Deliberate self-harm in children subject to a child protection plan
Date First Published:
February 8, 2021
Last Updated:
February 8, 2021
Report by:
Megan Gemmell , Medical Student (University of Liverpool)
Search checked by:
Dr Lalith Wijedoru , University of Liverpool
Three-Part Question:
In [children] is [deliberate self-harm a predictor] for being subject to a [child protection plan]?
Clinical Scenario:
A 13 year old female presents with self-inflicted lacerations on her wrists. It is revealed she has a history of physical and emotional abuse, and a child protection plan is in place. You wonder if deliberate self-harm is a predictor for being subject to a child protection plan?
Search Strategy:
Medline using OVID interface
Medline: ({[self-harm or self-injury or deliberate self-harm or self-injurious behaviour] OR self-poisoning OR [drug and alcohol abuse]} AND {[adolescents or teenagers or young adults] OR [children or adolescents or youth or child or teenager]} AND [child abuse or child neglect or child maltreatment] AND [social services OR [child welfare system or child protection or children’s services] AND [emergency department or emergency room])
PubMed: ([self-harm or self-injury] OR [self-mutilation] OR [cutting] OR [self-poisoning] OR [alcohol misuse] OR [drug misuse]) AND ([adolescents or young adults] OR [children] OR [teenagers]) AND ([child abuse] OR [child neglect] OR [child maltreatment]) AND ([social services] OR [child protection plan] OR [child welfare] AND emergency department)
Medline: ({[self-harm or self-injury or deliberate self-harm or self-injurious behaviour] OR self-poisoning OR [drug and alcohol abuse]} AND {[adolescents or teenagers or young adults] OR [children or adolescents or youth or child or teenager]} AND [child abuse or child neglect or child maltreatment] AND [social services OR [child welfare system or child protection or children’s services] AND [emergency department or emergency room])
PubMed: ([self-harm or self-injury] OR [self-mutilation] OR [cutting] OR [self-poisoning] OR [alcohol misuse] OR [drug misuse]) AND ([adolescents or young adults] OR [children] OR [teenagers]) AND ([child abuse] OR [child neglect] OR [child maltreatment]) AND ([social services] OR [child protection plan] OR [child welfare] AND emergency department)
Outcome:
114 full-texts articles were obtained and screened. 99 of these were irrelevant and excluded leaving 11 papers included in the review.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Child maltreatment and onset of emergency department presentations for suicide-related behaviors Anne E. Rhodes, Michael H. Boyle, Jennifer Bethell, Christine Wekerle, Deborah Goodman, Lil Tonmyr, Bruce Leslie, Kelvin Lam, Ian Manion 2012 Canada | 4,683 12–17-year-olds who had been removed from their parental home because of maltreatment and 1,034,546 of their population-based peers. |
Cohort study | Rates of a first presentation to the ED for suicide-related behaviour. | Adjusted odds ratio for first ED presentation for suicide related behaviour in those who suffered maltreatment, compared to their peers was 5.13 for boys and 5.36 for girls. | Coding in hospital records did not differentiate suicidal related behaviours- included both suicidal intent and non-suicidal self-injury. The study also lacks information on the type of abuse/maltreatment. Some sociodemographic factors such as ethnicity and postcode were missing from the records. |
| Depressive symptoms and self-harm among youngsters referred to child welfare: The role of trust in caregiver support and communication Tara Santens, Laurence Claes, Guy S Diamond, Guy Bosmans 2018 Belgium | 217 subjects aged 10-21 who had been involved in Flemish Child Welfare Services. | Online survey | Non-suicidal self-injury | 32.7% of the sample engaged in non-suicidal self-injury. | Cross-sectional data so can’t draw causal conclusions. Self-reporting bias. |
| Substance use and suicidal ideation among child welfare involved adolescents: A longitudinal examination Christina M Sellers, Ruth G McRoy, Kimberly H McManama O'Brien 2019 U.S. | 1050 adolescents aged 11-17.5 who were subjects of child abuse or neglect investigations. |
Secondary analysis of a national survey (data was obtained from the National Survey of Child and Adolescent Wellbeing II). |
Substance and alcohol misuse | 43.24% reported lifetime alcohol use and 23.01% marijuana use at baseline. This increased to 55.77% and 38.69% respectively by the third wave at 36 months. | Data is 10 years old so not representative of the current population. Self-reporting bias. Did not explore other forms of substance abuse e.g., inhalants or cocaine use. All forms of self-harm were not explored only suicidal ideation. |
| The linkages among childhood maltreatment, adolescent mental health, and self-compassion in child welfare adolescents Masako Tanaka, Christine Wekerle, Mary Lou Schmuck, Angela Paglia-Boak, MAP Research Team 2011 Canada | 117 adolescents aged 13-19 who were receiving services from Child Protection Services (CPS). | Cohort Study | Substance and alcohol abuse | In the youth involved with CPS 14.5% had exceeded the clinical cut off for The Alcohol Use Disorders Identification Test, compared to 20.8% of the comparison group. 24.8% met the cut for CRAFT, while only 15.8% did for the comparison. | Self-reporting bias Study sample was too small to generalise to the broad population of child welfare. Does not measure self-injury in terms of cutaneous damage or self-poisoning. |
Author Commentary:
Overall the study design of the papers included was inconsistent and could be improved. The papers examined were heterogenous as different settings, forms of self-harm and outcomes were measured.
While deliberate self-harm was not found to be a predictor for being subject to child protection plan, it is still an important and prevalent issue in children suffering from child abuse.
While deliberate self-harm was not found to be a predictor for being subject to child protection plan, it is still an important and prevalent issue in children suffering from child abuse.
Bottom Line:
In children, deliberate self-harm is not a strong predictor for being subject to a child protection plan.
References:
- Anne E. Rhodes, Michael H. Boyle, Jennifer Bethell, Christine Wekerle, Deborah Goodman, Lil Tonmyr, Bruce Leslie, Kelvin Lam, Ian Manion. Child maltreatment and onset of emergency department presentations for suicide-related behaviors
- Tara Santens, Laurence Claes, Guy S Diamond, Guy Bosmans . Depressive symptoms and self-harm among youngsters referred to child welfare: The role of trust in caregiver support and communication
- Christina M Sellers, Ruth G McRoy, Kimberly H McManama O'Brien . Substance use and suicidal ideation among child welfare involved adolescents: A longitudinal examination
- Masako Tanaka, Christine Wekerle, Mary Lou Schmuck, Angela Paglia-Boak, MAP Research Team. The linkages among childhood maltreatment, adolescent mental health, and self-compassion in child welfare adolescents