About the project

SASH is a three year research

trial aimed at testing a promising new intervention for young people who self-harm. The trial aims to investigate whether we can better support adolescents who present with self-harm at Emergency Departments (EDs) across London, by using the SASH intervention.

The intervention involves a combination of a Therapeutic Assessment, a safety plan, and rapid solution-focused follow-up care. The Therapeutic Assessment has been specifically developed by Prof. Dennis Ougrin for adolescents presenting with self-harm in a crisis.

The project is funded by the Kavli Trust, and is being led by researchers at City, University of London, in collaboration with Queen Mary University of London, University College London, and the McPin Foundation.

Background

When adolescents present in crisis, there is a crucial opportunity to intervene rapidly so that self-harm does not become an established coping strategy for life, significantly increasing the risk of suicide.

The period immediately following discharge from hospital is associated with the highest risk of repeat self-harm and suicide, demonstrating a need for rapid intervention.

Furthermore, previous research emphasises the need for compassionate, personalised care to break the cycle of self-harm. A promising approach to address this is a Therapeutic Assessment with safety planning and rapid follow-up contacts using a solution focused approach.

Aim

This trial aims to test the clinical- and cost-effectiveness of this approach for adolescents presenting to the Emergency Department with self-harm.

Method

Work package 1: Co-Design
with Adolescents

Work package 2: Trial

Work package 3: Outcome Analysis

We are working with the Young People’s Network at the McPin Foundation to develop and set up this trial. We have set up a Young People’s Advisory Group (YPAG). The YPAG includes 6 young people and will meet around three times a year, to advise on all aspects of the study.

We will conduct a randomised controlled trial with 18 mental health practitioners from Emergency Departments and 144 young people. The trial will test the clinical- and cost-effectiveness of the intervention. All young people will continue with their normal care and, in addition, half will receive the new approach. After 6 months we will compare whether those receiving the intervention have better mental health and quality of life, and have harmed themselves less, than those not receiving it.

The outcome analysis will focus on whether the participants who received the intervention harmed themselves less throughout the study period of 6 months,  compared to those who did not receive it. It will also focus on whether they had better mental health and quality of life. If our findings show better outcomes, it offers the potential to improve outcomes for adolescents who self-harm, using an evidence-based and consistent approach.

Work package 4: Economic Evaluation

Work package 5: Qualitative Process Evaluation

Work package 6: Dissemination and Impact Activities

To look into the cost-effectiveness of the intervention, we will conduct an economic evaluation. The evaluation will focus on the period from starting the intervention to the end of the follow up period at 6 months, and the costs will include resource usage to train personnel, deliver the intervention, provide other health/social care services to adolescents, costs to parents, and impact on education.

The outcome analysis will be complemented by a qualitative process evaluation to explore how the intervention was experienced by practitioners, guardians, and young people.

We will share our findings widely and explore whether the intervention could also be helpful in other settings.