Table 1.

Comparison of Sources of Suicide Risk Assessment Competencies

AAS, 2010	Joiner, 2005	Sullivan & Bongar, 2009	Kleespies et al., 1993, 2009	Rudd, 2006
1. Manage reactions to suicide.	1. Clinician should be aware of their own reactions: do not be an “alarmist” or dismissive.
2. Reconcile clinician’s goal to prevent suicide and client’s goal to eliminate psychological pain.
3. Maintain a collaborative, nonadversarial stance.				1. Develop a good quality, ongoing, long term relationship with the client, marked by a positive alliance.
4. Make a realistic assessment of one’s ability to care for a suicidal client.				2. Have a list of other professionals that are available for consultation.
5. Define basic terms related to suicidality.				3. Be clear and precise with suicide terminology.
6. Be familiar with suicide-related statistics.
7. Describe phenomenology of suicide.
8. Demonstrate understanding of risk and protective factors.			1. Understand that having a physical illness (e.g., HIV/ AIDS, cancer, TBI, etc.) can be a risk factor for suicide especially early in the onset. High risk of suicide when depression in combined with medical illness.	4. Consider risk factors such as: loss, health problems, Axis I and Axis II diagnosis, and family conflict.
9. Integrate a risk assessment and continue to collect assessment information.		1. Do a complete diagnostic assessment. 1.a. Psychological testing.		5. Do a thorough history and interview. 5.a. Ask about suicidal history and address every suicidal crisis in detail. 5.b. Ask about current situation, especially in terms of frequency, intensity, duration, when, where, and access to method.
10. Elicit risk and protective factors.	2. Identify three main risk factors: ability to commit suicide (including multiple attempts), thwarted belonging, and perceived burdensomeness.	1.b. Assess for mental disorders. 1.c. Assess for “accelerants” (i.e. insomnia, substance use, pain, personal loss, hopelessness, etc.) 2. Determine risk and protective factors.		6. Identify risk factors. 7. Assess for protective factors, especially social support and the therapeutic relationship.
11. Elicit suicide ideation, behaviors, and plans.	3. Specifically address the client’s ability to commit suicide. Discuss resolved plans, preparations, and a desire for suicide.	3. Ask directly about suicide. 3.a. Assess suicidal ideation. 3.b. Assess for previous suicide attempts and behavior.
12. Elicit warning signs of imminent risk of suicide.	-
13. Obtain records and information from collateral sources as appropriate.	-
14. Make a clinical judgment of the risk that a client will attempt or complete suicide in the short and long term.	4. Make a judgment of risk while continuing to monitor level of risk as risk level can change with fluctuations in dynamic risk factors.	4. Determine level of risk.		8. Determine risk level based on a continuum (e.g., minimal, mild, moderate, severe, and extreme), increasing as intent and symptom severity increases.
15. Write the judgment and the rationale in the client’s record.				9. Thoroughly and clearly document thought processes, decisions, and assessments. Include direct quotes when useful/necessary.
16. Collaboratively develop an emergency plan that assures safety and conveys the message that the client’s safety is not negotiable.				10. Create a crisis plan with all clients.
17. Develop a written treatment and services plan that addresses the client’s immediate, acute, and continuing suicide ideation and risk for suicide behavior.	5. Enact an intervention to minimize distress in session (i.e. symptom matching hierarchy, creating a crisis card, etc.) 6. Develop suicide-specific therapeutic intervention plan: I: Identification of a negative thought C: Connection of the thought to broad categories of cognitive distortion A: Assessment of the thought R: Restructuring the thought E: Execute	5. Make a treatment plan.
18. Coordinate and work collaboratively with other treatment and service providers in an interdisciplinary team approach.		5.a. Consider psychiatric medication and/or hospitalization.
19. Develop policies and procedures for following clients closely including taking reasonable steps to be proactive.	-	5.b. Get others involved in a client’s care.
20. Follow principles of crisis management.	-			11. Respond as needed based on risk level.
21. Document the following items related to suicidality: informed consent, information that was collected from a bio-psychosocial perspective, formulation of risk and rationale, treatment and services plan, management, interaction with professional colleagues, and progress and outcomes.	-			12. Document everything, including: discussion of any and all suicidal crises and suicidal ideation, crisis plan, treatment plan, rationale for risk level and intervention, all consultations, etc.
22. Understand State laws pertaining to suicide.
23. Understand legal challenges that are difficult to defend against as a result of poor or incomplete documentation.				13. Keep documentation accurate and specific as to not be misleading if case notes are needed in legal matters.
24. Protect client records and rights to privacy and confidentiality following The Health Insurance Portability and Accountability Act of 1996 that went into effect April 15, 2003.
	7. Know and follow the standards of care for treatment and assessment of suicidality, but also be aware of the limits of intervention and people’s autonomy.		2. Clinician should take advantage of coping strategies like social support (e.g., supervisor, peers, family, friends, and significant others), meeting the patient’s family or attending a post-mortem conference (if a patient completes suicide), also a case conference to review the case has been found to be helpful.