Texas Administrative Code › Title 37 - PUBLIC SAFETY AND CORRECTIONS › Part 11 - TEXAS JUVENILE JUSTICE DEPARTMENT › Chapter 380 - RULES FOR STATE-OPERATED PROGRAMS AND FACILITIES › Subchapter C - PROGRAM SERVICES › Division 4 - HEALTH CARE SERVICES › Section 380.9187 - Suicide Alert Definitions

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose. This
					 rule establishes definitions of terms used in the Texas Juvenile Justice
					 Department's (TJJD's) suicide prevention policies as set forth in §§
											380.9188,
					 380.9189,
					 380.9190, and
					 380.9745 of this
					 chapter.
(b) Definitions.
(1) Completed Suicide--a death resulting from
					 deliberate actions to harm oneself.
(2) Critical Incident Review--a review
					 conducted by a multi-disciplinary team designed to critically review the
					 circumstances surrounding a death or serious incident and to recommend
					 corrective action where necessary. The critical incident review may consider
					 information such as incident reports, training/personnel records,
					 policies/procedures, other relevant documents, facility practices, any
					 non-confidential information resulting from a morbidity and mortality review,
					 and any other information the review team determines is necessary for a
					 comprehensive review.
(3) Critical
					 Incident Support Team--a team used to provide support to youth, employees, and
					 families involved in or adversely affected by the death of a TJJD youth or
					 staff member.
(4) Designated Mental
					 Health Professional--a doctoral-level psychologist who has primary
					 responsibility and accountability for the evaluation, monitoring, and treatment
					 of youth referred for suicide risk in high-restriction facilities. In the
					 absence of a doctoral-level psychologist, a licensed mental health professional
					 may be appointed to serve as the designated mental health professional with the
					 approval of the Central Office director over treatment services.
(5) Life-Threatening Suicide Attempt--a
					 suicide attempt that a health care professional determines would have likely
					 resulted in death except for circumstances beyond the youth's
					 control.
(6) Mental Health
					 Professional--a doctoral-level psychologist, masters-level mental health
					 specialist, licensed professional counselor, licensed psychological associate,
					 or licensed clinical social worker.
(7) Morbidity and Mortality Review--an
					 assessment of the overall clinical care provided and the circumstances leading
					 up to a death or certain serious medical incidents. Its purpose is to identify
					 program strengths and opportunities for improvement in clinical care.
(8) Protective Custody--a temporary program
					 in high-restriction facilities designed for the placement of youth who cannot
					 be safely managed in the current dorm or living unit due to risk of suicidal
					 and/or self-harming behavior, as determined by a mental health
					 professional.
(9) Psychiatric
					 Provider--a:
(A) Texas-licensed psychiatrist;
					 or
(B) Texas-licensed physician
					 assistant or psychiatric nurse practitioner acting under the authorization of a
					 psychiatrist.
(10) Rescue
					 Kit--emergency medical items such as a CPR pocket mask, disposable gloves, and
					 a tool capable of cutting ligatures.
(11) Self-Harming Behavior--behavior that
					 causes harm, such as self-laceration, self-battering, taking overdoses, or
					 exhibiting deliberate recklessness. Self-harming behavior is not considered a
					 type of suicidal behavior, unless designated as such by a mental health
					 professional.
(12) Staggered
					 Intervals--periods of time that are irregular and unpredictable.
(13) Suicidal Behavior--includes suicide
					 attempts or taking deliberate action toward carrying out a specific plan or
					 strategy to injure oneself or to cause one's own death.
(14) Suicidal Ideation--thoughts of engaging
					 in suicide-related behavior. This means a youth expresses thoughts or fantasies
					 about committing suicide or expresses a desire to commit suicide.
(15) Suicide Alert--a status that begins
					 following a suicide risk assessment by a mental health professional, indicating
					 that a youth is at risk to attempt suicide or self-harming behavior and
					 requires increased supervision and/or precautions designed to limit the
					 risk.
(16) Suicide Attempt--an act
					 apparently intended to end one's life. A suicide attempt is a type of suicidal
					 behavior.
(17) Suicide Observation
					 Folder--a folder containing completed and/or active suicide observation
					 logs/check sheets and any other pertinent information as determined by a mental
					 health professional.
(18) Suicide
					 Observation Level--levels of observation determined by a mental health
					 professional to provide enhanced supervision for youth who are awaiting a
					 suicide risk assessment or who have been placed on suicide alert. General
					 criteria for determining the appropriate level of observation are provided in
					 subparagraphs (A) - (C) of this paragraph, however the mental health
					 professional may assign any level of observation deemed appropriate under the
					 circumstances based on the professional's clinical judgment.
(A) One-to-One Observation--generally
					 considered appropriate for a youth who is actively suicidal, either by
					 threatening or engaging in suicidal and/or self-harming behavior, and who may
					 require emergency psychiatric placement. One-to-one observation includes the
					 following:
(i) Assigned staff may not have any
					 other concurrent duties.
(ii)
					 Assigned staff remains within six feet of the youth and maintains continuous,
					 direct visual observation of the youth at all times, including while the youth
					 is in the youth's room or while the youth is sleeping.
(iii) Assigned staff documents the youth's
					 status at least once every five minutes.
(iv) Assigned staff must be formally relieved
					 by another staff or by the discontinuation of the one-to-one status.
(v) Doors to individual rooms remain
					 unlocked, except when a youth presents an imminent danger to staff due to
					 aggressive behavior.
(B)
					 Constant Observation--generally considered the appropriate level of observation
					 for a youth who is actively suicidal, either by threatening or engaging in
					 suicidal and/or self-harming behavior, but does not appear to require emergency
					 psychiatric placement. Constant observation includes the following:
(i) During waking hours, the youth is within
					 12 feet and within sight of assigned staff at all times. Staff may have
					 concurrent duties if the duties do not interfere with observation of the youth.
					 The assigned staff documents the youth's status at staggered intervals not to
					 exceed every five minutes.
(ii)
					 During sleeping hours, assigned staff observes and documents the youth's status
					 at staggered intervals not to exceed every five minutes.
(iii) For youth in a security unit or crisis
					 stabilization unit, doors to individual rooms remain locked.
(C) Close Observation--generally
					 considered the appropriate level of observation for a youth who is not actively
					 suicidal and would be considered a lower risk for suicide but expresses
					 suicidal ideation and/or has a recent history of suicidal and/or self-harming
					 behavior. In addition, close observation would be appropriate for a youth who
					 denies suicidal ideation or does not threaten suicide but demonstrates other
					 concerning behavior (through actions, current circumstances, or recent history)
					 indicating the potential for self-harm. With close observation, the assigned
					 staff is generally involved in concurrent duties that do not interfere with
					 required observation of the youth. The frequency of checks for youth on close
					 observation is as follows:
(i) for youth in a
					 security unit or crisis stabilization unit, assigned staff observes and
					 documents the youth's status at staggered intervals not to exceed every five
					 minutes; and
(ii) for all other
					 youth, assigned staff observes and documents the youth's status at staggered
					 intervals not to exceed 10 minutes.
(19) Suicide-Resistant
					 Clothing--tear-resistant, single-piece attire designed to promote a youth's
					 safety while still providing warmth and coverage.
(20) Suicide-Resistant Room--a room that
					 provides a safe environment and has no obvious materials or possessions that
					 can be used in suicidal and/or self-harming behavior or any item that can be
					 used for hanging. The room is free of all obvious protrusions and any items
					 that provide an easy anchoring device for hanging. Lighting is tamper-proof,
					 and there are no switches or electrical outlets in the room. The door of the
					 room has a heavy-gauge, clear panel that provides staff an unobstructed view of
					 the room.
(21) Suicide Risk
					 Assessment--a standardized assessment by a mental health professional that:
(A) is conducted in-person or via remote
					 computer service that allows both parties to see and hear one another;
					 and
(B) contains specific lines of
					 inquiry regarding suicide risk, a mental status examination, and clinical
					 observations and recommendations.
(22) Suicide Risk Screening--a standardized
					 interview to determine the appropriate suicide observation level until a
					 suicide risk assessment is conducted. The screening is conducted in-person or
					 via remote computer service that allows both parties to see and hear one
					 another.
(23) Trained Designated
					 Staff Member--a staff member trained to conduct a suicide risk
					 screening.