| (a) Purpose. This rule establishes definitions of terms
used in the Texas Juvenile Justice Department's (TJJD's) suicide prevention
policies as set forth in §§380.9188, 380.9189, 380.9190,
and 380.9745 of this chapter.
(b) Definitions.
(1) Completed Suicide--a death resulting from deliberate
actions to harm oneself.
(2) Critical Incident Review--a review conducted by
a multi-disciplinary team designed to critically review the circumstances
surrounding a death or serious incident and to recommend corrective
action where necessary. The critical incident review may consider
information such as incident reports, training/personnel records,
policies/procedures, other relevant documents, facility practices,
any non-confidential information resulting from a morbidity and mortality
review, and any other information the review team determines is necessary
for a comprehensive review.
(3) Critical Incident Support Team--a team used to
provide support to youth, employees, and families involved in or adversely
affected by the death of a TJJD youth or staff member.
(4) Designated Mental Health Professional--a doctoral-level
psychologist who has primary responsibility and accountability for
the evaluation, monitoring, and treatment of youth referred for suicide
risk in high-restriction facilities. In the absence of a doctoral-level
psychologist, a licensed mental health professional may be appointed
to serve as the designated mental health professional with the approval
of the Central Office director over treatment services.
(5) Life-Threatening Suicide Attempt--a suicide attempt
that a health care professional determines would have likely resulted
in death except for circumstances beyond the youth's control.
(6) Mental Health Professional--a doctoral-level psychologist,
masters-level mental health specialist, licensed professional counselor,
licensed psychological associate, or licensed clinical social worker.
(7) Morbidity and Mortality Review--an assessment of
the overall clinical care provided and the circumstances leading up
to a death or certain serious medical incidents. Its purpose is to
identify program strengths and opportunities for improvement in clinical
care.
(8) Protective Custody--a temporary program in high-restriction
facilities designed for the placement of youth who cannot be safely
managed in the current dorm or living unit due to risk of suicidal
and/or self-harming behavior, as determined by a mental health professional.
(9) Psychiatric Provider--a:
(A) Texas-licensed psychiatrist; or
(B) Texas-licensed physician assistant or psychiatric
nurse practitioner acting under the authorization of a psychiatrist.
(10) Rescue Kit--emergency medical items such as a
CPR pocket mask, disposable gloves, and a tool capable of cutting
ligatures.
(11) Self-Harming Behavior--behavior that causes harm,
such as self-laceration, self-battering, taking overdoses, or exhibiting
deliberate recklessness. Self-harming behavior is not considered a
type of suicidal behavior, unless designated as such by a mental health
professional.
(12) Staggered Intervals--periods of time that are
irregular and unpredictable.
(13) Suicidal Behavior--includes suicide attempts or
taking deliberate action toward carrying out a specific plan or strategy
to injure oneself or to cause one's own death.
(14) Suicidal Ideation--thoughts of engaging in suicide-related
behavior. This means a youth expresses thoughts or fantasies about
committing suicide or expresses a desire to commit suicide.
(15) Suicide Alert--a status that begins following
a suicide risk assessment by a mental health professional, indicating
that a youth is at risk to attempt suicide or self-harming behavior
and requires increased supervision and/or precautions designed to
limit the risk.
(16) Suicide Attempt--an act apparently intended to
end one's life. A suicide attempt is a type of suicidal behavior.
(17) Suicide Observation Folder--a folder containing
completed and/or active suicide observation logs/check sheets and
any other pertinent information as determined by a mental health professional.
(18) Suicide Observation Level--levels of observation
determined by a mental health professional to provide enhanced supervision
for youth who are awaiting a suicide risk assessment or who have been
placed on suicide alert. General criteria for determining the appropriate
level of observation are provided in subparagraphs (A) - (C) of this
paragraph, however the mental health professional may assign any level
of observation deemed appropriate under the circumstances based on
the professional's clinical judgment.
(A) One-to-One Observation--generally considered appropriate
for a youth who is actively suicidal, either by threatening or engaging
in suicidal and/or self-harming behavior, and who may require emergency
psychiatric placement. One-to-one observation includes the following:
(i) Assigned staff may not have any other concurrent
duties.
(ii) Assigned staff remains within six feet of the
youth and maintains continuous, direct visual observation of the youth
at all times, including while the youth is in the youth's room or
while the youth is sleeping.
(iii) Assigned staff documents the youth's status at
least once every five minutes.
(iv) Assigned staff must be formally relieved by another
staff or by the discontinuation of the one-to-one status.
(v) Doors to individual rooms remain unlocked, except
when a youth presents an imminent danger to staff due to aggressive
behavior.
(B) Constant Observation--generally considered the
appropriate level of observation for a youth who is actively suicidal,
either by threatening or engaging in suicidal and/or self-harming
behavior, but does not appear to require emergency psychiatric placement.
Constant observation includes the following:
(i) During waking hours, the youth is within 12 feet
and within sight of assigned staff at all times. Staff may have concurrent
duties if the duties do not interfere with observation of the youth.
The assigned staff documents the youth's status at staggered intervals
not to exceed every five minutes.
(ii) During sleeping hours, assigned staff observes
and documents the youth's status at staggered intervals not to exceed
every five minutes.
(iii) For youth in a security unit or crisis stabilization
unit, doors to individual rooms remain locked.
(C) Close Observation--generally considered the appropriate
level of observation for a youth who is not actively suicidal and
would be considered a lower risk for suicide but expresses suicidal
ideation and/or has a recent history of suicidal and/or self-harming
behavior. In addition, close observation would be appropriate for
a youth who denies suicidal ideation or does not threaten suicide
but demonstrates other concerning behavior (through actions, current
circumstances, or recent history) indicating the potential for self-harm.
With close observation, the assigned staff is generally involved in
concurrent duties that do not interfere with required observation
of the youth. The frequency of checks for youth on close observation
is as follows:
(i) for youth in a security unit or crisis stabilization
unit, assigned staff observes and documents the youth's status at
staggered intervals not to exceed every five minutes; and
(ii) for all other youth, assigned staff observes and
documents the youth's status at staggered intervals not to exceed
10 minutes.
(19) Suicide-Resistant Clothing--tear-resistant, single-piece
attire designed to promote a youth's safety while still providing
warmth and coverage.
(20) Suicide-Resistant Room--a room that provides a
safe environment and has no obvious materials or possessions that
can be used in suicidal and/or self-harming behavior or any item that
can be used for hanging. The room is free of all obvious protrusions
and any items that provide an easy anchoring device for hanging. Lighting
is tamper-proof, and there are no switches or electrical outlets in
the room. The door of the room has a heavy-gauge, clear panel that
provides staff an unobstructed view of the room.
(21) Suicide Risk Assessment--a standardized assessment
by a mental health professional that:
(A) is conducted in-person or via remote computer service
that allows both parties to see and hear one another; and
(B) contains specific lines of inquiry regarding suicide
risk, a mental status examination, and clinical observations and recommendations.
(22) Suicide Risk Screening--a standardized interview
to determine the appropriate suicide observation level until a suicide
risk assessment is conducted. The screening is conducted in-person
or via remote computer service that allows both parties to see and
hear one another.
(23) Trained Designated Staff Member--a staff member
trained to conduct a suicide risk screening.
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| Source Note: The provisions of this §380.9187 adopted to be effective December 1, 2009, 34 TexReg 8543; transferred effective June 4, 2012, as published in the Texas Register June 22, 2012, 37 TexReg 4639; amended to be effective April 15, 2015, 40 TexReg 1976; amended to be effective August 1, 2023, 48 TexReg 2380 |
