young person.

	If the child or young person has regularly self harmed, they are likely to be the expert in what helps them or makes them feel worse.
	Consider tapping into a child or young person's expertise by asking them what they usually do to help themselves during periods when they feel like self-harming. If they make no suggestions, you may feel it appropriate to offer alternative 'safer' self-harm methods such as snapping a rubber band around the wrist, holding ice cubes or using a stress ball.
	Should you suggest alternatives, do acknowledge that this will not be the same as cutting (or whatever method they have self-harmed) but explain it may help while they are staying on the ward.