Suicide Assessment and Prevention

· The therapist’s current working hypotheses about dynamics and diagnoses.

· The therapist’s description of client’s progress in response to the treatment.

· Perceived (YOUR perceptions about) client insights and motivation to change (readiness).

P – Plan – statements about what will happen next. It includes two (or three) things:

· When and what is the next session? (e.g., we will continue weekly individual therapy next week). If there will be a gap due to vacation, holiday, etc., note that. ---

>>>Document any homework you are giving.

· What is the plan for the next session? (e.g., we will continue to focus on anger management, or we will include spouse and address communication issues).

· If new information becomes available, progress (or the lack thereof) occurs, additional problems arise, or the simple passage of time means a treatment plan update is needed, note that too, as a prompt to do the update next session.

· Any other info? Client s begin referred for any other service. ???with any other provider, or continuing to see someone else for services, e.g., case management? Medical provider? And so on…It could be that you are using this note and including in termination summary…..

Other Suggestions for DAP notes:

· Write legibly and use only black ink.

· Spell correctly and use full, grammatically correct sentences.

· For class, no abbreviations. LATER>>If permitted to use abbreviations, be careful (must be standardized and consistent).

· Content must be written in a way that even someone unfamiliar with the case can easily understand what occurred.

· Client name, number, date, time, and other top-of-the-page data elements must be completed.

· Sign every note.

· Do a note for each missed session (client cancellations / no shows).

Refer to assigned case vignette. The assignment includes an current APA paper (refer to template attached on the assignment submission link further down on this page), a DAP case note (template) and treatment plan (template). 

Students will respond to   the provided vignette through research and a written a paper to include,  

1)  addressing personal views, thoughts, and feelings related to suicidality;

2) suicide prevention model(s);

3) risk and protective factors in suicidality;

4) relevant suicide assessment instrument(s);

5)  correct diagnosis(es); ethical issues and codes of ethics;

6) ethical decision-making model;

7) the state laws; and,

8) the development of a case note and treatment plan in response to the provided vignette.

The student will,  

1) write a detailed summary of answers to the questions below;

2) develop a case note, and treatment plan relative to the specific case vignette assigned to the student. Students may use the DAP case note. The case note and/or treatment plan must include family/social, community, and medical resources and referrals.

Instructions for the Paper

1. Know ethics, the law, and your risks:

a. Choose  a code of ethics to review (Ex: ACA, NBCC, State Code). Review the code of ethics related to your vignette. Choose, use, and document an ethical decision-making model of your choice to guide your choices with your vignette.

b. What are your state laws regarding suicide? What does your state law enforce/how does your state respond if you have a client who completes suicide?

c. What kind of documentation do you need to assist you in your defense if a client does complete suicide (check with local, state, and HPSO (your liability insurance)?

2. What are your personal thoughts and feelings about suicide? How might you regulate your own emotional reactions related to suicidality?

3. Who and how might you seek professional assistance from/who are your supports?

4. What is your plan to accept and understand the functional/useful purpose of suicidality to the client? What is your plan to accept and understand a client’s strong feelings (state of mental anguish/pain and loss of self-respect) and desires to be free of their pain?

5. What is your plan to maintain a judgment free and supportive stance towards your case vignette client?

6. How do you plan to accept this client as an individual and voice authentic concern about their future while maintaining a collaborative and non-adversarial stance?

7. How do you plan to address the risk and protective factors?

a. Early in clinical interview: integrate and prioritize all information collected.

B. Continued assessment, ongoing (personal and family history of mental illness).

C. Ideation, behavior, plans, chronicity, previous attempts (number of instances, dates, eras, peripheral and direct circumstances, family history).

d. Resiliency and protective factors.

e. Any developmental, cultural, and gender related concerns regarding suicidality?

8. Assessment:

A. Which assessment instrument will you utilize to assess/reassess your client for suicidality? Why did you choose that instrument?

B. How do you document the assessment/reassessment of your client?

C. How does the assessment/reassessment guide the counselor’s counseling session, influence a plan to assist/empower the client, and lead into developing a comprehensive treatment plan?

9.  Case note:

A. Must be in a case note format (DAP).

B. Must document counselor’s interactions with the client, including assessment/reassessment; education; prevention; supports; plans (acute, immediate, and continuing); interventions utilized in session; referrals.

10.  Develop a treatment and service plan (using a treatment plan format, template):

A. Collaboratively develop an emergency plan that addresses safety and conveys the message that the client’s safety is non-negotiable.

B. Develop a written treatment plan that addresses the client’s immediate, acute, and continuing suicidality.

C. Develop a range of treatment interventions for specific periods of time: immediate, acute, continuing care, maintenance of resolved suicidality.

D. The plan needs to include the client, family members, and close friends.

E. The plan needs to include other treatment and service providers for interdisciplinary treatment approach and referrals to these sources.