- Access and review the Columbia-Suicide Severity Rating Scale (C-SSRS) in the Learning Resources. Select one of the Screeners to use for this Discussion.
- Navigate through the Military Veteran interactive media piece and engage with the client. Using the C-SSRS, assess the client’s suicide risk.
- https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures
- https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/#filter=.healthcare.english
Post your assessment of the client’s suicide risk. Identify the risk and protective factors that led you to this assessment. Then, explain what further steps and/or interventions you would take as the client’s social worker, based on the suicide risk assessment.
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Military Veteran Program Transcript
INTRODUCTION
Warning: The following scenario discusses depression and suicide. It can be emotionally triggering. The scenario lasts 6-8 minutes. If you need to exit the scenario, please stop at any time.
NOTE: When you click on a hyperlink in this document, you will move to the intended result of the described response or action.
You are preparing to meet with Mike, who has been recently discharged from active duty. He is finding his adjustment back to civilian life challenging. Mike is not sleeping well since returning home and has developed negative habits to compensate. He had been given an ultimatum by his wife to get help or leave after she catches him drinking and driving. Mike reached out to you through his VA program for counseling services. You are waiting for him to arrive.
YOUR OFFICE
[You are seated behind your desk facing your open office door. Your client, Mike, gently knocks on the open door.]
MIKE: Uh…hi. Uh…is this Room 104. I’m running late for an appointment.
• Introduce yourself, invite your client in and verify his identity. o Click here to continue to Decision Point 1.
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MIKE: [hands in pocket] Um…I’m Corporal Andrews, Mike. Mike Andrews, nice to meet you. [looks around the room]
DECISION POINT 1 This is a good opportunity to assess your client’s body language, something you should be doing constantly. What do you notice?
1. YOUR RESPONSE: He looks mad. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 1 -OR-
2. YOUR RESPONSE: He looks hungover. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 1 -OR-
3. YOUR REPONSE: He looks uncomfortable. RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 1 RESPONSE 1 – FEEDBACK
• Don’t jump to conclusions just because the client is standoffish. Try to make them feel comfortable in this new environment.
o Click here to ask him to take a seat. RESPONSE 2 – FEEDBACK
• That may be, if the client is abusing alcohol, it may be a symptom of a bigger issue. Regardless, make sure they feel comfortable in this new environment.
o Click here to ask him to take a seat.
RESPONSE 3 – FEEDBACK
• True, the lack of eye contact and stiff responses are a giveaway. Help you client feel comfortable in this new environment.
o Click here to ask him to take a seat.
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[Your client reaches back to close the office door, before sitting down on the couch and staring towards the ground with his hands folded.]
• Ask him if he needs anything before you start. o Click here to continue to Decision Point 2.
MIKE: I’d like to get right into it, if that’s okay with you. [pauses] Where do we start?
DECISION POINT 2 What do you do next?
1. YOUR RESPONSE: “Tell me about your family problems.” RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 2 -OR-
2. YOUR RESPONSE: “Tell me about your deployment.” RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 2 -OR-
3. YOUR REPONSE: “Let’s start with why you are here.” RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 2 RESPONSE 1 – FEEDBACK
• Try not to assume problems before getting all the information. Empower your client to lead the conversation.
o Click here to say, “Let’s start with why you are here.” RESPONSE 2 – FEEDBACK
• Leading the conversation to a source of trauma can be a hard place to start. Empower your client to lead the conversation.
o Click here to say, “Let’s start with why you are here.”
RESPONSE 3 – FEEDBACK
• Good thinking. Letting your client lead the conversation can help them feel more comfortable while you get context for the situation.
o Click here to continue to Decision Point 3.
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MIKE: At first, everything was great. When I returned from deployment, everyone was so happy to see me. I mean seeing my wife and my boys again…the best. I mean, I felt like a hero. But now I’ve been back for almost a year and, [pauses and shakes head] I don’t know, I just feel useless. It was from, “Mike’s home” to “Mike’s in the way” real fast. My wife, you know my kids, they…they started this great routine while I was away. But now that I’m back, I just don’t fit in it anywhere.
DECISION POINT 3 How will you respond?
1. YOUR RESPONSE: “Are you taking any medications for your sleep problems?”
RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 3 -OR-
2. YOUR RESPONSE: “Do you think the war changed you?” RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 3 -OR-
3. YOUR REPONSE: “In what ways don’t you fit in?” RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 3 RESPONSE 1 – FEEDBACK
• Try to not change the subject. Actively listen to what your client says and let them lead the conversation.
o Click here to say, “In what ways don’t you fit in?” RESPONSE 2 – FEEDBACK
• Be careful when asking about traumatic subjects. Actively listen to what your client says and let them lead the conversation.
o Click here to say, “In what ways don’t you fit in?”
RESPONSE 3 – FEEDBACK
• This is a good example of active listening. You still need the full context of the situation, and you want your client to lead that conversation.
o Click here to continue to Decision Point 4.
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MIKE: [sighs] I guess I still feel like I just got back yesterday. You know, I wake when my wife’s already at work and the kids are at school. You know, some days I completely forget to eat if nobody puts anything out in front of me. And…and it doesn’t help that I haven’t been able to find a job yet. Not that I’ve been looking that hard, you know. Everything just feels empty. Like a job has no meaning now. Does that make sense?
ACTION POINT
The client is opening up, keep encouraging him to share. o Click here to say, “Tell me more about that.”
MIKE: [leans towards you] You know, during the war, I never had to think about what came next. I didn’t even know if there would be a next. You know, I got really good at dealing with life and death problems and being in the moment. And now, I’m supposed to deal with sales quotas? Customer service…after what I’ve seen.
DECISION POINT 4 How will you respond?
1. YOUR RESPONSE: “I understand.” RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 4 -OR-
2. YOUR RESPONSE: “Everything will be alright.” RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 4 -OR-
3. YOUR REPONSE: “I can see and hear your pain.” RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 4
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RESPONSE 1 – FEEDBACK
MIKE: [leans back and puts hands up] Oh geez…you understand? Sounds like everyone understands but me, huh. You ever kill someone? You ever drink until you pass out, so you don’t wake up in the middle of the night screaming? What is that? Why do you think that happens?
• Saying “it’s okay” or that you “understand” can sound like you are minimizing your client’s problem. Give them space to feel their emotions.
o Click here to say, “I apologize. I can see and hear that this is upsetting.”
RESPONSE 2 – FEEDBACK
MIKE: Alright? You’re kidding me. It sure as hell doesn’t feel alright. I mean, I barely sleep, like at all. Hell, I have to get drunk enough so that I don’t wake my wife up in the middle of the night screaming. How is this going to be alright?
• Saying “it’s okay” or that you “understand” can sound like you are minimizing your client’s problem. Give them space to feel their emotions.
o Click here to say, “I apologize. I can see and hear that this is upsetting.”
RESPONSE 3 – FEEDBACK
MIKE: Listen…I just…I don’t know what to do. I mean, I can’t sleep. Every time I close my eyes, I just see my friends dying all over again. I drink so that I don’t wake up in the middle of the night screaming.
• It’s important to validate your client’s feelings. They may need space to feel their emotions.
• The client has just divulged a lot. You’ll need to be sensitive to your client’s feelings.
o Click here to say, “It sounds like you experienced a lot over there.”
MIKE: Hell yeah I did. I try not to think about it, but that’s why we’re here right. My wife says I need to talk it out, because bottling up my feelings is the problem. But maybe coming home at all is the problem.
o Click here to continue to Decision Point 5.
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DECISION POINT 5 How will you respond?
1. YOUR RESPONSE: “At least you’re home and not still deployed.” RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 5 -OR-
2. YOUR RESPONSE: “You shouldn’t talk like that.” RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 5 -OR-
3. YOUR REPONSE: “It sounds like you’re having conflicted feelings.” RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 5
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RESPONSE 1 – FEEDBACK
MIKE: Yeah, some home. You know, how would you even know? How many tours have you served? Huh. See, I’m sitting over here barely sleeping every night, feeling trapped in my home. And you’re talking like you know anything about me.
• Be careful, even if it sounds harmless to you, telling your client how to feel can provoke them.
• The client has presented a few red flags that signify suicide ideation. o Click here to continue to Decision Point 6.
RESPONSE 2 – FEEDBACK
MIKE: How should I talk then? I keep thinking about all my dead buddies and how I survived. Nothing I do makes those memories stop. They’re just stuck in my head and I’m stuck with them.
• Don’t invalidate your client’s feelings. Keep practicing active listening.
• The client may be describing survivor’s guilt and has presented a few red flags that signify suicide ideation.
o Click here to continue to Decision Point 6.
RESPONSE 3 – FEEDBACK
MIKE: I guess. You know, if I’m being honest, there’s this little voice in the back of my head that keeps asking me why I’m alive and my friends aren’t. I mean, I keep telling myself that I shouldn’t think like that, but it’s hard to ignore, you know, when I feel so useless. I just feel…I feel trapped.
• The client may be describing survivor’s guilt and has presented a few red flags that signify suicide ideation.
o Click here to continue to Decision Point 6.
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DECISION POINT 6 Have you noticed any other signs or symptoms that fall under a Suicide Assessment?
1. YOUR RESPONSE: No sense of purpose RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 6 -OR-
2. YOUR RESPONSE: Substance abuse RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 6 -OR-
3. YOUR REPONSE: Reckless behavior RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 6 -OR-
4. YOUR REPONSE: Feeling trapped RESPONSE OPTION 4 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 6 -OR-
5. YOUR REPONSE: Lack of sleep RESPONSE OPTION 5 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 6
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RESPONSE 1 – FEEDBACK
• Correct. In fact, your client has displayed all of these. Be mindful of this as you begin to put together a treatment plan.
o Click here to continue the session. RESPONSE 2 – FEEDBACK
• Correct. In fact, your client has displayed all of these. Be mindful of this as you begin to put together a treatment plan.
o Click here to continue the session.
RESPONSE 3 – FEEDBACK
• Correct. In fact, your client has displayed all of these. Be mindful of this as you begin to put together a treatment plan.
o Click here to continue the session. RESPONSE 4– FEEDBACK
• Correct. In fact, your client has displayed all of these. Be mindful of this as you begin to put together a treatment plan.
o Click here to continue the session. RESPONSE 5 – FEEDBACK
• Correct. In fact, your client has displayed all of these. Be mindful of this as you begin to put together a treatment plan.
o Click here to continue the session.
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• The client senses that he may have just overshared. o Click here to continue to Decision Point 7.
MIKE: Okay. Okay. Wait…wait…wait…wait! I…I know how bad all this sounds, but I’m not like depressed or anything. [nervously laughs] I’m just [pauses] I’ve got to think ahead, you know. What if…what if I wasn’t around anymore? [near tears] Who would teach my boys guy stuff? You know, I already missed so much time. I can’t stand the thought of missing another second with them, but they just ignore me. Like [pause] would they even care if I wasn’t there anymore?
DECISION POINT 7 The client seems to be clarifying earlier remarks as a misunderstanding. How do you proceed?
1. YOUR RESPONSE: Move on to a different topic. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 7 -OR-
2. YOUR RESPONSE: Proceed with the suicide assessment. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 7 RESPONSE 1 – FEEDBACK
• The client is backpedaling from a serious red flag. Continue assessing to make sure the client will be safe going forward.
o Click here to continue assessment. RESPONSE 2 – FEEDBACK
• Right. Clients may backpedal after revealing a negative behavior. It’s important to make sure you understand your client’s mental health.
o Click here to continue to Decision Point 8.
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DECISION POINT 8 How will you ask your client about suicide?
1. YOUR RESPONSE: “Have you thought about killing yourself?” RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 8 -OR-
2. YOUR RESPONSE: “Have you thought about hurting yourself?” RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 8 RESPONSE 1 – FEEDBACK
• This wording can be interpreted as overly abrupt and accusatory. Try rephrasing the question.
o Click here say, “Have you thought about hurting yourself?” RESPONSE 2 – FEEDBACK
• Correct; by softening the question to ask about “hurting” himself instead of “killing” himself, it’s easier for him to open up honestly.
o Click here to continue to Decision Point 9.
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MIKE: [nervous rocking back and forth] Yeah…I thought about it, but…once or twice [puts hands together in front of his face as he pauses] I’m not there yet. Okay, drinking helps. Drinking helps.
DECISION POINT 9 What should be your next course of action?
1. YOUR RESPONSE: Recommend a doctor. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 9 -OR-
2. YOUR RESPONSE: Recommend the client talk about this with his family. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 9 -OR-
3. YOUR REPONSE: Encourage your client to share more. RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 9 RESPONSE 1 – FEEDBACK
• While this may be part of a future plan, it’s important to establish a treatment plan before recommending anything.
o Click here to encourage your client to share more. RESPONSE 2 – FEEDBACK
• Eventually this will become true, but your client may have more work to do before bringing this to his family.
o Click here to encourage your client to share more.
RESPONSE 3 – FEEDBACK
• Your client is doing a great job of opening up. Keep encouraging him to share.
o Click here to continue to Decision Point 10.
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MIKE: [crying] I just…I can’t keep living like this. I thought I could, but I can’t. My wife was right. [sobbing] My wife was right.
DECISION POINT 10 What should be your next course of action?
1. YOUR RESPONSE: Call for help. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 10 -OR-
2. YOUR RESPONSE: Send him home. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 10 -OR-
3. YOUR REPONSE: Let him cry. RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 10 RESPONSE 1 – FEEDBACK
• This could indicate a lack of confidence or imply there is a problem. Try to help your client calm down.
o Click here to let him cry. RESPONSE 2 – FEEDBACK
• This is not a good time to leave your client alone. Try to help your client calm down.
o Click here to let him cry.
RESPONSE 3 – FEEDBACK
• It’s important to be comfortable with silence. Giving your client space to grieve can be more valuable than trying to fix the problem.
o Click here to continue to the Conclusion.
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MIKE: [continues crying]
CONCLUSION
You’ve completed the exercise.
Click here to Start the Experience Again.
- Military Veteran
- Program Transcript
- INTRODUCTION
- YOUR OFFICE
- MIKE: Uh…hi. Uh…is this Room 104. I’m running late for an appointment.
- MIKE: [hands in pocket] Um…I’m Corporal Andrews, Mike. Mike Andrews, nice to meet you. [looks around the room]
- DECISION POINT 1
- [Your client reaches back to close the office door, before sitting down on the couch and staring towards the ground with his hands folded.]
- MIKE: I’d like to get right into it, if that’s okay with you. [pauses] Where do we start?
- DECISION POINT 2
- MIKE: At first, everything was great. When I returned from deployment, everyone was so happy to see me. I mean seeing my wife and my boys again…the best. I mean, I felt like a hero. But now I’ve been back for almost a year and, [pauses and shakes head…
- DECISION POINT 3
- MIKE: [sighs] I guess I still feel like I just got back yesterday. You know, I wake when my wife’s already at work and the kids are at school. You know, some days I completely forget to eat if nobody puts anything out in front of me. And…and it doesn’…
- ACTION POINT
- MIKE: [leans towards you] You know, during the war, I never had to think about what came next. I didn’t even know if there would be a next. You know, I got really good at dealing with life and death problems and being in the moment. And now, I’m suppo…
- DECISION POINT 4
- MIKE: [leans back and puts hands up] Oh geez…you understand? Sounds like everyone understands but me, huh. You ever kill someone? You ever drink until you pass out, so you don’t wake up in the middle of the night screaming? What is that? Why do you th…
- MIKE: Alright? You’re kidding me. It sure as hell doesn’t feel alright. I mean, I barely sleep, like at all. Hell, I have to get drunk enough so that I don’t wake my wife up in the middle of the night screaming. How is this going to be alright?
- MIKE: Listen…I just…I don’t know what to do. I mean, I can’t sleep. Every time I close my eyes, I just see my friends dying all over again. I drink so that I don’t wake up in the middle of the night screaming.
- MIKE: Hell yeah I did. I try not to think about it, but that’s why we’re here right. My wife says I need to talk it out, because bottling up my feelings is the problem. But maybe coming home at all is the problem.
- DECISION POINT 5
- MIKE: Yeah, some home. You know, how would you even know? How many tours have you served? Huh. See, I’m sitting over here barely sleeping every night, feeling trapped in my home. And you’re talking like you know anything about me.
- MIKE: How should I talk then? I keep thinking about all my dead buddies and how I survived. Nothing I do makes those memories stop. They’re just stuck in my head and I’m stuck with them.
- MIKE: I guess. You know, if I’m being honest, there’s this little voice in the back of my head that keeps asking me why I’m alive and my friends aren’t. I mean, I keep telling myself that I shouldn’t think like that, but it’s hard to ignore, you know,…
- DECISION POINT 6
- MIKE: Okay. Okay. Wait…wait…wait…wait! I…I know how bad all this sounds, but I’m not like depressed or anything. [nervously laughs] I’m just [pauses] I’ve got to think ahead, you know. What if…what if I wasn’t around anymore? [near tears] Who would …
- DECISION POINT 7
- DECISION POINT 8
- MIKE: [nervous rocking back and forth] Yeah…I thought about it, but…once or twice [puts hands together in front of his face as he pauses] I’m not there yet. Okay, drinking helps. Drinking helps.
- DECISION POINT 9
- MIKE: [crying] I just…I can’t keep living like this. I thought I could, but I can’t. My wife was right. [sobbing] My wife was right.
- DECISION POINT 10
- MIKE: [continues crying]
- CONCLUSION
