(a) Purpose. The purpose of the model suicide prevention, intervention, and postvention policy is to:
  (1) Protect the health and well-being of children in the care of general residential operations by implementing procedures to prevent suicide, including screening and assessment procedures for risk of suicide;
  (2) Require intervention when a child attempts or dies by suicide; and
  (3) Address the needs of children in care and staff after a child attempts or dies by suicide.
(b) Definitions.
  (1) Postvention--Activities that promote healing and reduce the risk of suicide by a person affected by the suicide of another.
  (2) Protective factors of suicide--Characteristics that make it less likely that a child will consider, attempt, or die by suicide, including:
    (A) Effective behavioral health care;
    (B) Connectedness to individuals, family, community, and social institutions;
    (C) Supportive relationships with caregivers;
    (D) Problem-solving skills, coping skills, and ability to adapt to change;
    (E) Self-esteem or sense of purpose; and
    (F) Cultural or personal beliefs that discourage suicide.
  (3) Risk factors of suicide--Characteristics or conditions that increase the chance that a child may consider, attempt, or die by suicide, including:
    (A) A prior suicide attempt;
    (B) Knowing someone who died by suicide, particularly a family member, friend, peer, or hero;
    (C) Access to lethal means;
    (D) History of childhood trauma, including neglect, physical abuse, or sexual abuse or assault;
    (E) A history of being bullied;
    (F) A mental health diagnosis, particularly depressive disorders and other mood disorders;
    (G) Abuse of alcohol or drugs;
    (H) Social isolation;
    (I) Severe or prolonged stress;
    (J) Chronic physical pain or illness;
    (K) Loss of a family member; or
    (L) The ending of a relationship.
  (4) Suicide contagion--Exposure to suicide or suicidal behaviors within a family, or from friends or media reports, that can result in an increase in suicide or suicidal behaviors.
  (5) Suicide risk assessment--A comprehensive evaluation of a child by a medical health professional to confirm suspected suicide risk, estimate the immediate danger to the child, and decide on a course of treatment and a plan for intervention to ensure the child's safety.
  (6) Suicide risk screening--A procedure in which a standardized instrument is used to identify children who may be at risk of suicide. The screening may be done orally (with the screener asking questions), with pencil and paper, or using a computer.
  (7) Warning signs of suicide--Indicators that a child may be in danger of suicide and need help, including:
    (A) Talking about wanting to die or to hurt or kill oneself;
    (B) Looking for a way to kill oneself;
    (C) Being preoccupied with death in conversation, writing, or drawing;
    (D) Talking about feeling hopeless or having no reason to live;
    (E) A change in personality;
    (F) Giving away belongings;
    (G) Withdrawing from friends and family;
    (H) Having aggressive or hostile behavior;
    (I) Neglecting personal appearance;
    (J) Running away from home or a residential placement; or
    (K) Risk-taking behavior, such as reckless driving or being sexually promiscuous.
(c) Prevention--Training.
  (1) All caregivers and employees must complete at least one hour of annual suicide prevention training that meets the instructor and documentation requirements of Subchapter F, Division 6 of this chapter (relating to Annual Training) with a curriculum that includes:
    (A) The risk factors, protective factors, and warning signs of suicide;
    (B) Understanding safety planning, including:
      (i) How safety plans are created;
      (ii) How safety plans are shared with employees and caregivers;
      (iii) How safety plans are expected to be implemented by employees and caregivers; and
      (iv) Each employee's or caregiver's role in the prevention of suicide, including never leaving a child alone if the suicide risk screening finds that the child is a high risk for suicide, until a mental health professional conducts a suicide risk assessment; and
    (C) Understanding suicide screening, including clarifying:
      (i) Each person's role in the screening process;
      (ii) When an employee or caregiver should initiate a suicide risk screening for a child; and
      (iii) What actions an employee or caregiver must take to initiate a suicide risk screening for a child.
  (2) The operation must promote suicide prevention training for non-employees, as appropriate.
(d) Prevention--Suicide Risk Screening.
  (1) The policy must describe the suicide risk screening tool that you will use and the process for implementing the screenings.
  (2) The suicide risk screening tool must be supported by evidence-based research demonstrating the tool performs reliably regardless of who administers the tool or performs the scoring or rating.
  (3) Any person who meets the conditions and training requirements of the screening tool manual or instructions may administer the suicide risk screening to a child. You must document that any person conducting a screening meets the conditions and training requirements.
  (4) At a minimum, the screening tool must be administered:
    (A) At admission for each child 10 years of age or older;
    (B) At admission for each child younger than 10 years of age if:
      (i) The information provided to the operation at the time of admission indicates that the child has a history of suicide attempts or suicidal thoughts; or
      (ii) The parent who admits the child or operation requests a screening to be administered because of the child's risk factors or warning signs of suicide;
    (C) Every 30 days after admission for each child 10 years of age or older in a residential treatment center;
    (D) Every 90 days after admission for each child 10 years of age or older in a general residential operation that is not a residential treatment center; and
    (E) Immediately for a child of any age whenever the child exhibits warning signs of suicide that necessitate a suicide screening be conducted.
  (5) Any screening must be performed in a manner that protects the child's privacy.
  (6) Each screening must be documented.
(e) Intervention--Based on the Results of a Suicide Risk Screening.
  (1) If the suicide risk screening finds the child to be a high risk for suicide, the operation must:
    (A) Immediately refer the child to a mental health professional for a suicide risk assessment;
    (B) Not leave the child alone until a mental health professional assesses the child;
    (C) Remove any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt;
    (D) Alert each person responsible for the child's care or supervision of the high risk for suicide and any new or updated safety plan; and
    (E) Upon conclusion of the risk assessment, follow through on recommendations by the mental health professional and update the child's safety plan and service plan accordingly.
  (2) If the suicide risk screening finds the child to have a potential for risk of suicide, the operation must:
    (A) Refer the child to a mental health professional for a suicide risk assessment within 24 hours;
    (B) Closely monitor the child to ensure the child's safety until a mental health professional assesses the child;
    (C) Remove any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt;
    (D) Alert each person responsible for the child's care or supervision of the potential risk of suicide and any new or updated safety plan; and
Cont'd...