SECTION 749.137. What is the model suicide prevention, intervention, and postvention policy?

(a) Purpose. The purpose of the model suicide prevention, intervention, and postvention policy is to:

(1) Protect the health and well-being of children in an agency's care by implementing procedures to prevent suicide, including screening and assessment procedures for risk of suicide;

(2) Require intervention when a child attempts or dies by suicide; and

(3) Address the needs of children in an agency's care, employees, caregivers, and adoptive parents after a child attempts or dies by suicide.

(b) Definitions.

(1) Postvention--Activities that promote healing and reduce the risk of suicide by a person affected by the suicide of another.

(2) Protective factors of suicide--Characteristics that make it less likely that a child will consider, attempt, or die by suicide, including:

(A) Effective behavioral health care;

(B) Connectedness to individuals, family, community, and social institutions;

(C) Supportive relationships with caregivers;

(D) Problem-solving skills, coping skills, and ability to adapt to change;

(E) Self-esteem or sense of purpose; and

(F) Cultural or personal beliefs that discourage suicide.

(3) Risk factors of suicide--Characteristics or conditions that increase the chance that a child may consider, attempt, or die by suicide, including:

(A) A prior suicide attempt;

(B) Knowing someone who died by suicide, particularly a family member, friend, peer, or hero;

(C) Access to lethal means;

(D) History of childhood trauma, including neglect, physical abuse, or sexual abuse or assault;

(E) A history of being bullied;

(F) A mental health diagnosis, particularly depressive disorders and other mood disorders;

(G) Abuse of alcohol or drugs;

(H) Social isolation;

(I) Severe or prolonged stress;

(J) Chronic physical pain or illness;

(K) Loss of a family member; or

(L) The ending of a relationship.

(4) Suicide contagion--Exposure to suicide or suicidal behaviors within a family, or from friends or media reports, that can result in an increase in suicide or suicidal behaviors.

(5) Suicide risk assessment--A comprehensive evaluation of a child by a medical health professional to confirm suspected suicide risk, estimate the immediate danger to the child, and decide on a course of treatment and a plan for intervention to ensure the child's safety.

(6) Suicide risk screening--A procedure in which a standardized instrument is used to identify children who may be at risk of suicide. The screening may be done orally (with the screener asking questions), with pencil and paper, or using a computer.

(7) Warning signs of suicide--Indicators that a child may be in danger of suicide and need help, including:

(A) Talking about wanting to die or to hurt or kill oneself;

(B) Looking for a way to kill oneself;

(C) Being preoccupied with death in conversation, writing, or drawing;

(D) Talking about feeling hopeless or having no reason to live;

(E) A change in personality;

(F) Giving away belongings;

(G) Withdrawing from friends and family;

(H) Having aggressive or hostile behavior;

(I) Neglecting personal appearance;

(J) Running away from home or a residential placement; or

(K) Risk-taking behavior, such as reckless driving or being sexually promiscuous.

(c) Prevention--Training.

(1) Employees and foster parents must complete at least one hour of suicide prevention training as follows:

(A) Employees must complete the training annually;

(B) Foster parents verified to care for children five years of age or older must complete the training:

(i) Within a year of verification; and

(ii) every two years thereafter; and

(C) The suicide prevention training must meet the instructor and documentation requirements of Subchapter F, Division 7 of this chapter (relating to Annual Training).

(2) The curriculum for the suicide prevention training in paragraph (1) of this subsection must include:

(A) The risk factors, protective factors, and warning signs of suicide;

(B) Understanding safety planning, including:

(i) How safety plans are created;

(ii) How safety plans are shared with employees and caregivers;

(iii) How safety plans are expected to be implemented by employees and caregivers; and

(iv) Each employee's or caregiver's role in the prevention of suicide, including never leaving a child alone if the suicide risk screening finds that the child is a high risk for suicide, until a mental health professional conducts a suicide risk assessment; and

(C) Understanding suicide screening, including clarifying:

(i) Each person's role in the screening process;

(ii) When an employee or caregiver should initiate a suicide risk screening for a child; and

(iii) What actions an employee or caregiver must take to initiate a suicide risk screening for a child.

(3) The agency must promote suicide prevention training for non-employees, as appropriate.

(d) Prevention--Suicide Risk Screening.

(1) The policy must describe the suicide risk screening tool that you will use and the process for implementing the screenings.

(2) The suicide risk screening tool must be supported by evidence-based research demonstrating the tool performs reliably regardless of who administers the tool or performs the scoring or rating.

(3) Any person who meets the conditions and training requirements of the screening tool manual or instructions may administer the suicide risk screening to a child. You must document that any person conducting a screening meets the conditions and training requirements.

(4) For children receiving foster care services, the screening tool must be administered:

(A) At admission for each child 10 years of age or older;

(B) At admission for each child younger than 10 years of age if:

(i) The information provided to the operation at the time of admission indicates that the child has a history of suicide attempts or suicidal thoughts; or

(ii) The parent who admits the child, a foster parent, or child-placing agency requests a screening to be administered because of the child's risk factors or warning signs of suicide;

(C) Every 90 days after admission for all children 10 years of age or older; and

(D) Immediately for a child of any age whenever the child exhibits warning signs of suicide that necessitate a suicide screening be conducted, including when requested by a foster parent.

(5) For children receiving adoption services, the screening tool must be administered immediately for a child of any age whenever the child exhibits warning signs of suicide that necessitate a suicide screening be conducted, including when requested by an adoptive parent.

(6) Any screening must be performed in a manner that protects the child's privacy.

(7) Each screening must be documented in the child's record.

(e) Intervention--Based on the Results of a Suicide Risk Screening.

(1) If the suicide risk screening finds the child to be a high risk for suicide, the agency, caregiver, or adoptive parent must:

(A) Immediately refer the child to a mental health professional for a suicide risk assessment;

(B) Not leave the child alone 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 high risk for 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.

(2) If the suicide risk screening finds the child to have a potential for risk of suicide, the agency, caregiver, or adoptive parent must:

(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.

Source Note: The provisions of this §749.137 adopted to be effective September 19, 2022, 47 TexReg 5490