(a) Purpose. This rule establishes procedures for identification, assessment, treatment, and protection of youth in medium-restriction facilities who may be at risk for suicide.
(b) Applicability.
  (1) This rule applies to all youth currently placed in medium-restriction facilities operated by the Texas Juvenile Justice Department (TJJD).
  (2) Responsibilities assigned to mental health professionals in this rule apply only to mental health professionals employed by TJJD.
  (3) For facilities that do not have a mental health professional employed by TJJD and during periods when a TJJD-employed mental health professional is not on call or on duty:
    (A) TJJD uses community resources such as local mental health authorities and psychiatric hospitals for all required clinical services;
    (B) TJJD staff will attempt to obtain guidance from the mental health professional regarding any enhanced precautions or supervision requirements (consistent with §380.9187 of this chapter when possible) and frequency of follow-up assessments. TJJD staff follow the guidance and instructions provided by the community mental health professional regarding precautions and supervision for youth even when such differ from this rule; and
    (C) TJJD staff are authorized to seek additional instruction, guidance, or assessments from mental health professionals within TJJD or in the community at any time if there are concerns about the appropriateness of precautions or required supervision level.
(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.
  (3) A rescue kit for use in medical emergencies is placed in at least one designated location within the facility that is not accessible to youth.
  (4) 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.
  (1) Upon a youth's admission to a medium-restriction facility, a trained designated staff member conducts a health screening, which includes a review of the youth's file and questions relating to suicidal ideation and behavior. The results of the health screening are documented.
  (2) If a youth is identified during the screening as potentially at risk for suicide:
    (A) the staff member who conducted the screening immediately notifies the facility administrator or designee;
    (B) the facility administrator or designee contacts a mental health professional to conduct a suicide risk assessment; and
    (C) the youth is placed on the one-to-one suicide observation level until assessed by a mental health professional.
  (3) If a TJJD-employed mental health professional is contacted to conduct the suicide risk assessment, the assessment must be completed as soon as possible, not to exceed 72 hours.
(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 suicidal or self-harming 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) immediately notify the facility administrator or designee and document the notification;
    (D) provide one-to-one observation;
    (E) begin a suicide observation log to document status checks of the youth; and
    (F) refer the youth for a suicide screening.
  (2) As soon as possible but no later than one hour after notification, a trained designated staff member initiates a suicide risk screening or a mental health professional initiates an assessment. If a screening is conducted:
    (A) the staff member who conducted the screening immediately communicates the results of the screening to the facility administrator or designee; and
    (B) the facility administrator or designee ensures the youth is assessed by a mental health professional.
  (3) This screening or assessment is not required when deemed inappropriate due to a medical emergency.
  (4) If a TJJD-employed mental health professional is contacted to conduct the suicide risk assessment, the mental health professional assigns an observation level based on the results of the suicide screening.
  (5) Youth who are waiting for a suicide risk assessment are not allowed community access (e.g., community service, employment, academic attendance) unless TJJD staff supervise the youth on one-to-one observation.
  (6) If the youth is transported to the emergency room, upon return to the medium-restriction facility, the youth is placed on one-to-one observation until assessed by a mental health professional.
  (7) In facilities with a TJJD-employed mental health professional who is either on call or on duty, 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.
(g) Actions Taken Upon Completion of Suicide Risk Assessment.
  (1) Documentation Requirements. Upon completion of a suicide risk assessment conducted by a TJJD-employed mental health professional, the mental health professional documents the results of the assessment, including any changes in the youth's observation level.
  (2) Notification of Assessment Results.
    (A) Upon completion of a suicide risk assessment, the facility administrator or designee ensures appropriate facility staff are notified of the results.
    (B) If the youth is placed on suicide alert:
      (i) the facility administrator or designee immediately notifies facility staff of the youth's enhanced supervision requirements and any additional instructions; and
      (ii) the youth's parent or guardian is notified as soon as possible after the youth is placed on suicide alert (with the youth's consent if the youth is age 18 or older).
    (C) If the youth is not placed on suicide alert, the facility administrator or designee notifies the referring staff and the youth's case manager that the youth was assessed and not placed on suicide alert.
  (3) Assignment of Staff to Monitor Youth. If the youth is placed on suicide alert, the facility administrator or designee assigns a specific staff member to monitor the youth and document status checks.
(h) Supervision of Youth on Suicide Alert.
  (1) The facility administrator or designee coordinates a search of the youth's room and removes any potentially dangerous items.
  (2) A suicide observation monitoring sheet must be in the possession of the monitoring staff member at all times while the youth is on suicide alert.
    (A) At no time may the youth possess the suicide observation sheet.
    (B) Each time the youth is transferred to the supervision of another staff member, the receiving staff member must take possession of the observation sheet and document the transfer of supervision.
  (3) The monitoring staff member must:
    (A) maintain direct visual observation of the youth if required;
    (B) document the youth's status at the required interval; and
    (C) follow any precautions set by the mental health professional.
  (4) The monitoring staff member must not leave a youth assigned to one-to-one observation unattended or let the youth out of the staff member's sight.
  (5) During waking hours, the monitoring staff must not leave a youth assigned to constant observation unattended or let the youth out of the staff member's sight.
  (6) Any time a youth on one-to-one or constant observation is in the bathroom or shower, the monitoring staff must remain within six feet of the youth, and:
    (A) observe at least a portion of the youth's body (i.e., head, feet, or other observable parts, excluding genitalia, breasts, and buttocks); and/or
Cont'd...