An RCT of a brief psycholgoical intervention for young people who attend ED having self-harmed

Intro: Suicide is a leading cause of death in children and young people (CYP) globally and the strongest predictor is self-harm, irrespective of suicidal intent. Visits to the Emergency Department (ED) are associated with repeat self-harm and suicide. Supporting CYP after presentation at ED offers a unique opportunity to intervene to prevent self-harm becoming an entrenched coping strategy. However, there are limited interventions to support CYP with self-harm. Therapeutic Assessment (TA) and Solution-focused (SF) follow-ups have shown promise in reducing self-harm and increasing engagement with care after ED attendance. Incorporating these approaches, we aimed to develop and evaluate a brief psychological intervention to address this gap.

Methods: We co-designed the SASH approach with CYP with lived experience. We have recruited 42 CYP crisis team and dedicated SASH practitioners who are delivering SASH across five teams, serving seven EDs in London, England. A randomised controlled trial with a target of 144 CYP is currently underway to evaluate its clinical and cost-effectiveness.

Results and Discussion: The SASH approach was designed and is a brief intervention including TA, enhanced safety planning, SF follow-ups and letters, delivered after young people present at the ED. TA involves the young person identifying their cycle of self-harm, with a SF approach used to identify ways to break the cycle and focus on the young person’s strengths and broader hopes for their future. This presentation will discuss practitioner experiences of delivering the intervention and the challenges of delivering the trial in a post-pandemic public healthcare landscape in England, including recruiting and retaining practitioners and embedding new pathways of care in acute and CYP crisis settings.

Conclusion: Challenges and creative approaches to embedding and delivering the SASH approach in crisis settings in England have wider implications for interventional studies delivered in crisis care settings in public healthcare institutions.