Assessing risk of self-harm in acute paediatric settings: a multicentre exploratory evaluation of the CYP-MH SAPhE instrument

• Main Authors: David Clark, Tim Carter, Joseph C Manning, Coral Smith, Marie Armstrong, Aimee Aubeeluck, Miranda Witchell, Rachel Barker, Sharon O’love, Tessa Jones, Rachel Dolby, Lynda Walton, Elizabeth Byrne, Rebecca Green, Gemma Walker, Dorothy Bean, Gisela Robinson, Melanie Hayman, Vanessa Unsworth, Caroline Moulds, Laura Looby
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2021-06-01
• Series: BMJ Open
• Online Access: https://bmjopen.bmj.com/content/11/5/e043762.full

Objective To psychometrically assess the Children and Young People-Mental Health Self-harm Assessment in Paediatric healthcare Environments (CYP-MH SAPhE) instrument for the identification of immediate risk of self-harm in CYP, aged 10–19 years, in acute paediatric wards or emergency departments.Design The CYP-MH SAPhE Instrument was developed through a robust scoping review and Delphi consensus with 30 clinicians/topic experts. To evaluate the psychometric properties, a multicentre exploratory study was conducted.Setting Three acute hospitals in the UK.Participants 163 CYP presenting at acute hospital settings with primary mental health (cases) or physical health (non-cases) conditions.Primary and secondary outcome measures Psychometric properties of the CYP-MH SAPhE instrument were evaluated through Principle Axis Factoring (PAF) with Oblimin (Kaiser normalisation) alongside measures of internal consistency (Cronbach’s α), convergent, discriminant and face validity.Results PAF of the dichotomous items (n=9) loaded onto three factors (1) behaviours and intentions; (2) suicidality and (3) self-harm. Factors 1 (Cronbach’s α=0.960) and 3 (Cronbach’s α=1) had high internal consistency. There was: good level of agreement between raters (kappa=0.65); a moderately positive correlation between the CYP-MH SAPhE instrument and the Columbia-Suicide Severity Rating Scale; and discrimination between cases and non-cases across the three factors (factor 1: m=88 vs 70; factor 2: m=102 vs 70; factor 3: m=104 vs 68). Assessment of face validity resulted in six items being removed, culminating in an eight question, rapid assessment instrument.Conclusions The results support the CYP-MH SAPhE Tool as a potentially reliable and valid instrument to identify immediate risk of self-harm in CYP presenting to acute paediatric healthcare environments, which is a burgeoning and significant global health issue.