As Melannie Litscher and her Milwaukee Public Schools colleagues were researching best practices for working with teens who engage in nonsuicidal self-injury, one name kept popping up in the literature: Jennifer Muehlenkamp.
When Litscher googled the often-published and highly respected international expert, she was surprised to discover that Muehlenkamp, a psychology professor at UW-Eau Claire, was just a few hours away.
Even more surprising to her?
Muehlenkamp’s willingness to help MPS staff create evidence-based processes and protocols to guide them as they work with students engaging in NSSI behaviors in their schools.
“I sent her an email thinking a person as busy and renowned as she would not reply,” Litscher, a school psychologist at an MPS high school, says of Muehlenkamp. “She did reply, and she offered her consultation services to us freely.
“Then, at the beginning of the following school year, after we had developed our protocol for the assessment and management of NSSI alongside Jennifer, she presented to nearly 500 pupil services staff in the district about the topic.”
NSSI is a behavior that involves someone — often teens and young adults — purposely cutting, bruising, burning or in some other way injuring themselves without intending to die.
It’s estimated that bout 20% of middle and high school students engage in some form of NSSI behavior, says Muehlenkamp, noting that the behavior often begins in early adolescence and can continue into young adulthood.
Reasons for engaging in NSSI behaviors vary, but young people, regardless of socioeconomic status, gender or ethnicity, may self-injure to cope with stress or to distract themselves from emotional pain. Teens with low self-esteem or who have issues with depression or anxiety also are thought to be more likely to self-injure.
At MPS — a large district with more than 70,000 students — staff have long interacted with students who engage in NSSI behaviors. While staff always assessed and managed the situations to the best of their abilities, many felt underprepared or unqualified to intervene effectively, Litscher says.
However, with Muehlenkamp’s help, MPS now has a best practices-based protocol in place, helping staff feel more confident as they work with students engaging in these behaviors, Litscher says.
“As a result of Jennifer’s contributions to our district, we have gotten reports from our staff that they feel better equipped to address the issue of NSSI,” Litscher says. “They have knowledge and skills they can and do readily use on a daily basis.”
During the 2018-19 school year, the new protocol was used more than 400 times by MPS staff, Litscher says, noting that she expects that number to grow as additional staff become familiar with it.
“School staff are naturally wary of anything ‘new’ as education best-practices can change so frequently,” Litscher says. “Having Jennifer, a world-renowned expert in the topic, endorse our work and offer her expertise to our staff was essential for getting buy-in.
“I believe that with the consultation and knowledge Jennifer offered MPS, we have set a new standard in the assessment and management of NSSI in school settings.”
The MPS’s NSSI protocol was featured at the 2019 Prevent Suicide Wisconsin conference, helping even more school districts increase their knowledge about best practices for responding to NSSI.
Given that nearly 1 in 4 teens engages in NSSI behaviors, interest among school psychologists and other school staff is high.
“It’s definitely on their radar,” says Muehlenkamp, who has consulted with numerous Wisconsin school districts and communities. “There isn’t a school in the U.S. that hasn’t had to deal with NSSI. The extent to which they deal with it varies, but it is in every school.”
Muehlenkamp says friends or siblings often know that a teen is engaging in self-injury behaviors, and many of them alert a teacher or another adult at the school about the behavior.
Because few graduate or other professional training programs adequately address NSSI, most school personnel don’t know how to best assess and support students who engage in self-injury behaviors, Muehlenkamp says.
“Schools are desperate for this information because they know that the sooner they can identify NSSI and intervene, the less likely it is that the behavior will persist and become a chronic problem,” Muehlenkamp says.
There is no one-size-fits-all NSSI protocol because needs and resources vary by district, she says.
After all, one school might have school psychologists, social workers, school nurses and other staff available to provide therapy to students at school, while another district may have only limited support staff available, so on-site therapy isn’t an option, she says.
“I share best practices with them, and then we transfer those to the specific school, so they can practice them in a way that works for them,” Muehlenkamp says.