By Sarah Stanford.
Two words that can spark excitement or relief. It’s time to finish work. It’s time for the party to start. It’s time to get a coffee. It’s time to take off your skinny jeans.
But in this instance, these two words did not spark excitement. Instead, my heart felt a little tighter inside my chest and my hands felt a little cold and clammy.
“It’s time to start recruiting schools,” my supervisor urged.
In that moment, I questioned my decision to research in high schools. I wondered why I didn’t stick with using first-year psychology students who were freely available. And I wrote down inspirational advice for myself in my notes: Start NOW.
I’m writing to share my experiences in carrying out self-harm research in Australian high schools. There’s a lot to consider, but for today’s post I’ll focus on three areas: collaboration, context, and consent.
A collaborative relationship with schools is one of the foremost principles in my research approach. In our conversations, staff would often express their frustration with past research projects in which they had invested valuable staff and student time, only to hear nothing of the results of the project. Offering nothing back is like turning up to a bring-a-plate BBQ empty handed.
So how did I bring a plate, so to speak? Long before the first ethics application was submitted, I met with school principals and welfare staff. I shared the aim of the project, discussed the proposed questionnaire, heard their concerns, and asked how the project could benefit their school community.
For example, feedback on the first draft of our questionnaire indicated that it was too negative overall. While I had focused on the risk factors for self-harm with the strongest evidence, they wanted to see more positive questions in the mix. In response, I included a greater range of protective factors in my questionnaire. Yes, it was challenging to keep the questionnaire length down! But I felt that the change strengthened the project, resulting in a better questionnaire experience for the young people and more grounded results.
Early discussions with school staff revealed an eagerness to better understand the mental health and wellbeing of their students. In response, I produced welfare reports for each participating school soon after the students completed the questionnaires. These reports provided an overview of the mental health strengths and challenges within the school. Later, I offered to speak about the study’s results with welfare teams.
So my number one tip for anyone wishing to research in high schools: engage with schools in a collaborative relationship.
What else opens doors for researching self-harm in schools? In my case, researching self-harm within the broader context of youth coping. This encouraged schools to collaborate with me when otherwise they might have been hesitant. Schools are a lot more comfortable talking about coping, wellbeing, resilience, and mental health more broadly, compared with discussing self-harm.
Research to date is supportive of researching self-harm openly, failing to find iatrogenic effects . However, school welfare staff and executives may not share this confidence. In my experience, schools greatly preferred that self-harm measurement was brief. And we found that for most young people, their working definition of self-harm was generally concordant with the definition our study used .
It is worth considering whether your research aims require detailed self-harm measurement and therefore a focus on self-harm in the project description. My research focused on the risk and protective factors associated with self-harm, so I did not need to go into extensive detail about self-harm behaviors in the questionnaire. Self-harm was listed in the information and consent form, right alongside all the other factors that the questionnaire covered. But self-harm was not the main focus in describing the project.
Approaching our project within a broader context also helped us to engage students. The questionnaire gave young people an opportunity to have a voice about their experience with youth coping and mental health. Their experiences were communicated through the welfare reports that each school received.
One of the most difficult aspects of high school research was obtaining parental consent for youth participation in research. Not because parents are against their teen participating, but because completing yet another piece of paperwork is not high on a busy parent’s do list.
One way to minimise this is to use opt-out or ‘passive’ parental consent. Using this approach, students are free to take part unless their parent has declined participation. As I prepared my ethics application, I was informed by other school researchers at my uni that opt-in parental consent is the only way forward. That is, we need physical or digital written consent from every participant and their parent or guardian.
I encountered two big challenges with using opt-in parent consent:
First, it was a major barrier in schools’ willingness to even be involved with the project. School staff do not like collecting consent and find it a huge hassle in their already stretched schedules. One welfare coordinator told me he’d even resorted to giving out chocolates for returning consent forms for a camp.
Second, for those schools that agree to take part, using opt-in parental consent makes it difficult to obtain a representative sample within the school.
If you are faced with using opt-in parent consent, here are some tips that may help:
- Present talks and announcements about the project’s aims and benefits to engage school executive, welfare teams, and teaching staff. Staff motivation directly impacts on student participation.
- Engage students with the why behind the study, and offer a small appreciation of participation (chocolate helps!).
- Schedule the questionnaire during class time so students have nowhere better to be. Avoid timetabling during elective subjects, lunch time, or on fun mufti days.
- Put up well-designed flyers in the school and notices in the school newsletter.
- Ask the school counsellor to email parents to explain the value of the project.
- Recruit more schools than you think you’ll need. Work on a worst-case rather than best-case scenario.
Despite attempting to use all these strategies (depending on what each school would allow), participation rates were lower than ideal in my first round of data collection. We managed to secure opt-out parental consent for students aged 14 and older for the second round of data collection. The committee’s decision to approve opt-out parental consent for the second round was greatly influenced by the collaborative nature of the project, and the benefit to the school community through the welfare reports.
Is it worth it?
Let me be honest with you: researching self-harm in high schools was hard. It took a lot of time and sustained effort. When weighing up whether this is the right path for you, I encourage you to consider what the benefits are – not only for your own research and career, but for the broader community.
Prior to my PhD I was a youth worker in a public high school, supporting young people who were struggling with self-harm. My motivation for doing a PhD was to make a contribution to helping young people who self-harm. I wanted my research results to be directly applicable to high schools.
As I reflect on the process, I remember vividly how challenging it was. But was it worth it? I believe it was.
 DeCou, C. R. & Schumann, M. E. (2017), On the iatrogenic risk of assessing suicidality: A meta-analysis. Suicide and Life Threatening Behavior. doi:10.1111/sltb.12368
 Stanford, S and Jones, M.P. (2010). How much detail needs to be elucidated in self-harm research? Journal of Youth and Adolescence, 39(5):504-13. doi: 10.1007/s10964-009-9492-y.
Sarah Stanford is an Honorary Postdoctoral Associate at Macquarie University. As a self-harm speaker, writer, and researcher she works with schools, churches and community groups to identify and respond to self-harm. Her current projects include working with schools to develop education programs for staff and parents.