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Wk 6 – Summative Assessment: Suicide Risk Assessment and Safety Plan
Most counselors will encounter a client expressing suicidal ideations at some point in their career. A counselor’s ability to recognize and address suicidality can be a life-saving skill. When the risk of suicide is identified, counselors should work to develop a therapeutic relationship with the client and their family as appropriate and work to develop safety plans in collaboration with the client. The safety plan indicates the actions that clients can take to respond and monitor their suicidal urges by outlining their coping and problem-solving skills and abilities.
Use the relevant information given in the video to complete a suicide risk assessment for the example client using Part 1 of the Patient Safety Plan form. In this form, be sure to document the rationale for the risk level, ways to reduce the current risk, and if relevant, a proposed plan for follow-up.
Develop an ongoing safety plan for this client to follow once the initial intervention is complete. Use Part 2 of the form to document the parts of your plan using clear language that the client can understand if in crisis.
Format your citations and references according to APA guidelines.
CCMH/558 v3
Client Safety Plan
CCMH/558 v3
Page 6 of 6
When someone seeks treatment after trauma, counselors must complete a risk assessment, even when clients may not be demonstrating behaviors that seem high risk.
Complete Parts 1 and 2 of this form including references. Submit the completed form for your assignment.
Instructions
Assess risk for the client in the case study using the Suicide Risk Assessment Form based on the
Suicide Assessment Five-step Evaluation and Triage
from SAMHSA in 175–250 words. Use full sentences and appropriate grammar.
Support your assessment with appropriate terminology from the DSM-5.
Develop an ongoing safety plan for this client to follow once the initial intervention is complete. Use the Client Safety Plan section of the form to document the parts of your plan using clear language the client can understand if in crisis.
Explain the potential cultural differences between counselor and client that might influence the professional counseling relationship in this scenario. Explain how your safety plan incorporates these cultural considerations to benefit the client’s experience with the treatment process.
Note: Your Client Safety Plan and cultural explanations should be 350–450 words.
Format your citations and references according to APA guidelines.
Part 1: Suicide Risk Assessment
Risk Factor
s
| Risk Factors |
Notes |
|||||||||
|
Precipitants and stressors · Recent trauma, triggering events (real or anticipated), another prior crisis · Medical illness, intoxication · Family or interpersonal turmoil, history of physical or sexual abuse, social isolation · Change in treatment or treatment provider, or discharge from psychiatric hospital |
Enter notes here. |
|||||||||
|
History of risk factors · Attempts to die by suicide · Self-injurious behavior · Psychiatric disorders, comorbidity, and mental health treatments · Attempts of family members to die by suicide · Family diagnosed with Axis 1 psychiatric disorders that required hospitalization |
||||||||||
|
Key symptoms · Anhedonia |
||||||||||
|
Lethal Access · Access to firearms or other lethal methods |
Protective Factor
s
| Protective Factors |
|
Internal · Ability to cope with stress or frustration · Spiritual beliefs |
|
External · Social supports · Responsibility to loved ones, children, or pets · Positive therapeutic relationships |
|
Ask About |
|
|
Ideations · Frequency, intensity, and duration of suicidal thoughts and ideations in: a. the last 48 hours b. the past month c. the worst ever |
|
|
Plan · Time · Place · Lethality of their method · Availability of their method · Ways they have prepared for death |
|
|
Behavior · History of attempts (and aborted attempts) to die by suicide · Rehearsal behaviors for suicide vs. non-suicidal self-injurious actions |
|
|
Intent · Extent to which the client expects to carry out the plan · Extent to which the client believes it to be lethal versus self-injurious |
|
|
Special Considerations · For youth and parents/guardians of minors: ask about evidence of suicidal thoughts, plans, or behaviors as well as changes in mood, behaviors, or dispositions · When indicated, or for character disordered or paranoid males dealing with loss or humiliation: ask about 4 areas above and conduct homicide inquiry |
Enter notes here, if applicable. |
Risk Level
/ Intervention
| Risk Level | Risk Factor | Protective Factor |
Suicidality |
Possible Interventions |
|
High |
Psychiatric diagnoses with severe symptoms or acute precipitating event |
Protective factors not relevant |
Potentially lethal suicide attempt or persistent ideation with strong intent or suicide rehearsal |
· Admission generally indicated unless a significant change reduces risk · Take suicide precautions |
|
Moderate |
Multiple risk factors |
Few protective factors |
Suicidal ideation with plan, but no intent or behavior |
· Admission may be necessary depending on risk factors · Develop crisis plan · Give emergency and crisis numbers |
|
Low |
Modifiable risk factors |
Strong protective factors |
Thoughts of death, no plan, intent, or behavior |
· Outclient referral, symptom reduction · Give emergency and crisis numbers |
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Enter your response, or N/A if not applicable.
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Part 2: Client Safety Plan
The client should refer to this safety plan in times of crisis.
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Name and Phone Number: Enter your response.
Name and Phone Number: Enter your response.
Place: Enter your response.
Place: Enter your response.
Name and Phone Number: Enter your response.
Name and Phone Number: Enter your response.
Name and Phone Number: Enter your response.
Clinician Name, Phone Number, and Emergency Number: Enter your response.
Clinician Name, Phone Number, and Emergency Number: Enter your response.
Local Urgent Care Services Name, Address, and Phone Number: Enter your response.
1. Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255)
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Enter your references for both Parts 1 and 2 in APA format.
Copyright 2021 by University of Phoenix. All rights reserved.
Copyright 2021 by University of Phoenix. All rights reserved.
CCMH558 – Suicide Risk Intake Assessment Transcript
Counselor is an African American male in his mid to late thirties.
Client is a White female in her mid to late thirties.
Counselor – So tell me what’s bringing you into counseling today?
Client – I’ve just been feeling really, really overwhelmed lately.
Client – Something happened on campus last week and I haven’t felt like myself ever since.
Counselor – Okay. So tell me what you mean by overwhelmed.
Client – Well, just I’ve been having a hard time focusing and I’ve been having a really hard time sleeping. My emotions are all over the place, sometimes I’ll cry for no reason. I’m really jumpy. You know, like, I catch myself looking over my shoulder a lot and every little sound kinda sets me off.
Counselor – I noticed that you’re shifting in your chair a lot and you’re kind of wringing your hands and I’m wondering, how you’re feeling right now?
Client – Not great. I’ve just, I mean, I kinda feel, I don’t know, frightened or sad, or kind of like I’m watching everything from really far away, kinda like things aren’t really real around me anymore, you know?
Counselor – Okay. Do you feel comfortable with me as a counselor and things like that? I’m not really comfortable with, I’m not really comfortable talking to strangers, let alone counselors.
Client – And then especially after last week, I’m not typically comfortable talking to men.
Counselor – Okay. With me being a male, do you feel comfortable talking to me or would you rather me get someone else?
Client – I’m just not so sure how you’ll be able to understand where I’m coming from.
Counselor – Okay. Well, I have some training in working with diverse clients and so hopefully I can be able to relate to you. And one of the things with counseling is that there is confidentiality with a few exceptions. One of those exceptions is if you are thinking about harming yourself or are actively suicidal. And so hopefully that makes you feel a little bit more comfortable in our relationship together. So I’m gonna do a quick assessment and so I’m gonna ask you a couple of questions and I just want you to be as truthful as possible and things like that. So tell me, do you have any previous psychological diagnoses or anything like that?
Client – No. I saw a counselor for a while when I was back in high school, but I haven’t been diagnosed with anything.
Counselor – Okay. And what about any family history of psychiatric diagnoses or anything like that?
Client – There’s some depression in the family, especially, yeah, I mean, with my brother.
Counselor – Okay. Tell me about that.
Client – Well, I mean, he was always a weird little kid but he was diagnosed in a pretty straightforward way. I mean, we were able to get him into counseling and therapy early, but his was different than mine. You know, I was just a teenager going through some stuff though and his was different.
Counselor – Okay. Is there been any suicidal behavior in the family? Has anyone completed suicide or had any suicide attempts? Attempts?
Client – Yes, but no suicides.
Counselor – Okay. And so tell me, do you have any thoughts about harming yourself or anything like that?
Client – Sometimes, especially since last week.
Counselor – Tell me what happened last week.
Client – I was finishing class, and it was my late night class. I’ve been taking classes at night after work and I didn’t…
Client – I don’t really know the details of what happened. Campus security doesn’t usually have the cameras on in that dark part of the quad, but I was attacked from behind and I was assaulted and I still don’t know who it was.
Counselor – You sound really scared and really kind of afraid right now. It seems like that is affecting you in multiple areas of your life right now.
Client – Yeah. Yeah, it’s getting in the way of everything.
Counselor – Okay. And so I’m wondering, you mentioned that you kind of have some thoughts about harming yourself. Have you thought about attempting suicide?
Client – Thinking about it and thinking about doing it or different things, you know, like, it seems like it would be a good idea. It seems like it would be really, really easy. When I can’t sleep I have sleeping pills, they’re right there. I know how easy it would be. And sometimes it just seems like the best option would just be go to sleep and not wake up again.
Counselor – So you have a plan and that would be to.
Client – I mean, if I were to go through with such a thing.
Counselor – Okay. So like on a scale of one to 10, one being, not at all and 10 being definitely gonna do it. Where would you say that your intent is right now?
Client – I would say that, depending on whether or not I am distracted and whether or not I have had a nightmare maybe a seven.
Counselor – Okay. So I’m really worried about your safety right now. So one of the things that I’m worried about is You said that your kind of intend is kinda high now. So I’m wondering what are some reasons to live? Tell me about some reasons that you have to wake up tomorrow.
Client – I don’t want to hurt anyone whom might care for me. I mean, you never know how that’s gonna hurt people. I remember how I felt when that kid in my class killed himself when he was in high school. And I just, I don’t want to do that to people, you know. My mom loves me, my roommate would be really scared. I’m certain that my friends from work would be worried about me. But I don’t really, I don’t really know why me being in the world would make it more important for me to be there.
Counselor – So I hear that you’re worried about the impact that completing suicide would have on like your family, your friends, your coworkers, and things like that. But you still may be a little bit hesitant or you still kind of have those suicidal thoughts surrounding you.
Client – It just seems like it would be the easiest fix.
Counselor – Okay. I’m wondering if you have any other, maybe, factors to live, maybe some children or anything like that, a beloved pet, just something to wake up to in the morning?
Client – I do have a cat who would be very upset if anything happened to me. And I know, I know that my mom, even though that we’re not close, like we used to be, I know that my mom, she wouldn’t be the same.
Okay. So I’m wondering if we can call someone to maybe secure those pills, maybe your mom or someone who can just be able to secure those pills, so that way we don’t, you don’t attempt suicide or complete suicide cause I’m really worried about just safety right now.
Client – Do you think it’s necessary that I go without the pills?
Counselor – Yeah, I’m really worried about your health and your safety. And so I think that the best thing that we do is to secure those pills, because one of the things about counseling is we want to make sure that you’re safe and we want to make sure that things are secure. And so I think that the best option right now is to really call someone while we’re here in session to secure those pills.
Client – I can call my mom.
Counselor – Okay. So let’s go ahead and do that now.
ResouRces
n
n
n
n
Download this card and additional resources at http://wwww.sprc.org
Resource for implementing The Joint Commission 2007 Patient
Safety Goals on Suicide http://www.sprc.org/library/jcsafetygoals
sAFe-T drew upon the American Psychiatric Association
Practice Guidelines for the Assessment and Treatment of
Patients with Suicidal Behaviors http://www.psychiatryonline.com/
pracGuide/pracGuideTopic_14.aspx
Practice Parameter for the Assessment and Treatment of Children and
Adolescents with Suicidal Behavior. Journal of the American Academy
of Child and Adolescent Psychiatry, 2001, 40 (7 Supplement): 24s-51s
AcKNoWLeDGMeNTs
n Originally conceived by Douglas Jacobs, MD, and developed as
a collaboration between Screening for Mental Health, Inc. and
the Suicide Prevention Resource Center.
n This material is based upon work supported by the Substance
Abuse and Mental Health Services Administration (SAMHSA) under
Grant No. 1U79SM57392. Any opinions/findings/conclusions/
recommendations expressed in this material are those of the
author and do not necessarily reflect the views of SAMHSA.
National Suicide Prevention Lifeline
1-800-273-TALK (8255)
HHS Publication No. (SMA) 09-4432 • CMHS-NSP-0193
Printed 2009
SAFE-T
Suicide Assessment Five-step
Evaluation and Triage
1
IDeNTIFY RIsK FAcToRs
Note those that can be
modified to reduce risk
2
IDeNTIFY PRoTecTIVe FAcToRs
Note those that can be enhanced
3
coNDucT suIcIDe INQuIRY
Suicidal thoughts, plans,
behavior, and intent
4
DeTeRMINe RIsK LeVeL/INTeRVeNTIoN
Determine risk. Choose appropriate
intervention to address and reduce risk
5
DocuMeNT
Assessment of risk, rationale,
intervention, and follow-up
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
www.samhsa.gov
Suicide assessments should be conducted at first contact, with any subsequent suicidal behavior, increased ideation, or pertinent clinical
change; for inpatients, prior to increasing privileges and at discharge.
1. RISK FACTORS
3 suicidal behavior: history of prior suicide attempts, aborted suicide attempts, or self-injurious behavior
3 current/past psychiatric disorders: especially mood disorders, psychotic disorders, alcohol/substance abuse, ADHD, TBI, PTSD, Cluster B personality
disorders, conduct disorders (antisocial behavior, aggression, impulsivity)
Co-morbidity and recent onset of illness increase risk
3 Key symptoms: anhedonia, impulsivity, hopelessness, anxiety/panic, global insomnia, command hallucinations
3
3 Precipitants/stressors/Interpersonal: triggering events leading to humiliation, shame, or despair (e.g, loss of relationship, financial or health status—real
or anticipated). Ongoing medical illness (esp. CNS disorders, pain). Intoxication. Family turmoil/chaos. History of physical or sexual abuse. Social isolation
3 change in treatment: discharge from psychiatric hospital, provider or treatment change
3 Access to firearms
Family history: of suicide, attempts, or Axis 1 psychiatric disorders requiring hospitalization
2. PROTECTIVE FACTORS Protective factors, even if present, may not counteract significant acute risk
Internal: ability to cope with stress, religious beliefs, frustration tolerance
external: responsibility to children or beloved pets, positive therapeutic relationships, social supports
3. SUICIDE INQUIRY Specific questioning about thoughts, plans, behaviors, intent
Ideation: frequency, intensity, duration—in last 48 hours, past month, and worst ever
Plan: timing, location, lethality, availability, preparatory acts
Behaviors: past attempts, aborted attempts, rehearsals (tying noose, loading gun) vs. non-suicidal self injurious actions
Intent: extent to which the patient (1) expects to carry out the plan and (2) believes the plan/act to be lethal vs. self-injurious.
Explore ambivalence: reasons to die vs. reasons to live
3
3
3
3
3
3
* For Youths: ask parent/guardian about evidence of suicidal thoughts, plans, or behaviors, and changes in mood, behaviors, or disposition
* Homicide Inquiry: when indicated, esp. in character disordered or paranoid males dealing with loss or humiliation. Inquire in four areas listed above
3
3
4. RISK LEVEL/INTERVENTION
Assessment of risk level is based on clinical judgment, after completing steps 1–3
Reassess as patient or environmental circumstances change
RISK LEVEL RISK/PROTECTIVE FACTOR SUICIDALITY POSSIBLE INTERVENTIONS
High
Psychiatric diagnoses with severe
symptoms or acute precipitating event;
protective factors not relevant
Potentially lethal suicide attempt or
persistent ideation with strong intent or
suicide rehearsal
Admission generally indicated unless a significant
change reduces risk. Suicide precautions
Moderate
Multiple risk factors, few protective
factors
Suicidal ideation with plan, but no intent
or behavior
Admission may be necessary depending on risk
factors. Develop crisis plan. Give emergency/crisis
numbers
Low
Modifiable risk factors, strong protective
factors
Thoughts of death, no plan, intent, or
behavior
Outpatient referral, symptom reduction.
Give emergency/crisis numbers
(This chart is intended to represent a range of risk levels and interventions, not actual determinations.)
5. DOCUMENT Risk level and rationale; treatment plan to address/reduce current risk (e.g., medication, setting, psychotherapy, E.C.T., contact with significant
others, consultation); firearms instructions, if relevant; follow-up plan. For youths, treatment plan should include roles for parent/guardian.
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