| (B) If the youth is placed on suicide alert, the mental
health professional ensures the youth's name is placed on the facility's
suicide alert list. The designated mental health professional ensures
the updated list is distributed to facility staff.
(2) Notification of Assessment Results.
(A) If the youth is placed on suicide alert:
(i) as soon as possible, infirmary staff, the youth's
case manager, staff responsible for supervising the youth, and the
campus shift supervisor are notified of the youth's observation level,
other safety precautions, 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).
(B) If the youth is not placed on suicide alert, the
mental health professional notifies the referring staff and the youth's
case manager that the youth was assessed but not placed on suicide
alert.
(3) Assignment of Staff to Monitor Youth. If the youth
is placed on suicide alert, the campus shift supervisor ensures a
specific staff member is assigned to monitor the youth and carry the
suicide observation folder.
(h) Supervision of Youth on Suicide Alert.
(1) Unless the youth is already placed in a suicide-resistant
room, the campus shift supervisor or trained designated staff member
coordinates a search of the youth's room or personal area and removes
any potentially dangerous items.
(2) The suicide observation folder 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
folder.
(B) Each time the youth is transferred to the supervision
of another staff member, the receiving staff member must take possession
of the folder and document the transfer of supervision in the folder.
(3) As required by the suicide observation level and
other safety precautions assigned to the youth, the monitoring staff
member must:
(A) maintain direct visual observation of the youth;
(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
(B) maintain verbal contact.
(7) When a youth on one-to-one or constant observation
is engaged in regular programming (e.g., education, group sessions,
recreation), the monitoring staff will accompany the youth to the
activity and remain within the required distance (i.e., 6 or 12 feet).
If the youth cannot be maintained within the required distance without
disrupting the program, a mental health professional must be consulted
to consider possible modifications to the youth's supervision plan
or scheduled routine to ensure the youth can be appropriately monitored.
(8) Issuing suicide-resistant clothing and removing
a youth's clothing, as well as canceling programming and routine privileges,
will be avoided whenever possible and used only as a last resort for
periods during which the youth is physically engaging in suicidal
and/or self-harming behavior.
(A) Decisions regarding issuance of suicide-resistant
clothing and restrictions in programming and/or routine privileges
may be made only by a mental health professional.
(B) A decision to conduct a strip search if criteria
in §380.9709 of this chapter are met may be made only in consultation
with a mental health professional.
(C) A decision to use force in order to remove a youth's
regular clothing after a youth has been issued suicide-resistant clothing
may occur only upon the recommendation of a mental health professional
and with the approval of the directors over treatment and facility
operations or the directors' designees.
(D) If force is used to remove a youth's regular clothing
as provided by subparagraph (C) of this paragraph, a mental health
professional must evaluate the youth's need for trauma symptom care
and ensure the care is provided if appropriate.
(9) Unless approved by the designated mental health
professional in consultation with the facility administrator, youth
on suicide alert are not allowed access to off-campus activities or
non-medical appointments. Decisions regarding off-campus medical appointments
are made by medical staff.
(i) Treatment and Reassessment of Youth on Suicide
Alert.
(1) A mental health professional develops a written
treatment plan (or revises an existing care plan) that includes treatment
goals and specific interventions designed to address and reduce suicidal
ideation and threats, suicidal and/or self-harming behavior, and suicidal
threats perceived to be based upon attention-seeking or manipulative
behavior. The treatment plan describes:
(A) signs, symptoms, and circumstances under which
the risk for suicide or other self-harming behavior is likely to reoccur;
(B) how reoccurrence of suicidal and other self-harming
behavior can be avoided; and
(C) actions the youth and staff can take if the suicidal
and other self-harming behavior does occur.
(2) The mental health professional consults with the
youth's case manager, as needed, to recommend modifications to the
youth's individual case plan based on issues identified in the treatment
plan. The mental health professional consults with staff responsible
for supervising the youth regarding the youth's progress.
(3) While the youth is on suicide alert, a mental health
professional assesses the youth at least once every 48 hours, unless
the youth is placed on one-to-one observation, in which case the mental
health professional assesses the youth at least once every 24 hours.
(4) For each assessment, the mental health professional:
(A) reviews the contents of the suicide observation
folder, as well as suicide risk assessments and progress notes from
other mental health professionals as applicable;
(B) determines whether any changes should be made to
the youth's observation level or other safety precautions, in consultation
with the designated mental health professional;
(C) documents any changes in the observation level
or other safety precautions in the suicide observation folder; and
(D) documents the assessment, including a sufficient
description of the youth's emotional status, observed behavior, recommended
observation level, justification for decision, and any special instructions
for staff.
(5) Each time a change is made to the youth's observation
level or other safety precautions, staff responsible for supervising
the youth are notified and updated information regarding the youth
is distributed to designated facility staff, including infirmary staff.
(6) During routine meetings between the psychology
department and the psychiatric provider, the designated mental health
professional or designee discusses information concerning youth on
suicide alert who are on the psychiatric caseload.
(j) Protective Custody or Emergency Psychiatric Placement.
(1) Youth who cannot be safely managed in their assigned
living units may be referred for placement in a suicide-resistant
room in the protective custody program, in accordance with §380.9745
of this chapter. All treatment, reassessment, and observation requirements
established in this rule will continue to apply while a youth is assigned
to protective custody unless otherwise noted in §380.9745 of
this chapter.
(2) If the designated mental health professional or
psychiatric provider determines that a youth is in serious and imminent
risk of suicidal and/or self-harming behavior and cannot be safely
or appropriately managed within TJJD custody, the designated mental
health professional or psychiatric provider may seek emergency psychiatric
placement in accordance with §380.8771 of this chapter. The youth
will be placed on one-to-one observation until received at the emergency
placement.
(k) Intrasystem Transfer of Youth on Suicide Alert.
(1) Prior to transferring a youth on suicide alert
to another high-restriction TJJD facility:
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