Self Harm

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Any help or suggestions would be greatly appreciated!

I have a first grade little girl that is hurting herself almost daily and it is escalating in severity. It started at the end of last school year with minor things, like picking her nose till it bled and picking at an insect bite or scab till it bled, etc. Now she is putting stuff in her ears, biting her tongue till it bleeds, cut her ear lobe with scissors, gaging herself till she vomits, and so on. There is an injury involving blood daily. The teacher, myself and counselor have all talked with her and tried to give her other ways of coping and dealing with stress. I was just informed that yesterday, during a meeting the teacher had with the mom (I was not invited to this meeting), she told the teacher that before the little girl started school she had pulled out her toe nails several times and has pulled out 14 teeth before they were ready to come out. I think the mom is in denial that there is a problem that needs to be addressed. She needs constant supervision but of course in a large class room and one teacher that is hard. I am so scared and worried for this child! Admin is aware of this child and what she is doing but, still noting is getting done! I want to get her help but don't know where to turn.

Has anyone dealt with something like this before? Any suggestions would be great!!

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Specializes in IMC, school nursing.

Does your counselor have access to the health department? Ours has a youth service bureau that I can consult in emergencies, very helpful as we do not have a counselor. No parent wants to admit their child is different, some more than others. Hope she can receive the help she needs. Sounds like she has had some serious trauma in her life.

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This child probably has mental illness and needs to be evaluated by a DOCTOR stat. STAT.

She needs 24/7 care if this is what's going on. This is waaaaaaaay beyond "cutting".

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Call CPS.

You are a manadated reporter.

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I agree with Farawyn, this is definitely a "stat" situation. If the parent is unwilling to take her to the doctor and discuss the entire situation, I'm afraid I'd be making a CPS call.

We are lucky that our guidance counselor can have a student seen by a mental health counselor within minutes. We have one at our school 5 days a week.

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This child probably has mental illness and needs to be evaluated by a DOCTOR stat. STAT.

She needs 24/7 care if this is what's going on. This is waaaaaaaay beyond "cutting".

She is seeing a therapist outside of school several times a month and is being seen by her pedi. He has her taking Strattera and Abilify. Would you still report to CPS since she is seeing a dr?

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Does your counselor have access to the health department? Ours has a youth service bureau that I can consult in emergencies, very helpful as we do not have a counselor. No parent wants to admit their child is different, some more than others. Hope she can receive the help she needs. Sounds like she has had some serious trauma in her life.

Our Health Department does not have any resourses for mental health. They basically give immunizations and track "reportable illnesses".

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She is seeing a therapist outside of school several times a month and is being seen by her pedi. He has her taking Strattera and Abilify. Would you still report to CPS since she is seeing a dr?

No, if the mom is doing all she can, I would not.

I hope the mom and the school and the doc are all speaking.

I'm scared for this girl.

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She is seeing a therapist outside of school several times a month and is being seen by her pedi. He has her taking Strattera and Abilify. Would you still report to CPS since she is seeing a dr?

If she's been on the meds for an extended period of time, I'd say they aren't effective. Kind of makes me wonder if there's something OTHER than mental illness going on. For my peace of mind, I'd try to set up a meeting with her mother that INCLUDES you. Maybe you'll be able to get more information and then you can ask the questions you need to. If that doesn't work, I'd be calling CPS. This little girl is only in 1st grade. She clearly needs more help than she is getting, whether its a med change or a deeper look into home life.

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Specializes in School nursing.
This child probably has mental illness and needs to be evaluated by a DOCTOR stat. STAT.

She needs 24/7 care if this is what's going on. This is waaaaaaaay beyond "cutting".

THIS.

My counselor and I would be calling in a Team ASAP. I'm not sure what Texas has, but MA have an emergency response team specifically for this situation. They provide 24 hour response to youth in need of crisis invention for mental health. This feels like a crisis situation to me.

If Mom refuses to have child seen, I'd call CPS. If Mom is willing and you don't have the above, I'd tell Mom to take the student straight to the Emergency Room for evaluation.

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Specializes in Pediatrics Retired.
She is seeing a therapist outside of school several times a month and is being seen by her pedi. He has her taking Strattera and Abilify. Would you still report to CPS since she is seeing a dr?

"Strattera" - the first blip on the radar she isn't receiving the care she needs.

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Specializes in school nursing, ortho, trauma.

So to piggyback on Jen-Eliz we would probably send this child out for an eval the next time there is an incident of self harm to our local childrens crisis team or calling mobile psych intervention services in to intervene. We would make it clear to the parent that this would be the intervention so there would be no surprises - especially since there is a feeling that the mom may be in denial. However - and this is something to consider - you noted that she is seeing a therapist. Is she seeing a therapist for the self harm issues? Do you have consent to communicate with the therapist? It's possible that he/she does not have a full picture of what's going on in school. Also - is the self harm happening only at school, mostly at school, even split of school and home?

Moving forward, it is beneficial to get a behaviorist in to help with this. If your district does not have one, you can contract out the services. Contact other local districts to see who they use / if they are happy with that person / so forth...

Once the behaviorist is in place and they help you draft the behavior plan - use it - stick with it- make sure everyone is being consistent.

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