TABLE 1. Best Practice Outpatient Intervention with Youth in an Acute Suicidal Crisis
Area
|
Key questions
|
|
| Assessment |
|
| Attempta |
What method was employed, how lethal, and how much planning was involved? |
| Ideatora |
Did you ever feel so upset that you wished you were not alive or wanted to die? Did you ever do something that you knew was so dangerous that you could get hurt or killed by doing it? Did you ever think about or try to commit suicide? (Jacobson, 1994, as cited in Shaffer & Pfeffer, 2001, p. 37S). |
| Underlying conditionsa |
Do you have an existing diagnosis? |
| Risk factors for repeated suicide attempta |
See Table 2 |
| Protective factorsb |
What part of you wants to stay alive? What has kept you from killing yourself up to this point? |
| Parent/guardianc |
Are you able to maintain a safe environment? |
| Intervention |
|
| Negotiate no-harm contractd |
What can you do other than kill yourself? Who can you call? What can I do? |
| Limit availability of lethal meansd |
What lethal means are available? Are they accessible? How can they be secured or removed? |
| Provide support and 24-hr contactd |
What number should you call in a crisis? |
| Hospitalize if necessaryd |
Are you able to keep yourself safe in the community? |
| Refer to psychiatrist for an evaluation for medicationse |
Are you currently seeing a psychiatrist? |
| Other |
|
| Supervision and consultationf |
Are there any areas of my assessment, diagnosis or treatment plan that are incomplete and therefore fail to protect my client? |
Documentationf
|
Based on my documentation, would a lawyer and jury understand how the client presented, what I did and why I did it?
|
|
Note. Questions taken or adapted from cited source when possible. Otherwise, questions derive from the author's practice experience.
a Shaffer and Pfeffer (2001);
b Berman et al. (2006);
c Rudd, Joiner, Jobes, and King (1999);
d Brent et al. (1997);
e Brent and Birmaher (2002);
f Bongar (2002).
