SOCW 6446

Referral Issues

Suicidal children and adolescents come in all sizes and shapes, from all back- grounds, and with many different reasons for their suicidality. You will prob- ably find you can work comfortably and effectively with some young clients who are suicidal and cannot do so with a small subset of one type or another. Accurate assessment is an important component of determining the appropri- ate treatment approach and setting for young suicidal clients. Honest self- scrutiny is another. If you find yourself working with a suicidal youth who is a poor fit for you, it is better to refer quickly and connect that youth with another professional as early as possible in the treatment process. The literature sug- gests that young clients who attend therapy because of suicidality don't usu- ally stay long, and they handle mid-therapy referrals even worse than do most clients (Pfeffer et al., 1991) .

Pause for Reflection Stop for a minute and imagine the kinds of distressed or angry young people you are drawn to, and the kinds you are uncomfort- able with or even frightened of. What are some steps you might tal<.e to increase your awareness and tolerance in this area of men- tal health work? Try to identify types of situations in which you think it would be best for you to refer a suicidal young client to a differ- ent professional. How could you work on your personal issues and competence to make it more likely you could deal with the sort of situation you find especially stressful?

Consultation

As discussed at the outset of this chapter, suicide assessment and management is complex and stressful for counselors. We recommend that counselors rou- tinely obtain consultation regarding assessment and management of suicidal youths. To aid counselors working with a suicidal youth, we provide a check- list of general suicide assessment procedures in Table 8.1.

TableB.1 Checklist of General Suicide Assessment Procedures

1. Assess risk factors. __ 2. Ask about suicidal thoughts. __ 3. Assess suicide plans.

4. Assess self-control. __ 5. Assess client intent or goals associated with suicidal behaviors. __ 6. Obtain psychiatric or collegial consultation. __ 7. Determine appropriate action (degree of intervention).

Assessment and Management of Young Clients Who Are Suicida1 119

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