| (a) Purpose. This rule establishes procedures for identification,
assessment, treatment, and protection of youth in high-restriction
facilities who may be at risk for suicide.
(b) Applicability. This rule applies to all youth currently
placed in high-restriction facilities operated by the Texas Juvenile
Justice Department (TJJD).
(c) Definitions. Definitions pertaining to this rule
are under §380.9187 of this chapter.
(d) General Provisions.
(1) Treatment for youth determined to be at risk for
suicide is provided within the least restrictive environment necessary
to ensure safety.
(2) Youth determined to be at risk for suicide participate
in regular programming to the extent possible, as determined by a
mental health professional. Only a mental health professional may
make exceptions to the provision of regular programming, housing placement,
or clothing.
(3) Using force to remove clothing shall be avoided
whenever possible and used only as a last resort when the youth is
physically engaging in suicidal and/or self-harming behavior.
(4) Designated staff carry rescue kits at all times
while on duty for use in the event of a medical emergency caused by
a suicide attempt. Rescue kits are also placed in designated buildings
or areas of the campus that are not accessible to youth.
(5) As soon as possible, but not to exceed two hours,
after a suicide attempt, the youth's parent or guardian is notified
(with the youth's consent if the youth is age 18 or older).
(e) Intake Screening and Assessment.
(1) Upon Initial Admission to TJJD.
(A) Upon arrival to a TJJD orientation and assessment
unit, designated intake staff keep youth within direct line-of-sight
supervision until the youth is screened or assessed for suicide risk.
(B) Within one hour after the youth's arrival to a
TJJD orientation and assessment unit, a mental health professional
initiates an initial mental health screening and documents the results.
(C) If the mental health professional identifies the
youth as potentially at risk for suicide, the mental health professional
immediately conducts a suicide risk assessment.
(D) Within 14 days after arrival at the orientation
and assessment unit, all youth receive a comprehensive mental health
evaluation conducted by a mental health professional. The mental health
evaluation will include a suicide risk assessment if one has not already
been completed.
(E) The suicide risk assessment completed upon initial
admission includes, at a minimum:
(i) a mental status exam;
(ii) a review of all mental health and medical records
submitted from the courts, county juvenile detention facilities, or
any other medical or mental health provider, to include any assessments
by mental health professionals relating to prior suicide alerts during
confinement;
(iii) a review of all other available screenings and
assessments; and
(iv) referrals for follow-up treatment or further assessment,
as indicated.
(F) The designated mental health professional reviews
the suicide risk assessment.
(2) Upon Arrival at a TJJD Facility after Intake.
(A) Except for youth who are on suicide alert at the
time of arrival, the following actions must occur within one hour
after a youth's arrival at a high-restriction facility following an
intrasystem transfer, any period of time spent out of TJJD's physical
custody due to a significant life event, or a period of at least 48
hours spent out of TJJD's physical custody for any reason:
(i) a trained designated staff member initiates a suicide
risk screening; or
(ii) a mental health professional initiates a suicide
risk assessment.
(B) The youth is kept within direct line-of-sight supervision
until the youth is screened or assessed.
(C) If a screening is conducted:
(i) the trained designated staff member immediately
contacts a mental health professional to assign an observation level,
if appropriate, based on results of the screening; and
(ii) the youth is immediately placed on the observation
level directed by the mental health professional; and
(iii) the mental health professional conducts a suicide
risk assessment within an appropriate time frame, as established in
agency procedures. Procedures will assign time frames based on the
youth's assigned observation level and screening result.
(D) The suicide risk assessment conducted upon a youth's
arrival at a TJJD facility includes, at a minimum:
(i) a mental status exam;
(ii) a review of the youth's masterfile and medical
record, as indicated;
(iii) referrals for follow-up treatment or further
assessment, as indicated;
(iv) a determination of whether to place the youth
on suicide alert, and if placed, designation of the appropriate observation
level and other safety precautions; and
(v) a review by the designated mental health professional
of the assessment.
(3) Additional Screening by Infirmary for Intrasystem
Transfers.
(A) Upon arrival of a youth from another high-restriction
TJJD facility, a nurse completes an intrasystem health screening,
including questions relating to suicidal ideation and suicidal behavior.
(B) If the youth is identified by the screening as
potentially at risk for suicide, the nurse immediately contacts a
mental health professional and communicates the results of the screening.
(f) Responding to Suicidal Ideation, Self-Harming Behavior,
or Suicidal Behavior.
(1) A staff member who has reason to believe that a
youth has verbalized suicidal ideation or demonstrated self-harming
or suicidal behavior must:
(A) immediately use the rescue kit if appropriate and
seek medical attention if there is a medical emergency;
(B) verbally engage the youth;
(C) provide constant observation unless a mental health
professional directs a higher observation level;
(D) begin a suicide observation log to document status
checks of the youth;
(E) immediately notify the campus shift supervisor
and document the notification; and
(F) refer the youth for a suicide screening.
(2) As soon as possible, but no later than one hour
after notification, the campus shift supervisor ensures a trained
designated staff member initiates a suicide risk screening or a mental
health professional initiates a suicide risk assessment. This screening
or assessment is not required when deemed inappropriate due to a medical
emergency.
(3) If a screening is conducted:
(A) the trained designated staff member immediately
contacts a mental health professional to assign an observation level
based on results of the screening; and
(B) the mental health professional conducts a suicide
risk assessment within an appropriate time frame, as established in
agency procedures. Procedures will assign time frames based on the
youth's assigned observation level and screening result.
(4) If the youth is transported to the emergency room:
(A) upon return to the facility, the youth is placed
on one-to-one observation until assessed by a mental health professional;
and
(B) a mental health professional initiates a suicide
risk assessment within four hours after the youth's return to the
facility.
(5) The suicide risk assessment conducted in response
to suicidal behavior or ideation includes:
(A) a mental status exam;
(B) a review of the youth's masterfile and medical
record, as indicated;
(C) referrals for follow-up treatment or further assessment,
as indicated;
(D) a determination of whether to place the youth on
suicide alert, and if placed, designation of the appropriate observation
level and other safety precautions; and
(E) a review by the designated mental health professional
of the assessment.
(6) Whenever possible, suicide risk screenings and
assessments are conducted in a confidential setting.
(g) Actions Taken Upon Completion of Suicide Risk Assessment.
(1) Documentation Requirements.
(A) Upon completion of a suicide risk assessment, the
mental health professional documents the results of the assessment,
including any changes in the youth's observation level.
Cont'd... |
