All youths identified as having suicide risk factors by screening, information obtained regarding the youth or staff observations must receive an assessment of suicide risk. The superintendent or program director is responsible for ensuring that all assessments of suicide risk are conducted by, or under the direct supervision of, a licensed mental health professional, and that assessments of suicide risk are appropriately administered, documented and reviewed within the facility as follows:
A. COMPONENTS OF AN ASSESSMENT OF SUICIDE RISK: An assessment of suicide risk must
reflect consideration of the following elements: 1. Reason for Assessment of Suicide Risk;
2. Methods of Assessment (e.g., Interview, Suicide Scale/Questionnaire, Testing);
3. Mental Status Examination to include direct questioning of the youth and collateral informants regarding the youth’s appearance, behavior, mood and affect, emotional state, insight,
a. Current thoughts of suicide/harming self, b. Suicide plan and method,
c. Youth’s confidence in his/her ability to carry out the plan, d. Availability/access to means to harm self,
e. Precipitating stressful event(s), f. Previous attempt(s),
g. Lethality of previous attempt(s), h. Psychiatric/mental health history, i. Drug abuse/dependence,
j. Hopelessness.
4. Determining Dangerousness to Self:
a.
Imminence of behavior,b.
Intent of behavior,c.
Clarity of danger (i.e., Definiteness of danger posed to the youth)d.
Lethality of behavior.5. Determining Level of Suicide Risk;
6. Supervision Recommendations (e.g., Suicide Precautions); 7. Summary of Findings; and
8. Recommendations for Treatment or Follow-up
B. DOCUMENTATION OF ASSESSMENT OF SUICIDE RISK:
1. Documentation of an assessment of suicide risk must be provided by the mental health clinical staff person on the form provided in Appendix P.
2. The assessment of suicide risk must provide details of the information obtained by the assessment (youth statements, behavioral observations, collateral information). The specific information supporting the assessment of suicide risk findings and recommendations must be documented on the form.
3. The Assessment of Suicide Risk Form must be signed and dated by the mental health clinical staff person conducting the assessment. If the assessment of suicide risk is conducted by a non-licensed mental health clinical staff person a licensed mental health professional must review, sign as a reviewer and date the assessment. The licensed mental health professional
must sign the Assessment of Suicide Risk Form the next scheduled time he/she is on-site.
UPDATE
4. Youths determined to be a potential suicide risk through assessment of suicide risk must be placed or maintained on Suicide Precautions (i.e., Precautionary Observation or Secure Observation) until follow-up assessment of suicide risk, by or under the direct supervision of a
licensed mental health professional, determines the youth is no longer a potential suicide risk.
C. PROFESSIONAL QUALIFICATIONS: An assessment of suicide risk must be conducted by a
licensed mental health professional or a non-licensed mental health clinical staff person working under the direct supervision of a licensed mental health professional.
A licensed mental health professional means a mental health professional licensed pursuant to Chapter 458, 459 F.S. (psychiatrists), Chapter 490, F.S. (psychologists), Chapter 491, F.S., (mental health counselors, clinical social workers, marriage and family therapists), or as defined in Section 394.455(23), F.S. (psychiatric nurses).
A non-licensed mental health clinical staff person conducting an assessment of suicide risk
must meet the education/training requirements provided at pages 2-7 and 2-8 of the Manual and must have received at least 20 hours training and supervised experience in assessing suicide risk, mental health crisis intervention and emergency mental health services. The non-licensed
mental health clinical staff person’s training hours must have included administration of five
assessments of suicide risk or crisis assessments conducted on-site in the physical presence of a
licensed mental health professional. The non-licensed mental health clinical staff person’s training and supervised experience must be provided by a licensed mental health professional and must be documented and on-file in the facility or program.
D. TIMEFRAME FOR ASSESSMENTS OF SUICIDE RISK: The assessment of suicide risk must be
conducted by, or under the direct supervision of, a licensed mental health professional within 24 hours of the referral, or immediately if the youth is in crisis.
Note: Any youth with current suicide ideation must be immediately referred to a mental
health clinical staff person who will confer with a licensed mental health professional to
determine whether the assessment of suicide risk is to be conducted immediately rather
than within 24 hours. Any youth who makes a suicide attempt or attempts serious self-
inflicted injury must receive immediate assessment of suicide risk or emergency services
An assessment of suicide risk conducted by a non-licensed mental health clinical staff person
must be reviewed by a licensed mental health professional within 24 hours of the referral.
In the circumstance where the Assessment of Suicide Risk is conducted by a non-licensed mental health clinical staff person within 24 hours of the referral but cannot be reviewed by a licensed mental health professional within 24 hours of the referral through face-to-face interaction, the
licensed mental health professional may accomplish a review of the Assessment of Suicide Risk
within 24 hours of the referral through the following methods each of which requires verbal consultation:
1. Verbal consultation through telephonic communication (telephone, cell phone, blackberry) with the non-licensed mental health clinical staff person detailing the Assessment of Suicide Risk
findings. The verbal consultation and telephonic communication must be documented and summarized in the Assessment of Suicide Risk form by the non-licensed mental health clinical staff person, including any instructions or recommendations made by the licensed mental health professional. The Assessment of Suicide Risk form must be placed in the youth's mental health file and Verbal consultation AND consultation through electronically transmitted communications (e-mail) between the non-licensed mental health clinical staff person and
licensed mental health professional detailing the Assessment of Suicide Risk findings. The verbal consultation and e-mail communications must be documented and summarized in the Assessment of Suicide Risk form by the non-licensed mental health clinical staff person, including any instructions or recommendations made by the licensed mental health professional. The Assessment of Suicide Risk form and e-mail must be placed in the youth's mental health file and each document must be reviewed and the Assessment of Suicide Risk
signed “as reviewer” by the licensed mental health professional the next scheduled time he/she is on-site.
2. Verbal consultation AND off-site review of an electronically transmitted or faxed copy of the completed Assessment of Suicide Risk form. The licensed mental health professional would fax or electronically transmit confirmation the Assessment of Suicide Risk was reviewed and whether he or she concurs with the findings. The faxed or electronic transmission and the
Assessment of Suicide Risk and must be signed “as reviewer” by the licensed mental health professional the next scheduled time he/she is on-site.
E. ASSESSMENTS OF SUICIDE RISK PERFORMED IN THE FACILITY OR PROGRAM:
1. Documentation. When an assessment of suicide risk is conducted in the facility, the mental
health clinical staff person conducting the assessment must document his/her findings and recommendations on the form provided in Appendix P. The Assessment of Suicide Risk must provide details of the information obtained by the assessment (youth statements, behavioral observations, collateral information). The specific information supporting the Assessment of Suicide Risk findings and recommendations must be documented on the form. The
Assessment of Suicide Risk form must be signed and dated by the mental health clinical staff person conducting the assessment. If the Assessment of Suicide Risk is conducted by a non- licensed mental health clinical staff person, a licensed mental health professional must review, sign as a “reviewer” and date the original assessment form the next scheduled time he/she is on-site. The facility superintendent or program director or his/her designee must be notified of the assessment of suicide risk findings and recommendations in accordance with facility operating procedures.
2. Review of Findings/Recommendations. The superintendent or program director or his/her
designee is responsible for reviewing assessment of suicide risk findings and recommendations and ensuring that procedures are in place to follow findings and recommendations pertaining to monitoring and supervision. Administrative and/or supervisory staff instructions with regard to the assessment of suicide risk findings and recommendations and Suicide Precaution decisions must be documented in the facility log in accordance with facility operating procedures and on the Assessment of Suicide Risk form (Appendix P).
NOTE: Youths determined to be a potential suicide risk through Assessment of Suicide Risk
must be placed or maintained on Suicide Precautions (i.e., Precautionary Observation or
Secure Observation) until follow-up assessment of suicide risk, by or under the supervision of a licensed mental health professional, determines that the youth is not a potential suicide risk.
3. The assessment of suicide risk must be permanently filed in the youth’s individual healthcare record.
F.
ASSESSMENTS OF SUICIDE RISK PERFORMED OUTSIDE OF THE FACILITY/PROGRAM:
1. Documentation. When an assessment of suicide risk is conducted outside of the facility, documentation of the assessment should be requested by the juvenile justice representative responsible for the youth during the off-site assessment. For example, if a youth is seen in an emergency room by a psychiatrist, is not found suicidal and is discharged back to the facility, the emergency room discharge summary or other form of documentation of the assessment should be requested by the juvenile justice representative for review upon the youth’s return to the facility.
Upon the youth’s return from an off-site assessment due to suicide risk behaviors, the youth must be placed on constant supervision until a mental health clinical staff person reviews the off-site assessment documents and provides a follow-up assessment of suicide risk
2. Review of Findings/Recommendations. The superintendent or program director is
responsible for ensuring that assessment of suicide risk documents are reviewed by designated administrative or supervisory staff and designated mental health clinical staff upon the youth’s return to the facility, and that recommendations contained in the assessment
of suicide risk regarding Suicide Precautions are followed. Administrative or supervisory staff’s instructions regarding supervision and monitoring of the youth must be documented in the facility log in accordance with facility operating procedures.
NOTE: Youths determined to be a potential suicide risk through Assessment of Suicide Risk
must be placed or maintained on Suicide Precautions (i.e., Precautionary Observation or
Secure Observation) until follow-up assessment of suicide risk, by or under the supervision of a licensed mental health professional, determines that the youth is not a potential suicide risk.
3. The assessment of suicide risk must be permanently filed in the youth’s individual healthcare record.
G. FOLLOW-UP ASSESSMENT OF SUICIDE RISK
1. When a youth has received an assessment of suicide risk and has been determined by a
licensed mental health professional or non-licensed mental health clinical staff person after consultation with a licensed mental health professional to be a potential suicide risk and is being maintained on suicide precautions, follow-up assessment of suicide risk must be provided to determine the youth’s mental status and dangerousness to self. A follow-up assessment of suicide risk must be documented and reviewed by a licensed mental health professional prior to the youth’s removal from suicide precautions.
A follow-up assessment of suicide risk must reflect consideration of the following elements: a. Mental Status Examination to include direct questioning of the youth and collateral
informants regarding the youth’s appearance, behavior, mood and affect, emotional state, insight, cooperation, judgment, and suicide risk factors.
Current thoughts of suicide/harming self,
Suicide plan and method,
Precipitating and current stressors,
Hopelessness