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Maintaining safety with patients who self-injure is one of the most challenging responsibilities facing psychiatric staff.
Therefore, in addition to the standard inpatient treatment administered at a Virginia hospital for patients who self-injure, the use of a patient-designed and self-administered coping strategy referred to as a safe kit was investigated. The safe kit is a box personally decorated by the patient and filled with various "tools" (e.g., Play-Doh® , stress balls, temporary tattoos, small journal, stuffed animal, tactile toys) that he or she could use to cope when the urge to self-harm was high (Figure ) (Moyer, 2008 ). This specific intervention was designed to encourage increased autonomy for the patient coping with urges to self-injure. In support of the need for this study, a search of the literature found limited empirical evidence on the use of self-administered short-term interventions in the inpatient setting. While reviewing the literature, an article was found regarding a safe kit that was used in outpatient therapy (Moyer, 2008 ). This study sought to apply the use of a safe kit to an inpatient clinical setting.
Literature Review
Self-injury is often defined as "the intentional destruction of body tissue without suicidal intent" (Klonsky & Muehlenkamp, 2007 , p. 1045). Self-injury is referred in the literature as non-suicidal self-injury, self-mutilation, deliberate self-harm, self-injurious behavior (SIB), para-suicide, self-abuse, self-harm, and self-inflicted violence. For the purpose of this study, the author used SIB to describe self-injury. Self-injury is most often associated with depression and anxiety disorders and, to a smaller degree, eating disorders and substance abuse. It is thought that anxiety may be more closely related to SIB than depression because of the emotional arousal or pressure that often prompts self-injury (Klonsky & Muehlenkamp, 2007 ).
Approximately 15% of adolescents in one study reported at least one incidence of SIB (Klonsky & Muehlenkamp, 2007 ). Higher rates appeared in those receiving mental health treatment: 20% of adult psychiatric patients and 40% to 80% of adolescent psychiatric patients (Klonsky & Muehlenkamp, 2007 ). Many adolescents who self-injure become hospitalized. In one study of hospitalized adolescents, 74% of those who engaged in SIB were admitted for suicidal ideation. The age of onset for SIB is approximately...