| (B) maintain verbal contact.
(7) Youth on suicide alert are not allowed access to
off-site activities or appointments unless it is approved on a case-by-case
basis. In such cases, the youth must be supervised on one-to-one observation.
(i) Treatment and Reassessment of Youth on Suicide
Alert.
(1) Subparagraphs (A)-(D) of this paragraph apply to
TJJD-employed mental health professionals.
(A) A mental health professional prepares a written
treatment plan for each youth on suicide alert, updating or revising
the plan as necessary. The treatment plan includes:
(i) identification of the crisis stabilization issues
to be addressed in ongoing assessment sessions;
(ii) a plan of action to address these issues; and
(iii) the degree of community restriction necessary
to provide for the youth's safety.
(B) The mental health professional consults with facility
staff to recommend modifications to the youth's individual case plan
based on issues identified in the treatment plan.
(C) While the youth is on suicide alert, the mental
health professional assesses the youth as needed, but at least once
every two calendar days.
(D) For each assessment, the mental health professional:
(i) reviews relevant suicide alert documentation and
information;
(ii) determines whether any changes should be made
to the youth's observation level or other precautions; and
(iii) documents any changes in the observation level,
community restrictions, or other safety precautions.
(2) Each time a change is made to the youth's observation
level or other safety precautions, the facility administrator or designee
ensures the changes are documented and facility staff are notified.
(3) If the youth is receiving routine psychiatric services,
the facility administrator or designee ensures the psychiatric provider
is notified of the youth's placement on suicide alert and of any relevant
information concerning the youth's treatment and supervision while
on suicide alert.
(j) Youth Who Cannot Be Safely Managed in Current Placement.
(1) If the facility administrator or mental health
professional determines that a youth cannot be safely managed within
the structure of the current placement due to behavior that indicates
imminent risk of suicide or serious self-injury, the facility administrator
or designee:
(A) ensures one-to-one observation for the youth until
an emergency psychiatric placement is obtained;
(B) obtains emergency psychiatric placement at a TJJD
crisis stabilization unit or in a private psychiatric hospital. For
youth not on parole status, the facility administrator or designee
may also seek temporary admission to protective custody in a high-restriction
TJJD facility pending emergency psychiatric placement if no such placements
are immediately available; and
(C) maintains communication with staff at the emergency
placement to obtain current mental status information and to assess
the length and suitability of the current placement.
(2) For youth maintained on constant and/or one-to-one
observation longer than seven days in a medium-restriction facility,
the facility administrator or designee must pursue an alternative
placement with longer-term stabilization, clinical resources, and
increased supervision.
(k) Reduction of Observation Level and Removal from
Suicide Alert.
(1) The observation level for a youth on suicide alert
may be lowered or discontinued only after an assessment by a mental
health professional.
(A) A youth's suicide observation level may be lowered
by no more than one level every 24 hours.
(B) Only youth on the lowest available observation
level may be removed from suicide alert.
(2) The facility administrator or designee notifies
facility staff when a youth's observation level is reduced and when
a youth is removed from suicide alert.
(3) The youth's parent or guardian is notified when
the youth is removed from suicide alert (with the youth's consent
if the youth is age 18 or older).
(4) For youth being treated by a TJJD-employed mental
health professional, the mental health professional identifies in
the treatment plan any needed follow-up mental health services when
the youth is removed from suicide alert.
(l) Release or Discharge of Youth on Suicide Alert.
Prior to releasing or discharging a youth on suicide alert to a community
placement (i.e., another non-secure placement or home placement),
the facility administrator or designee ensures a mental health professional
has arranged for appropriate continuity of care when possible.
(m) Training.
(1) All staff who have regular, direct contact with
youth receive initial training in suicide prevention and response
during new-hire training. Training addresses topics including, but
not limited to:
(A) identifying the warning signs and symptoms of suicidal
and/or self-harming behavior;
(B) high-risk periods for suicidal and/or self-harming
behavior;
(C) juvenile suicide research, to include the demographic
and cultural parameters of suicidal behavior, incidence, and precipitating
factors;
(D) responding to suicidal youth and youth experiencing
mental health symptoms;
(E) communication between correctional and health care
personnel;
(F) referral procedures;
(G) housing, observation, and suicide alert procedures;
and
(H) follow-up monitoring of youth who engage in suicidal
behavior, self-harming behavior, and/or suicidal ideation.
(2) All staff who have regular, direct contact with
youth receive annual suicide prevention training.
(3) Staff designated to conduct suicide screenings
receive annual training from a mental health professional regarding
suicide alert policy, suicide indicators, and suicide screening.
(4) All training described by this subsection shall
be accompanied by a test or demonstration to establish competency
in the subject matter.
(n) Post-Incident Debriefing and Analysis.
(1) After a completed suicide or a life-threatening
suicide attempt, the facility administrator or designee coordinates
a debriefing with appropriate facility staff as soon as possible after
the situation has been stabilized, in accordance with agency procedures.
(2) After a completed suicide, the executive director
or designee may dispatch a critical incident support team to provide
counseling for youth and staff, coordination of facility activities,
and assistance with follow-up care.
(3) After a completed suicide, the medical director
conducts a morbidity and mortality review in coordination with appropriate
clinical staff. The medical director may conduct a morbidity and mortality
review after a life-threatening suicide attempt.
(4) After a completed suicide or a life-threatening
suicide attempt, a critical incident review is convened to determine
if the incident reveals system-wide deficiencies and to recommend
improvements to agency policies, operational procedures, the physical
plant, and/or training requirements.
(5) In the event of a completed suicide, all actions,
notifications, and reports required under §385.9951 of this chapter
must be completed.
|
| Source Note: The provisions of this §380.9189 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 |
