Risk Assessment & Safety Response Protocol

Use during care

Four response levels

Use labels and clinical findings together. Avoid “no risk,” “below risk,” or unsupported declarations that a client is safe.

Assessment prompts

• Distinguish passive death wishes from active suicidal thoughts; assess frequency, recency, intensity, and controllability.
• Assess intent, plan, timing, access to means, and preparatory behavior.
• Assess previous attempts, interrupted or aborted attempts, and self-injury; clarify intent associated with each.
• Assess current stressors, agitation, intoxication, psychosis, hopelessness, sleep disruption, and functional changes.
• Identify protective factors and whether they are actually available now.
• Assess ability to participate in safety measures and whether the proposed environment and supports are sufficient.
• Formulate acute risk, longer-term vulnerability, change from baseline, and foreseeable changes that could worsen safety.

Who to activate

This page does not provide live clinical supervision and does not invent local crisis numbers. Confirm local resources before they are needed.

Collaborative safety plan

1. 1. Personal warning signs.
2. 2. Usable coping strategies.
3. 3. Safe people and places for distraction.
4. 4. People to ask directly for help.
5. 5. Professional and crisis contacts, including emergency thresholds.
6. 6. Specific means-safety arrangements: who will secure what, and when.

Give the client an accessible copy and confirm feasibility. A promise or “contract for safety” is not a substitute for assessment and a workable safety arrangement.

All-age adaptations

• Use developmentally appropriate language and tools.
• NIMH ASQ materials cover ages eight and older. Suspected suicide risk in younger children requires a full developmentally appropriate evaluation rather than reliance on a screening score.
• For youth, gather caregiver information and establish necessary supervision and means safety. Do not expect children to manage safety independently.
• Follow minor-consent and confidentiality law. If a caregiver may be unsafe, identify an alternative protective response.
• For adults, obtain consent for support involvement when feasible; apply lawful emergency disclosure exceptions when needed.
• Adapt assessment for cognitive, developmental, language, hearing, and communication needs. Do not infer safety or incapacity from diagnosis alone.

Separate safety pathways

Suicide assessment does not replace assessment and action for threats toward others, suspected child abuse or neglect, suspected elder/dependent-adult abuse, medical instability, or dangerous inability to meet essential needs.

Telehealth, handoff & follow-up

• Confirm physical location, callback number, local emergency access, and a disconnection plan.
• If imminent concern exists and contact drops, attempt reconnection while activating local help.
• Record who accepted an urgent handoff, destination, transport, and follow-up responsibility.
• Use risk-informed outreach for missed appointments; a missed visit alone does not automatically justify police involvement.
• Document assessed findings, formulation, consultation, interventions, disclosures, disposition rationale, and follow-up ownership.
• Clearly explain practice response hours and after-hours crisis options.

Practice implementation panel

Before using this protocol operationally, the practice should designate and keep current: