PCH EXPAAND Nested Intervention: Evaluating Therapeutic Assessment as a brief intervention for children and adolescents who self-harm at the time of a mental health emergency.

INTERVENTION: Group 1: Control: treatment as usual Group 2: Expanded assessment including standardized measures of attentional conditions and difficulties with emotional processing, and the semi‐structured diagnostic interview (K‐SADS). Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K‐SADS‐PL) is most widely used diagnostic interviews in research. It is a standardized semi‐structured interview to measure current and past symptoms of mood, anxiety, psychotic and disruptive behaviour disorders (including ADHD) in children aged 6‐18 years old. Administration time is between 45‐75 minutes. The K‐SADS diagnostic interview takes between 1‐2 hours to administer Group 3: Expanded Assessment with Nested Intervention ‐ Therapeutic Assessment: a brief, manualised psychological assessment technique developed specifically to make the assessment for children and adolescents who have self‐harmed more therapeutic Therapeutic Assessment (TA; Ougrin et al., 2009) is a brief, manualised psychological assessment technique developed specifically to make the assessment for children and adolescents who have self‐harmed more therapeutic (Ougrin et al., 2009). TA is a therapeutic intervention where the clinician and patient co‐construct a narrative with regards to their DSH / suicidal crisis behaviours within the context of a theoretical model developed by Ougrin and colleagues (2009) over a single 1‐hour to 1.5‐hour session. The content of this session is then recorded in a ‘therapeutic letter’ and provided to the patient in paper mail form (with an additional electronic form provided if requested. The intervention will be delivered by a Clinical Psychologist, and/ or masters‐level provisionally registered Clinical CONDITION: Child and Adolescent Mental Health;Deliberate Self‐Harm;Suicide ; ; Child and Adolescent Mental Health ; Deliberate Self‐Harm ; Suicide Mental Health ‐ Anxiety Mental Health ‐ Depression Mental Health ‐ Other mental health disorders Mental Health ‐ Suicide PRIMARY OUTCOME: Rates of re‐presentation to hospital emergency departments for mental health crisis (including deliberate self‐harm) within a 6‐month period from index presentation. ; ; 1. Rates of re‐presentation ; Number of presentations for a mental health crisis (including DSH) to PCH ED within a 6‐month period Medical records/ PSOLIS records.; [6‐months ] SECONDARY OUTCOME: 1. Acute engagement with treatment ‐ attendance at treatment appointments within two weeks of index presentation to ED. ; ; Rate of attendance at follow‐up first follow‐up appointment following DSH presentation to PCH ED in the acute time period ; Audit of appointments attended (CAMHS‐PSOLIS), vs appointments scheduled as per CAMHS clinical guidelines and Risk Management Plans ; ; ; [Two weeks ; ] 2. Sub‐acute engagement with treatment ‐ rate of attendance at follow‐up appointments in sub‐acute phase following index presentation to ED for a six‐month time‐period. ; ; Rate of attendance at follow‐up first follow‐up appointment following DSH presentation to PCH ED in the sub acute time period ; Audit of appointments attended (CAMHS‐PSOLIS), vs appointments scheduled as per CAMHS Management Plans and recorded as 'missed' appointment in PSOLIS [6‐months ] 3. Clinical Symptoms ‐ number of deliberate self‐harm episodes following index presentation to ED in the acute (2 weeks) and sub‐acute (6‐months) time periods. ; ; Number of DSH Episodes following presentation in the acute and sub‐acute period. Self ‐and parent‐report (structured phone interview) / medical records/ PSOLIS ; [acute: 2 weeks ; sub‐acute: 6 months ] 4. Medical seriousness of presentations for mental health crisis/ DSH behavior to emergency departments within a 6‐month time period. ; ; Medical seriousness ; Medical seriousness of presentations for mental health crisis/ DSH behaviour within a 6‐month period ; Medical Lethality Scale of the K‐SADS (Scale 4d.) – revised: (1= no medical damage; 2= subthreshold, superficial cuts; 3= threshold indicating medical intervention, significant cut with bleeding); clinician rated ; ; Potential lethality ; Potential lethality of presentations for mental health crisis/ DSH behaviour within a 6‐month period ; Potential Lethality Scale; Haw et al., 2003) (1 = certain survival; 2 = <50% chance of death; 3. >50% chance of death; 4 = certain death); clinician rated ; ; [6‐months ] INCLUSION CRITERIA: Children and adolescents aged 10 to17 who attend a hospital emergency department after a mental health crisis (including deliberate self‐harm) for the duration of recruitment phase of the project and who give consent.