Risk Quick Reference Lists
In my article on Risk, I shared my quick reference for domestic violence assessing and safety planning. Below are some of my other risk assessment reference lists, which I left out of the article to keep it shorter. Here they are in full. My personal versions of these lists are regularly updated and I generally write them in short-hand.
We need to be good enough at knowing when to ask more about details that seem concerning (i.e., risk assess), and know how to decide when to seek assistance (supervisor, peer, external resource etc).
Suicide, Risk assess questions:
Any history of previous attempts? When + regret over attempts
Specific plans + How lethal are they?
Do they have access to this plan?
[check a risk question on the particular outcome measure I use]
Isolation?
Feelings of hopelessness
Has anyone in family /close friends attempted or completed?
Expectation about outcome of self-harming behaviour or suicide attempt/threat.
Other self-harming behaviour.
Length of time suicidal feelings have been present.
Mental state at time of self-harm or suicide attempt or threat (alcohol or drug intake, social situation, relationship changes, bereavements).
Plans for others after death: suicide notes, changes to will, consequences
Suicide safety planning:
** How will clients know/decide they need to enact part of this plan? Unreliable independent judgement?
Draw 1 to 5 scale, cooperatively define symptoms of each number on the scale and what support is needed for that severity
Agree to come to the next session
Agree to call local 24 hour crisis line as needed, perhaps call it with them during the session to build their comfort doing so
Agree to stay with safe people or call them (friends, family)
Agree to go to hospital emergency or call 911 as needed
Important to help them feel more comfortable accessing these resources
Risk assessing DV:
Do they have any children? Name + DoB of oldest? (which is how my jurisdiction identifies families)
Almost any time a client mentions they have a child, they can see I’m drawing a genogram and I casually ask “hey when’s Jimmy’s birthday?” and write it down in the first session like it’s normal, which it is. Absolute life saver sometimes
Does the client currently feel safe being at home with this person?
Frequency and type of abuse, weapons involved etc?
When did the abuse first occur? When was the most recent time?
What’s the worst or most dangerous behaviour they’ve used?
Ask about escalation over time from arguing to criticism, yelling, swearing, hitting table, throwing things, punching holes in wall, blocking doors
Where are children during this behaviour? Do they witness it? Are they upset, crying etc?
Substance use?
History of police involvement? History of child services involvement?
Have you left this person before?
Have they threatened you, or to harm themselves?
Safety planning DV:
Generally asking them what they need to feel safe and how I can help
How will they know/decide they need to enact part of this plan?
1 to 5 scale of severity, behaviours at each number and what's needed based on intensity
Safe, alternative place they can stay agreed on beforehand with friend/family
Extra person who can check in, regularly, daily of possible. Extended family, neighbour etc. Could have secret signal for “I need help call 911”- someone who you can call for support, and local 24 hour distress lines- are they willing to call 911 if needed?
Contact info for local shelters, free childcare for overwhelmed parents, any good stuff your community has. If you don’t know about it ask peers and call a few local places when they’d be slow]
Give relevant local resources like crisis call lines
Help them feel more comfortable accessing resources, possibly calling the line together on speaker during the session to get them familiar with what it’s like and what the service does
Comfortable calling 911 and police non-emergency, and know what they’re for?
Have a “Go bag” ready or in the car- Hide extra clothing, house keys, car keys, money, etc. at a friend’s house- Have a scan/copy of important documents (id, prescriptions etc) stored somewhere else
Child welfare (in my area) usually needs to know:
What's the child's birthday?
Any other siblings in the home
What school do they go to, what grade they're in
Parents work schedules, when get home
obviously the concern for why you’re calling, but the above details to identify the child and see if already in their system
Risk factors for child abuse/neglect:
Parental substance abuse
Foster care? Or group home
Does the child have temperament or behavioural issues, eg diagnosed ODD
DV in the home
Parent involvement in criminal behaviour
Child disability
Cultural factors? Methods accepted in previous country but illegal here
Impulsivity?
* Child abuse/neglect happens in homes across all socioeconomic statuses, and it's still very serious if it's a women perpetrating the abuse--ask yourself how concerned you'd be if the dad used the same behaviour
Risk assessing: Parents
Types, severity and frequency of abuse
Neglect occurring
Risk assessing: Children for abuse
(have to make this age appropriate and use discretion about how to ask)
Do you feel safe at home? What about when you visit your [other parent’s house]?
If they disclose that mom and dad fight, how often, when last time (not great w dates), what happens. Don't give leading questions
Frequency, duration, type.
Does any place on your body hurt?
What happens when you do something your parents don’t like?
What happens at your house (or daycare) when people get angry?
Do people ever hit? Who do they hit? What do they hit with?
How often does it happen? Is it scary?
Are you afraid of anyone?
When was the last time you felt scared
What happens when you take a bath?
Where do you sleep?
What happens when you go to sleep?
Has anyone touched you in a way you didn’t like?
Risk assess children for neglect
(this can be harder to spot)
If showing up tired or seems unwell, comments of not having food
Ask child to describe a typical day
What they eat, who makes the food, where do they play, who comes to or leaves the house and when, do they have electricity, etc.
Safety plan, with parents vs kids
Don't have the plan depend on the judgement of person using abuse if their judgement is unreliable
Where can they go if feeling unsafe, who to call, what to do
Who does child trust outside of these situations: Other family, trusted neighbour, friend's parents? Community resources, crisis call lines, other relevant local resources, Do they know how/when to call 911
You could add sections for homicide, self-harm etc