STAR-TRAIN

Non-suicidal self-injury, NSSI, deliberate self harm, dissemination, guidelines, training

• Prof. Dr. Paul L. Plener, Medical University Vienna (STAR Consortium)  
• Prof. Dr. Michael Kaess, University Hospital Heidelberg (STAR-Online)
• Prof. Dr. Christian Schmahl, Central Institute of Mental Health Mannheim (STAR-Neuro)
• Prof. Dr. Tina In-Albon, University of Koblenz-Landau (STAR-Assess)
• Prof. Dr. Ulrich Ebner-Priemer, Karlsruher Institute of Technology (STAR-EMA)
• Dr. Daniel Radeloff, University of Leipzig (STAR-Data)

   

11/2017-10/2021

Star-Train is part of the consortium STAR (Self-Injury: Treatment, Assessment, Recovery) which has the focus on understanding the course of non-suicidal self-injury (NSSI) in adolescence, especially with regard to psychological mechanisms of stopping NSSI and possible neurobiological predictors. Based on those insights, specific future intervention and prevention strategies can be conceptualized and conducted to improve the psychosocial care for those affected.

NSSI is a widespread phenomenon among adolescents with a prevalence rate of 4% for repetitive NSSI. Given that high number, primary health care providers often encounter NSSI in their practice and are in a privileged position to guide youths to accept treatment. Subsequently, they should hold knowledge and competences in dealing with NSSI.

A new national AWMF guideline on the treatment of NSSI was published in 2015, offering the necessary information for professionals. However, it is known that often guidelines lack dissemination. It seems crucial to develop strategies for disseminating clinical guidelines among prime health care providers to optimize the care in the mentioned population.

Description of the Project

Star-​Train is part of the consortium STAR (Self-​Injury: Treatment, Assessment, Recovery) which has the focus on understanding the course of non-​suicidal self-​injury (NSSI) in adolescence, especially with regard to psychological mechanisms of stopping NSSI and possible neurobiological predictors. Based on those insights, specific future intervention and prevention strategies can be conceptualized and conducted to improve the psychosocial care for those affected.

NSSI is a widespread phenomenon among adolescents with a prevalence rate of 4% for repetitive NSSI. Given that high number, primary health care providers often encounter NSSI in their practice and are in a privileged position to guide youths to accept treatment. Subsequently, they should hold knowledge and competences in dealing with NSSI and those affected.

In 2016, the German clinical guidelines for “diagnostic assessment and treatment of NSSI in childhood and adolescence” were published as the first internationally published guidelines on NSSI specifically. Research shows that patients treated with guideline-adherent treatments improve to a greater degree and more quickly than patients treated with treatment-as-usual. However, evidence-based clinical guidelines are poorly implemented in clinical practice and require active actions for implementation.

One crucial part of this is the dissemination of evidence-based knowledge and competences among professionals. Aim of Star-Train was to develop and evaluate three different training methods for primary health care providers like physicians and psychotherapists.

For one, we conducted an online-survey assessing current knowledge of professionals on NSSV and the treatment guideline and the need for information on the topic. The results of survey among 677 physicians, psychotherapists and psychologists show that the respondents are frequently confronted with NSSV in their professional context. Most of them state that they have prior knowledge about NSSV, which they have acquired less through systematic offers such as further education or studies, but through exchange with colleagues, through professional experience or through self-study. The own competences and knowledge in relation to NSSV are estimated on a medium level. Most of the respondents saw a need for further training, especially in the treatment of NSSV and in the therapeutic/medical approach. Approximately half of the respondents stated that they were aware of the guideline, and about a quarter stated that they were aware of the guideline's requirements, with about 70% of them following these requirements in "all" or "most cases".

Additionally, we compared in a randomized controlled trial the effect of the three different dissemination strategies which were developed within the framework of the project (printed educational material, e-learning, blended-learning), based on the German consensus based clinical guidelines for diagnostic assessment and treatment of non-suicidal self-injury (NSSI) in childhood and adolescence. 671 datasets of physicians and psychotherapists were included in the study and mixed effect models were applied.

Results show that all three training formats contributed to the intended change of the assessed variables and that the training effect remained stable upon the follow-up assessment three months later. Generally, the printed educational material condition showed the lowest improvement and the lowest evaluations regarding quality and the blended-learning condition reported the highest application rate of acquired intervention techniques into clinical practice.

The developed training strategies imply different level of demanded resources for development and implementation, thus the choice of training method could be driven by considering, which training goals are aimed to be achieved and the benefit-cost ratio allowing for tailored training approaches.