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Many times, school counselors become aware of students' self-injurious behaviors prior to families and persons outside of the school setting. The school counselor's first awareness that a student is self-injuring can come from many sources: observations or physical indicators of self-injury, information reported to the counselor by the student, concerns of teachers and parents reported to counselor, or finally, other students reporting a peer's self-injury.

The dynamics of adolescent self-injurious behaviors and implications and strategies for school counselors in working with this population are important to understanding these behaviors. School counselors' functions as providers of interventions, referral agents, advocates, and as educators and prevention agents of student self-injurious behavior are essential in helping these adolescents.

SCHOOL COUNSELORS' ROLE IN INTERVENING AND MANAGING SELF-INJURIOUS BEHAVIORS

According to Dahir, Sheldon, and Valiga (1998), the heart of the National Standards for school counseling programs is a focus on student success being equated with academic development, career development, and personal/social development. Therefore, in terms of facilitating student success, school counselors have an important role to play in ensuring that students are safe and that they have the resources they need to develop in all of the aforementioned areas. School counselors can help facilitate student success by providing interventions, and referrals as well as acting as advocates, educators, and prevention agents with regard to student self-injurious behaviors.

Intervention

Most adolescents who self-injure are evasive about their role in the injury, attempt to avoid attention and embarrassment, and frequently wear clothes that hide their injuries (Alderman, 2000). Physical indicators of self-injury include numerous unexplained scars, burns or cuts. The scars are often more prevalent on the arm opposite the student's dominant hand and are more likely on the forearm at an angle. Some non-threatening questions that can be helpful in eliciting information about injuries are: "What is this from?"; "Could you say more about this?"; "Have you had accidents like this before?"; "What were you thinking or feeling prior to the accident?"; "Have you found a pattern to these accidents?"; and, "How did you feel after the accident?" (Barstow, 1995; Dallam, 1997).

The primary goal for school counselors intervening with self-injuring students is to help them create a safe environment. As many students who self-injure have been physically and sexually abused and thus have a history of adults abusing their power and disregarding their needs, it may be difficult for the student to trust the counselor. Therefore, care should be taken in fostering a strong alliance with the student. An emphasis on structure, consistency, and predictability can be stressed and modeled in the counseling relationship. Developing a plan with the student that emphasizes the students' taking responsibility for behaviors and making the safest decisions possible is one method for accomplishing this goal. A detailed safety plan should be developed including identifying self-injury triggers, physical cues, and reducers related to self-injury; exploring safe people and safe places to go when wanting to self-injure; and the deliberate avoidance of objects which could be used to self-injure (e.g., paper clips, staples, erasers, sharp objects). This plan should serve to help stabilize the student and to provide structure and support until community-based counseling can begin. Techniques that can be used in helping the student manage self-injurious impulses include increasing feeling awareness and recognition, increasing coping skills to be used in managing feelings, encouraging the use of self-soothing techniques such as relaxation exercises, and encouraging the use of a safe places (Kehrberg, 1997).

Research has indicated that two important factors contribute to a cessation of self-injury (Dallam, 1997). The first factor that contributes to a cessation of self-injury is developing an ability to identify and express feelings verbally. The second factor contributing to a decrease in self-injury is learning to use behavioral alternatives to self-injury. The short-term safety plan could be used as a means of fostering the students' development of impulse control and a sense of control in managing the self-injurious behaviors (Kehrberg, 1997). Encouraging the student to be around others when wanting to injure can be helpful, as self-harm is rarely done when others are nearby (Dallam).

Safety issues should also be explored with the student including the importance of not bringing dangerous objects such as razor blades or knifes to school. Students should be instructed on the dangers of using rusty blades or sharing blades with other people who self-injure so as to prevent disease transmission (Dallam, 1997; DiClemente et al., 1991). DiClemente et al. found that 61% of a hospitalized sample of adolescents self-injured, and of that sample, 27% reported that they had shared cutting implements with other adolescents. Clearly, school counselors can play an important role in educating students about the issues associated with sharing cutting implements.

One serious complication of self-injury is the possibility of accidental death as a result of damage inflicted on the body. Thus, in assessing a student's self-injury, it is important to consider the severity of the behaviors as well as possible medical complications. If there is any concern that the student has infections or is engaging in self-injury of a severe and chronic nature (e.g., infections secondary to recurrent cutting, etc.) that could cause severe medical complications, the student should be referred to a physician for an assessment.

To facilitate student safety, Issues related to suicide should be assessed, Counselors should consider (a) an assessment of depression, helplessness, and hopelessness; (b) suicidal ideation, plan and intent, preparation and access to a means of suicide, and past attempts; (c) social support; (d) family history of suicide; and (e) recent stressors. It is important to note that suicide and self-injury are not necessarily related. Indeed, self-injury should only be thought of as suicidal if the student indicates intent to die. It should be noted however, that the link between suicide and self-injury is complicated; one can have suicidal ideation and self-injure and not be considered suicidal (Simeon & Favazza, 2001). An over-reactive stance could alienate students and fracture a developing student/counselor alliance.

The school counselor could provide support during aftercare and could be involved in helping to arrange home tutoring if needed. School counselors might also suggest modifications of the students schedule if needed through the use of a 504 plan. This type of plan allows students identified with a physical or mental impairment, yet not qualified for specialized education, to receive accommodations in their school schedule to receive help for the impairment. For example, the self-injuring student may need to leave class for counseling sessions, follow-up medical care, behavior modification scheduled checks, and time-out sessions to practice cognitive-behavioral intervention techniques. The 504 plan is an agreed upon arrangement between school, parent, and student.

Finally, an important part of a school counselor's intervention plan for self-injurious students is to follow their ethical duty in assessing and, if necessary, reporting the situation. School counselors are obligated to assess the student's behavior in doing harm to him or herself. Legally, school counselors are obligated to contact the student's parents or local authorities in helping the student. Although this task may appear clear, it is often difficult to decipher the severity of behavior and the intent of the self-injury. Part of the process should include assessing the family situation and determining if the student is safe in his or her home environment. If appropriate, parents should be called to the school and appropriate referral information should be given. However, parents should not be the first contacted if issues of abuse are part of the student's report. Following school protocol, the local social

service agency or police should be contacted if abuse is suspected.

Referral Issues

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