| (a) Purpose. This rule establishes procedures for identification,
assessment, treatment, and protection of youth in medium-restriction
facilities who may be at risk for suicide.
(b) Applicability.
(1) This rule applies to all youth currently placed
in medium-restriction facilities operated by the Texas Juvenile Justice
Department (TJJD).
(2) Responsibilities assigned to mental health professionals
in this rule apply only to mental health professionals employed by
TJJD.
(3) For facilities that do not have a mental health
professional employed by TJJD and during periods when a TJJD-employed
mental health professional is not on call or on duty:
(A) TJJD uses community resources such as local mental
health authorities and psychiatric hospitals for all required clinical
services;
(B) TJJD staff will attempt to obtain guidance from
the mental health professional regarding any enhanced precautions
or supervision requirements (consistent with §380.9187 of this
chapter when possible) and frequency of follow-up assessments. TJJD
staff follow the guidance and instructions provided by the community
mental health professional regarding precautions and supervision for
youth even when such differ from this rule; and
(C) TJJD staff are authorized to seek additional instruction,
guidance, or assessments from mental health professionals within TJJD
or in the community at any time if there are concerns about the appropriateness
of precautions or required supervision level.
(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.
(3) A rescue kit for use in medical emergencies is
placed in at least one designated location within the facility that
is not accessible to youth.
(4) 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.
(1) Upon a youth's admission to a medium-restriction
facility, a trained designated staff member conducts a health screening,
which includes a review of the youth's file and questions relating
to suicidal ideation and behavior. The results of the health screening
are documented.
(2) If a youth is identified during the screening as
potentially at risk for suicide:
(A) the staff member who conducted the screening immediately
notifies the facility administrator or designee;
(B) the facility administrator or designee contacts
a mental health professional to conduct a suicide risk assessment;
and
(C) the youth is placed on the one-to-one suicide observation
level until assessed by a mental health professional.
(3) If a TJJD-employed mental health professional is
contacted to conduct the suicide risk assessment, the assessment must
be completed as soon as possible, not to exceed 72 hours.
(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 suicidal or
self-harming 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) immediately notify the facility administrator or
designee and document the notification;
(D) provide one-to-one observation;
(E) begin a suicide observation log to document status
checks of the youth; and
(F) refer the youth for a suicide screening.
(2) As soon as possible but no later than one hour
after notification, a trained designated staff member initiates a
suicide risk screening or a mental health professional initiates an
assessment. If a screening is conducted:
(A) the staff member who conducted the screening immediately
communicates the results of the screening to the facility administrator
or designee; and
(B) the facility administrator or designee ensures
the youth is assessed by a mental health professional.
(3) This screening or assessment is not required when
deemed inappropriate due to a medical emergency.
(4) If a TJJD-employed mental health professional is
contacted to conduct the suicide risk assessment, the mental health
professional assigns an observation level based on the results of
the suicide screening.
(5) Youth who are waiting for a suicide risk assessment
are not allowed community access (e.g., community service, employment,
academic attendance) unless TJJD staff supervise the youth on one-to-one
observation.
(6) If the youth is transported to the emergency room,
upon return to the medium-restriction facility, the youth is placed
on one-to-one observation until assessed by a mental health professional.
(7) In facilities with a TJJD-employed mental health
professional who is either on call or on duty, 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.
(g) Actions Taken Upon Completion of Suicide Risk Assessment.
(1) Documentation Requirements. Upon completion of
a suicide risk assessment conducted by a TJJD-employed mental health
professional, the mental health professional documents the results
of the assessment, including any changes in the youth's observation
level.
(2) Notification of Assessment Results.
(A) Upon completion of a suicide risk assessment, the
facility administrator or designee ensures appropriate facility staff
are notified of the results.
(B) If the youth is placed on suicide alert:
(i) the facility administrator or designee immediately
notifies facility staff of the youth's enhanced supervision requirements
and any additional instructions; and
(ii) the youth's parent or guardian is notified as
soon as possible after the youth is placed on suicide alert (with
the youth's consent if the youth is age 18 or older).
(C) If the youth is not placed on suicide alert, the
facility administrator or designee notifies the referring staff and
the youth's case manager that the youth was assessed and not placed
on suicide alert.
(3) Assignment of Staff to Monitor Youth. If the youth
is placed on suicide alert, the facility administrator or designee
assigns a specific staff member to monitor the youth and document
status checks.
(h) Supervision of Youth on Suicide Alert.
(1) The facility administrator or designee coordinates
a search of the youth's room and removes any potentially dangerous
items.
(2) A suicide observation monitoring sheet must be
in the possession of the monitoring staff member at all times while
the youth is on suicide alert.
(A) At no time may the youth possess the suicide observation
sheet.
(B) Each time the youth is transferred to the supervision
of another staff member, the receiving staff member must take possession
of the observation sheet and document the transfer of supervision.
(3) The monitoring staff member must:
(A) maintain direct visual observation of the youth
if required;
(B) document the youth's status at the required interval;
and
(C) follow any precautions set by the mental health
professional.
(4) The monitoring staff member must not leave a youth
assigned to one-to-one observation unattended or let the youth out
of the staff member's sight.
(5) During waking hours, the monitoring staff must
not leave a youth assigned to constant observation unattended or let
the youth out of the staff member's sight.
(6) Any time a youth on one-to-one or constant observation
is in the bathroom or shower, the monitoring staff must remain within
six feet of the youth, and:
(A) observe at least a portion of the youth's body
(i.e., head, feet, or other observable parts, excluding genitalia,
breasts, and buttocks); and/or
Cont'd... |
