2.5 SUICIDE PREVENTION RESPONSE

PROBATION POLICY AND PROCEDURE: DELINQUENCY INTAKE

Approved by: Shannon Dilley, Director

Date Signed: 10/20/2023

Review Due: 10/20/2028

Previous Version: 9/17/2014

Attachments: none

Authority: AS 47.06.010 Duties of Department, AS 47.06.020 Purpose and Policy Relating to Children, and AS 47.12.010 Delinquent Minors.

POLICY:

The Division of Juvenile Justice considers suicide prevention for youth a priority.  The Division will develop and implement a training program for probation staff that provides information about suicidal behavior, risk factors, protective factors, suicide contagion and imitation, and prevention guidelines. The training will consist of both initial and annual refresher courses. 

The Division’s probation staff will be vigilant in preventing suicide; take all suicidal comments, threats, ideation or attempts seriously; will intervene when youth indicate an increased risk; and will make reasonable efforts to involve families, guardians, and other natural supports in addressing risk and protective factors.

Probation Officers will ensure youth believed to be actively suicidal are not left alone or isolated and connect them with appropriate health care providers or caregivers.

APPLICABILITY:

This policy and procedure applies to all Probation staff.

DEFINITIONS:

1. Self-Injurious Behavior: is behavior that may cause harm and may be indicative of a youth not effectively dealing or coping with events and activities.  For the purposes of this policy, self-injurious behavior includes wall punching, kicking, and superficial cutting or scratching (i.e., breaks the skin but does not require immediate medical intervention to stop bleeding or to evaluate the injury).

2. Suicidal Ideation: Self-reported thoughts and/or feelings of engaging in suicide-related behavior.  Youth verbally express thoughts or fantasies about dying by suicide or verbally express a desire to kill themselves.  Suicidal ideation does not include cases of a youth developing a plan or strategy for dying by suicide, because planning suicide is considered suicidal behavior.

3. Suicidal Behavior: Attempted suicides and suicidal gestures such as intentional overdoses, hanging, suffocation, and developing a plan or strategy for dying by suicide. Suicidal behavior includes self-mutilations (any intentional self-harm action that breaks the skin that requires immediate medical intervention), self-battering (repeatedly striking one’s head against walls or objects).  Unlike suicidal ideation or self-injurious behavior, suicidal behavior usually involves some overt action by youth, indicating intent to injure or kill themselves. These behaviors must be classified as “suicidal behavior” because it is impossible for probation staff to know the youth’s true motivation.

4. For the purposes of this policy, self-injurious behavior and/or suicidal behavior does not include tattooing or gang rituals involving scratching or cutting (scarification).

PROCEDURES:

1. Intake Investigation
   1. As part of an intake interview for a referral from a law enforcement agency,  Probation Officers will ask questions of the youth and the parent, guardian, or care provider regarding the youth’s history of or current thoughts, actions, or plans regarding self-injurious behavior, suicidal ideation and suicidal behavior.  Questions must be specific and include: "Have you been so unhappy or frustrated lately that you have had thoughts of ending your life?" and “Are you currently having thoughts of suicide or hurting yourself?"  The Probation Officer shall document that these questions were asked in the intake interview(s) by recording their answers in the assessment module (“Suicide Screening – Probation”).

1. 2. In the event the youth is not accompanied by a parent or guardian during the intake interview and the youth discloses a history of suicidal ideation, self-injurious or suicidal behavior within the previous 60 days the Probation Officer will make reasonable efforts to notify the parents, legal guardians, or other caregivers of the concerns.  Nothing in this section precludes the Probation Officer from disclosing to a parent, legal guardian or other caregiver an older history of suicidal ideation, self-injurious or suicidal behavior.

1. 3. If Probation Officers receive information indicating a youth is currently engaging in suicidal ideation or suicidal behavior during the intake process and investigation, they will take steps to ensure the youth is not left alone or isolated and will assist the youth, parents, guardians or other caregivers in having the youth seen by and/or connected with appropriate health care providers.  In the event the Probation Officer receives this information while on the telephone with the youth, the Probation Officer will maintain telephonic contact with the youth while also making efforts to ascertain the youth's location and notifying law enforcement, clinic staff or other persons on site or in the community who may be able to assist in getting the youth needed services.

1. 4. Probation Officers will make reasonable efforts to follow up with youth, parents, guardians, care providers to determine the outcome of any referrals made or services recommended.

2. Arrest, Detention, and Placement
   1. Arrest and/or placement in a jail or detention facility may increase a youth’s risk for suicide and self-harm.  If Probation Officers receive information indicating a youth is currently engaging in suicidal ideation or suicidal behavior, they will coordinate with facility, escorting, law enforcement, or other staff in ensuring the youth is not left alone or isolated and will assist them in having the youth seen by and/or connected with appropriate health care providers.

1. 2. The risk of suicide may also be heightened among youth under supervision and those who have been recently released from secure treatment programs and non-secure residential care. Probation Officers will be responsive to verbal, behavioral, historical or situational indicators of self-injurious behavior, suicidal ideation and suicidal behavior.  Warning signs may include:
      1. Change in interaction with family and friends;
      2. Recent disappointment or rejection;
      3. Sudden decline or improvement in academic performance;
      4. Physical symptoms such as eating disturbances, changes in sleep patterns, chronic headaches, stomach problems, menstrual irregularities;
      5. Increased apathy;
      6. Being expelled from school /fired from job;
      7. Family problems/alienation;
      8. Feeling embarrassed or humiliated in front of peers;
      1. Victim of assault or bullying.

1. 3. When there is an indication the youth is currently engaging in suicidal ideation or suicidal behavior the Probation Officer will document the information and Probation Officer response. The Probation Officer and DJJ Facility staff shall coordinate with each other in the completion of an Incident Report to avoid duplication in Incident Tracker.  Generally, the Probation Officer will complete the Incident Report if the suicidal ideation or suicidal behavior is discovered prior to the youth entering a DJJ facility.

1. 4. When Probation Officers arrest and/or transport a youth to a detention facility they will complete the facility’s “Arresting Officer Questionnaire” to report self-injurious behavior, suicidal ideation and suicidal behavior to admitting facility staff.

1. 5. When Probation Officers transport youth between DJJ facilities or a youth treatment program they will work with facility staff to complete the facility’s “Sending Agency Transfer Form” to communicate self-harm, suicide risk or active suicidal ideation concerning the youth.  Probation staff will complete the transporting officer section of the form.

1. 6. When a youth is released to a parent, relative, guardian or care provider directly from a DJJ facility, detention or secure treatment, the transporting or releasing staff member will inform them of the youth’s current or previous suicide risk, and any mental health services delivered for suicidal behavior during the facility stay.  Probation staff will provide contact information for community-based mental health services as applicable. The name of the receiving person, date and time of notification, summary of information provided and the signature of the DJJ staff who notified the receiving person, will be documented on the youth release form. This procedure will apply to youth released from DJJ facilities regardless of the reason for admission or length of stay. (See Statewide Facility Policy J -102 Suicide Prevention and Intervention)

1. 7. When a youth is released from a court proceeding with no advanced notice, the Probation Officer or other escort staff will make reasonable efforts to provide information regarding the youth’s known suicide risk within a DJJ facility to the receiving party and/or the Probation Officer.  The notification to the receiving party will include a summary of information, including the youth’s current or previous suicide risk, medications, and any history of mental health services delivered for suicidal behavior while in the facility.  If at the time of release the Probation Officer/escort staff is uncertain of the youth’s suicide history while in the facility, the Probation Officer/escort staff will advise the receiving party to contact the facility and request information regarding known suicide risk history and status, medications, history of mental health services delivered and personal property status.  The Probation Officer shall also notify the facility, as soon as practicable, of the youth’s release and that the receiving party was advised to contact the facility regarding known suicide risk history and status, medications, history of mental health services delivered and personal property status.

1. 8. If the Probation Officer has concerns regarding a youth being at risk of self-injurious behavior or suicide or receives information indicating a youth is currently engaging in suicidal ideation or suicidal behavior, they will make reasonable efforts to notify the parents, legal guardians, or other caregivers of the incident and take steps to ensure the youth is not left alone or isolated.

1. 9.  In the event the Probation Officer receives this information while on the telephone with the youth, the Probation Officer will maintain telephonic contact with the youth while also making efforts to ascertain the youth's location and notifying law enforcement, clinic staff or other persons on site or in the community who may be able to assist in getting the youth needed services. The Probation Officer will document the information and Probation Officer response and notify the supervisor and complete an incident report pursuant to Probation policy 7.5 Incident Notification and Reporting.

3. Crisis Intervention for Acutely Suicidal Youth
   1. A Probation Officer or Social Services Associate who discovers a youth engaging in suicidal behavior.
      1. Will immediately survey the scene to assess the severity of the emergency/safety concerns and call “911” if necessary;
      2. If the youth is unresponsive, the Probation Officer will initiate appropriate life-saving measures;
      3. If the youth does not need emergency lifesaving procedures, the Probation Officer will ensure the youth receives medical attention and/or is referred for mental health intervention.

1. 2. The Probation Officer will immediately make reasonable efforts to notify the parents, legal guardians, or other caregivers of the incident.

1. 3. The Chief Probation Officer or designee will ensure Probation Officers and other staff involved in an incident involving suicide or attempted suicide are debriefed on the situation and provided guidance and support.  They will also ensure staff are made aware of, and encouraged to take advantage of, their Employee Assistance Program (EAP).

1. 4. The Chief Probation Officer will ensure that every suicide or suicide attempt by a youth in the custody of DJJ resulting in psychiatric or medical hospitalization is examined through an administrative review and process.  The Deputy Director of Operations may also require an administrative review of suicides or suicide attempts by other DJJ-involved youth.  The review will include a chronology of the event, case history, review of contacts with the youth and care provider leading up to the incident and the actions taken by involved parties and DJJ.  The review will include any recommendations for changes to policies, procedures and practices.  In cases involving a suicide attempt, a safety plan for the youth will be included in the review.  The report will be submitted by the Chief Probation Officer to the Statewide Probation Chief and the Director.

4. Case Management
   1. The Probation Officer will ask the youth, parent, guardian/care provider direct questions about the youth’s history of mental health, self-injurious behavior, suicidal ideation, and suicidal behavior when completing the Youth Level of Service/Case Management Inventory Assessment (YLS/CMI).  These questions are included in the YLS/CMI Parent and Youth Interview Guides. 

1. 2. If a youth discloses a history of suicidal ideation, self-injurious or suicidal behavior within the previous 60 days the Probation Officer will make reasonable efforts to notify the parents, legal guardians, or other caregivers of the concerns.  Nothing in this section precludes the Probation Officer from disclosing to a parent, legal guardian or other caregiver an older history of suicidal ideation, self-injurious or suicidal behavior.

1. 3. The Probation Officer will assist the youth, parents, guardians or other caregivers in having the youth seen by and/or connected with appropriate health care providers and will make efforts to follow up with the youth, parents, guardians, care providers to determine the outcome of any referrals made or services recommended.

1. 4. The Probation Officer will ensure the Success Plan or facility/agency treatment plan addresses goals and objectives integrating the youth’s responsivity factors relating to mental health, self-injurious behavior and suicidal ideation and behavior.

5. Documentation

1. The Probation Officer will document when there is the indication that the youth is:
   1. currently engaging in suicidal ideation or
   2. suicidal behavior or
   3. information is provided indicating a history of self-injurious behavior,
   4. suicidal ideation or suicidal behavior.

2. Documentation in JOMIS:
   1. chronological entry “Suicide” Note Type.
   2. include the youth’s response, regardless of whether the youth has confirmed

or denied thoughts/actions of suicidal ideation or suicidal behavior

1. 3. the Probation Officer’s response/intervention to include parent/guardian notification.

3. For youth currently engaging in suicidal ideation or suicidal behavior the Probation Officer will also:
   1. notify the supervisor 
   2. complete an incident report pursuant to P&P 7.5 Incident Notification and Reporting.

TRAINING:

The Division will provide an initial training for suicide prevention and intervention that includes: administrative and staff attitudes toward suicide; how negative attitudes impede suicide prevention efforts; how and why youth in the youth justice system are more at risk of suicidal behavior; potential predisposition to suicide factors; high-risk suicide periods; youth suicide research; warning signs and symptoms; identifying suicidal youth despite the denial of risk; components of this suicide prevention policy; liability issues associated with suicide.

The Division will provide annual refresher trainings that will include: administrator/staff attitudes about suicide; how negative attitudes impede suicide prevention efforts; review of predisposing risk factors; warning signs and symptoms; identifying suicidal youth despite the denial of risk; review of any changes to the probation suicide policy; general discussion and review of any recent suicides or suicide attempts by DJJ-involved youth.

In addition, all Probation Officers shall be certified in cardiopulmonary resuscitation (CPR) and trained in First Aid, the use of automated external defibrillation (AED) devices and NARCAN administration.

QUALITY ASSURANCE: NA

IMPLEMENTATION:

This policy and procedure is effective when it is signed by the Director.