SOCW 6090 Walden University Assessing Suicide Risk Discussions Replies

Respond to at least two colleagues in the following ways:

Provide suggestions to manage the emotional responses your colleague identified.

Explain why consideration of culture is important when working with diverse clients.

DB 1

Shirley

DISCUSSION: Assessing Suicide Risk

Suicide can occur anytime, with little warning, impacts people of all ages, creeds, colors, genders, racial groups, and throughout the human lifespan.According to(Osteen et al., 2014), suicide is the eleven-leading cause of death in the United States, as reported by the CDC ( Centers for Disease Control).Social workers play a pivotal role in identifying appropriate risk assessments and implementing safety plans.

In the video, Dr. Sommers-Flanagan’s suicide risk assessment consisted of the following: risk factors, depression assessment, exploration of suicidal ideations(client’s thoughts about suicide), exploration of a safety suicide plan, determination of suicide or intent, and developing a collaborate safety plan ( Clinical Interviewing: Intake, assessment and therapeutic alliance {Video file}.

In the video clip, Tommi presents as an AmericanIndian/Alaska Native female ( early twenties), with a history of two suicide attempts, substance abuse addiction, family history of physical abuse, and the suicidal death of her close friend.Tommi maintains strong tribal ties to her Indian heritage yet may be feeling disconnected from her immediate family.From an empathic stance, Tommi desperately wants a loving connection with her family but cannot surrender the pain and hurt she feels inside.The use of drugs and alcohol may be her way to escape from reality.However, Tommi reflected on engaging in singing, writing poetry, and exercising to help her feel better.Moreover, Tommi felt emotional when leaving messages on the wall for her family before hanging herself.It was ribboning to hear because she would not be there to see their reactions.

In the AI/AN ( American Indians/Alaska Natives culture, suicide rates have increased since 2003 ( Leavitt et al., 2018).In fact, (Leavitt et al., 2018) states theNational Violent Death Reporting System asserts AI/AN deaths was 21.5 per 100,000, more than 3,5 times higher than those among racial/ethnic groups with the lowest rate ( p. 237).

Suicide is a difficult situation, and social workers should view it as an imminent matter.In Tommi’s situation, the social worker must consider her cultural background.It is also essential to reflect on cultural differences when conducting risk assessment ( Chu et al., 2013).

In the case of Tommi, she has made two attempts to commit suicide.Therefore, during the first week, my safety plan would consist of the following: identifying warning signs, coping methods to address suicidal thoughts, two persons to notify when her mood changes, and removing any weapons. During the first month, the following things would be added: collaborating with Tommi to include a list of places to call ( including 911) and significant people to contact, identify reasons to live, list mental health providers to contact during a crisis, and steps taken to remove any access to harming self.

In Tommi’s case, after conducting a depression assessment, it may be prudent to the following risk assessment tool: Beck Depression Inventory or Beck Scale for Suicidal Ideation ( Cochran-Brink et al., 2000).The Beck Depression Inventory consists of twenty items addressing the severity of depression ( p. 446).Furthermore, the Beck scale addressing suicidal ideations consists of nineteen items ( p. 447).My preference would be to use the Beck suicidal ideation scale because when asked by Dr. Sommers-Flanagan, Tommi confirmed thoughts of taking her life and the steps she would take.This tool is useful for assessing her thoughts, plans, and intent to commit suicide ( p. 447).

Given Tommi’s AJ/AN heritage background, the social worker should be aware of cultural competence when developing a Tommi safety plan.According to(Leavitt et al.,2018),Tommi’s culture decedents are more likely to have a friend’s or family member’s suicide contribute to their death; in this case, Tommi’s friend committed suicide.The social worker should also recognize Tommi’s drug addiction as a risk factor for suicidal behavior ( p. 241).

References:

Cochrane-Brink, K. A., Oxon, D. P., Lofchy, J. S., & Sakinofsky, I. ( 2000). Clinical rating scales in suicide risk assessment. General Hospital Psychiatry, 22, 445-451.

Chu, J., Floyd, R., Diep, H., Pardo, S., Goldblum, P., & Bongar, B. ( 2013). A tool for the culturally competent suicide assessment:The Cultural Assessment of Risk for Suicide (CARS) measure.Psychological Assessment, 25(2), 424-434.Doi:10.1037/a00312664.

Leavitt, R. A., Ertl, A., Sheats, K., Petrosky, E., Ivey-Stephenson, A., & Fowler, K. A. ( 2018).Suicides among American Indian/American Alaska Natives-National Violent Death Reporting System, Morbidity and Mortality Weekly Report, 67(8), March, pp. 237-242.

Osteen, P. J., Jacobson, J. M., & Sharpe, T. L. ( 2014).Suicide prevention in social work education: How prepared are social work students? Journal of Social Work Education, 50(20, 340-364.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (Producers).(2014). Clinical Interviewing: Intake, assessment, and therapeutic alliance [Video file].

DB 2

Julia

Identify elements of Dr. Sommers-Flanagan’s suicide risk assessment.

Dr. Sommers-Flanagan’s suicide risk assessment consisted of 11 elements. Dr. Sommers-Flanagan began the assessment by discussing Tommi’s mood and exploring any depressive symptoms (Sommers-Flanagan & Sommers-Flanagan, 2014). The next element was a cultural check-in followed by a cognitive triad assessment to address Tommi’s Native Alaskan culture and explore Tommi’s thoughts of herself, the world and the future (Sommers-Flanagan & Sommers-Flanagan, 2014). The assessment continued by assessing for physical symptoms and assessing social relationships; Tommi shared she had difficulty sleeping, had some friends but they called her a zombie (Sommers-Flanagan & Sommers-Flanagan, 2014). Dr. Sommers-Flanagan continued by asking Tommi directly about thoughts of suicide, asking about exceptions when she was not having suicidal ideations and asked Tommi if she had a plan on how she would kill herself (Sommers-Flanagan & Sommers-Flanagan, 2014). Dr. Sommers-Flanagan then explored previous attempts, explored intent in the present to see if Tommi was still actively thinking about suicide and then collaboratively discussed a safety plan (Sommers-Flanagan & Sommers-Flanagan, 2014). Throughout the assessment, Dr. Sommers-Flanagan would begin each question by stating that sometimes people have such and such symptoms when they are upset and then asked Tommi about her symptoms; I believe this allowed Tommi to feel a bit more at ease when answering since she knows that she is not the only one who has faced similar challenging symptoms.

Describe any personal emotional responses you would have to Tommi’s revelations and reflect on reasons you might experience these emotions.

A personal emotional response I would probably have to Tommi’s revelations of depressive symptoms, active thoughts of suicide as well as past attempts would be that unfortunately it’s common now a days. I believe I would have this response because when I began working with the adolescent population, I was shocked to find out how many children have suicidal ideations and also attempt suicide. I try not to let it get to me anymore because it’s common within my work, but when I first began hearing about young children/adolescents with these same symptoms and attempts, it made me really sad and confused as to why so many young individuals are experiencing these thoughts and feelings.

Describe the elements of safety planning that you would put in place as Tommi’s social worker in the first week and in the first months.

As Tommi’s social worker I would create a safety plan with her within the first day/week of meeting with her, just as Dr. Sommers-Flanagan did. I would work with Tommi to identify what some of her triggers were and some of her coping skills/activities she enjoys to do, which may assist her when she is upset and down. Each week that I would meet with Tommi, I would ask her to rate her depression and thoughts of suicide on a scale of 1-10. I would also implement journaling with Tommi, so she can write down each day a little on how she feels, whether it is happy or sad and to describe why. I would work with Tommi to identify someone at Job Corp who she feels comfortable with, so that person can be a support to her and check in with her throughout the week.

Identify a suicide risk assessment tool you would use at future sessions to identify changes in her risk level. Explain why you would use this tool.

To assess changes in Tommi’s suicide risk level I would utilize The Columbia-Suicide Severity Rating Scale (C-SSRS). I would use the C-SSRS because it is an assessment tool that assists to gather information on the full range of suicidal ideation and suicidal behavior and is also suitable to use on individuals of all ages (Greville, 2017). Additionally, the C-SSRS is a screening tool that can easily be administered by nonmental health professionals, which would assist myself as her social worker, since the adults around her at Job Corp (teachers, guidance counselor, residential staff etc.) can also administer it if they have concerns (Greville, 2017). If the adults in Tommi’s life administer the same assessment and report back to me the concerns, it would be easier to understand what red flags were shown since I would know they would be asking and assessing the same items I would have.

Explain any adjustments or enhancements that might be helpful given Tommi’s cultural background. Support your ideas with scholarly resources.

“Current mortality statistics reveal that suicide is the second leading cause of death for American Indian/Alaska Native populations aged 15 to 24 years of age, the third leading cause of death for ages 5 to 14 and 25 to 44 years of age, and the eighth leading cause of death for decedents of all ages” (Alcántara & Gone, 2007, p. 461). Given Tommi’s Native Alaskan culture and the rising suicide statistics, I would enhance the questions regarding her culture to get a better understanding of the life she lived when she was home and not at Job Corp. Having more information from Tommi’s cultural background would assist in trying to figure out the underlining cause of her suicidal ideations and attempts, since she mentioned family troubles and wanting to “send a message to her parents”, so they could know everything that ever hurt her (Sommers-Flanagan & Sommers-Flanagan, 2014). “The leading method of suicide among the American Indian and Alaskan Native youth was death by firearms followed by hanging” (Alcántara & Gone, 2007, p. 461). Tommi mentioned her plan for suicide was shooting herself in the head, but not having a gun available and her second plan was to hang herself in her room (Sommers-Flanagan & Sommers-Flanagan, 2014). There seems to be commonalities among the Alaskan Native youth and as a social worker who is unfamiliar with the culture, it is important to ask more questions about the culture. Learning more about the Native Alaskan culture may help identify different risk factors than other cultures. “… racism and general stress have been previously referenced as risk factors in suicidal behaviors for American Indian and Alaskan Native’s” (Alcántara & Gone, 2007, p. 468). Although racism and stress can be a common risk factor, it is important to explore what does racism look like for Tommi since she is Native Alaskan and how she may have experienced stress.

References:

Alcántara C, & Gone JP. (2007). Reviewing Suicide in Native American Communities: Situating Risk and Protective Factors within a Transactional-Ecological Framework. Death Studies, 31(5), 457–477.

Greville, L. (2017). Children and families forum: Suicide prevention for children and adolescents. Social Work Today. Retrieved from http://www.socialworktoday.com/archive/SO17p32.s html

Sommers-Flanagan, J., & Sommers-Flanagan, R. (Producers). (2014). Clinical interviewing: Intake, assessment and therapeutic alliance [Video file].