14 Recording an alert

14 Recording an alert

Contents 1. Types of alerts and where to record an alert 2. Checking for a historic or current alert for a young person 3. Recording a suicide risk alert for a young person 4. Decision to record a suicide risk alert for a young person 5. Recording a suicide risk event and immediate risk management plan for a young person (SR1) 6. Developing the immediate risk management plan for a young person 7. Ongoing medium to long term risk management for a young person 8. Suicide risk alerts and critical incident reporting for a young person 9. Reviewing and closing the suicide risk alert for a young person 10. Physical aggression / potential violence alert for involved parties (including a young person) 11. Medical / serious health issues alerts for involved parties (including a young person) 12. Behaviour alerts for involved parties (including a young person) Addendum 1: Addendum 2: Addendum 3: Risk factors and warning signs suicide risk Suicide risk alert flowchart Immediate risk management flowchart Youth Justice Conferencing Practice Manual Recording a suicide alert Page 1 of 15

Purpose To explain the responsibility of youth justice conferencing staff: when a young person is contemplating suicide or self harm or is at risk of suicide or self harm when recording a physical aggression/potential violence alert; a medical/serious health issues alert; and/or a behaviour alert. 1. Types of alerts and where to record an alert The four types of alerts youth justice conferencing staff may identify are: suicide risk this alert is only to be recorded for the young person and is recorded on the ICMS database, refer to section one through to section nine of this chapter physical aggression/potential violence alert if the alert is for the young person it is recorded on the ICMS database. If the alert is for another involved party (other than the young person) it is recorded on the CRIS database., refer to section 10 of this chapter medical/serious health issues alerts if the alert is for the young person it is recorded on the ICMS database. If the alert is for another involved party (other than the young person) it is recorded on the CRIS database, refer to section 11 of this chapter behaviour alerts if the alert is for the young person it is recorded on the ICMS database. If the alert is for another involved party (other than the young person) it is recorded on the CRIS database, refer to section 12 of this chapter. 2. Checking for a historic or current alert for a young person Upon receipt of a referral, the service leader checks the department s client information management system to establish if there are any historic or current alerts relevant to the safety and/or wellbeing of the young person or youth justice conferencing staff. The service leader updates the database and the comments section on the referral summary with the details of relevant historic or current alerts. 3. Recording a suicide risk alert for a young person The safety and wellbeing of a young person is paramount and therefore all youth justice conferencing staff must remain vigilant and alert to the risk factors and/or warning signs that indicate that a young person is contemplating suicide or self harm or is at risk of suicide or self harm. A young person who is involved with the youth justice conferencing program is regarded at risk of suicide or self harm when they display / disclose (or other person advises) a history of one or more of the following: a suicide attempt a diagnosis of depression self injurious behaviour expressed or assessed suicidal ideation. Youth Justice Conferencing Practice Manual Recording a suicide alert Page 2 of 15

For other risk factors and warning signs, refer to Addendum 1: Risk factors and warning signs suicide risk. 4. Decision to record a suicide risk alert for a young person Legislation Youth Justice Act 1992, s. 292 Youth Justice Act 1992, schedule one charter of youth justice principles (2) Relevant documents Critical incident reporting policy and procedures - records file no: ADM/06309 Critical incident report form SR1 Addendum 1: Risk factors and warning signs All suicide risk concerns must be taken seriously. The decision to record a suicide alert is a significant decision and upon receipt of information that indicates that a young person is at risk of suicide, the youth justice conferencing staff member consults with their service leader and/or manager of the youth justice service centre to discuss the information and the need to record a suicide alert on the ICMS system. If a manager and/or service leader receive information from a youth justice conferencing staff member that a young person is contemplating suicide or self harm or is at risk of suicide or self harm, refer to section five of this chapter. If it is identified that staff from youth justice services or child safety services have already completed a suicide risk alert for a young person subject to a youth justice conference referral for the same incident, youth justice conferencing staff do not need to create another suicide risk alert. If it is identified that there is a current suicide risk alert for a young person who is a client of youth justice services and/or child safety services on the ICMS or CRIS system and youth justice conferencing staff identify a different incident or an additional risk of suicide or self harm, the service leader and/or manager of the youth justice service centre consults with the relevant youth justice services staff and/or child safety services staff to determine whether an additional event/alert is required. Note: If the service leader and/or manager are unable to consult with youth justice services staff and/or child safety services staff within 24 hours of identifying a suicide risk, the convenor discusses the risk with the service leader/manager who makes the final decision of whether to record a suicide risk alert. If an additional alert is required, refer to section five of this chapter - Recording suicide risk event and immediate risk management plan for a young person (SR1). a 5. Recording a suicide risk event and immediate risk management plan for a young person (SR1) Relevant documents SR1 Immediate risk management plan Youth Justice Conferencing Practice Manual Recording a suicide alert Page 3 of 15

A new suicide risk event (SR1) must be completed whenever a young person engages in a new episode of suicide risk behaviour(s). The suicide risk event and immediate risk management plan must be entered on the ICMS system and approved within 24 hours of the risk being identified. Where it is determined that a young person is at risk of suicide or self-harm/selfinjurious behaviour, the service leader/manager in consultation with the convenor must within 24 hours of identifying the risk: create a current suicide risk event on ICMS and complete the immediate risk management plan including details of any current child safety and/or youth justice services intervention submit the SR1 and the immediate risk management plan forms to the manager youth justice service centre for their approval, refer to section six of this chapter Developing the immediate risk management plan for a young person. The service leader/manager ensures: if the young person is subject to youth justice services or child safety services intervention, the relevant team leader is contacted and informed of the recording of the SR1 and of the details of the immediate risk management plan a meeting is organised with the relevant youth justice conferencing staff member and the youth justice services/child safety services officer and their relevant team leaders to discuss the effective management of ongoing risk management responsibilities, refer to section seven of this chapter Ongoing medium to long term risk management for a young person. The manager informs the regional director if the risk of suicide is deemed to be significant, refer to section eight of this chapter Suicide risk alerts and critical incident reporting. 6. Developing the immediate risk management plan for a young person Legislation Youth Justice Act 1992, s 292 Relevant documents Immediate risk management plan Appendix one: Risk factors and warning signs To ensure the immediate safety of a young person determined to be a suicide risk, the youth justice conferencing staff member in consultation with the service leader/manager develops an immediate risk management plan, as part of a suicide risk event (SR1), to ensure the young person is provided with assessment and support. When developing an immediate risk management plan, the youth justice conferencing staff member considers: exploring with the young person their issue or problem identifying the issue and risk factors, refer to Addendum 1: Risk factors and warning signs suicide risk. Youth Justice Conferencing Practice Manual Recording a suicide alert Page 4 of 15

informing the young person and their parent/carer that a suicide risk alert will be recorded informing the young person s parent/s or carer of the suicide risk to ensure an adequate level of monitoring and support is provided to the young person involving the young person and their parent/carer in the development of the immediate risk plan. If it is identified that a young person is currently engaged with other support agencies, consideration should be given to disclose suicide risk event information to these agencies to provide any necessary assistance and support for the young person. If it is considered necessary to disclose suicide risk event information to an agency or any other person to ensure the young person s safety, youth justice conferencing staff must inform the young person that disclosure to this agency may occur without their consent. The details of the risk management plan must be clearly documented on the (SR1) form and submitted to the service leader and/or manager for final approval. If the young person is subject to intervention by youth justice services and/or child safety services, the immediate risk management plan may include an assisted referral to child and youth mental health services or to another support service recommended by child and youth mental health services. If the young person is not subject to intervention by youth justice services and/or child safety services, the immediate risk management plan must include an assisted referral to child and youth mental health services or another support service recommended by child and youth mental health services. There may also be instances where the young person may need immediate medical attention. When a youth justice conferencing staff member identifies a suicide risk concern of a young person who is in detention, the youth detention centre caseworker or shift supervisor must be immediately notified either in person or by telephone. 7. Ongoing medium to long term risk management for a young person If the young person is not subject to intervention by youth justice services and/or child safety services, the support service that resulted as part of the assisted referral will be responsible for the on-going risk management of the young person. If the young person is subject to intervention by youth justice services and/or child safety services, the relevant caseworker is responsible for the on-going medium to long term risk management, monitoring and reporting on the suicide risk alert events created by a youth justice conferencing services. Within two weeks of the creation of the alert, a medium to long term risk management plan must be developed for the young person. Youth Justice Conferencing Practice Manual Recording a suicide alert Page 5 of 15

Within 24 hours of the risk being identified and of the immediate risk management plan being developed, the youth conferencing staff member in consultation with the service leader and/or manager: advises the youth justice services officer, child safety services officer and/or relevant team leader of the recording of the SR1 and immediate risk management plan briefs the youth justice services officer and/or child safety services officer of the details of the immediate risk management plan to ensure they can effectively manage future case management requirements. When a medium to long term risk management plan is developed, the youth justice services officer or child safety services officer will liaise with the youth justice conferencing service to ensure that there is a shared understanding of the plan. The service leader ensures the relevant youth justice conferencing staff are informed of the name and contact details of: the youth justice services or child safety services officer that is responsible for the on-going risk management, monitoring and reporting on the suicide risk alert the name of the support service the young person has been referred to for assessment and support. For further information on medium to long term risk management of young people, refer to Youth Justice Services Practice Manual section one, chapter seven Recording alerts. 8. Suicide risk alerts and critical incident reporting for a young person Relevant documents Critical incident reporting policy and procedures - records file no: ADM/06309 Critical incident report form SR1 The service leader/manager completes a critical incident report form when a young person: attempts suicide (including self-harming episodes assessed as attempted suicide) - this is considered a level one critical incident participates in a self-harming episode where medical treatment or hospitalisation is required - this is considered a level two critical incident, refer to the critical incident reporting policy and procedures records file no: ADM/06309. The service leader/manager then forwards this form to the regional director for their attention. 9. Reviewing and closing the suicide risk alert for a young person If a young person is subject to intervention by youth justice services and/or child safety services, these services are responsible for the reviewing and closing of a suicide risk alert. Youth Justice Conferencing Practice Manual Recording a suicide alert Page 6 of 15

The service leader/manager informs the relevant youth justice services and/or child safety services officer when the young person s youth justice conferencing file is closed. If a young person is not subject to intervention of youth justice services and/or child safety services i.e. is only involved with youth justice conferencing services, the service leader/manager is responsible for the reviewing and closing the suicide risk alert. If an assisted referral is made for the young person to Queensland Health or another support service recommended by Queensland Health, the youth justice conferencing service may receive confirmation from this service that the suicide risk is no longer current for the young person. In this instance the service leader/manager may close the alert from the ICMS system prior to the young person s youth justice conferencing file being closed. Where the young person is not subject to intervention of youth justice services and/or child safety services, a suicide risk alert should only remain current until the young person s youth justice conferencing file is closed. Prior to closing the youth justice conferencing file, and removing the suicide risk alert, the service leader/manager must ensure: the young person has been appropriately referred to child and youth mental health services or other support service recommended by child and youth mental health services the incident closure form is completed. 10. Physical aggression/potential violence alert for an involved party (including a young person) A youth justice conferencing staff member may identify that an involved party has: verbally or physically threatened departmental or community agency staff a history of personal violence offences against others been assessed as having the potential to be violent. The youth justice conferencing staff member discusses with their service leader and/or manager the decision to record a physical aggression/potential violence alert. When completing the alert, the youth justice conferencing staff member provides factual and complete information about the assessed risk. The alert information should then be used to inform appropriate planning for the safety of involved parties and departmental staff. To place the alert on CRIS, the youth justice conferencing staff member will discuss the information with the service leader and/or manager and at the direction of the service leader and/or manager: identify the information that should be placed on the relevant database i.e. ICMS or CRIS open the alerts tab on the relevant database to add a new alert enter the details of the alert. Youth Justice Conferencing Practice Manual Recording a suicide alert Page 7 of 15

The service leader and/or manager identify the start and end date of the alert on the ICMS or CRIS database. In most instances the start and end date of the alert will be the same date as the date the alert was created. 11. Medical/serious health issues alerts for an involved party (including a young person) If the youth justice conferencing service becomes aware that an involved party suffers from a serious medical condition, the completion of a medical/serious health issues alert will enable appropriate measures to be put in place to ensure the involved party s well-being. Examples of medical information that may need to be recorded as an alert include conditions such as: life-threatening allergies e.g. nut allergies a medical condition requiring medication such as epilepsy, diabetes or asthma a diagnosed medical condition that may impact on the involved party s ability to participate in programs the young person is suffering a psychotic episode and/or has significant mental health issues phobias. If the youth justice conferencing staff member considers that the medical information of the involved party may be considered eligible to be recorded as a medical/serious health issues alert, they discuss this information with their service leader and/or manager including the name of the person who supplied the information about the medical condition. If the manager and/or service leader consider that a medical/serious health issues alert should be recorded, the youth justice conferencing staff member: identifies the medical information that should be placed on the relevant database i.e. ICMS or CRIS - all medical information recorded is highly confidential and must only be used with the knowledge and agreement of the involved party or an authorised medical officer open the alerts tab on the relevant database to add a new alert enter the details of the alert. The service leader and/or manager identify the start and end date of the alert on the ICMS or CRIS database. In most instances the start and end date of the alert will be the same date as the date the alert was created. 12. Behaviour alerts for an involved party (including a young person) An involved party may display behaviours that may be considered eligible for a behaviour alert to be recorded on the database and these behaviours may include: significant drug and/or alcohol use volatile substance misuse fire lighting Youth Justice Conferencing Practice Manual Recording a suicide alert Page 8 of 15

the young person is a sex offender who is assessed to be at high risk of reoffending the young person displays sexualised behaviour. If the youth justice conferencing staff member considers that the behaviour of the involved party may be considered eligible to be recorded as a behaviour alert, they discuss this information with their service leader and/or manager. If the manager or service leader considers that a behaviour alert should be recorded, the youth justice conferencing staff member: identifies the information that should be placed on the relevant database i.e. ICMS or CRIS open the alerts tab on the relevant database enters the details of the alert. The service leader and/or manager identify the start and end date of the alert on the ICMS or CRIS database. In most instances the start and end date of the alert will be the same date as the date the alert was created. Addendum 1 Risk factors and warning signs suicide risk Suicide is a complex human behaviour that cannot be easily predicted. Consequently all staff must remain vigilant and alert to the fact that a number of risk factors and or warning signs can indicate that a young person is contemplating suicide or self harm or is at risk of suicide or self harm. It is easy to become accustomed to frequent statements by young people threatening self-harm, however this behaviour may indicate suicide risk or become an indicator of suicide risk. Risk factors and warning signs may occur in clusters, or one single risk factor or warning sign may provide the only clue that a young person is in trouble. The saying that "people who talk about suicide will not do it" is false. Both longer term risk factors and immediate events may contribute to an attempted suicide. Stress and crises are very important precursors to suicide. Outlined below are some examples of risk factors. The list is not exhaustive, but evidence has shown that a range of primary risk factors may contribute to youth suicide and suicidal behaviour. These include: a previous suicide attempt, the most significant risk factor for a completed suicide deliberate self harm ahistory of mental illness including clinical depression being bereaved by the suicide of a family member, friend or significant other drug and alcohol abuse major loss disruptive and unsupportive family background/ family breakdown/ conflict exposure to suicide Youth Justice Conferencing Practice Manual Recording a suicide alert Page 9 of 15

social isolation/ alienation/ not belonging within family or community having poor coping and problem-solving skills and low self-esteem issues relating to sexuality and sexual identity problems with the law or being detained in a watch house or detention centre being on remand and uncertain about the future. Outlined below are some examples of warning signs of possible suicide risk. The list is not exhaustive. The presence of warning signs or symptoms will not always indicate suicidal intent. However the more that symptoms point towards an overall and pervasive theme of hopelessness and helplessness, the greater is the likelihood that they are indicators of suicide risk. A preoccupation with death and or preparations for death such as: making a will/indicating who should have their possessions saying goodbye to people giving away personal possessions recurring themes of death in music, poetry, art work talking about death talking about a person who has died gathering the means to attempt suicide. Verbal warning signs such as: direct threats like "I'm going to kill myself" or I want to die. Indirect statements such as: "You'll be sorry when I'm dead" "I might as well be dead" "They would be better off without me" "Life has no meaning/has lost its meaning" "If I killed myself they would be sorry" "If I don't see you again, thanks for everything" "Here, take this, I won't need it any more". Situational crisis and or stressors such as: loss/death of relatives or significant others loss of relationship - "Dear John/Jane" letter rejection of family/significant other separation from family/significant others peers leave detention centre family crisis/parent or sibling in jail family or relationship conflict trouble with the law Youth Justice Conferencing Practice Manual Recording a suicide alert Page 10 of 15

point of sentence or legal decision such as admission to detention centre, return to detention, additional custodial sentence, bail refused, losing a sentence appeal or review a change in health status, e.g. unwanted pregnancy, onset of serious or chronic illness anniversary of death or other significant event incident of abuse victimisation by peers disruptive/violent incident in detention major failure. Changes in behaviour/personality such as: social withdrawal and isolation from others impatience or impulsive behaviours increased use of drugs/alcohol mood swings, angry outbursts, irritability sudden happiness may indicate a decision to die disorientation/disorganisation agitated depression such as aggressive outbursts, frenetic behaviour and oppositional behaviour loss of interest in appearance/normal activities no future plans/no ability to plan for the future. Depression and or changes in feelings such as: anxiety apathy chronic fatigue crying easily hopelessness/helplessness self defeating attitude Physical changes such as: abrupt change in appearance self neglect lack of energy recent weight or appetite change changing in sleeping patterns increase in unexplained or minor illnesses. Changes in thinking such as: drop in self-esteem scattered thoughts/tunnel vision difficulty in decision making Youth Justice Conferencing Practice Manual Recording a suicide alert Page 11 of 15

inability to concentrate or think rationally exaggerated fears of disease. Additionally, young people in detention can feel particularly isolated and vulnerable at holiday and celebration times such as Easter and Christmas. This can initiate, increase and or revive their risk of self harm and suicide. Also many staff members with whom young people have valuable interactions during the year, are often absent at these times. Young people at risk of self-harm and suicide should be especially monitored at these times and contingency plans put in place as required. The impending release of a young person into the community following a period in detention may also prompt feelings of anxiety and stress in a young person and increase or revive their risk of suicide or self harm. As such a young person s risk should be assessed and monitored as part of the young person s transition plan. When changes in behaviour, feelings, physical condition or thinking (as above) are observed in a young person, immediate assessment should be undertaken to ascertain if thoughts of suicide are involved. Additional risk factors and warning signs for Aboriginal and Torres Strait Islander young people For Aboriginal and Torres Strait Islander young people it has been identified that the risk of suicide and self-harming behaviour can increase: at a time of emotional stress and anger when young people feel unable to outwardly express their anger and instead turn the aggression inwards and harm themselves as a means of expression In situations where young people feel they have lost control over their personal situation, usually soon after being incarcerated and they would rather take their own life and regain personal control than feel that others have total control over their situation. Staff must not underestimate the importance of cultural and other factors affecting Aboriginal and Torres Strait Islander young people in detention, for example: - when conducting assessments it may be important to take into account the diversity of cultural beliefs across Aboriginal and Torres Strait Islander communities - Aboriginal and Torres Strait Islander young people can be very traumatised when separated from their family and community - spiritual beliefs and isolation at night may have special relevance as it is often not customary for Aboriginal and Torres Strait Islander people to be isolated at night or for long periods of time - Aboriginal and Torres Strait Islander young people in detention are more geographically isolated from their families and communities than most non- Indigenous young people. (Source: Management and recording of suicide risk concerns) Youth Justice Conferencing Practice Manual Recording a suicide alert Page 12 of 15

Addendum 2 Suicide alert risk flowchart Upon receipt of referral SL checks ICMS for any current alerts for the young person File allocated to convenor Convenor identifies a suicide risk for a young person Convenor discusses with manager/service leader Convenor engages immediate assistance if required i.e. medical response Is there a current event for the same alert? Yes No No further alert recorded No Is the young person a current youth justice services/child safety client? Yes Manager/service leader creates the suicide risk event and immediate risk management plan Manager approves the suicide risk event and immediate risk management plan Within 24 hours manager/service leader contact relevant youth justice service/child safety officer to discuss the alert and consider if a new alert should be added If cannot contact youth justice services/child safety within 24hrs, manager/service leader makes the decision themselves Manager/service leader completes a critical incident report if there has been: a suicide attempt (level one incident) a self harming episode where medical or hospital treatment is needed (level two incident) Manager/service leader forwards critical incident report to regional director Youth Justice Conferencing Practice Manual Recording a suicide alert Page 13 of 15

Addendum 3 Immediate risk management plan Youth justice conferencing client only Youth justice service/child safety client Create suicide risk event and immediate risk management plan Immediate risk management plan involves either: referral to child and youth mental health services other support service nominated by child and youth mental health services On going risk management is managed by child and youth mental health services or other support service nominated by child and youth mental health services Ongoing medium to long term risk is managed by youth justice services/child safety Manager/service leader are responsible for reviewing and closing the suicide risk alert Service leader provides information on the progress of suicide risk alert to the convenor Child and youth mental health services or other support service nominated by child and youth mental health services may advise that the suicide risk alert is no longer current If advised the suicide risk alert is no longer current, manager/service leader may remove the suicide risk alert and complete incident closure form, even whilst the youth justice conferencing file is still open Youth justice services/child safety liaises with manager/service leader on the medium to long term management plan Service leader advises convenor on the medium to long term management plan Youth justice services/child safety are responsible for closing the suicide risk alert Youth justice services/child safety liaises with manager/service leader on the review and closure of the suicide risk alert Manager/service leader may close suicide risk alert even if the youth justice conferencing file is still open Service leader provides information o the progress of the suicide risk alert to the convenor Manager/service leader liaises with child and youth mental health services or other support service nominated by child and youth mental health services to ensure the young person is receiving support beyond the closure of the file Youth Justice Conferencing Practice Manual Recording a suicide alert Page 14 of 15