Brief Risk Assessment of Self-Harm & Suicidal Ideation
All too frequently, children and teens in the care of the child welfare system experience severe post-traumatic stress that leads to thoughts about harming or even killing themselves (i.e. “suicidal ideation”).
As a therapist and treatment director, I consider such thoughts in context of a particular history, relevant developmental issues, recent life difficulties, and considerations related to psychological functioning .
No matter a person’s age, circumstance, or level of functioning, we must provide swift and compassionate response to thoughts or acts of self-harm and suicidal ideation in ways that welcome open dialogue and seek to therapeutically address whatever is causing an increasing sense of isolation and lack of hope.
Our first response should always be to assess risk. Although not a substitute for formal clinical assessment, one of the most common and useful forms of brief risk assessment is captured in the acronym “SLAP.”
“S” is for “specificity.” If one is going to harm him/herself, how would he/she do it? If the answer to this question is specific, the risk is higher; if not, then it is lower.
“L” is for “lethality.” If a specific method is described, would such a method actually be lethal? If yes, the risk is higher; if not, then it is lower.
“A” is for “availability.” Does the person have available to them the means or opportunity to engage in the self-harming actions? If yes, the risk is higher; if not, then it is lower.
“P” is for “proximity to help.” If an attempt was made, will it likely happen in a situation in which someone could stop the attempt or provide rescue? If yes, the risk is lower; if not, then it is higher.
A very immediate, informal, and brief conversation can provide the platform for conducting risk assessment. Risk is often best assessed through a dialogue of thoughtful, indirect questioning with a caring person.
As child welfare professionals, we must be sensitive to signs and cries for help. When in doubt, we should always engage in therapeutic risk assessment, collaborate with the child’s circle of support, and document all.
Remain engaged beyond traditional visits by increasing contact through phone calls to check-in to express genuine care and concern and more frequent visits to provide empathy and encouragement. It is also necessary to provide coaching to care providers to increase understanding and promote concerned engagement.
Whenever substance addiction or severe mental illness are present, such risk assessment is insufficient as judgment is extraordinarily distorted and the level of risk already high. Always ensure treatment is underway.
Blake Griffin Edwards, MSMFT LMFT LCPAA
Clinical Director, Fostering at Metrocare, Dallas, Texas
Recommended Resource for More Detailed Clinical Direction In Risk Assessment
Granello, D.H., and Granello, P.F. (2007). Suicide assessment: Strategies for determining risk. Counselling, Psychotherapy, and Health, 3(1), 42-51, May 2007. http://www.cphjournal.com/archive_journals/V3_I1_Granello_42-51_2007.pdf