(a) Purpose. This rule establishes procedures for identification, assessment, treatment, and protection of youth in high-restriction facilities who may be at risk for suicide.
(b) Applicability. This rule applies to all youth currently placed in high-restriction facilities operated by the Texas Juvenile Justice Department (TJJD).
(c) Definitions. Definitions pertaining to this rule are under §380.9187 of this chapter.
(d) General Provisions.
  (1) Treatment for youth determined to be at risk for suicide is provided within the least restrictive environment necessary to ensure safety.
  (2) Youth determined to be at risk for suicide participate in regular programming to the extent possible, as determined by a mental health professional. Only a mental health professional may make exceptions to the provision of regular programming, housing placement, or clothing.
  (3) Using force to remove clothing shall be avoided whenever possible and used only as a last resort when the youth is physically engaging in suicidal and/or self-harming behavior.
  (4) Designated staff carry rescue kits at all times while on duty for use in the event of a medical emergency caused by a suicide attempt. Rescue kits are also placed in designated buildings or areas of the campus that are not accessible to youth.
  (5) As soon as possible, but not to exceed two hours, after a suicide attempt, the youth's parent or guardian is notified (with the youth's consent if the youth is age 18 or older).
(e) Intake Screening and Assessment.
  (1) Upon Initial Admission to TJJD.
    (A) Upon arrival to a TJJD orientation and assessment unit, designated intake staff keep youth within direct line-of-sight supervision until the youth is screened or assessed for suicide risk.
    (B) Within one hour after the youth's arrival to a TJJD orientation and assessment unit, a mental health professional initiates an initial mental health screening and documents the results.
    (C) If the mental health professional identifies the youth as potentially at risk for suicide, the mental health professional immediately conducts a suicide risk assessment.
    (D) Within 14 days after arrival at the orientation and assessment unit, all youth receive a comprehensive mental health evaluation conducted by a mental health professional. The mental health evaluation will include a suicide risk assessment if one has not already been completed.
    (E) The suicide risk assessment completed upon initial admission includes, at a minimum:
      (i) a mental status exam;
      (ii) a review of all mental health and medical records submitted from the courts, county juvenile detention facilities, or any other medical or mental health provider, to include any assessments by mental health professionals relating to prior suicide alerts during confinement;
      (iii) a review of all other available screenings and assessments; and
      (iv) referrals for follow-up treatment or further assessment, as indicated.
    (F) The designated mental health professional reviews the suicide risk assessment.
  (2) Upon Arrival at a TJJD Facility after Intake.
    (A) Except for youth who are on suicide alert at the time of arrival, the following actions must occur within one hour after a youth's arrival at a high-restriction facility following an intrasystem transfer, any period of time spent out of TJJD's physical custody due to a significant life event, or a period of at least 48 hours spent out of TJJD's physical custody for any reason:
      (i) a trained designated staff member initiates a suicide risk screening; or
      (ii) a mental health professional initiates a suicide risk assessment.
    (B) The youth is kept within direct line-of-sight supervision until the youth is screened or assessed.
    (C) If a screening is conducted:
      (i) the trained designated staff member immediately contacts a mental health professional to assign an observation level, if appropriate, based on results of the screening; and
      (ii) the youth is immediately placed on the observation level directed by the mental health professional; and
      (iii) the mental health professional conducts a suicide risk assessment within an appropriate time frame, as established in agency procedures. Procedures will assign time frames based on the youth's assigned observation level and screening result.
    (D) The suicide risk assessment conducted upon a youth's arrival at a TJJD facility includes, at a minimum:
      (i) a mental status exam;
      (ii) a review of the youth's masterfile and medical record, as indicated;
      (iii) referrals for follow-up treatment or further assessment, as indicated;
      (iv) a determination of whether to place the youth on suicide alert, and if placed, designation of the appropriate observation level and other safety precautions; and
      (v) a review by the designated mental health professional of the assessment.
  (3) Additional Screening by Infirmary for Intrasystem Transfers.
    (A) Upon arrival of a youth from another high-restriction TJJD facility, a nurse completes an intrasystem health screening, including questions relating to suicidal ideation and suicidal behavior.
    (B) If the youth is identified by the screening as potentially at risk for suicide, the nurse immediately contacts a mental health professional and communicates the results of the screening.
(f) Responding to Suicidal Ideation, Self-Harming Behavior, or Suicidal Behavior.
  (1) A staff member who has reason to believe that a youth has verbalized suicidal ideation or demonstrated self-harming or suicidal behavior must:
    (A) immediately use the rescue kit if appropriate and seek medical attention if there is a medical emergency;
    (B) verbally engage the youth;
    (C) provide constant observation unless a mental health professional directs a higher observation level;
    (D) begin a suicide observation log to document status checks of the youth;
    (E) immediately notify the campus shift supervisor and document the notification; and
    (F) refer the youth for a suicide screening.
  (2) As soon as possible, but no later than one hour after notification, the campus shift supervisor ensures a trained designated staff member initiates a suicide risk screening or a mental health professional initiates a suicide risk assessment. This screening or assessment is not required when deemed inappropriate due to a medical emergency.
  (3) If a screening is conducted:
    (A) the trained designated staff member immediately contacts a mental health professional to assign an observation level based on results of the screening; and
    (B) the mental health professional conducts a suicide risk assessment within an appropriate time frame, as established in agency procedures. Procedures will assign time frames based on the youth's assigned observation level and screening result.
  (4) If the youth is transported to the emergency room:
    (A) upon return to the facility, the youth is placed on one-to-one observation until assessed by a mental health professional; and
    (B) a mental health professional initiates a suicide risk assessment within four hours after the youth's return to the facility.
  (5) The suicide risk assessment conducted in response to suicidal behavior or ideation includes:
    (A) a mental status exam;
    (B) a review of the youth's masterfile and medical record, as indicated;
    (C) referrals for follow-up treatment or further assessment, as indicated;
    (D) a determination of whether to place the youth on suicide alert, and if placed, designation of the appropriate observation level and other safety precautions; and
    (E) a review by the designated mental health professional of the assessment.
  (6) Whenever possible, suicide risk screenings and assessments are conducted in a confidential setting.
(g) Actions Taken Upon Completion of Suicide Risk Assessment.
  (1) Documentation Requirements.
    (A) Upon completion of a suicide risk assessment, the mental health professional documents the results of the assessment, including any changes in the youth's observation level.
Cont'd...