Assignment Prompt & Instructions
Please see attachment
– ## RISKASSESSMENT.docx
– ## TRANSCRIPT-SuicideRiskAssessment.pdf
**## RISKASSESSMENT.docx**
As an intern in generalist social work practice, your aim is to provide resources through the agency and refer a client elsewhere for additional assistance. However, this does not mean ignoring the warning signs that may arise during a conversation with the client. These warning signs, which could include the client’s disclosure about self-harm or suicidal ideation, can take the resource-based discussion in a different direction. The discussion might turn into a risk assessment interview, for example, as immediate harm to self and others takes priority. In this way, social workers must be nimble and able to adapt to new information they are receiving.
Interns, in particular, must understand when to continue and when to seek help from a supervisor.
For this Discussion, you practice handling just such a situation in an interactive media piece. You then explore your agency’s policies about clients at risk and use both these experiences to inform your discussion about suicide risk assessment.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
[**WEEKLY RESOURCES**](https://waldenu.instructure.com/courses/185893/modules/items/7696125)
To Prepare
· Access and complete the interactive media in the Learning Resources.
· Consider the choices you make while navigating the client scenario and your reasoning behind those choices.
· Explore your agency’s policies concerning clients at risk.
**ASSIGNMENT**
**Post** a reflection on the decisions you made in the Risk Assessment client scenario. What did you choose to do, and why? Then, describe your agency’s scope of practice and its policies related to clients at risk. How would these policies have changed your actions in the interactive scenario?
NOTE; Risk assessment attached separately.
**## TRANSCRIPT-SuicideRiskAssessment.pdf**
1
© 2022 Walden University, LLC
TRANSCRIPT: SUICIDE RISK ASSESSMENT
Lesson 1: Background on Suicidality
In the United States, more than 47,000 people die by suicide every year. It is the 10th
leading cause of death.
Myth or Fact?
Asking about suicide plants ideas about it in the client’s head.
Response: Myth
People who talk about suicide do not act on it.
Response: Myth
Self-harm does not always lead to suicide.
Response: Fact
Suicide rates are highest among middle-aged white men.
Response: Fact
If somebody really wants to die by suicide, there is nothing you can do about it.
Response: Myth
Self-injurious behaviors mean the person is just trying to get attention.
Response: Myth
Further statistics and information on suicide and suicide prevention can be found at the
American Foundation for Suicide Prevention: https://afsp.org/suicide-statistics/.
Important Considerations for Social Work Practice
1. This one lesson does not make you an expert on suicidality and suicide
assessment. You will constantly be growing in this area.
2. Always consult others and use supervision.
3. Make sure you are in alignment with agency policies around risk.
4. Know your state’s laws around harm to self and others.
5. Know your state’s process of involuntary mental health watch/hospitalization.
6. Be mindful of potential vicarious traumatization.
7. Know the warning signs.
Potential Warning Signs
• Threatening to hurt or kill self
• Looking for ways to kill self; seeking access to pills, weapons, or other means
• Talking or writing about death, dying, or suicide
• Getting affairs in order and giving away valued possessions
[https://afsp.org/suicide-statistics/](https://afsp.org/suicide-statistics/)
2
© 2022 Walden University, LLC
• No future orientation
• Severe distress and ruminative behavior; tunnel vision
• Behavioral change (social, vocational, academic, appearance)
• Loss of self-worth
• Impulsive and/or aggressive tendencies
• Guardedness or inconsistency
• Sudden recovery from depression
Vicarious Trauma: An Issue for Social Workers
Vicarious trauma is a shift in the internal experience and psychological well-being of the
social worker. Vicarious trauma undermines a social worker’s sense of safety in the
world and sense of control over life situations.
Symptoms
• Loss of energy
• Difficulty in maintaining interpersonal relationships
• Cynicism
• Nightmares
• Feelings of hopelessness and despair
• Disruptive frame of reference (i.e., change in worldview)
• Increased emotionality
• Emotional numbness
• Dissociation or depersonalization
How to Deal With Vicarious Trauma
Awareness
• Be aware of your own history of trauma and recognize when emotions and
memories related to your own experience are triggered.
• Seek help to manage your shifting belief about the goodness of self and others.
Wellness
• Develop a personal self-care and wellness plan. The plan should include eating
healthy, getting adequate sleep, and exercising regularly.
o Emotional wellness: Maintain a sense of humor and engage in activities
that promote self-awareness.
o Cognitive wellness: Engage in activities using imagination and problem-
solving skills.
o Spiritual wellness: Practice your spirituality, read poetry, get out in nature,
meditate, or attend religious services.
o Interpersonal wellness: Foster positive interpersonal relationships.
3
© 2022 Walden University, LLC
Support
• Develop a strong supervisory working alliance.
Lesson 2: Assessing for Suicide
Suicide Assessment Five-Step Evaluation and Triage for Mental Health
Professionals (SAFE-T)
1. Identify risk factors.
2. Identify protective factors.
3. Conduct suicide inquiry.
4. Determine risk level/intervention.
5. Document risk, rationale, intervention, and follow-up.
Risk Factors
Current and Past Psychiatric Diagnoses
• Mood disorder
• Psychotic disorder
• Alcohol/substance use disorders
• Posttraumatic stress disorder
• Attention deficit hyperactivity disorder
• Traumatic brain injury
• Conduct problems (antisocial behavior, aggression, impulsivity)
• Family history of mental illness
Presenting Symptoms
• Anhedonia
• Impulsivity
• Hopelessness or despair
• Anxiety and/or panic
• Insomnia
• Command hallucinations
• Psychosis
Precipitants/Stressors
• Triggering events leading to humiliation, shame, and/or despair (e.g., loss of
relationship)
• Chronic physical pain or other acute medical problem (e.g., central nervous
system disorders)
• Sexual/physical abuse
• Pending incarceration or homelessness
4
© 2022 Walden University, LLC
• Legal problems
• Inadequate social supports; social isolation
• Perceived burden on others
Protective Factors
Internal
• Cultural, spiritual, and/or moral attitudes against suicide
• Coping and problem-solving skills
External
• Responsibility to children
• Beloved pets
• Supportive social network of family or friends
• Positive therapeutic relationships
• Engaged in work or school
Columbia-Suicide Severity Rating Scale (C-SSRS)
Suicide Assessment Questions
1. Have you wished you were dead or wished you could go to sleep and not wake
up?
2. Have you actually had any thoughts of killing yourself?
If yes, ask Questions 3, 4, 5, and 6. If no, go directly to Question 6.
3. Have you been thinking about how you might kill yourself?
4. Have you had these thoughts and had some intention of acting on them?
5. Have you started to work out or worked out the details of how to kill yourself? Do
you intend to carry out this plan?
6. Have you ever done anything, started to do anything, or prepared to do anything
to end your life?
If yes, ask: How long ago did you do any of these?
months?
Additional Resources
Access this website for more detail on SAFE-T: https://store.samhsa.gov/product/SAFE-
T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-
Clinicians/sma09-4432
Access this website for more detail on the C-SSRS, including screeners to download:
https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/
Lesson 3: Scenario
Disclaimer: This is a scenario for learning purposes and is not meant to be used verbatim for client
interactions, or to represent what is appropriate in all such situations. The goal is to reflect on your
problem solving and decision making in situations involving clients at risk.
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/](https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/)
5
© 2022 Walden University, LLC
Imagine that you are an intern at an agency that assists individuals with accessing job,
food, and housing support. Navigate the following scenario by selecting the most
appropriate responses from the choices.
You are working with client Adam Donovan, a 29-year-old male.
have no respect for what I’ve done for them. Zero.
Student choices Client reaction Result
Option 1: Tell me more
about the job. What
happened?
Client reaction: What
happened? They canned
me. Said I was slacking
off, coming in late, with an
“attitude.”
Try again.
Option 2: It sounds like you
might benefit from job
assistance. How are you
doing with your rent, food,
and other essentials?
Client reaction: Not too
good. I’ve been trying to
do odd jobs. Money’s
been tight.
Continue.
Option 3: That does sound
like a very tough situation.
What are you doing to better
yourself and move forward?
Client reaction: I don’t
want to move forward. I
want my job back!
Try again.
Mr. Donovan: I could use some help with food, rent, and the electric bill.
Intern: We can see about getting you into a work program and about a food
supplement. We can also consider housing if you need to move out due to nonpayment.
Mr. Donovan: Thanks.
But really, what’s the point? My wife left with the kids. My friends were all from work. I
might as well end it; nobody would miss me.
Student choices Client reaction Result
Option 1: Just a minute. Let
me get the benefit
application forms and we
can fill them out.
Client reaction: Okay. Try again.
Option 2: That’s not true. I
bet a lot of people would
miss you if you were gone.
Client reaction: Sure …
then how come nobody
ever calls?
Try again.
Option 3: Have you actually
had any thoughts of killing
yourself?
Client reaction: Yes, ever
since Rochelle took the
kids.
Continue.
6
© 2022 Walden University, LLC
Mr. Donovan: My life is just … falling apart. Better to not be here.
Student choices Client reaction Result
Option 1: Have you been
thinking about how you
might kill yourself?
Client reaction:
Sometimes when I get
really drunk, I think about
mixing alcohol and pills.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Option 2: In what ways is
your life not falling apart,
though? How would you
characterize your strengths?
Client reaction: Uh, what
strengths? I’ve got
nothing.
Try again.
Option 3: Once we get these
forms filled out, and you can
get services, maybe some of
that pressure you are feeling
will lessen.
Client reaction: I doubt it. Try again.
Mr. Donovan: I have a bunch of oxy that was prescribed for my neck pain. It’s in the
cabinet, and sometimes I bring it out. I think about what it would be like.
Student options Client reaction Result
Option 1: What happened
with your neck?
Client reaction: Got in a
car accident 6 months
ago. It still hurts, mostly
on rainy days.
Try again.
Option 2: Oxycodone is a
strong pain medication that
should not be used in
excess.
Client reaction: I know,
but it’s the only thing that
really helps the pain. I
don’t take it all that often;
Try again.
7
© 2022 Walden University, LLC
that’s why I have so much
of it just sitting there.
Option 3: Have you had
some intention of acting on
these thoughts?
Client reaction: I came
close the last time. I did
take a couple pills before I
stopped.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Mr. Donovan: But I never go through with it.
Intern: So it sounds like you have started to work out the details of how to kill yourself.
Do you plan to drink tonight?
Mr. Donovan: No, not tonight. The last time was a little scary.
Whenever I’m there with the bottle, I start thinking about my mom and what she’d want
for me. She passed a couple of years ago.
Student options Client reaction Result
Option 1: It sounds like you
have had a rough couple of
years. Who has helped you
since your mother’s
passing?
Client reaction: I don’t
really have anyone now,
but my mom is like my
guardian angel. She
makes sure I’m okay.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
8
© 2022 Walden University, LLC
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Option 2: It sounds like you
may need some mental
health and grief counseling
in addition to the other
services we are
coordinating. Would that be
accurate?
Client reaction: Woah,
woah, woah—there’s
nothing wrong with me.
Everyone thinks this way
sometimes.
Try again.
Option 3: How did your
mother’s death make you
feel?
Client reaction: Not
great—but I don’t really
want to talk about that
right now.
Try again.
Intern: Thank you for sharing all of this with me. Let’s see how we can support you.
End of Scenario
Reflection
After completing the scenario, reflect on your choices. Then, research your agency’s
policies and resources related to clients at risk. Determine your agency’s stance on
when you should contact your Field Instructor.
How would your decision making in the scenario be different based on your agency’s
policies and context?
Lesson 4: Summary
Depending on your agency, you may have more or less autonomy as an intern to
complete a risk assessment or engage with a client about suicidal thoughts and
behaviors. Be prepared by knowing your agency’s policies and scope of practice.
If you do encounter such a situation, consider the following questions:
• Is this a reportable situation?
o Know the guidelines for mandated reporting.
• What are your organizational policies?
o Ensure you know the following:
▪ Whom to report to
▪ What to report
▪ How to report
▪ When to report
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© 2022 Walden University, LLC
▪ Where to go for guidance
• How will you document the situation?
• What are the professional and legal consequences for failure to report?
**## TRANSCRIPT-SuicideRiskAssessment.pdf**
1
© 2022 Walden University, LLC
TRANSCRIPT: SUICIDE RISK ASSESSMENT
Lesson 1: Background on Suicidality
In the United States, more than 47,000 people die by suicide every year. It is the 10th
leading cause of death.
Myth or Fact?
Asking about suicide plants ideas about it in the client’s head.
Response: Myth
People who talk about suicide do not act on it.
Response: Myth
Self-harm does not always lead to suicide.
Response: Fact
Suicide rates are highest among middle-aged white men.
Response: Fact
If somebody really wants to die by suicide, there is nothing you can do about it.
Response: Myth
Self-injurious behaviors mean the person is just trying to get attention.
Response: Myth
Further statistics and information on suicide and suicide prevention can be found at the
American Foundation for Suicide Prevention: https://afsp.org/suicide-statistics/.
Important Considerations for Social Work Practice
1. This one lesson does not make you an expert on suicidality and suicide
assessment. You will constantly be growing in this area.
2. Always consult others and use supervision.
3. Make sure you are in alignment with agency policies around risk.
4. Know your state’s laws around harm to self and others.
5. Know your state’s process of involuntary mental health watch/hospitalization.
6. Be mindful of potential vicarious traumatization.
7. Know the warning signs.
Potential Warning Signs
• Threatening to hurt or kill self
• Looking for ways to kill self; seeking access to pills, weapons, or other means
• Talking or writing about death, dying, or suicide
• Getting affairs in order and giving away valued possessions
[https://afsp.org/suicide-statistics/](https://afsp.org/suicide-statistics/)
2
© 2022 Walden University, LLC
• No future orientation
• Severe distress and ruminative behavior; tunnel vision
• Behavioral change (social, vocational, academic, appearance)
• Loss of self-worth
• Impulsive and/or aggressive tendencies
• Guardedness or inconsistency
• Sudden recovery from depression
Vicarious Trauma: An Issue for Social Workers
Vicarious trauma is a shift in the internal experience and psychological well-being of the
social worker. Vicarious trauma undermines a social worker’s sense of safety in the
world and sense of control over life situations.
Symptoms
• Loss of energy
• Difficulty in maintaining interpersonal relationships
• Cynicism
• Nightmares
• Feelings of hopelessness and despair
• Disruptive frame of reference (i.e., change in worldview)
• Increased emotionality
• Emotional numbness
• Dissociation or depersonalization
How to Deal With Vicarious Trauma
Awareness
• Be aware of your own history of trauma and recognize when emotions and
memories related to your own experience are triggered.
• Seek help to manage your shifting belief about the goodness of self and others.
Wellness
• Develop a personal self-care and wellness plan. The plan should include eating
healthy, getting adequate sleep, and exercising regularly.
o Emotional wellness: Maintain a sense of humor and engage in activities
that promote self-awareness.
o Cognitive wellness: Engage in activities using imagination and problem-
solving skills.
o Spiritual wellness: Practice your spirituality, read poetry, get out in nature,
meditate, or attend religious services.
o Interpersonal wellness: Foster positive interpersonal relationships.
3
© 2022 Walden University, LLC
Support
• Develop a strong supervisory working alliance.
Lesson 2: Assessing for Suicide
Suicide Assessment Five-Step Evaluation and Triage for Mental Health
Professionals (SAFE-T)
1. Identify risk factors.
2. Identify protective factors.
3. Conduct suicide inquiry.
4. Determine risk level/intervention.
5. Document risk, rationale, intervention, and follow-up.
Risk Factors
Current and Past Psychiatric Diagnoses
• Mood disorder
• Psychotic disorder
• Alcohol/substance use disorders
• Posttraumatic stress disorder
• Attention deficit hyperactivity disorder
• Traumatic brain injury
• Conduct problems (antisocial behavior, aggression, impulsivity)
• Family history of mental illness
Presenting Symptoms
• Anhedonia
• Impulsivity
• Hopelessness or despair
• Anxiety and/or panic
• Insomnia
• Command hallucinations
• Psychosis
Precipitants/Stressors
• Triggering events leading to humiliation, shame, and/or despair (e.g., loss of
relationship)
• Chronic physical pain or other acute medical problem (e.g., central nervous
system disorders)
• Sexual/physical abuse
• Pending incarceration or homelessness
4
© 2022 Walden University, LLC
• Legal problems
• Inadequate social supports; social isolation
• Perceived burden on others
Protective Factors
Internal
• Cultural, spiritual, and/or moral attitudes against suicide
• Coping and problem-solving skills
External
• Responsibility to children
• Beloved pets
• Supportive social network of family or friends
• Positive therapeutic relationships
• Engaged in work or school
Columbia-Suicide Severity Rating Scale (C-SSRS)
Suicide Assessment Questions
1. Have you wished you were dead or wished you could go to sleep and not wake
up?
2. Have you actually had any thoughts of killing yourself?
If yes, ask Questions 3, 4, 5, and 6. If no, go directly to Question 6.
3. Have you been thinking about how you might kill yourself?
4. Have you had these thoughts and had some intention of acting on them?
5. Have you started to work out or worked out the details of how to kill yourself? Do
you intend to carry out this plan?
6. Have you ever done anything, started to do anything, or prepared to do anything
to end your life?
If yes, ask: How long ago did you do any of these?
months?
Additional Resources
Access this website for more detail on SAFE-T: https://store.samhsa.gov/product/SAFE-
T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-
Clinicians/sma09-4432
Access this website for more detail on the C-SSRS, including screeners to download:
https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/
Lesson 3: Scenario
Disclaimer: This is a scenario for learning purposes and is not meant to be used verbatim for client
interactions, or to represent what is appropriate in all such situations. The goal is to reflect on your
problem solving and decision making in situations involving clients at risk.
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/](https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/)
5
© 2022 Walden University, LLC
Imagine that you are an intern at an agency that assists individuals with accessing job,
food, and housing support. Navigate the following scenario by selecting the most
appropriate responses from the choices.
You are working with client Adam Donovan, a 29-year-old male.
have no respect for what I’ve done for them. Zero.
Student choices Client reaction Result
Option 1: Tell me more
about the job. What
happened?
Client reaction: What
happened? They canned
me. Said I was slacking
off, coming in late, with an
“attitude.”
Try again.
Option 2: It sounds like you
might benefit from job
assistance. How are you
doing with your rent, food,
and other essentials?
Client reaction: Not too
good. I’ve been trying to
do odd jobs. Money’s
been tight.
Continue.
Option 3: That does sound
like a very tough situation.
What are you doing to better
yourself and move forward?
Client reaction: I don’t
want to move forward. I
want my job back!
Try again.
Mr. Donovan: I could use some help with food, rent, and the electric bill.
Intern: We can see about getting you into a work program and about a food
supplement. We can also consider housing if you need to move out due to nonpayment.
Mr. Donovan: Thanks.
But really, what’s the point? My wife left with the kids. My friends were all from work. I
might as well end it; nobody would miss me.
Student choices Client reaction Result
Option 1: Just a minute. Let
me get the benefit
application forms and we
can fill them out.
Client reaction: Okay. Try again.
Option 2: That’s not true. I
bet a lot of people would
miss you if you were gone.
Client reaction: Sure …
then how come nobody
ever calls?
Try again.
Option 3: Have you actually
had any thoughts of killing
yourself?
Client reaction: Yes, ever
since Rochelle took the
kids.
Continue.
6
© 2022 Walden University, LLC
Mr. Donovan: My life is just … falling apart. Better to not be here.
Student choices Client reaction Result
Option 1: Have you been
thinking about how you
might kill yourself?
Client reaction:
Sometimes when I get
really drunk, I think about
mixing alcohol and pills.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Option 2: In what ways is
your life not falling apart,
though? How would you
characterize your strengths?
Client reaction: Uh, what
strengths? I’ve got
nothing.
Try again.
Option 3: Once we get these
forms filled out, and you can
get services, maybe some of
that pressure you are feeling
will lessen.
Client reaction: I doubt it. Try again.
Mr. Donovan: I have a bunch of oxy that was prescribed for my neck pain. It’s in the
cabinet, and sometimes I bring it out. I think about what it would be like.
Student options Client reaction Result
Option 1: What happened
with your neck?
Client reaction: Got in a
car accident 6 months
ago. It still hurts, mostly
on rainy days.
Try again.
Option 2: Oxycodone is a
strong pain medication that
should not be used in
excess.
Client reaction: I know,
but it’s the only thing that
really helps the pain. I
don’t take it all that often;
Try again.
7
© 2022 Walden University, LLC
that’s why I have so much
of it just sitting there.
Option 3: Have you had
some intention of acting on
these thoughts?
Client reaction: I came
close the last time. I did
take a couple pills before I
stopped.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Mr. Donovan: But I never go through with it.
Intern: So it sounds like you have started to work out the details of how to kill yourself.
Do you plan to drink tonight?
Mr. Donovan: No, not tonight. The last time was a little scary.
Whenever I’m there with the bottle, I start thinking about my mom and what she’d want
for me. She passed a couple of years ago.
Student options Client reaction Result
Option 1: It sounds like you
have had a rough couple of
years. Who has helped you
since your mother’s
passing?
Client reaction: I don’t
really have anyone now,
but my mom is like my
guardian angel. She
makes sure I’m okay.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
8
© 2022 Walden University, LLC
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Option 2: It sounds like you
may need some mental
health and grief counseling
in addition to the other
services we are
coordinating. Would that be
accurate?
Client reaction: Woah,
woah, woah—there’s
nothing wrong with me.
Everyone thinks this way
sometimes.
Try again.
Option 3: How did your
mother’s death make you
feel?
Client reaction: Not
great—but I don’t really
want to talk about that
right now.
Try again.
Intern: Thank you for sharing all of this with me. Let’s see how we can support you.
End of Scenario
Reflection
After completing the scenario, reflect on your choices. Then, research your agency’s
policies and resources related to clients at risk. Determine your agency’s stance on
when you should contact your Field Instructor.
How would your decision making in the scenario be different based on your agency’s
policies and context?
Lesson 4: Summary
Depending on your agency, you may have more or less autonomy as an intern to
complete a risk assessment or engage with a client about suicidal thoughts and
behaviors. Be prepared by knowing your agency’s policies and scope of practice.
If you do encounter such a situation, consider the following questions:
• Is this a reportable situation?
o Know the guidelines for mandated reporting.
• What are your organizational policies?
o Ensure you know the following:
▪ Whom to report to
▪ What to report
▪ How to report
▪ When to report
9
© 2022 Walden University, LLC
▪ Where to go for guidance
• How will you document the situation?
• What are the professional and legal consequences for failure to report?
**## RISKASSESSMENT.docx**
As an intern in generalist social work practice, your aim is to provide resources through the agency and refer a client elsewhere for additional assistance. However, this does not mean ignoring the warning signs that may arise during a conversation with the client. These warning signs, which could include the client’s disclosure about self-harm or suicidal ideation, can take the resource-based discussion in a different direction. The discussion might turn into a risk assessment interview, for example, as immediate harm to self and others takes priority. In this way, social workers must be nimble and able to adapt to new information they are receiving.
Interns, in particular, must understand when to continue and when to seek help from a supervisor.
For this Discussion, you practice handling just such a situation in an interactive media piece. You then explore your agency’s policies about clients at risk and use both these experiences to inform your discussion about suicide risk assessment.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
[**WEEKLY RESOURCES**](https://waldenu.instructure.com/courses/185893/modules/items/7696125)
To Prepare
· Access and complete the interactive media in the Learning Resources.
· Consider the choices you make while navigating the client scenario and your reasoning behind those choices.
· Explore your agency’s policies concerning clients at risk.
**ASSIGNMENT**
**Post** a reflection on the decisions you made in the Risk Assessment client scenario. What did you choose to do, and why? Then, describe your agency’s scope of practice and its policies related to clients at risk. How would these policies have changed your actions in the interactive scenario?
NOTE; Risk assessment attached separately.
**## TRANSCRIPT-SuicideRiskAssessment.pdf**
1
© 2022 Walden University, LLC
TRANSCRIPT: SUICIDE RISK ASSESSMENT
Lesson 1: Background on Suicidality
In the United States, more than 47,000 people die by suicide every year. It is the 10th
leading cause of death.
Myth or Fact?
Asking about suicide plants ideas about it in the client’s head.
Response: Myth
People who talk about suicide do not act on it.
Response: Myth
Self-harm does not always lead to suicide.
Response: Fact
Suicide rates are highest among middle-aged white men.
Response: Fact
If somebody really wants to die by suicide, there is nothing you can do about it.
Response: Myth
Self-injurious behaviors mean the person is just trying to get attention.
Response: Myth
Further statistics and information on suicide and suicide prevention can be found at the
American Foundation for Suicide Prevention: https://afsp.org/suicide-statistics/.
Important Considerations for Social Work Practice
1. This one lesson does not make you an expert on suicidality and suicide
assessment. You will constantly be growing in this area.
2. Always consult others and use supervision.
3. Make sure you are in alignment with agency policies around risk.
4. Know your state’s laws around harm to self and others.
5. Know your state’s process of involuntary mental health watch/hospitalization.
6. Be mindful of potential vicarious traumatization.
7. Know the warning signs.
Potential Warning Signs
• Threatening to hurt or kill self
• Looking for ways to kill self; seeking access to pills, weapons, or other means
• Talking or writing about death, dying, or suicide
• Getting affairs in order and giving away valued possessions
[https://afsp.org/suicide-statistics/](https://afsp.org/suicide-statistics/)
2
© 2022 Walden University, LLC
• No future orientation
• Severe distress and ruminative behavior; tunnel vision
• Behavioral change (social, vocational, academic, appearance)
• Loss of self-worth
• Impulsive and/or aggressive tendencies
• Guardedness or inconsistency
• Sudden recovery from depression
Vicarious Trauma: An Issue for Social Workers
Vicarious trauma is a shift in the internal experience and psychological well-being of the
social worker. Vicarious trauma undermines a social worker’s sense of safety in the
world and sense of control over life situations.
Symptoms
• Loss of energy
• Difficulty in maintaining interpersonal relationships
• Cynicism
• Nightmares
• Feelings of hopelessness and despair
• Disruptive frame of reference (i.e., change in worldview)
• Increased emotionality
• Emotional numbness
• Dissociation or depersonalization
How to Deal With Vicarious Trauma
Awareness
• Be aware of your own history of trauma and recognize when emotions and
memories related to your own experience are triggered.
• Seek help to manage your shifting belief about the goodness of self and others.
Wellness
• Develop a personal self-care and wellness plan. The plan should include eating
healthy, getting adequate sleep, and exercising regularly.
o Emotional wellness: Maintain a sense of humor and engage in activities
that promote self-awareness.
o Cognitive wellness: Engage in activities using imagination and problem-
solving skills.
o Spiritual wellness: Practice your spirituality, read poetry, get out in nature,
meditate, or attend religious services.
o Interpersonal wellness: Foster positive interpersonal relationships.
3
© 2022 Walden University, LLC
Support
• Develop a strong supervisory working alliance.
Lesson 2: Assessing for Suicide
Suicide Assessment Five-Step Evaluation and Triage for Mental Health
Professionals (SAFE-T)
1. Identify risk factors.
2. Identify protective factors.
3. Conduct suicide inquiry.
4. Determine risk level/intervention.
5. Document risk, rationale, intervention, and follow-up.
Risk Factors
Current and Past Psychiatric Diagnoses
• Mood disorder
• Psychotic disorder
• Alcohol/substance use disorders
• Posttraumatic stress disorder
• Attention deficit hyperactivity disorder
• Traumatic brain injury
• Conduct problems (antisocial behavior, aggression, impulsivity)
• Family history of mental illness
Presenting Symptoms
• Anhedonia
• Impulsivity
• Hopelessness or despair
• Anxiety and/or panic
• Insomnia
• Command hallucinations
• Psychosis
Precipitants/Stressors
• Triggering events leading to humiliation, shame, and/or despair (e.g., loss of
relationship)
• Chronic physical pain or other acute medical problem (e.g., central nervous
system disorders)
• Sexual/physical abuse
• Pending incarceration or homelessness
4
© 2022 Walden University, LLC
• Legal problems
• Inadequate social supports; social isolation
• Perceived burden on others
Protective Factors
Internal
• Cultural, spiritual, and/or moral attitudes against suicide
• Coping and problem-solving skills
External
• Responsibility to children
• Beloved pets
• Supportive social network of family or friends
• Positive therapeutic relationships
• Engaged in work or school
Columbia-Suicide Severity Rating Scale (C-SSRS)
Suicide Assessment Questions
1. Have you wished you were dead or wished you could go to sleep and not wake
up?
2. Have you actually had any thoughts of killing yourself?
If yes, ask Questions 3, 4, 5, and 6. If no, go directly to Question 6.
3. Have you been thinking about how you might kill yourself?
4. Have you had these thoughts and had some intention of acting on them?
5. Have you started to work out or worked out the details of how to kill yourself? Do
you intend to carry out this plan?
6. Have you ever done anything, started to do anything, or prepared to do anything
to end your life?
If yes, ask: How long ago did you do any of these?
months?
Additional Resources
Access this website for more detail on SAFE-T: https://store.samhsa.gov/product/SAFE-
T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-
Clinicians/sma09-4432
Access this website for more detail on the C-SSRS, including screeners to download:
https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/
Lesson 3: Scenario
Disclaimer: This is a scenario for learning purposes and is not meant to be used verbatim for client
interactions, or to represent what is appropriate in all such situations. The goal is to reflect on your
problem solving and decision making in situations involving clients at risk.
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/](https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/)
5
© 2022 Walden University, LLC
Imagine that you are an intern at an agency that assists individuals with accessing job,
food, and housing support. Navigate the following scenario by selecting the most
appropriate responses from the choices.
You are working with client Adam Donovan, a 29-year-old male.
have no respect for what I’ve done for them. Zero.
Student choices Client reaction Result
Option 1: Tell me more
about the job. What
happened?
Client reaction: What
happened? They canned
me. Said I was slacking
off, coming in late, with an
“attitude.”
Try again.
Option 2: It sounds like you
might benefit from job
assistance. How are you
doing with your rent, food,
and other essentials?
Client reaction: Not too
good. I’ve been trying to
do odd jobs. Money’s
been tight.
Continue.
Option 3: That does sound
like a very tough situation.
What are you doing to better
yourself and move forward?
Client reaction: I don’t
want to move forward. I
want my job back!
Try again.
Mr. Donovan: I could use some help with food, rent, and the electric bill.
Intern: We can see about getting you into a work program and about a food
supplement. We can also consider housing if you need to move out due to nonpayment.
Mr. Donovan: Thanks.
But really, what’s the point? My wife left with the kids. My friends were all from work. I
might as well end it; nobody would miss me.
Student choices Client reaction Result
Option 1: Just a minute. Let
me get the benefit
application forms and we
can fill them out.
Client reaction: Okay. Try again.
Option 2: That’s not true. I
bet a lot of people would
miss you if you were gone.
Client reaction: Sure …
then how come nobody
ever calls?
Try again.
Option 3: Have you actually
had any thoughts of killing
yourself?
Client reaction: Yes, ever
since Rochelle took the
kids.
Continue.
6
© 2022 Walden University, LLC
Mr. Donovan: My life is just … falling apart. Better to not be here.
Student choices Client reaction Result
Option 1: Have you been
thinking about how you
might kill yourself?
Client reaction:
Sometimes when I get
really drunk, I think about
mixing alcohol and pills.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Option 2: In what ways is
your life not falling apart,
though? How would you
characterize your strengths?
Client reaction: Uh, what
strengths? I’ve got
nothing.
Try again.
Option 3: Once we get these
forms filled out, and you can
get services, maybe some of
that pressure you are feeling
will lessen.
Client reaction: I doubt it. Try again.
Mr. Donovan: I have a bunch of oxy that was prescribed for my neck pain. It’s in the
cabinet, and sometimes I bring it out. I think about what it would be like.
Student options Client reaction Result
Option 1: What happened
with your neck?
Client reaction: Got in a
car accident 6 months
ago. It still hurts, mostly
on rainy days.
Try again.
Option 2: Oxycodone is a
strong pain medication that
should not be used in
excess.
Client reaction: I know,
but it’s the only thing that
really helps the pain. I
don’t take it all that often;
Try again.
7
© 2022 Walden University, LLC
that’s why I have so much
of it just sitting there.
Option 3: Have you had
some intention of acting on
these thoughts?
Client reaction: I came
close the last time. I did
take a couple pills before I
stopped.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Mr. Donovan: But I never go through with it.
Intern: So it sounds like you have started to work out the details of how to kill yourself.
Do you plan to drink tonight?
Mr. Donovan: No, not tonight. The last time was a little scary.
Whenever I’m there with the bottle, I start thinking about my mom and what she’d want
for me. She passed a couple of years ago.
Student options Client reaction Result
Option 1: It sounds like you
have had a rough couple of
years. Who has helped you
since your mother’s
passing?
Client reaction: I don’t
really have anyone now,
but my mom is like my
guardian angel. She
makes sure I’m okay.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
8
© 2022 Walden University, LLC
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Option 2: It sounds like you
may need some mental
health and grief counseling
in addition to the other
services we are
coordinating. Would that be
accurate?
Client reaction: Woah,
woah, woah—there’s
nothing wrong with me.
Everyone thinks this way
sometimes.
Try again.
Option 3: How did your
mother’s death make you
feel?
Client reaction: Not
great—but I don’t really
want to talk about that
right now.
Try again.
Intern: Thank you for sharing all of this with me. Let’s see how we can support you.
End of Scenario
Reflection
After completing the scenario, reflect on your choices. Then, research your agency’s
policies and resources related to clients at risk. Determine your agency’s stance on
when you should contact your Field Instructor.
How would your decision making in the scenario be different based on your agency’s
policies and context?
Lesson 4: Summary
Depending on your agency, you may have more or less autonomy as an intern to
complete a risk assessment or engage with a client about suicidal thoughts and
behaviors. Be prepared by knowing your agency’s policies and scope of practice.
If you do encounter such a situation, consider the following questions:
• Is this a reportable situation?
o Know the guidelines for mandated reporting.
• What are your organizational policies?
o Ensure you know the following:
▪ Whom to report to
▪ What to report
▪ How to report
▪ When to report
9
© 2022 Walden University, LLC
▪ Where to go for guidance
• How will you document the situation?
• What are the professional and legal consequences for failure to report?
**## RISKASSESSMENT.docx**
As an intern in generalist social work practice, your aim is to provide resources through the agency and refer a client elsewhere for additional assistance. However, this does not mean ignoring the warning signs that may arise during a conversation with the client. These warning signs, which could include the client’s disclosure about self-harm or suicidal ideation, can take the resource-based discussion in a different direction. The discussion might turn into a risk assessment interview, for example, as immediate harm to self and others takes priority. In this way, social workers must be nimble and able to adapt to new information they are receiving.
Interns, in particular, must understand when to continue and when to seek help from a supervisor.
For this Discussion, you practice handling just such a situation in an interactive media piece. You then explore your agency’s policies about clients at risk and use both these experiences to inform your discussion about suicide risk assessment.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
[**WEEKLY RESOURCES**](https://waldenu.instructure.com/courses/185893/modules/items/7696125)
To Prepare
· Access and complete the interactive media in the Learning Resources.
· Consider the choices you make while navigating the client scenario and your reasoning behind those choices.
· Explore your agency’s policies concerning clients at risk.
**ASSIGNMENT**
**Post** a reflection on the decisions you made in the Risk Assessment client scenario. What did you choose to do, and why? Then, describe your agency’s scope of practice and its policies related to clients at risk. How would these policies have changed your actions in the interactive scenario?
NOTE; Risk assessment attached separately.
**## TRANSCRIPT-SuicideRiskAssessment.pdf**
1
© 2022 Walden University, LLC
TRANSCRIPT: SUICIDE RISK ASSESSMENT
Lesson 1: Background on Suicidality
In the United States, more than 47,000 people die by suicide every year. It is the 10th
leading cause of death.
Myth or Fact?
Asking about suicide plants ideas about it in the client’s head.
Response: Myth
People who talk about suicide do not act on it.
Response: Myth
Self-harm does not always lead to suicide.
Response: Fact
Suicide rates are highest among middle-aged white men.
Response: Fact
If somebody really wants to die by suicide, there is nothing you can do about it.
Response: Myth
Self-injurious behaviors mean the person is just trying to get attention.
Response: Myth
Further statistics and information on suicide and suicide prevention can be found at the
American Foundation for Suicide Prevention: https://afsp.org/suicide-statistics/.
Important Considerations for Social Work Practice
1. This one lesson does not make you an expert on suicidality and suicide
assessment. You will constantly be growing in this area.
2. Always consult others and use supervision.
3. Make sure you are in alignment with agency policies around risk.
4. Know your state’s laws around harm to self and others.
5. Know your state’s process of involuntary mental health watch/hospitalization.
6. Be mindful of potential vicarious traumatization.
7. Know the warning signs.
Potential Warning Signs
• Threatening to hurt or kill self
• Looking for ways to kill self; seeking access to pills, weapons, or other means
• Talking or writing about death, dying, or suicide
• Getting affairs in order and giving away valued possessions
[https://afsp.org/suicide-statistics/](https://afsp.org/suicide-statistics/)
2
© 2022 Walden University, LLC
• No future orientation
• Severe distress and ruminative behavior; tunnel vision
• Behavioral change (social, vocational, academic, appearance)
• Loss of self-worth
• Impulsive and/or aggressive tendencies
• Guardedness or inconsistency
• Sudden recovery from depression
Vicarious Trauma: An Issue for Social Workers
Vicarious trauma is a shift in the internal experience and psychological well-being of the
social worker. Vicarious trauma undermines a social worker’s sense of safety in the
world and sense of control over life situations.
Symptoms
• Loss of energy
• Difficulty in maintaining interpersonal relationships
• Cynicism
• Nightmares
• Feelings of hopelessness and despair
• Disruptive frame of reference (i.e., change in worldview)
• Increased emotionality
• Emotional numbness
• Dissociation or depersonalization
How to Deal With Vicarious Trauma
Awareness
• Be aware of your own history of trauma and recognize when emotions and
memories related to your own experience are triggered.
• Seek help to manage your shifting belief about the goodness of self and others.
Wellness
• Develop a personal self-care and wellness plan. The plan should include eating
healthy, getting adequate sleep, and exercising regularly.
o Emotional wellness: Maintain a sense of humor and engage in activities
that promote self-awareness.
o Cognitive wellness: Engage in activities using imagination and problem-
solving skills.
o Spiritual wellness: Practice your spirituality, read poetry, get out in nature,
meditate, or attend religious services.
o Interpersonal wellness: Foster positive interpersonal relationships.
3
© 2022 Walden University, LLC
Support
• Develop a strong supervisory working alliance.
Lesson 2: Assessing for Suicide
Suicide Assessment Five-Step Evaluation and Triage for Mental Health
Professionals (SAFE-T)
1. Identify risk factors.
2. Identify protective factors.
3. Conduct suicide inquiry.
4. Determine risk level/intervention.
5. Document risk, rationale, intervention, and follow-up.
Risk Factors
Current and Past Psychiatric Diagnoses
• Mood disorder
• Psychotic disorder
• Alcohol/substance use disorders
• Posttraumatic stress disorder
• Attention deficit hyperactivity disorder
• Traumatic brain injury
• Conduct problems (antisocial behavior, aggression, impulsivity)
• Family history of mental illness
Presenting Symptoms
• Anhedonia
• Impulsivity
• Hopelessness or despair
• Anxiety and/or panic
• Insomnia
• Command hallucinations
• Psychosis
Precipitants/Stressors
• Triggering events leading to humiliation, shame, and/or despair (e.g., loss of
relationship)
• Chronic physical pain or other acute medical problem (e.g., central nervous
system disorders)
• Sexual/physical abuse
• Pending incarceration or homelessness
4
© 2022 Walden University, LLC
• Legal problems
• Inadequate social supports; social isolation
• Perceived burden on others
Protective Factors
Internal
• Cultural, spiritual, and/or moral attitudes against suicide
• Coping and problem-solving skills
External
• Responsibility to children
• Beloved pets
• Supportive social network of family or friends
• Positive therapeutic relationships
• Engaged in work or school
Columbia-Suicide Severity Rating Scale (C-SSRS)
Suicide Assessment Questions
1. Have you wished you were dead or wished you could go to sleep and not wake
up?
2. Have you actually had any thoughts of killing yourself?
If yes, ask Questions 3, 4, 5, and 6. If no, go directly to Question 6.
3. Have you been thinking about how you might kill yourself?
4. Have you had these thoughts and had some intention of acting on them?
5. Have you started to work out or worked out the details of how to kill yourself? Do
you intend to carry out this plan?
6. Have you ever done anything, started to do anything, or prepared to do anything
to end your life?
If yes, ask: How long ago did you do any of these?
months?
Additional Resources
Access this website for more detail on SAFE-T: https://store.samhsa.gov/product/SAFE-
T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-
Clinicians/sma09-4432
Access this website for more detail on the C-SSRS, including screeners to download:
https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/
Lesson 3: Scenario
Disclaimer: This is a scenario for learning purposes and is not meant to be used verbatim for client
interactions, or to represent what is appropriate in all such situations. The goal is to reflect on your
problem solving and decision making in situations involving clients at risk.
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432](https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432)
[https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/](https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/)
5
© 2022 Walden University, LLC
Imagine that you are an intern at an agency that assists individuals with accessing job,
food, and housing support. Navigate the following scenario by selecting the most
appropriate responses from the choices.
You are working with client Adam Donovan, a 29-year-old male.
have no respect for what I’ve done for them. Zero.
Student choices Client reaction Result
Option 1: Tell me more
about the job. What
happened?
Client reaction: What
happened? They canned
me. Said I was slacking
off, coming in late, with an
“attitude.”
Try again.
Option 2: It sounds like you
might benefit from job
assistance. How are you
doing with your rent, food,
and other essentials?
Client reaction: Not too
good. I’ve been trying to
do odd jobs. Money’s
been tight.
Continue.
Option 3: That does sound
like a very tough situation.
What are you doing to better
yourself and move forward?
Client reaction: I don’t
want to move forward. I
want my job back!
Try again.
Mr. Donovan: I could use some help with food, rent, and the electric bill.
Intern: We can see about getting you into a work program and about a food
supplement. We can also consider housing if you need to move out due to nonpayment.
Mr. Donovan: Thanks.
But really, what’s the point? My wife left with the kids. My friends were all from work. I
might as well end it; nobody would miss me.
Student choices Client reaction Result
Option 1: Just a minute. Let
me get the benefit
application forms and we
can fill them out.
Client reaction: Okay. Try again.
Option 2: That’s not true. I
bet a lot of people would
miss you if you were gone.
Client reaction: Sure …
then how come nobody
ever calls?
Try again.
Option 3: Have you actually
had any thoughts of killing
yourself?
Client reaction: Yes, ever
since Rochelle took the
kids.
Continue.
6
© 2022 Walden University, LLC
Mr. Donovan: My life is just … falling apart. Better to not be here.
Student choices Client reaction Result
Option 1: Have you been
thinking about how you
might kill yourself?
Client reaction:
Sometimes when I get
really drunk, I think about
mixing alcohol and pills.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Option 2: In what ways is
your life not falling apart,
though? How would you
characterize your strengths?
Client reaction: Uh, what
strengths? I’ve got
nothing.
Try again.
Option 3: Once we get these
forms filled out, and you can
get services, maybe some of
that pressure you are feeling
will lessen.
Client reaction: I doubt it. Try again.
Mr. Donovan: I have a bunch of oxy that was prescribed for my neck pain. It’s in the
cabinet, and sometimes I bring it out. I think about what it would be like.
Student options Client reaction Result
Option 1: What happened
with your neck?
Client reaction: Got in a
car accident 6 months
ago. It still hurts, mostly
on rainy days.
Try again.
Option 2: Oxycodone is a
strong pain medication that
should not be used in
excess.
Client reaction: I know,
but it’s the only thing that
really helps the pain. I
don’t take it all that often;
Try again.
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that’s why I have so much
of it just sitting there.
Option 3: Have you had
some intention of acting on
these thoughts?
Client reaction: I came
close the last time. I did
take a couple pills before I
stopped.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Mr. Donovan: But I never go through with it.
Intern: So it sounds like you have started to work out the details of how to kill yourself.
Do you plan to drink tonight?
Mr. Donovan: No, not tonight. The last time was a little scary.
Whenever I’m there with the bottle, I start thinking about my mom and what she’d want
for me. She passed a couple of years ago.
Student options Client reaction Result
Option 1: It sounds like you
have had a rough couple of
years. Who has helped you
since your mother’s
passing?
Client reaction: I don’t
really have anyone now,
but my mom is like my
guardian angel. She
makes sure I’m okay.
1. Continue the
conversation.
Feedback: This could be a
good choice depending
on agency policy.
2. Get your Field
Instructor (supervisor).
Feedback: This could be a
good choice given the
client’s disclosure,
depending on agency
policy.
3. Call 911.
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Feedback: Try again. The
client’s disclosure does
not rise to an immediate
and current threat for him
or anyone else in the
agency.
Option 2: It sounds like you
may need some mental
health and grief counseling
in addition to the other
services we are
coordinating. Would that be
accurate?
Client reaction: Woah,
woah, woah—there’s
nothing wrong with me.
Everyone thinks this way
sometimes.
Try again.
Option 3: How did your
mother’s death make you
feel?
Client reaction: Not
great—but I don’t really
want to talk about that
right now.
Try again.
Intern: Thank you for sharing all of this with me. Let’s see how we can support you.
End of Scenario
Reflection
After completing the scenario, reflect on your choices. Then, research your agency’s
policies and resources related to clients at risk. Determine your agency’s stance on
when you should contact your Field Instructor.
How would your decision making in the scenario be different based on your agency’s
policies and context?
Lesson 4: Summary
Depending on your agency, you may have more or less autonomy as an intern to
complete a risk assessment or engage with a client about suicidal thoughts and
behaviors. Be prepared by knowing your agency’s policies and scope of practice.
If you do encounter such a situation, consider the following questions:
• Is this a reportable situation?
o Know the guidelines for mandated reporting.
• What are your organizational policies?
o Ensure you know the following:
▪ Whom to report to
▪ What to report
▪ How to report
▪ When to report
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▪ Where to go for guidance
• How will you document the situation?
• What are the professional and legal consequences for failure to report?
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