Burden of Suicidal Behavior in Health Systems. Since 1995 the Joint Commission has consistently listed suicide among the top 5 sentinel events, i.e., unexpected occurrences involving death or serious physical or psychological injury, in health care settings. Of the 1.3 million individuals in the US who reported making a suicide attempt within the past 12 months, about 6% also reported receiving treatment in an outpatient mental health clinic (estimated 206,000 cases). Rates of individuals reporting attempts within the year have also been estimated for those receiving care in other settings that include: those receiving substance use treatment (5%, estimated 122,000 cases); and those having accessed emergency care in the same year (1%, estimated 728,000 cases). Despite the large number of suicide events among persons receiving healthcare, only 28 states require health care systems to report adverse events that include suicide deaths and attempts, that occur during or following receipt of services. Lack of information about the rate and nature of suicide events within and between care systems hinders efforts to eliminate these adverse events through quality improvement initiatives.
Suicide ideation and behavior are highly prevalent among youth in contact with the juvenile justice system, who are estimated to have a three times greater risk for dying by suicide than youth in the general population. In addition, specific factors associated with suicide ideation and behavior (e.g., histories of depression, sexual abuse, physical abuse, substance use and abuse) have been shown to be far more common among this population. The Youth in Contact with the Juvenile Justice System Task Force (convened by the National Action Alliance for Suicide Prevention) produced a set of materials that includes a comprehensive review of the literature on prevalence of suicidal ideation and behavior in this population ( ) and on existing tools and procedures for screening and assessment ().
Choosing one of these large issues will shape your research paper on NAFTA. If you are interested in U.S. decision making, for example, you might study the lobbying process or perhaps the differences between Democrats and Republicans. If you are interested in diplomacy, you would focus on negotiations between the United States, Canada, and Mexico. Either would make an interesting research paper, but they are different topics.
is ambivalent about living or dying
(University of Washington, 2012)
an important note about
written statements from clients that they will not harm themselves, or will contact a specified person if they feel like harming themselves
are commonly used, however can offer a
for the clinician
although they are often signed, they are not a legal document and will not alleviate liability from the clinician
that shows they
The assessment instruments are tools for you to use which will allow a more structured and standardized format for suicide assessment to be as consistent as possible agency wide.
Describe how the proposed design includes innovative elements (e.g., pragmatic design approaches, propensity analyses), as appropriate, that enhance its sensitivity and potential for enhancing scientific understanding of suicide prevention in health care settings.
Women attempt suicide 2 to 3 times as often as men
The most common method of suicide for men is firearms and for women is poisoning
Potential consequences of inaccurately assessing suicide risk
Overestimation of risk may deprive a consumer of their rights and be a drain on a stretched system.
Underestimation of risk may jeopardize the health and safety of the consumer and increase the liability of the clinician.
Westbrook Guidelines and Procedures related to Suicide Screening and Assessment
Upon intake, a screening for risk of suicide will be performed on all clients unless contraindicated.
This FOA encourages applications that leverage existing health care networks with adequate infrastructure (e.g., electronic health records; networked health care systems) and services research expertise in quality improvement strategies, in order to improve the efficiency and relevance of research on suicide reduction approaches. The envisioned by the Institute of Medicine would be an ideal platform for these ‘Zero Suicide’ efforts that improve patient care, and also allow for the process of scientific discovery. Analytic approaches used within learning health systems can include randomized controlled trials, quasi-experimental designs with non-randomized comparison groups, time series designs, and other designs of equivalent rigor and relevance. Considerations for selecting a research design consider practical constraints, ethical issues, and the tradeoff between maximizing internal and external validity. Practical considerations for testing these efforts may require that multiple components be combined to be safe and ethical, such as appropriate referral and follow up after screening. Other approaches could test various “bundled” quality improvement efforts, based on knowledge from system surveillance information.
The screening should address the following three areas: the presence of suicidal intent, the presence of a suicidal plan, access to the means to carry out the plan.
If the screening indicates the need for further assessment, the staff member will assess the consumer (or immediately refer them to an individual who is able to do so) utilizing one of the following tools based on the age of the consumer.
ADOLESCENT SUICIDE ASSESSMENT PROTOCOL – (ASAP 20)
SUICIDAL ADULT ASSESSMENT PROTOCOL – (SAAP)
SUICIDAL OLDER ADULT PROTOCOL – (SOAP)
The results of the assessment will trigger the following actions:
Consultation with the staff member's clinical supervisor or the equivalent.
The use of clinical judgement if the individual receives a risk level of medium or high on the ASAP 20, high or extreme on the SAAP or medium or high on the SOAP to determine if a petition needs to be filed for involuntary hospitalization.
If it is determined that the individual can be safely maintained without involuntary hospitalization, determination and implementation of the appropriate level of response such as developing a safety plan, facilitating a voluntary hospitalization or the creation of a Voluntary Treatment Agreement.
Documentation of the entire encounter on a progress note, to include the following elements.
Actions bringing the event to staff attention
Results of the screening, and if completed, the formal assessment
Actions taken to address the situation
Placement or referral information as required
Filing of an incident report, noting the situation as a critical incident.
Filing of all documentation (including a copy of the assessment) in the consumer's chart.
Use of a standardized assessment, in conjunction with use of sound clinical judgement, consultation with peers and supervisors, when documented thoroughly provides evidence that a clinician has utilized a high standard of professional judgement and engaged in best practice.
This collection of almost 100 political science research paper topics and example papers on political science highlights the most important topics, issues, questions, and debates that any student obtaining a degree in this field ought to have mastered for effectiveness. The purpose is to provide students in political science with an authoritative reference sources and sample research papers that will help their writing efforts with far more detailed information than short essays. See
The list of domestic violence research paper topics below will show that domestic violence takes on many forms. Through recent scientific study, it is now known that domestic violence occurs within different types of households. The purpose of creating this list is for students to have available a comprehensive, state-of-the-research, easy-to-read compilation of a wide variety of domestic violence topics and provide research paper examples on those topics. See