Title: Design of an online training programme and support tool for secondary schools to improve response to young people who self-harm (SORTS – SuppOrtive Response To Self-harm).
Funder: Department of Health and Social Care

Abstract: Background: Self-harm among young people (YP) is a serious concern. UK prevalence is at nearly 20% (1) and early reports suggest that the current Covid-19 pandemic will have long-term, negative effects on YP s mental health (MH) (2), potentially increasing rates of self-harm (3). YP who self-harm are at high risk of adverse outcomes, including increased suicide risk (4, 5), yet, most YP who self-harm do not seek or receive professional help (6) There are numerous barriers to YP s help-seeking including fears about negative reactions to discovery or disclosure (5). School staff are well placed to respond to self-harm (7); however they often do not feel equipped to support YP (8). This may result in unhelpful responses that further deter YP from seeking help, or in missed opportunities to intervene. Consequently, there is a substantial, unmet need for an accessible, feasible training programme and support tool for schools to address self-harm among their pupils. Aims and Objectives: To co-produce and test a prototype online training programme and support tool for school staff (SORTS) to improve their response to YP who self-harm. The objectives are to: (i) explore YP s expectations of how schools and staff should respond to self-harm. (ii) co-design a SORTS prototype training programme through interactive workshops with school staff. Methods: Drawing on our systematic review (9) and existing guidelines (10), we will work with a technical provider to develop a SORTS prototype. It will include functional examples of interactive tools and techniques designed to deliver the content and enable users to practice and consolidate new skills. We will conduct online focus groups/interviews with YP to elicit their views about how schools and staff should address self-harm. Co-design workshops with school staff will gather their views on the proposed content and training strategies. Data will be thematically analysed (11) Timelines: The study duration is 15-months. Prototype development (WP1) will start when funding is confirmed and finalised in month 7 (M7). M1-M2: Recruitment and consent. WP2: (M3-M8): M3-M6: Focus groups/interviews with YP; M5-M8: Data analysis; M3-M7: Prototype development WP3: (M6-M14): M6-M7: Recruitment; M8-M14: Participant communication platform; M8-M11: Staff co-design workshops; M10-M13: Data analysis; M12-M15: Design document and final report Anticipated Impact: Impact will necessarily be limited as this is an early phase developmental project. In the medium-term, should SORTS prove effective in further evaluation, we hypothesize that school staff s improved confidence will lead to more appropriate responses that will encourage pupil disclosure and facilitate access to available on-site and external support. This will reduce serious consequences of self-harm, i.e. hospitalisation. Long term, larger-scale benefits will include reduction of societal and healthcare adverse outcomes and costs related to self-harm. Dissemination: Main outputs: (i) prototype SORTS programme; (ii) final design specification for the beta version development (iii) open-access publication on co-design process. In partnership with Charlie Waller Trust, we will engage schools and MH professionals to adopt SORTS. We will explore feasible routes to deliver the programme at scale to end-users at lowest possible cost.

Lay abstract: Self-harm is a common problem among adolescents and is a serious health concern. Self-harm is when you hurt yourself on purpose. There are lots of reasons why young people self-harm but it is often a reaction to difficult and distressing feelings. Research shows that young people who self-harm are more likely to have mental health difficulties in later life and are at a higher risk of suicide. The annual cost of assessing and treating self-harm in England is estimated to be &pound;162 million. This has highlighted the need to prevent self-harm as early as possible. School staff are often the first professionals to notice that a young person is self-harming and are in an ideal position to provide those students with support. However, many teachers say they don t have the right knowledge or training to deal with the problem, and they don t feel confident in how they should react. Many schools do not have a self-harm policy in place and this means staff may not have clear guidance in how to respond to students who self-harm. There is a clear need to provide schools with the tools and training to help them to improve in their response. The aim of this study is to design an online training programme and support tool to improve the staff response to students who self-harm. We call the programme SORTS: SuppOrtive Response To Self-harm. The programme will provide a flexible and cost-effective method of increasing staff knowledge, skills and confidence in how to respond to students who self-harm. It will also include a support tool which will help schools to develop a self-harm policy tailored specifically for their school. We will work in partnership with the Charlie Waller Trust to develop the training content and with a technical provider to develop the SORTS online training prototype. It will be designed by working closely with secondary school students, school staff and mental health professionals. First, we will run online focus groups with young people aged 14-21 years to explore their views on what school staff should know about self-harm, and how they should respond and support students. We will also run interactive co-design workshops with school staff and mental health professionals to gather their views on the prototype and this will help us to finalise the programme. Once the design is finalised, we will seek further funding to test the training programme and support tool in schools.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH