1. Illinois Division of Mental Health Quality & Safety Improvement Initiative Charter Team Topic: Risk Assessment: Self-Harm and/or Suicide Hospital: Choate Mental Health QCSI III Charter Teams Report Out Meeting June 24, 2013 – Springfield, IL DRAFT: For Review and Discussion1

2. Charter Team Members Team Choate 8 Core Members Multidisciplinary Team Zella Moore, APN Joel Vercide, M.D. Linda Parsons, R.N., D.O.N. Vicki Fuentes, Quality Manager Mary Kay Bachman, Chief Social Worker Rhonda Keck, Recovery Support Specialist J. Strothmann, Recipient Donna Murray, Hospital Administrator, Facilitator Sonja McShan, M.D., Medical Director, Chairperson DRAFT: For Review and Discussion2

3. Topic: Risk Assessment: Self-Harm and/or Suicide Overview of Deliverables Design and develop a process for the evaluation and management of Self- Harm and/or Suicide Risk through routine screening, appropriate assessment and effective intervention. Design and develop training to ensure staff knowledge and appropriate/effective application of the risk assessment process. Identify a core set of activities that indicate appropriate use of the risk assessment process and provide recommendations for related evaluation measures and monitoring. DRAFT: For Review and Discussion3

4. QCSI Charter Team Work Process Weekly face-to-face meetings were started on 3/12/13. Input was multi-disciplinary which included a recipient and a recovery support specialist who participated in the team’s work process. The committee gathered and reviewed literature and multiple assessment tools. Committee members collected this information and designed the proposed risk assessment tools. DHS hospital assessment tools were utilized for review. DRAFT: For Review and Discussion4

5. Difficulties/Barriers TIME!!!!! This committee developed a dated action plan breaking up the three major phases of work. Phase I scheduled weeks 1 though 7, Phase II scheduled weeks 8 through 9 and Phase III scheduled weeks 10 through 12. DRAFT: For Review and Discussion5

6. Deliverables/Work Products (4) Suicide Risk Assessment Tools  (Tool 1a and 1b) Immediate Suicide Risk Assessment*  (Tool 2a and 2b) Psychiatric Suicide Risk Assessment ^  (Tool 3) Special Observation Suicide Reassessment ^  (Tool 4a and 4b) 24 Hour Discharge Assessment for Suicide Potential ^ (2) Self Harm Assessment Tools  (Tool 5) Baseline Self Harm Inventory^  (Tool 6a and 6b) Self Harm Risk Assessment* * (New) ^ (Adapted) DRAFT: For Review and Discussion6

7. Tool 1 a Immediate Suicide Risk Assessment

8. DRAFT: For Review and Discussion8 Tool 1b Reverse side of Immediate Suicide Risk Assessment

9. DRAFT: For Review and Discussion9 Tool 2a Psychiatric Suicide Risk Assessment

10. DRAFT: For Review and Discussion10 Tool 2b Psychiatric Suicide Risk Assessment

11. DRAFT: For Review and Discussion11 Tool 3 Special Observation Suicide Reassessment

12. DRAFT: For Review and Discussion12 Tool 4a Discharge Suicide Assessment

13. DRAFT: For Review and Discussion13 Tool 4b Discharge Suicide Assessment

14. DRAFT: For Review and Discussion14 Tool 5 Baseline Self-Harm Inventory

15. DRAFT: For Review and Discussion15 Tool 6a Self-Harm Risk Assessment Tool

16. DRAFT: For Review and Discussion16 Tool 6b Self-Harm Risk Assessment Tool

17. Outstanding Questions/Issues Question & Answer Session DRAFT: For Review and Discussion17

18. Lessons Learned/Recommendations This process has revealed outstanding efforts on the part of committee members working together, not only in the weekly team meetings, but also outside of committee time to assist in achieving the deliverable goals. We recommend continuation of state-wide initiatives to improve the quality and safety of our hospitals. DRAFT: For Review and Discussion18