Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 748 - MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
Subchapter C - ORGANIZATION AND ADMINISTRATION
Division 1 - REQUIRED PLANS AND POLICIES, INCLUDING DURING THE APPLICATION PROCESS
Section 748.125 - What is the model suicide prevention, intervention, and postvention policy?
Universal Citation: 26 TX Admin Code § 748.125
Current through Reg. 50, No. 13; March 28, 2025
(a) Purpose. The purpose of the model suicide prevention, intervention, and postvention policy is to:
(1) Protect the health and well-being
of children in the care of general residential operations by implementing
procedures to prevent suicide, including screening and assessment procedures
for risk of suicide;
(2) Require
intervention when a child attempts or dies by suicide; and
(3) Address the needs of children in care and
staff after a child attempts or dies by suicide.
(b) Definitions.
(1) Postvention--Activities that promote
healing and reduce the risk of suicide by a person affected by the suicide of
another.
(2) Protective factors of
suicide--Characteristics that make it less likely that a child will consider,
attempt, or die by suicide, including:
(A)
Effective behavioral health care;
(B) Connectedness to individuals, family,
community, and social institutions;
(C) Supportive relationships with
caregivers;
(D) Problem-solving
skills, coping skills, and ability to adapt to change;
(E) Self-esteem or sense of purpose;
and
(F) Cultural or personal
beliefs that discourage suicide.
(3) Risk factors of suicide--Characteristics
or conditions that increase the chance that a child may consider, attempt, or
die by suicide, including:
(A) A prior suicide
attempt;
(B) Knowing someone who
died by suicide, particularly a family member, friend, peer, or hero;
(C) Access to lethal means;
(D) History of childhood trauma, including
neglect, physical abuse, or sexual abuse or assault;
(E) A history of being bullied;
(F) A mental health diagnosis, particularly
depressive disorders and other mood disorders;
(G) Abuse of alcohol or drugs;
(H) Social isolation;
(I) Severe or prolonged stress;
(J) Chronic physical pain or
illness;
(K) Loss of a family
member; or
(L) The ending of a
relationship.
(4) Suicide
contagion--Exposure to suicide or suicidal behaviors within a family, or from
friends or media reports, that can result in an increase in suicide or suicidal
behaviors.
(5) Suicide risk
assessment--A comprehensive evaluation of a child by a medical health
professional to confirm suspected suicide risk, estimate the immediate danger
to the child, and decide on a course of treatment and a plan for intervention
to ensure the child's safety.
(6)
Suicide risk screening--A procedure in which a standardized instrument is used
to identify children who may be at risk of suicide. The screening may be done
orally (with the screener asking questions), with pencil and paper, or using a
computer.
(7) Warning signs of
suicide--Indicators that a child may be in danger of suicide and need help,
including:
(A) Talking about wanting to die or
to hurt or kill oneself;
(B)
Looking for a way to kill oneself;
(C) Being preoccupied with death in
conversation, writing, or drawing;
(D) Talking about feeling hopeless or having
no reason to live;
(E) A change in
personality;
(F) Giving away
belongings;
(G) Withdrawing from
friends and family;
(H) Having
aggressive or hostile behavior;
(I)
Neglecting personal appearance;
(J)
Running away from home or a residential placement; or
(K) Risk-taking behavior, such as reckless
driving or being sexually promiscuous.
(c) Prevention--Training.
(1) All caregivers and employees must
complete at least one hour of annual suicide prevention training that meets the
instructor and documentation requirements of Subchapter F, Division 6 of this
chapter (relating to Annual Training) with a curriculum that includes:
(A) The risk factors, protective factors, and
warning signs of suicide;
(B)
Understanding safety planning, including:
(i)
How safety plans are created;
(ii)
How safety plans are shared with employees and caregivers;
(iii) How safety plans are expected to be
implemented by employees and caregivers; and
(iv) Each employee's or caregiver's role in
the prevention of suicide, including never leaving a child alone if the suicide
risk screening finds that the child is a high risk for suicide, until a mental
health professional conducts a suicide risk assessment; and
(C) Understanding suicide
screening, including clarifying:
(i) Each
person's role in the screening process;
(ii) When an employee or caregiver should
initiate a suicide risk screening for a child; and
(iii) What actions an employee or caregiver
must take to initiate a suicide risk screening for a child.
(2) The operation must
promote suicide prevention training for non-employees, as
appropriate.
(d) Prevention--Suicide Risk Screening.
(1) The
policy must describe the suicide risk screening tool that you will use and the
process for implementing the screenings.
(2) The suicide risk screening tool must be
supported by evidence-based research demonstrating the tool performs reliably
regardless of who administers the tool or performs the scoring or
rating.
(3) Any person who meets
the conditions and training requirements of the screening tool manual or
instructions may administer the suicide risk screening to a child. You must
document that any person conducting a screening meets the conditions and
training requirements.
(4) At a
minimum, the screening tool must be administered:
(A) At admission for each child 10 years of
age or older;
(B) At admission for
each child younger than 10 years of age if:
(i) The information provided to the operation
at the time of admission indicates that the child has a history of suicide
attempts or suicidal thoughts; or
(ii) The parent who admits the child or
operation requests a screening to be administered because of the child's risk
factors or warning signs of suicide;
(C) Every 30 days after admission for each
child 10 years of age or older in a residential treatment center;
(D) Every 90 days after admission for each
child 10 years of age or older in a general residential operation that is not a
residential treatment center; and
(E) Immediately for a child of any age
whenever the child exhibits warning signs of suicide that necessitate a suicide
screening be conducted.
(5) Any screening must be performed in a
manner that protects the child's privacy.
(6) Each screening must be
documented.
(e) Intervention--Based on the Results of a Suicide Risk Screening.
(1) If the suicide risk screening finds the
child to be a high risk for suicide, the operation must:
(A) Immediately refer the child to a mental
health professional for a suicide risk assessment;
(B) Not leave the child alone until a mental
health professional assesses the child;
(C) Remove any harmful objects, chemicals, or
substances that a child could use to carry out a suicide attempt;
(D) Alert each person responsible for the
child's care or supervision of the high risk for suicide and any new or updated
safety plan; and
(E) Upon
conclusion of the risk assessment, follow through on recommendations by the
mental health professional and update the child's safety plan and service plan
accordingly.
(2) If the
suicide risk screening finds the child to have a potential for risk of suicide,
the operation must:
(A) Refer the child to a
mental health professional for a suicide risk assessment within 24
hours;
(B) Closely monitor the
child to ensure the child's safety until a mental health professional assesses
the child;
(C) Remove any harmful
objects, chemicals, or substances that a child could use to carry out a suicide
attempt;
(D) Alert each person
responsible for the child's care or supervision of the potential risk of
suicide and any new or updated safety plan; and
(E) Upon conclusion of the risk assessment,
follow through on recommendations by the mental health professional and update
the child's safety plan and service plan accordingly.
(f) Intervention--Returning Post Hospitalization. To ensure a child's readiness to return to the care of your operation following a mental health crisis (for example, from a suicide attempt or psychiatric hospitalization):
(1) A
professional level service provider must meet with the child within 24 hours of
the child's return to an operation to discuss protocols that would help to ease
the child's transition back into the operation, ensure the child's safety, and
reduce any risk of suicide.
(2) The
protocols must include:
(A) Weekly suicide
risk screenings for the first 30 days or until the child is no longer reporting
suicidal thoughts, whichever is longer;
(B) Creating or reviewing and updating the
child's safety plan; and
(C)
Removal of any harmful objects, chemicals, or substances that a child could use
to carry out a suicide attempt or self-harm for a period to be determined by
the treatment team, but not less than 30 days.
(3) The operation must alert any persons
responsible for the child's care or supervision of the new protocols and new or
updated safety plan.
(g) Postvention.
(1) Addressing Suicide Deaths.
(A) Create a Postvention Team and Written
Action Plan and Protocols. To prevent suicide contagion and support the
children and staff at the operation, you must create a postvention team. This
team is responsible for developing a written action plan with protocols in the
event of a death by suicide. The postvention team should consider how a death
would affect other children and staff at the operation and consider how to
provide psychological first aid, crisis intervention, and other support to
children and staff at your operation.
(B) While the action plan needs to be
flexible for varying situations, the written action plan must include:
(i) A communication strategy that:
(I) Does not inadvertently glamorize or
romanticize the child or the death;
(II) Occurs in small group settings, allowing
the postvention team to monitor responses of individuals in the
group;
(III) Strives to treat all
deaths at the operation in the same way (for example, having one approach for
honoring a child who dies from cancer, a car accident, or suicide);
(IV) Emphasizes the importance of seeking
help for anyone with an underlying mental health diagnosis, such as a mood
disorder;
(V) Emphasizes the
importance of staff and other children recognizing the signs of suicide;
and
(VI) Decreases the stigma
associated with seeking help for mental health concerns;
(ii) Mental health resources for children and
staff who have a difficult time coping, including:
(I) Opportunities to debrief to process
thoughts and feelings related to the suicide death; and
(II) Referrals to grief counseling and
suicide survivor support groups to the extent possible; and
(iii) A review of lessons learned
from the child's death by suicide. All communications regarding lessons learned
should be approached in a way that ensures a blame-free environment.
(2) Addressing Suicide
Attempts. In the event of a suicide attempt according to §
748.305 of this chapter (relating
to What constitutes a suicide attempt by a child?), you must:
(A) As needed, immediately call emergency
services and render first aid until professional medical treatment can be
provided;
(B) Not leave the child
alone until a mental health professional assesses the child;
(C) Move all other children out of the
immediate area as soon as possible;
(D) Report and document the suicide attempt
as a serious incident as required by:
(i)
§
748.303(a)(12)
of this chapter (relating to When must I report and document a serious
incident?);
(ii)
§
748.311 of this chapter (relating
to How must I document a serious incident?); and
(iii)
§
748.313(1) of
this chapter (relating to What additional documentation must I include with a
written serious incident report?); and
(E) Offer mental health resources for
children and staff who have a difficult time coping, including:
(i) Opportunities to debrief to process
thoughts and feelings related to the suicide attempt; and
(ii) Referrals to grief counseling and
suicide survivor support groups to the extent possible; and
(F) Conduct a review of lessons
learned from the child's suicide attempt. All communications regarding lessons
learned should be approached in a way that ensures a blame-free
environment.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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