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.
The intern's critical role is to assess the level of risk while staying within the boundaries of their training and supervision. An intern should not attempt to handle the crisis alone. The most crucial decision for an intern is knowing when to seek help from a supervisor. This is not a sign of weakness; it's a fundamental professional and ethical responsibility.
Agency Policies on Clients at Risk
Every social service agency has specific policies and protocols for handling situations where a client is at risk of harm. These policies are designed to protect both the client and the social worker. A typical policy would include the following steps:
Immediate Supervisor Notification: The intern must immediately inform their supervisor of the client's disclosure. This is the most critical first step.
Risk Assessment Protocol: The policy will outline the specific questions and tools to use for a suicide risk assessment. This may include a standardized risk assessment scale.
Safety Plan Development: In collaboration with the supervisor and client, a safety plan must be created. This plan includes identifying triggers, coping mechanisms, and emergency contacts.
Documentation: Detailed and accurate documentation of the conversation, the risk assessment, and the safety plan is mandatory.
Emergency Procedures: The policy will outline the steps to take in a high-risk situation, such as contacting emergency services (911) or a mobile crisis unit if the client cannot be kept safe.
Referral for Higher Level of Care: The protocol will likely include referring the client to a hospital emergency room, a crisis center, or an inpatient psychiatric facility for a higher level of care and a more thorough assessment.
These policies ensure a consistent, safe, and ethical response to a crisis, guided by established procedures and the support of experienced professionals.
Suicide Risk Assessment
A suicide risk assessment is a structured, clinical interview aimed at determining the likelihood that a person will attempt to end their life. It is not about predicting the future but about understanding the current level of risk. The assessment focuses on several key areas:
Ideation: This involves asking direct questions about suicidal thoughts. Do they have thoughts of self-harm? How often?
Plan: Does the client have a specific plan? How detailed is it? Does the plan involve a lethal means? The more specific and accessible the plan, the higher the risk.
Intent: How strong is the client's intent to carry out the plan? Have they taken any steps to prepare?
Means: Do they have access to the means they plan to use? Removing access to lethal means (e.g., firearms, medications) is a critical safety intervention.
History: Has the client attempted suicide before? A history of past attempts is one of the strongest predictors of future attempts.
Risk Factors: These are characteristics that increase the likelihood of suicide. Examples include a history of mental illness (depression, bipolar disorder), substance abuse, social isolation, and recent negative life events.