SOCI 1018 Suicide risk assessment Final role Play

During the final role play, complete the following forms. This is an individual assignment and I will need each person to submit their work. Use the “Warning Signs” diagram on slide 18 of the slide deck to identify warning signs to determine the risk level for suicide. Explain your risk assessment. Complete a SAFEPLAN using the SAFEPLAN document attached. Grade yourself using the rubric attached.

In this scenario you work for a phone Crisis line.

Jen

	Age
	Gender
	Stress
	Symptoms
	Past
	Plan
	Partners/Resources
	WHAT ARE THE WARNING SIGNS?	1. 2. 3. 4. 5. 6.
	RISK ESTIMATION	L - Low risk;
	Explain your Risk Assessment. (ie. This person was ____ risk because _____ and with respect to apprehension I determined that ______)

If I have thoughts of hurting myself, I will start at Step 1. I will go through each step until I feel safe. I know suicidal thoughts can be very strong. I know with support and time, these thoughts will usually pass and I can put energy into sorting out the things that have contributed to feeling so badly. The hopelessness I may feel now will not last forever. It is important that I reach out for help and support so I can get through this difficult time. Since it can be hard to focus and think clearly when I feel suicidal, I will copy this plan and put it in places where I can easily find and use it. This is my plan:

Step 1 – My own warning signs/risks

Step 2 - I will do the following activities to calm/comfort myself:

Step 3 – These are my reasons for living:

Step 4: Friends or family I can call (names/numbers):

– a backup person I can call is (name/number):

Step 5 – Call a care provider (therapist/counselor/psychologist name/number)

Step 6 – Call 310-OPEN Crisis Line

Step 7 – Go somewhere I feel safe!

Step 8 – Go to the Emergency Room at the nearest hospital.

Step 9 – If I feel I cannot get to the hospital safely, call 911 and ask for transportation to the hospital. They will get me there safely.

A SAFEPLAN FOR: ___Jen ______________

Suicide Intervention Summative Role Play Checklist – 10%

Part 3:

Crisis Line worker:______________ LENGTH:______

Subject:_______________

Item	Meets (Full value)	Below (0 value)	Weight
Role Play: (Quality of Submission) Professionalism & Length	10+ minute role play with no significant gaps and all required components addressed competently.	Shorter than 10 minutes. Gaps in role play which resulted in key areas of assessment and/or intervention missing (ie. “Ummm”, did not know what to say or ask)	/1.0

Step 1: Completed Assessment	Completed and submitted with all warning signs identified and appropriate assessment of risk.	Not completed, or not submitted or missing warning signs, incorrect risk assessment.	/1.0
Step 2: First responder intro and rapport building	Use of introductory statement and SOLER to build rapport by active listening, empathy and appropriate questions.	Skipped intro, did not use SOLER, did not actively listen, empathize or build rapport	/1.5
Step 3: Ask: “Have you ever thought about or attempted suicide”? Ask: “Are you thinking about killing yourself now?”	Established rapport and asked the questions and engaged in appropriate follow up. Kept pursuing if encountered resistance.	Did not ask both questions.	/1.0 /1.0
Step 4: Ask: “Do you have a plan to kill yourself?” If any hint of plan ask ”When do you plan to kill yourself?	Asked the question and engaged in appropriate follow up.	Did not ask the question.	/1.5
Step 5: Ask: “Do you have the means available to kill yourself?” Ask “Who makes up your support system	Asked both question and engaged in appropriate follow up.	Did not ask both questions or did not follow up with additional discussion.	/1.0 /1.0
Step 6: Review & Submit COMPLETED Safety Plan	Reviewed safety plan with person. Submitted completed Safety Plan with all components included.	Safety Plan not submitted, missing components, or is substandard.	/1.0
Total:			/10

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