A foster carers introduction to self-harm in looked after children and young people.
Introduction to self-harm in looked after children and young people.
Self-harm is quite prevalent in looked after children and can be distressing for all concerned. Knowing how to approach it, what the warning signs are and how to work with the team around you to safeguard a child or young person are paramount.
What is self-harm?
Self-harm is where a child or young person hurts themselves as a way of dealing with difficult emotions, overwhelming situations or memories and painful experiences.
Self-harm is always an expression and symptom of deeper issues and underlying trauma.
Children and young people who have been taken into care have the added trauma of loss, grief, feelings of separation and abandonment to add to the already existing adverse childhood experiences such as neglect, and physical, mental or sexual abuse.
Why do children or young people self-harm?
Each child and young person is unique, their own set of circumstances, adverse childhood experiences (ACEs) and backgrounds will impact their mental health and physical well-being in a different way.
These are some reasons a child may self-harm:
- As a way of managing difficult emotions such as sadness, loss, grief, anger, feelings of abandonment and rejection.
- To distract from emotional pain, replacing it with physical pain.
- As a way of expressing feelings, they can’t talk about.
- As a means of control when they feel they have lost control over their lives.
- Punishing others they are angry with, their parents, their foster carers, and children’s services.
- Mental health conditions as a result of trauma and adverse childhood experiences such as anxiety, depression, and low self-esteem, as well as sexuality, gender identity, body image, and social media.
- Punishing themselves for being ‘bad’, you will find many looked-after children and young people wrongly blame themselves for the situation they find themselves in, they often say things like ‘I’m not worth it’ or ‘I’m not good enough’ or ‘It’s all my fault my mum/dad/family doesn’t want me’.
Different forms of self-harm
Children and young people will self-harm in many different ways, here are some of them:
- Cutting – One of the most common forms of self-harm and be anywhere on the body, forearms are the more visible forms of self-harm, inner thighs or tops of thighs when they want it to be invisible, but it varies as each child is an individual and cutting can be anywhere on the body.
- Burning – This can take many forms, burning with cigarettes is one.
- Scratching or biting themselves.
- Punching or kicking walls or other hard objects.
- Pulling hair out.
There are also some less obvious behaviours that can be equally deemed to be self-harm, such as excessive alcohol or drug use, under or overeating, regular unprotected sex with either strangers or peers and excessive exercising, they are not as obvious but are still potential form of harming themselves both physically and mentally.
Spotting signs of self-harming behaviour in children
Sometimes self-harm is outwardly obvious and many times it is equally hidden, many children or young people will cover up the cuts or injuries or explain them away.
As foster carers we cannot either search a child’s body or demand they show us, neither of these things would be helpful anyway.
So we have to be vigilant in looking out for signs that could indicate a child may be harming themselves, here are some:
- Any unexplained cuts or marks on their bodies that they can’t explain or the explanation seems unlikely.
- Asking to be excused from any form of PE at school, if they are not excused they may ‘forget their kit’, refuse to engage or go missing for those periods.
- They might be more withdrawn than usual, and reluctant to engage with things they usually do. This is a hard one as when children enter adolescence this can be one of the things they do, so stay vigilant and inquisitive.
- They also might sleep more or less and change their routines.
- Their language may centre more around how ‘useless’ they are, or how things are ‘their fault’ or expressing more anger, hurt, loss, grief, and rejection than before.
- Personal hygiene and self-care may become less important to them.
- They may be using alcohol or drugs.
What can you do as a foster carer?
If you think your child is self-harming, it can be very difficult to know what to do. You may feel upset, confused or even angry and frustrated, or wonder how you missed the signs. And, if you only suspect they’re harming themselves, you may not know how to approach them and offer the kind of help and support they need.
- The very first thing you need if you suspect or realise a child or young person is self-harming is to contact the team around you and the child.Top Tip: If you suspect a child is self-harming the first thing to do is contact your own supervising social worker or link worker and copy in the child’s social worker and ask for a meeting, help, support and advice.
- As hard as it is to resist ‘interrogating’ the child or young person, the more questioning or pressure you put on them will likely make them withdraw further. Let them come to you.
- Remove as many sharps from their own rooms as possible (with written permission from the fostering service) but be aware that if a child or young person wants to self-harm they will find anything to do it with, so although you remove the obvious things manage your exceptions on how much this will help.
- It will be hard for you to understand, but trauma-informed care will help with the underlying reasons and how it’s a coping mechanism for them. If you have had no training in trauma-informed care ask your fostering services for some.
- Try not to show you are alarmed or shocked, be calm and show them you are concerned about their welfare.
- Never diminish or minimise a child or young person’s internal emotional pain by dismissing cuts and marks if they are minimal or saying things like ‘oh it’s not that bad’. Validate their feelings if they talk to you, hear them and sit alongside them without the need to ‘fix’.
- If they do want to talk to you about it listen, don’t try and fix or stop them or give them an opinion on self-harming, sit alongside them, and listen with empathy. Keep all lines of communication open.
- Give them a simple first aid kit (with approval from the rest of the team around the child), it also will show them you care and understand.
- Report and record incidents of self-harm.Top Tip: As in all things fostering ensure you report and record meticulously when a child is self-harming, when, how, any discussions, any measures you’ve taken, who you’ve spoken to.
- It is the responsibility of the team around the child, their social workers and their managers to access mental health services for the child or young person, if the self-harming is acute then this should be a matter of urgency, it is our role as foster carers to support the child to attend mental health appointments.
- Ask your services for appropriate support lines and services for your child or young person.
Supporting you, the foster carer
Foster carers often get forgotten as the focus amongst the team is on the child or young person, however, if those who care for them are affected then their caring abilities can also be affected, and the very last thing they need is foster carers with compassion fatigue, burn out, secondary stress disorder, anxiety or depression.
Despite what the adverts say foster carers are not superhuman, they are simply good people trying hard to do the best they can, foster carers are ordinary human beings who are deeply affected by children who are in any sort of pain, physical or mental.
Being prepared will really support you:
- If you have not already had access to trauma-informed training then ask your fostering service, at the bottom of the page are training suggestions.
- Working in a trauma-informed way will help you understand the underlying causes of self-harm, which is a symptom of deeper issues. It will help you when you feel helpless and can not understand why a child would self-harm when they have the safety and love of your home.
- Working with self-regulation, and co-regulation will help you regulate yourself in the relationship with a child who is self-harming, this is crucial, and when you are working with children who are self-harming being able to suspend your own frame of reference and triggers is crucial.
- Learn as much as you can about self-harm, adverse childhood experiences, trauma and attachment.
Taking care of you
- It’s not always easy to reach out for help as a foster carer, sometimes we are afraid to show we are not coping or feeling powerless, however, good services and good teams will understand if you are struggling and put in the extra support you need.
- Reach out to your fostering colleagues, in confidence, whether it be personally, in support groups or as part of fostering hubs, talking and sharing will help.
- As impossible as it might seem try to take even the smallest amount of time for you. Few foster carers have the energy for the gym, running, yoga or Pilates, but you can find time for a short walk in nature, or even a sit in nature, breathing, maybe doing some mindfulness, or maybe you can organise a few hours with family, partners, birth children and friends, to catch up and reset.
- Try to organise some respite before you get to the point of burnout, contact your supervising social worker or link worker to discuss this.
Foster carers comments
- Foster Carer’s Mental Health
- Teenagers a Guide to Fostering Adolescents
- Help & support
- Finding Balance in Fostering
- Trauma-informed foundations
- NFCQ Foundation course in fostering
- Respite, breaks and holidays for foster carers
- Noah’s Campaign – Preventing broken attachments through care
- Attachment – Why is it SO important in foster care?
- Noah’s Campaign – Because we hold their future in our hands
- Time to raise awareness for foster carers’ mental health
- 5 Top Tips for self-care and mental health and They’re not what you think
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