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Reaching shared understanding, assessment and structured support around self-harm with a young person? The CaTS-app could help with that…

by | Mar 9, 2023

  • Guest blog by Jo Lockwood, Camilla Babbage and Ellen Townsend

We were very happy to have the wonderful Ellen Townsend join us back in September 2021 as keynote speaker for our Webinar: Responding effectively to young people who self-harm.

So many of you who attended, or watched the webinar on replay, reached out to us for more information about the CaTS (Card Sort Task for Self-Harm) and we heard you, so we got back together with Ellen and the lovely Jo and Camilla from the team at the University of Nottingham to find out more about the tool and how they are working to develop it further…

Jo Lockwood and Camilla Babbage are Research Fellows at NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham. Ellen Townsend is Professor of Psychology and leads the Self-Harm Research Group, School of Psychology, University of Nottingham.

CaTS-app is a digital version of an existing research tool called CaTS (Card sort Task for Self-harm)

Late in 2021, we embarked on an exciting journey to develop and build a new digital tool to improve outcomes for young people who self-harm and address the needs of frontline practitioners supporting them. Among us are world-leading interdisciplinary researchers and clinicians and a large team of youth advisors brought together to deliver the UKRI funded Digital Youth programme. Our focus – as one of seven research projects– is to co-create a digital tool to help young people tell the story of their self-harm and in so doing improve shared understanding, assessment of needs and treatment.

Why are we doing this work?

There is a strong case of need. Self-harming thoughts and behaviours, which include any act of self-injury or self-poisoning, irrespective of the apparent purpose, are increasing in young people, and have almost tripled in England over the past decade. Aside from being a stark indicator of emotional distress, a history of self-harm is a hugely significant risk factor for suicide, the leading cause of death of children and young people aged 5-19 in England and Wales. We need to take self-harm seriously.

With the increasing rates of self-harm, staff in NHS and other frontline settings such as schools and third sector services are encountering young people who have self-harmed in increasing numbers. Given that most young people will chose to hide their self-harm, a child presenting with self-harm to formal support services provides a critical opportunity to understand and support a young person’s needs. Not all experiences of formal support are judged as helpful by young people. We need to think carefully about why this is, and how we can make our responses to young people who self-harm work best for them, wherever and whenever that opportunity presents.

Ensuring our approaches are informed by young people, and work for those delivering support, is a good place to start.

Framing ways of assessing and managing self-harm

Recent national guidance sets out optimum ways for professionals across frontline settings (e.g. education, health and justice) to assess and manage self-harm with young people (NICE, 2022). Setting-specific recommendations are provided. Collectively, these recognise the need for a compassionate and collaborative approach, working with a young person to develop a shared understanding of needs.

Practitioners, especially those who do not specialise foremost in mental health, may not always be aware of these guidelines, or feel ill-equipped to steer this collaborative process sensitively and effectively with a young person.

Self-harm is a complex behaviour. It results from an interplay between various genetic, biological, psychological, psychiatric, cultural and sociodemographic factors which act in concert to confer risk. These factors are developmentally charged and also fluid  – changing from episode to episode and over time. Given this complexity, and the very sensitive and serious nature of the behaviour, it is challenging to explore with a young person what has led them to self-harm and what support needs they may have.

So what are we proposing and how might it help?

CaTS-app is a digital version of an existing research tool called CaTS (Card sort Task for Self-harm)

Building on our work with The Card Sort Task for Self-Harm (CaTS) research tool (previous CaTS research can be viewed here) we are co-developing a prototype CaTS-app designed to be used one-to-one with a young person to develop a shared understanding and assessment of self-harm. CaTS helps young people describe the factors involved in an episode of self-harm through the positioning of cards chronologically along a timeline. Cards describe various thoughts, feelings, events and behaviours and are informed by previous literature, explanatory models and co-creation with young people with lived experience.

The process of selecting and manoeuvring cards enables a young person to understand, mentalise and describe their journey toward a self-harm episode, mapping the factors involved in the lead-up to and following a self-harm episode, and identifying factors that pose risk or protection. It permits communication that is non-verbal and allows very sensitive issues to be highlighted. You can read more about the tool here.

Crucially, young people say they find the tool easy to use and helpful in articulating and reflecting on their self-harm. They also suggest that we explore the potential of CaTS as a therapeutic tool and draw on digital technology to improve and extend the possibilities of CaTS.  

How might this work?

There are lots of ways in which CaTS could be developed from the existing table-top research tool to a digital tool that supports professionals in clinical and frontline spaces.

The CaTS-App could

  • Scaffold the development of a shared understanding of self-harm supporting and structuring a compassionate conversation

  • Frame a collaborative, young person-led, needs-based assessment

  • Support decision-making on the timing and pertinence of therapeutic support by identifying target factors, and time-specific points for intervention. (Many of the factors identified through CaTS are modifiable and exist as treatment targets within approaches such as DBT-A.)

  • Offer, as a digital tool, specific functionality, flexibility and scope, including a process for recording, coding and tracking card selections with a young person, and capturing a shareable means of telling their story so that they don’t have to continually repeat it

  • Provide support as a brief intervention, or offer a framework for ongoing work with a young person

  • Work as a standalone tool, or support existing care provision.

So where are we now? Early development phase

As part of our Digital Youth work, and in close partnership with our advisory group of young people (Sprouting Minds) and a multi-disciplinary research group, we are undertaking a programme of development work to deliver a prototype CaTS-app. First steps in this process include:

  • Learning what professionals have to say about how, where and when a CaTS-app tool might support their practice, and how feasible and viable it would be to implement within their setting

  • Running co-production workshops with young people and other stakeholders to explore the design, content and operability of the app. Does it look and function in line with needs and preferences?

  • Building a prototype app and testing and evaluating it with practitioner+young person dyads

To find out more about our work developing the CaTS-app and next steps in our research with practitioners register your interest online

Register interest in the CaTS-app project



Linda's Story:

Meet Linda Gask: Co-founder

I studied medicine in Edinburgh, before moving to Manchester where I trained in psychiatry. I had both professional and personal interest in mental health, having experienced depression and anxiety myself. I was acutely aware of the need for effective communication to better understand and work with my patients.

Storm Skills Training started as a research project Manchester University funded by the Department of Health in the 1990s. Myself and Richard Morriss developed a training package that demonstrated how using viewing recorded roleplays could actually change people’s behaviour. We first tested our approach in Preston, then across a wider area in South Lancashire.

At that point, we named it Storm Skills Training and we were joined by Gill Green to roll out the delivery of training. Gill further developed Storm as a CIC and it’s wonderful to see how it has grown to where it is today under Bianca and her team.

My passion for many years has been on making mental health support more accessible in primary care. Until the Spring of 2023, I was Presidential lead for primary care at the Royal College of Psychiatrists and I continue to offer advice on the issue.

I moved to Orkney full time in 2020 at the start of the pandemic. I am Chair of a local mental health organisation called the Bilde Trust. As a rural community, we face our own challenges with mental health – it’s great to be involved in making a difference where I live.

Orkney is a wonderful place, unlike anywhere else in Scotland or the UK. I particularly enjoy writing here. After my first book, The Other Side of Silence, was published, I wrote my second (Finding True North) about how moving here positively impacted my own mental health.

My third book will be published at the end of 2024, exploring mental health and feminism. Maybe then I will take it easy, but that’s very hard for me to do!

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A not-for-profit social enterprise delivering high-quality skills training in self-harm and suicide prevention.

Keith's Story

Meet Keith Waters: Non-executive Director

Keith has over 25 years of clinical experience in Liaison psychiatry, self-harm and suicide prevention and was awarded an Honorary Research Fellowship by Derbyshire Healthcare Foundation Trust (DHCFT) in 2013.

For many years he was the lead for the Derby site of the Multicentre Study of self-harm in England, a study which he still maintains a very active role in. Until recently he was the Clinical director for self-harm and suicide prevention for the Trust and retains a post within the research team.

Keith is also a Storm Skills Training consultant with many years experience in facilitating, delivering, and supporting Storm Skills Training and has for a number of years held a seat on the National Suicide Prevention Alliance steering group.

He has been the Suicide Prevention manager for the East Midlands and Clinical Advisor for Suicide Prevention with the East Midlands Academic Health Science Network, developed a business and clinical case for Liaison Psychiatry Services in Derbyshire, and was the clinical advisor for its implementation.

Keith is an experienced trainer, facilitator, and presenter in Self Harm and Suicide prevention and management, locally and nationally in addition to the work with DHCFT and Storm Skills Training, has helped develop and delivered an initially lottery-funded suicide awareness training program across the East Midlands and organised chaired and delivered at numerous nation conferences and events. Keith has also been a joint author on numerous published research works, and chapters in clinical textbooks on self-harm and suicide prevention and has contributed to policy and practice guidance developments locally and nationally.

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Alf's Story

Meet Alf Hill: Non-executive Director

I first encountered Storm Skills Training CIC during my time as a volunteer Business Mentor at Unltd – a charity that supports social enterprises. Co-founder Gill Green was one my mentees in 2010 when Storm Skills Training was still within the University of Manchester and at the beginning of its journey to becoming an independent Community Interest Company.

At our first meeting I asked Gill, “How do you think I can help you?” Gill’s response was “Well… you could explain accounting to me.” We worked together for 18 months to develop Storm Skills Training as a social business. When Storm Skills Training CIC was finally incorporated in 2011, I was invited by Gill and Linda to be a non-executive Director and became Chair of the Board ten years later in 2021.

I’ve had a diverse career; initially as a civil servant, then in senior management and executive and non-executive roles in insurance and reinsurance in the UK and USA, in the corporate sector, and in Lloyd’s of London.

I returned to the public sector initially in adult education then at the Equal Opportunities Commission, later the Equality and Human Rights Commission.

A qualified accountant, I’ve been trustee of several charities, local and national, currently the Yapp Charitable Trust and the Centre for Investigative Journalism.

At Storm Skills Training, post-pandemic I feel that we are stronger than ever. I’m excited about the future with our new team with an ambitious plan.

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Gill's Story

Meet Gill Green: Co-founder

My career has taken me from nursing to academic research and finally to the development of Storm Skills Training CIC as a skills training company.

When I was nursing, so many of my patients often expressed that they felt so hopeless that they thought about ending their life. And like so many of my colleagues, I felt ill-equipped to know the right way to respond. It was a dilemma that I wanted to address through skills training – to give fellow healthcare professionals the confidence and practice they needed to have those difficult conversations.

In 1997, it was a chance job advertisement in a national paper for a Trainer and Researcher that introduced me to Storm Skills Training. At the time, I saw the 12-month project, working with Linda Gask at the University of Manchester, as an opportunity to learn new skills to take back to clinical practice. After the project, I stepped away for a few years, remaining in research but working with prisons on a different project. Research was definitely where I wanted to be.

I came back to the University of Manchester in 2003, when Linda and I started to develop the training package we now know as Storm Skills Training. It was important to us to translate the theory into usable, effective practice. I knew that as a healthcare practitioner, it wouldn’t be enough to sit in a room and be ‘taught’ suicide prevention. It is only through practice that we can actually ‘do’ suicide prevention.

I’m looking forward to supporting Bianca in realising her vision for where we go to next – and to exploring even more new directions for my own career. 

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Bianca's Story

Meet Bianca Romanyk: CEO

After 20 years in the mental health field, I am incredibly proud to be CEO of Storm Skills Training.

In my early career as a probationary psychologist working in community mental health, I can remember thinking that I’d like to one day have a role that could influence and impact the lives of many who were in distress. I recall meeting the CEO of the mental health service and being inspired by her and the compassion and empathy she showed those experiencing mental health issues.

Being in a small town in rural Australia I had the privilege of my role spanning across several areas of mental health, including working in an ongoing way with people with severe mental illness and crisis assessment (and being on call). I enjoyed all of it - I loved working with people, building trusting relationships, and working alongside them. I developed a special interest in working with younger adults with complex trauma and was lucky enough to train and be part of the Dialectical Behavioural Team for a short while. All of these experiences in my early career have driven my passion to make a difference for those in distress. I believe it is the quality of the connection that we make with people that makes a difference.

My career took me away from the frontline but rooted deeply in mental health and creating positive change. I found myself sat in a Storm Skills Training session as a trainee facilitator in 2013, Gill was delivering the course. I’d started in a brand-new role, working with schools in Australia to support their communities impacted by suicide. I recall vividly the anxiety of being on film in front of my new colleagues and the relief, value, and benefit the experience gave me. I left the training session feeling so empowered – I knew this course would help teachers and others working in schools to have conversations that made a difference to young people in significant distress. I wanted everyone to have Storm Skills Training!

Life presented itself with an opportunity to move to the UK. In 2014, before I left, Gill returned to Australia, we agreed to meet and talk about the opportunity to work together when I arrived. I arrived in the UK, with my two dogs, on the 7th of August 2015 and started work with Storm Skills Training on World Suicide Prevention Day the next month.

I haven’t looked back, my life here in the UK is lovely! When I’m not working, you’ll find me on my local common with my dogs, Derek and Doris, enjoying the view and nature. Or in my garden having a chat to the plants. I enjoy all things creative. More recently I have become a foster carer and am looking forward to this new life challenge and making a difference to the lives of young people.

I love the Storm Skills Training team, our consultants, and community and am always thinking about how to build and improve on the work we do, to have a positive impact on the world. I know that between us all we can make a real difference to people in distress. That’s what I am most excited about.

I believe passionately that Storm Skills Training helps to save lives. My vision for the future of Storm Skills Training, and our community, is to strive toward a more collaborative, empowering, and person-centred approach to self-harm and suicide prevention. A world where distress is met with compassion, everyone feels empowered to help and the support offered is tailored to the unique needs of people and their stories.





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Find support:

If you need help and support please reach out for it, here are some options:

Samaritans (UK)

Email: jo@samaritans.org

Phone: 116 123 (24 hours a day, 365 days a year)

Visit: samaritans.org

International Association for Suicide Prevention (International)

Visit: findahelpline.com/i/iasp