In evaluating risk of non-suicidal self-injury (NSSI) in youth, which elements should be assessed as part of risk assessment?

• A. Evaluate intent, lethality, frequency, access to means, protective factors, and safety planning.
• B. Only the frequency of NSSI over the past month.
• C. Reasoning about risk is not necessary if there is a single past incident.
• D. Focusing solely on parental reports without youth input.

Answer: (A)

A thorough risk assessment for non-suicidal self-injury in youth looks at multiple interacting factors that influence both current safety and future risk. Understanding intent helps distinguish why the self-injury is happening—whether as a means to regulate emotions, cope with distress, or communicate needs—since this shapes how you intervene. Lethality of the methods used indicates how quickly a situation could become dangerous and guides the urgency of safety planning. Frequency shows how persistent the behavior is and how much it has become a coping pattern, which informs the level of support needed. Access to means matters because easy access increases the chance of a future episode and crisis; identifying and reducing access is a concrete safety step. Protective factors, such as supportive relationships, effective coping skills, and reasons to stay safe, are powerful buffers that can be strengthened to reduce risk. Finally, safety planning provides a concrete, youth-centered plan for how to handle urges, what to do during a crisis, and who to contact for help.

All of these elements together give a comprehensive view of risk and guide targeted interventions. Focusing only on how often NSSI occurs, or relying on a single past incident, misses how the behavior functions and the current level of danger. Likewise, relying solely on parental reports without the youth’s input overlooks the person’s lived experience and current distress.