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Clinical Child Psychology and Psychiatry
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The Use of Secure Accommodation for Adolescent Girls who Engage in Severe and Repetitive Self-Injurious Behaviour

Kevin Epps

Glenthorne Centre, Birmingham, UK

Among the small number of girls detained in secure accommodation, severe and repetitive self-injurious behaviour (SIB) appears to be a significant problem. Effective management programmes must consider access to objects used for SIB, staff supervision, use of physical restraint and search procedures, consent to medical treatment, and effects on the peer group. Intervention programmes should be based on an analysis of the meaning and function of self-injury in individual cases, using information obtained through behavioural observation and interview. The effect on staff team behaviour and the extent to which SIB provides rewarding consequences require particular attention. Interventions to address associated emotional and psychological problems, such as the effects of childhood sexual abuse, are often not feasible within secure settings due to time factors and the reluctance of some girls to engage in therapy. Progress that is made in secure settings is often not maintained upon transfer to open settings due to insufficient service integration and a lack of time available for the generalization of behavioural change. Research is needed into outcomes and into the effectiveness of intervention programmes in secure settings. Only then will it be possible to make a realistic cost-benefit analysis of placing self injurious girls in secure settings.

Key Words: adolescent girls • secure accommodation • self-harm • self-injury

Clinical Child Psychology and Psychiatry, Vol. 2, No. 4, 539-552 (1997)
DOI: 10.1177/1359104597024007
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