| (E) Upon conclusion of the risk assessment, follow
through on recommendations by the mental health professional and update
the child's safety plan and service plan accordingly.
(f) Intervention--Returning Post Hospitalization. To
ensure a child's readiness to return to the care of your operation
following a mental health crisis (for example, from a suicide attempt
or psychiatric hospitalization):
(1) A professional level service provider must meet
with the child within 24 hours of the child's return to an operation
to discuss protocols that would help to ease the child's transition
back into the operation, ensure the child's safety, and reduce any
risk of suicide.
(2) The protocols must include:
(A) Weekly suicide risk screenings for the first 30
days or until the child is no longer reporting suicidal thoughts,
whichever is longer;
(B) Creating or reviewing and updating the child's
safety plan; and
(C) Removal of any harmful objects, chemicals, or substances
that a child could use to carry out a suicide attempt or self-harm
for a period to be determined by the treatment team, but not less
than 30 days.
(3) The operation must alert any persons responsible
for the child's care or supervision of the new protocols and new or
updated safety plan.
(g) Postvention.
(1) Addressing Suicide Deaths.
(A) Create a Postvention Team and Written Action Plan
and Protocols. To prevent suicide contagion and support the children
and staff at the operation, you must create a postvention team. This
team is responsible for developing a written action plan with protocols
in the event of a death by suicide. The postvention team should consider
how a death would affect other children and staff at the operation
and consider how to provide psychological first aid, crisis intervention,
and other support to children and staff at your operation.
(B) While the action plan needs to be flexible for
varying situations, the written action plan must include:
(i) A communication strategy that:
(I) Does not inadvertently glamorize or romanticize
the child or the death;
(II) Occurs in small group settings, allowing the postvention
team to monitor responses of individuals in the group;
(III) Strives to treat all deaths at the operation
in the same way (for example, having one approach for honoring a child
who dies from cancer, a car accident, or suicide);
(IV) Emphasizes the importance of seeking help for
anyone with an underlying mental health diagnosis, such as a mood
disorder;
(V) Emphasizes the importance of staff and other children
recognizing the signs of suicide; and
(VI) Decreases the stigma associated with seeking help
for mental health concerns;
(ii) Mental health resources for children and staff
who have a difficult time coping, including:
(I) Opportunities to debrief to process thoughts and
feelings related to the suicide death; and
(II) Referrals to grief counseling and suicide survivor
support groups to the extent possible; and
(iii) A review of lessons learned from the child's
death by suicide. All communications regarding lessons learned should
be approached in a way that ensures a blame-free environment.
(2) Addressing Suicide Attempts. In the event of a
suicide attempt according to §748.305 of this chapter (relating
to What constitutes a suicide attempt by a child?), you must:
(A) As needed, immediately call emergency services
and render first aid until professional medical treatment can be provided;
(B) Not leave the child alone until a mental health
professional assesses the child;
(C) Move all other children out of the immediate area
as soon as possible;
(D) Report and document the suicide attempt as a serious
incident as required by:
(i) §748.303(a)(12) of this chapter (relating
to When must I report and document a serious incident?);
(ii) §748.311 of this chapter (relating to How
must I document a serious incident?); and
(iii) §748.313(1) of this chapter (relating to
What additional documentation must I include with a written serious
incident report?); and
(E) Offer mental health resources for children and
staff who have a difficult time coping, including:
(i) Opportunities to debrief to process thoughts and
feelings related to the suicide attempt; and
(ii) Referrals to grief counseling and suicide survivor
support groups to the extent possible; and
(F) Conduct a review of lessons learned from the child's
suicide attempt. All communications regarding lessons learned should
be approached in a way that ensures a blame-free environment.
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