| (A) Refer the child to a mental health professional
for a suicide risk assessment within 24 hours;
(B) Closely monitor the child to ensure the child's
safety until a mental health professional assesses the child;
(C) Remove any harmful objects, chemicals, or substances
that a child could use to carry out a suicide attempt;
(D) Alert each person responsible for the child's care
or supervision of the potential risk of suicide and any new or updated
safety plan; and
(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 care under the same child-placing
agency following a mental health crisis (for example, from a suicide
attempt or psychiatric hospitalization):
(1) Child placement management staff must meet with
the child within 24 hours of the child's arrival to a home to discuss
protocols that would help to ease the child's transition into the
home post hospitalization, 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 agency 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 employees,
children, caregivers, and adoptive parents, 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:
(i) How a death would affect employees, caregivers,
adoptive parents, and other children receiving services in the home
where the death occurred; and
(ii) How to provide psychological first-aid, crisis
intervention, and other support to the employees, caregivers, adoptive
parents, and other children receiving services in the home where the
death occurred.
(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 settings that allow the postvention
team to monitor responses of individuals in the home;
(III) Strives to treat all deaths 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 employees, caregivers,
adoptive parents, and children recognizing the signs of suicide; and
(VI) Decreases the stigma associated with seeking help
for mental health concerns;
(ii) Mental health resources for employees, caregivers,
adoptive parents, and children 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 §749.505 of this chapter (relating
to What constitutes a suicide attempt by a child?):
(A) The caregiver must, as needed, immediately call
emergency services and render first aid until professional medical
treatment can be provided;
(B) The caregiver must not leave the child alone until
a mental health professional assesses the child;
(C) The caregiver must move all other children out
of the immediate area as soon as possible;
(D) The agency must report and document the suicide
attempt as a serious incident as required by:
(i) §749.503(a)(12) of this chapter (relating
to When must I report and document a serious incident?);
(ii) §749.511 of this chapter (relating to How
must I document a serious incident?); and
(iii) §749.513(1) of this chapter (relating to
What additional documentation must I include with a written serious
incident report?);
(E) The agency must offer mental health resources for
employees, caregivers, and children 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 community services and other resources
when a child has attempted suicide; and
(F) The agency must 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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