As an intern in generalist social work practice, your aim is to provide resources through the agency and refer a client elsewhere for additional assistance. However, this does not mean ignoring the warning signs that may arise during a conversation with the client. These warning signs, which could include the client’s disclosure about self-harm or suicidal ideation, can take the resource-based discussion in a different direction. The discussion might turn into a risk assessment interview, for example, as immediate harm to self and others takes priority. In this way, social workers must be nimble and able to adapt to new information they are receiving.
Interns, in particular, must understand when to continue and when to seek help from a supervisor.
For this Discussion, you practice handling just such a situation in an interactive media piece. You then explore your agency’s policies about clients at risk and use both these experiences to inform your discussion about suicide risk assessment.
• Access and complete the interactive media in the Learning Resources.
• Consider the choices you make while navigating the client scenario and your reasoning behind those choices.
• Explore your agency’s policies concerning clients at risk.
Post a reflection on the decisions you made in the Risk Assessment client scenario. What did you choose to do, and why? Then, describe your agency’s scope of practice and its policies related to clients at risk. How would these policies have changed your actions in the interactive scenario?
Avoid making promises of confidentiality: It's important to be transparent about the limits of confidentiality, particularly when there is a risk of harm to self or others. I would say something like, "I need to let you know that because you are talking about harming yourself, I can't keep this a secret. My top priority is your safety, and I need to involve my supervisor to ensure you get the help you need." This prepares the client for the next steps and maintains ethical transparency.
My reasoning for these choices is rooted in the social work code of ethics, which mandates that the protection of life and safety is the highest priority. Direct questions are not a catalyst for suicide; rather, they open the door for a crucial conversation that can lead to intervention and help.
Agency Policies and Scope of Practice
My agency's scope of practice for interns is limited. While interns are trained to recognize warning signs and conduct initial assessments, they do not have the authority to act independently in high-risk situations. . The policies regarding clients at risk are clear and hierarchical:
Immediate Consultation: The first step is always to immediately inform and consult with a supervisor. This is non-negotiable.
Documentation: All conversations, disclosures, and actions taken must be thoroughly documented in the client's file. This includes the date, time, and specific statements made by the client.
Safety Plan Development: In collaboration with the supervisor and client, a safety plan would be created. This plan includes identifying triggers, coping strategies, and a list of emergency contacts and resources.
Emergency Protocol: For clients who present an immediate and imminent threat, the protocol dictates calling emergency services (e.g., 911 or a mobile crisis unit) and not leaving the client alone.
How Policies Would Change My Actions
These agency policies would have significantly changed my actions in the interactive scenario by mandating immediate supervision and intervention. Instead of continuing the conversation alone, I would have used the initial disclosure as a signal to pause and say to the client, "Thank you for sharing this with me. This is very serious, and my agency's policy requires me to get my supervisor involved immediately to make sure we can create a plan to keep you safe." This action aligns with the ethical responsibility to ensure client safety while operating within the established boundaries of an intern's role. While the choices in the scenario may have led to a good outcome, the professional and ethical course of action is to always defer to the supervisor when faced with a high-stakes, life-or-death situation.
Sample Answer
As a generalist social work intern, encountering a client who discloses suicidal ideation requires a shift from a resource-focused discussion to an immediate risk assessment. The decisions made in the interactive media scenario would be guided by the principles of prioritizing safety and seeking supervision.
My Choices in the Scenario
In a scenario where a client reveals thoughts of self-harm or suicide, the initial choices would be to listen non-judgmentally, validate their feelings, and ask direct questions about their intent and plan. I would:
Acknowledge their pain: Start by saying something like, "Thank you for trusting me with this. That sounds incredibly difficult." This builds rapport and shows the client that they are being heard.
Assess for a plan: Ask direct questions such as, "Are you having thoughts of harming yourself?" or "Do you have a plan to end your life?" This is a critical step in a suicide risk assessment. It helps determine the level of immediate risk.