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I- SUICIDE IDEATION DEFINITIONS AND PROMPTS. Ask questions 1 and 2.
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1) Wish to be Dead: Person endorses thoughts about a wish to be dead or not alive anymore, or wish to fall asleep and not wake up. Have you wished you were dead or wished you could go to sleep and not wake up?
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2) Suicidal Thoughts: Non-specific thoughts of wanting to end one's life without general thoughts of ways to kill oneself/associated methods, intent, or plan. Have you actually had any thoughts of killing yourself?
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3) Suicidal Thoughts with Method (No Specific Plan or Intent to Act) Person has suicidal thoughts and at least one method. This is different than a specific plan with details worked out. Have you been thinking about how you might do this?
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4) Suicidal Intent (without Specific Plan): Active suicidal thoughts and patient reports having some intent to act on such thoughts. Have you had these thoughts and had some intention of acting on them?
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5) Suicide Intent with Specific Plan: Thoughts of suicide worked out and person has some intent to carry out. Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?
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6) Suicide Behavior Question: Have you ever done anything, started to do anything, or prepared to do anything to end your life?
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If YES to Question 6, How long ago?
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II- OVERALL LEVEL OF RISK:
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Level of Risk Options. If High Risk, tag as 'Suicide High Risk'
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III- DISPOSITION
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Note: Standard comprehensive assessment protocol, including the use of risk assessment, is required for all persons served.
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Disposition Options
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Disposition taken: check as many as appropriate
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Comments
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Does client present as moderate or high risk? if Yes, complete the following SAFE-T Suicide Risk Assessment.
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SAFE-T Suicide Risk Assessment
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Frequency - How many times have you had these thoughts?
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Duration - When you have the thoughts how long do they last?
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Controllability - Could/can you stop thinking about killing yourself or wanting to die if you want to?
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Deterrents - Are there things - anyone or anything (e.g., family, religion, pain of death) - that stopped you from wanting to die or acting on thoughts of suicide?
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Reasons for Ideation - What sort of reasons did you have for thinking about wanting to die or killing yourself?
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