Suicide Risk Assessment and Care Planning — Risk Formulation — Clinical Pathway: Outpatient Specialty

Suicide Risk Assessment and Care Planning Clinical Pathway — Outpatient Specialty Care

Risk Formulation

The process of risk formulation supports clinical decision-making and development of a plan to respond to acute and chronic suicide risk. Risk formulation is an examination of an individual’s history and current presence of suicidal ideation and behavior, as well as their unique combination of risk factors and protective factors, to inform the clinician about the level, extent and imminence of risk. This, in turn, informs understanding of steps needed to reduce risk and increase safety. The goal of risk formulation is to integrate all sources of information that contribute to an understanding of the patient’s acute and chronic risk, resulting in a collaborative treatment plan. A well-documented risk formulation can demonstrate that clinical decisions took into consideration the full range of factors; it can also aid in communication with the child, other clinical staff, and important people in the child’s life.

The risk formulation may make it apparent that a patient would benefit from enhanced interventions and increased support, particularly in the presence of “red flags,” significant worsening in clinical presentation, poor response to treatment interventions, or risk factors that seem to outweigh the patient’s and/or family’s ability to ensure safety.

Examples of factors that may influence a risk formulation and result in enhanced care (please note, factors identified below may not be applicable at all levels of risk):

  1. Patient and/or family is unable to:
    1. Maintain safety in their environment
    2. Engage in and follow treatment plan recommendations
    3. Identify and use coping strategies
    4. Initiate and follow the steps of a safety plan
  2. Presence of “red flags” such as:
    1. Sudden change in acuity of suicidal ideation
    2. Escalation in severity or intensity of self-injurious behaviors
    3. Increase in reckless or risk-taking behavior (e.g. increased alcohol and/or drug use)
    4. Significant decline in patient's mental state
    5. Dramatic changes in mood; or significant worsening in patient's presentation
    6. Homicidal ideation and/or threat to others

Case Examples