SLICE® Tool for Self-Harm: A School Nurse Feasibility and Reliability Pilot Study

Monday, 30 July 2012: 10:45 AM

Kimberly A. Williams, DNSc
Ellen B. Buckner, DSN, RN
College of Nursing, University of South Alabama, Mobile, AL

Learning Objective 1: Explain that one out of every five adolescents has a mental, behavioral, or emotional problem placing them at risk for self-harm.

Learning Objective 2: Explain that SLICE stands for scars, links, injuries, clothing and environment and is an assessment tool for self-harm.

Purpose: The purpose of this study was to evaluate the reliability and feasibility of a screening tool for self-harm risk factors in adolescents. The SLICE Self-Injury Screening Tool is an acronym for Scars, Links to risk factors, Injuries that do not match explanation, Clothing that does not match setting, and Environment conducive to self-harm. By developing a screening tool specific for self-harm or self-injury, the researchers hope to provide a tool that will assist primary care providers with early detection for referral to mental health services for diagnosis, treatment, and nursing intervention.

Methods: This pilot study involved tool development to evaluate reliability and feasibility with a sample of community-based providers who have contact with adolescents at risk. With IRB and state approval, school nurses were recruited by email. Nurses completed a SLICE assessment tool online for each of three hypothetical cases. Two to 4 weeks later they were asked to evaluate the same cases again to measure test-retest reliability. Additionally they completed a post-study survey of questions related to feasibility.

Results: There were a total of 20 school nurses from two county school districts who participated. Analysis used the Wilcox Sign-Rank to evaluate for statistical difference between times 1 and times 2 for the sections "S", "L", "I", "C", and "E". Additionally the totals of S+L+I+C+E was evaluate for statistical difference between times 1 and times 2, as well as the action indicated by the school nurse. Feasibility was based on response rate as well as consistency and ratings.

Conclusions: The tool was found to be useful by school nurses. Findings suggested a need for an educational component for self-harm assessment scoring of the tool. Some initial sensitivity and specificity analysis was possible. Continued development and testing is planned to include clinical validation.