ISCA 2025

Self-injury: Identifying and responding to adolescents in schools

Self-injury in adolescents, observed in 14–18% within schools in the U.S. (Hasking et al., 2016) and 16–22% globally (Xiao et al., 2022), often emerges as a coping mechanism for psychological distress. Despite its prevalence—and the fact that most school mental health professionals have encountered self-injuring students—many educators feel unprepared to intervene with students engaging in self-injury.

Additionally, self-injury, a spectrum of behaviors that function to manage intense emotional responses, is increasingly noted beyond psychiatric contexts, heightening its complexity and the need for school-based intervention strategies. Research increasingly suggests that self-injury signals a significant risk for suicidal behavior, underscoring the necessity for ongoing assessment of suicidal ideation.

The phenomenon of contagion, where self-injury occurs within peer groups or is influenced by online communities, further complicates management in the school setting. Experts advocate for systematic approaches, including a collaboratively designed school protocol to ensure consistent, appropriate responses within the school environment. This involves training staff, defining roles, assessing risk, and managing contagion.

This course will address issues related to identification and intervention of self-injury within the school context, a systematic school protocol for self-injury, and the critical role of school mental health professionals in mitigating self-injury. An electronic version of Coping with Self-Injury, a strategy guide for use with adolescents, will be provided to participants.

Student standards

This course will support you in providing strategies for your students to be able to:

  • SE A1:3 Develop self-awareness and self-management skills for mental health

  • SE A1:6 Develop healthy ways to identify, express, and respond to one’s emotions

  • SE A1:9 Identify long- and short-term goals

  • SE B1:3 Apply effective problem-solving and responsible decision-making skills to make safe and healthy choices

  • SE B1:5 Demonstrate when, where, and how to seek support for solving problems and making decisions

ASCA ethical standards

This course is aligned to the following ASCA ethical standards for school counselors:

A.9. Serious and foreseeable harm to self and others

School counselors:

  1. Inform parents/guardians and school administration when a student poses a serious and foreseeable risk of harm to self or others. This notification is to be done after careful deliberation and consultation with appropriate professionals, such as other school counselors, the school nurse, school psychologist, school social worker, school resource officer, or child protective services. Even if the danger appears relatively remote, parents/guardians must be notified. The consequence of not giving parents/guardians a chance to intervene on behalf of their child is too great.

A.1. Supporting student development

School counselors:

  1. Have a primary obligation to students, who are to be treated with dignity and respect as unique individuals.

  2. Foster and affirm all students and their identity and psychosocial development.

  3. Provide culturally responsive counseling to students in a brief context and support students and families/guardians in obtaining outside services if long-term mental health counseling is needed.

  4. Provide culturally responsive instruction, appraisal, and advisement to students.

ASCA professional standards and competencies

Based on the ASCA School Counselor Professional Standards and Competencies mindset (M7: School counseling programs promote and enhance student academic, career, and social/emotional outcomes), the following professional foundation behaviors apply:

B-SS 3. Provide short-term counseling in small-group and individual settings

a. Use data to identify students in need of counseling intervention.

  1. Provide support for students, including individual and small-group counseling, during times of transition, heightened stress, critical change, or other situations impeding student success.

  2. Explain the difference between appropriate short-term counseling and inappropriate long-term therapy.

  3. Explain the impact of adverse childhood experiences and trauma, and demonstrate techniques to support students who have experienced trauma.

  4. Respond with appropriate intervention strategies to meet the needs of the individual, group, or school community before, during, and after crisis response.

B-SS 4. Make referrals to appropriate school and community resources

  1. Maintain a list of current referral resources, consistent with school and district policies, for students, staff, and families to effectively address academic, career, and social/emotional issues.

  2. Communicate the limits of school counseling and the continuum of mental health services.

  3. Articulate why diagnoses and long-term therapy are outside the scope of school counseling.

Audience

School-based mental health professionals, including psychologists, school counselors, school psychologists, and social workers.

Essential questions

  • How can self-injury and suicidal behavior be distinguished?

  • How can self-injury be assessed in schools?

  • How should educators respond to self-injury?

By the end of this course, participants will have knowledge about:

  • Appropriate school-based screening methods for identifying self-injury in adolescents

  • The role of school-based mental health professionals in initiating self-injury intervention

  • Current resources for increased understanding of self-injury for adults supporting adolescents who engage in self-injury

Participants will be able to:

  • Identify self-injury behaviors in adolescents within the school setting

  • Apply evidence-based methods to respond effectively to adolescent self-injury as school-based mental health professionals

  • Develop and implement a research-based framework for a school protocol to mitigate self-injury

References list

Bubrick, K., Goodman, J., and Whitlock, J. 2010. Non-suicidal self-injury in schools: Developing and implementing school protocol [Fact sheet]. Cornell Research Program on Self-Injurious Behavior in Adolescents and Young Adults. Retrieved from http://crpsib.com/userfiles/NSSI-schools.pdf

Darosh, A. G., and Lloyd-Richardson, E. E. 2013. “Exploring why students self-injure: The functions of nonsuicidal self-injury.” School Psychology Forum: Research in Practice 7 (4): 111–120.

de Neve-Enthoven, N. G. M., Ringoot, A. P., Jongerling, J., Boersma, N., Berges, L. M., Meijnckens, D., Hoogendijk, W. J. G., and Grootendorst-van Mil. 2024. “Adolescent nonsuicidal self-injury and suicidality: A latent class analysis and associations with clinical characteristics in an at-risk cohort.” Journal of Youth and Adolescence 53: 1197–1213.

Dickstein, D. P., Puzia, M. E., Cushman, G. K., Weissman, A. B., Wegbreit, E., Kim, K. L., Nock, M. K., and Spirito, A. 2015. “Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury.” Journal of Child Psychology and Psychiatry 56 (10): 1127–1136.

Farkas, B. F., Takacs, Z. K., Kollarovics, N., and Balazs. 2022. “The prevalence of self-injury in adolescence: A systematic review and meta-analysis.” European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-023-02264-y

Glenn, C. R., Franklin, J. C., and Nock, M. K. 2015. “Evidence-based psychosocial treatments for self-injurious thoughts and behaviors in youth.” Journal of Clinical Child and Adolescent Psychology 44 (1): 1–29.

Glenn, C. R., Lanzillo, E. C., Esposito, E. C., Santee, A. C., Nock, M. K., and Auerbach, R. P. 2017. “Examining the course of suicidal and nonsuicidal self-injurious thoughts and behaviors in outpatient and inpatient adolescents.” Journal of Child Psychology 45: 971–983. https://doi.org/10.1007/s10802-016-0214-0

Guan, K., Fox, K. R., and Prinstein, M. J. 2012. “Nonsuicidal self-injury as a time-variant predictor of adolescent suicide ideation and attempts in a diverse community sample.” Journal of Consulting and Clinical Psychology 80 (5): 842–849.

Hasking, P. A., Heath, N. L., Kaess, M., Lewis, S. P., Plener, P. L., Walsh, B. W., Whitlock, J., and Wilson, M. S. 2016. “Position paper for guiding response to non-suicidal self-injury in schools.” School Psychology International 37 (6): 644–663.

Heath, N., and Lewis, S. P. 2013. “Nonsuicidal self-injury in our schools, from research to practice: Introduction to the special issue.” School Psychology Forum: Research in Practice 7 (4): 89–92.

Heath, N., Toste, J., and Beettam, E. 2006. “‘I am not well-equipped’: High school teachers’ perceptions of self-injury.” Canadian Journal of School Psychology 21: 73–92.

JED Foundation. 2023. Can the metaverse be good for youth mental health? Retrieved from https://jedfoundation.org/wp-content/uploads/2023/07/Can-The-Metaverse-Be-Good-For-Youth-Mental-Health-Jed-Foundation.pdf

Lieberman, R. 2010. General guidelines for administrators intervening with self-injurious youth. Los Angeles County Youth Suicide Prevention Project. Retrieved from http://preventsuicide.lacoe.edu

Lieberman, R. A., and Poland, S. 2006. “Self-mutilation.” In Children’s Needs III: Development, prevention, and intervention, edited by G. G. Bear and K. M. Minke, 965–976. Bethesda, MD: National Association of School Psychologists.

Lieberman, R. A., Poland, S., and Niznik, M. 2019. “Nonsuicidal self-injury: Handout for school.” In Helping handouts: Supporting students at school and home (S3H10), edited by G. G. Bear and K. M. Minke. Bethesda, MD: National Association of School Psychologists.

Lieberman, R. A., Toste, J. R., and Heath, N. L. 2009. “Non-suicidal self-injury in the schools: Prevention and intervention.” In Self-injury in youth: The essential guide to assessment and intervention, edited by M. K. Nixon and N. L. Heath, 195–215. New York: Routledge.

Mahdy, J. C., and Lewis, S. P. 2013. “Nonsuicidal self-injury on the internet: An overview and guide for school mental health professionals.” School Psychology Forum: Research in Practice 7 (4): 148–160.

Miller, D. N., and Brock, S. E. 2011. Identifying, assessing, and treating self-injury at school. New York: Springer Science and Business Media.

Nock, M. K., Joiner, T. E., Gordon, K. H., Lloyd-Richardson, E., and Prinstein, M. J. 2006. “Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts.” Psychiatry Research 144: 65–72.

Reddy, N., Rokito, L., and Whitlock, J. 2016. “What is the link? The relationship between non-suicidal self-injury and social media.” Information Brief Series. Cornell Research Program on Self-Injury and Recovery, Cornell University.

Ribeiro, J. D., Franklin, J. C., Fox, K. R., Bentley, K. H., Kleinman, E. M., Chang, B. P., and Nock, M. K. 2016. “Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies.” Psychological Medicine 46 (2): 225–236. https://doi.org/10.1017/S0033291715001804

Schatten, H. T., Morris, B. W., Wren, A. L., and Andover, M. S. 2013. “Mental health issues and nonsuicidal self-injury among youth: Implications for mental health professionals in the school system.” School Psychology Forum: Research in Practice 7 (4): 136–147.

Shinn, M. M. 2023. Nonsuicidal self-injury: A brief overview [Handout]. National Association of School Psychologists.

Walsh, B. W. 2012. Treating self-injury: A practical guide. 2nd ed. New York: Guilford Press.

Walsh, B. W., and Muehlenkamp, J. J. 2013. “Managing nonsuicidal self-injury in schools: Use of a structured protocol to manage the behavior and prevent social contagion.” School Psychology Forum: Research in Practice 7 (4): 161–171.

Whitlock, J., and Rodham, K. 2013. “Understanding nonsuicidal self-injury in youth.” School Psychology Forum: Research in Practice 7 (4): 93–110.

Xiao, Q., Song, X., Juang, L., Hou, D., and Huang, X. 2022. “Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among non-clinical samples of adolescents: A meta-analysis.” Frontiers in Psychiatry 13: 912441. https://doi.org/10.3389/fpsyt.2022.912441