PART 1. TEXAS DEPARTMENT OF PUBLIC SAFETY
CHAPTER 27. CRIME RECORDS
SUBCHAPTER A. REVIEW OF PERSONAL CRIMINAL HISTORY RECORD
The Texas Department of Public Safety (the department) adopts amendments to §27.1, concerning Right of Review. This rule is adopted without changes to the proposed text as published in the March 3, 2023, issue of the Texas Register (48 TexReg 1269) and will not be republished.
These amendments update and clarify language related to current procedures for the personal review of criminal history record information and the required fees.
No comments were received regarding the adoption of this rule.
This rule is adopted pursuant to Texas Government Code, §411.004(3), which authorizes the Public Safety Commission to adopt rules considered necessary for carrying out the department's work; §411.083(b)(3), which requires the department to grant access to criminal history record information to the person who is the subject of the information; and §411.086, which requires the department to adopt rules that provide for a uniform method of requesting criminal history record information from the department.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April 21, 2023.
TRD-202301438
D. Phillip Adkins
General Counsel
Texas Department of Public Safety
Effective date: May 11, 2023
Proposal publication date: March 3, 2023
For further information, please call: (512) 424-5848
CHAPTER 380. RULES FOR STATE-OPERATED PROGRAMS AND FACILITIES
SUBCHAPTER C. PROGRAM SERVICES
DIVISION 4. HEALTH CARE SERVICES
The Texas Juvenile Justice Department (TJJD) adopts amendments to Texas Administrative Code Chapter 380, Subchapter C, §§380.9187 - 380.9189 with changes to the proposed text as published in the October 28, 2022, issue of the Texas Register (47 TexReg 7240). The amended sections will be republished.
SUMMARY OF CHANGES
The amendments to §380.9187, concerning Suicide Alert Definitions, include adding that suicide risk screenings and assessments must be done either in person or via remote computer service that allows both parties to see and hear one another; modifying several definitions to remove the requirement for a suicide risk screening or assessment to be face-to-face, to list self-harming behavior separately from suicidal behavior, and to require staggered intervals for room checks and for documenting certain status checks (rather than a not-to-exceed time frame); increasing how often staff must document the status of youth on constant observation during waking hours and youth on one-to-one observation during all hours; and removing the prohibition on using close observation for youth in a crisis stabilization unit or security unit. (Such youth will be on maximum 5-minute checks rather than the standard maximum 10-minute checks for close observation.)
Other changes to §380.9187 include removing the requirement for staff to conduct an additional type of room check referred to as a constant motion check; removing the listing of specific staff positions that must be trained to conduct a suicide risk screening; replace the term Self-Injurious Behavior with Self-Harming Behavior; revising the definitions of Designated Mental Health Professional, Rescue Kit, Suicidal Behavior, Suicidal Ideation, Suicide Alert, Suicide Observation Folder, One-to-One Observation, Constant Observation, and Suicide Risk Screening; adding definitions for Completed Suicide, Staggered Intervals, and Suicide-Resistant Clothing; and making non-substantive revisions to the definitions of Suicide Observation Level and Suicide-Resistant Room.
The new amendment to §380.9187 clarifies the definition of Life-Threatening Suicide Attempt.
The amendments to §380.9188, concerning Suicide Alert for High Restriction Facilities, include changes in a number of areas.
General changes to §380.9188 include removing several references to which TJJD staff members are responsible for certain actions, such as family notifications, internal facility notifications, and transferring records; removing the requirement for suicide risk assessments to be conducted face-to-face; replacing the phrases self-injurious behavior and self-injury with either self-harming behavior or suicidal and/or self-harming behavior, as appropriate; specifying that certain screenings and assessments must be initiated (rather than conducted) within an identified time frame; and replacing references to on-duty supervisor and duty officer with campus shift supervisor.
The amendments to §380.9188 related to initial intake and youth arrival at a facility after initial intake include adding that the designated mental health professional reviews (rather than signs) the suicide risk assessments conducted by other mental health professionals upon a youth's admission to TJJD; adding that, when a youth transfers from one high-restriction facility to another, a suicide risk screening is conducted by trained staff within one hour after arrival, which is separate from the suicide screening completed by nursing staff as part of the intrasystem health screening; adding that a suicide risk screening is conducted upon a youth's return after spending any amount of time out of TJJD's physical custody due to a significant life event, regardless of whether the absence was at least 48 hours; clarifying that the requirement for conducting a screening or assessment within one hour after an intrasystem transfer or return from an absence does not apply to youth who are already on suicide alert at the time of arrival; and adding that, following a suicide risk screening performed due to intrasystem transfer or return from an absence, the level of observation is determined by a mental health professional (rather than specifying that all youth identified as at risk for suicide are placed on at least constant observation), and the suicide risk assessment is conducted within an appropriate time frame, as established in agency procedures, based on the youth's assigned observation level and screening result (rather than specifying within four hours for youth who are actively suicidal or engaged in a suicide attempt, 24 hours for youth who engaged in some other type of suicidal behavior or ideation, or seven days for youth not identified as being at risk).
The amendments to §380.9188 related to responding to youth actions include clarifying that staff must take the same immediate actions for a youth who has demonstrated self-harming behavior as for a youth who has demonstrated suicidal behavior; removing a reference to which form is used to document that a staff member has notified the shift supervisor of a youth's behavior or ideation; adding that any type of suicidal behavior or ideation or self-harming behavior must be referred for a suicide screening by staff who observe the behavior; removing a requirement to document suicidal behavior on an incident report; adding that the screening or assessment initiated within one hour after notification of a youth's suicidal or self-harming behavior or suicidal ideation is not required when deemed inappropriate due to a medical emergency; adding that, when a screening is conducted after a youth's suicidal or self-harming behavior or suicidal ideation, the suicide risk assessment is conducted within an appropriate time frame, as established in agency procedures, based on the youth's assigned observation level and screening result (rather than specifying within four hours for youth who are actively suicidal or engaged in a suicide attempt or 24 hours for youth who engaged in some other type of suicidal behavior); and adding that youth who return to the facility after being taken to the emergency room are placed on one-to-one observation (rather than either constant or one-to-one observation) until assessed by a mental health professional.
The amendments to §380.9188 related to the time after a suicide risk assessment include specifying that, the designated mental health professional (rather than the mental health professional who assessed a youth) ensures the updated suicide alert list is distributed to staff; and clarifying that the campus shift supervisor ensures a staff member is assigned (rather than assigns a staff member) to monitor a youth placed on suicide alert.
The amendments to §380.9188 related to supervising youth on suicide alert include adding that, in addition to maintaining visual observation and documenting status, the staff member assigned to monitor a youth must follow any precautions set by the mental health professional; clarifying that, for youth on the constant observation level, the requirement to not let the youth out of the monitoring staff member's sight applies only during waking hours (such youth are on maximum five-minute checks during sleeping hours); adding breasts and buttocks to the list of body parts that staff are prohibited from observing when a youth is in the bathroom or shower and is also on one-to-one or constant observation; and adding that a decision to use force to remove clothing after issuing suicide-resistant clothing requires a recommendation from a mental health professional and approval from the directors over treatment and facility operations or the directors' designees.
The amendments to §380.9188 related to treatment and assessment include clarifying that the mental health professional consults with the youth's case manager, as needed, to recommend modifications to the youth's individual case plan; clarifying that mental health professionals review suicide risk assessments from other mental health professionals when assessing a youth currently placed on suicide alert; clarifying that the mental health professional's assessment does not need to be documented as a progress note; adding that, when changes are made to a youth's observation level or other safety precautions, updated information regarding the youth (rather than an updated suicide alert list) is distributed to designated facility staff; and specifying that, when information about youth on suicide alert is discussed during meetings between the psychology department and the psychiatric provider, only youth who are on the psychiatric caseload are discussed.
The amendments to §380.9188 related to other placement options include removing information regarding criteria and referral for placement in the protective custody program, which is addressed in a separate rule; and clarifying that emergency psychiatric placement may be pursued when it is determined a youth cannot be safely or appropriately managed within TJJD custody (rather than in protective custody).
The amendments to §380.9188 related to transferring youth on suicide alert to the next placement include adding that, when a youth on suicide alert is moved to a less restrictive placement, the mental health professional communicates observation level and precautions to facility staff, if applicable. In addition, amendments specifically related to situations in which a youth on suicide alert will be transferred to another high-restriction facility will include adding that self-harming behavior (not just suicidal behavior) is also included in the summary that is sent to the receiving facility; removing requirements for a mental health professional at the sending facility to call the designated mental health professional at the receiving facility and to notify the health services administrator at the receiving facility; clarifying that a mental health professional at the receiving facility initiates a suicide risk assessment (rather than meets with the youth) within four hours of arrival; and adding that a mental health professional at the receiving facility consults with the designated mental health professional or a designee regarding the plan for treatment and assessment.
The amendments to §380.9188 related to reducing the observation level/removing youth from suicide alert, training, and other issues include specifying that, when a youth's observation level is lowered or a youth is removed from suicide alert, the psychiatric provider is notified only for youth who are on the psychiatric caseload; specifying that staff who have regular, direct contact (rather than just direct contact) with youth receive initial and annual suicide prevention training; adding self-harming behavior to several components of the new-hire suicide prevention training; adding that using force to remove clothing shall be avoided whenever possible and used only as a last resort when a youth is physically engaging in suicidal and/or self-harming behavior; and removing a reference to notifying parents/guardians after a completed suicide, which is addressed in a separate TJJD rule.
The new amendments to §380.9188 include adding that, if force is used to remove a youth's regular clothing, a mental health professional must evaluate the youth's need for trauma symptom care and ensure the care is provided if appropriate; clarifying that staff designated to conduct suicide screenings receive annual training from a mental health professional regarding suicide alert policy, suicide indicators, and suicide screening; and adding that all training described shall be accompanied by a test or demonstration to establish competency in the subject matter.
The amendments to §380.9189, concerning Suicide Alert for Medium Restriction Facilities, include changes in a number of areas.
General changes to §380.9189 include removing several references to which TJJD staff members are responsible for certain actions, such as family notifications and internal facility notifications; and removing the requirement for suicide risk assessments to be face-to-face. General changes also include adding the following provisions for medium-restriction facilities that do not have a TJJD-employed mental health professional on staff and during times when a TJJD-employed mental health professional is not on call or on duty: 1) TJJD uses community resources such as local mental health authorities and psychiatric hospitals for clinical services; 2) TJJD will attempt to obtain guidance from the mental health professional regarding frequency of follow-up assessments and any enhanced precautions or supervision requirements, consistent with TJJD's observation levels when possible; 3) TJJD staff follow the guidance of the community mental health professional regarding precautions and supervision even when such differ from requirements of this rule; and 4) TJJD staff are authorized to seek additional direction from mental health professionals within TJJD or in the community at any time if there are concerns about the appropriateness of precautions or supervision level.
The amendments to §380.9189 related to intake screening include adding that youth are placed on one-to-one observation (rather than an observation level assigned by the facility administrator or designee) until assessed by a mental health professional if the intake screening identifies the youth as at risk for suicide; and clarifying that the 72-hour time frame for conducting a suicide risk assessment after a youth is identified as at risk during an intake screening applies only when a TJJD-employed mental health professional is contacted to do the assessment.
The amendments to §380.9189 related to responding to youth actions include clarifying that staff must take the same immediate actions for a youth who has demonstrated self-harming behavior as for a youth who has demonstrated suicidal behavior; adding that staff must begin providing one-to-one observation (rather than constant observation unless the facility administrator/designee directs a higher level) when responding to suicidal or self-harming behavior or suicidal ideation; adding that the staff member who observes the youth's behavior or ideation is responsible for beginning the observation log (rather than the facility administrator or designee being responsible); removing a reference to which form is used to document that a staff member has notified the facility administrator or designee of a youth's behavior or ideation; clarifying that the staff who observes the behavior or ideation refers the youth for a suicide screening. Removed a requirement to document suicidal behavior on an incident report; adding that a suicide risk screening is not required if a mental health professional initiates a suicide risk assessment within one hour after being notified of a youth's behavior or ideation; adding that it is the responsibility of the facility administrator or designee to ensure the youth is assessed by a mental health professional; adding that the screening or assessment within one hour after a youth's behavior or ideation is not required when deemed inappropriate due to a medical emergency; removing the provision that directed the facility administrator or designee to assign the observation level following a screening; adding that, in cases where a TJJD-employed mental health professional has been contacted, the mental health professional assigns the observation level following a screening; adding that one-to-one observation (rather than at least constant observation) is required for a youth who is allowed to leave the facility while waiting for a suicide risk assessment; adding that youth who had been to the emergency room must be on one-to-one observation upon return to the facility until assessed by a mental health professional; removing time frames for when a mental health professional must complete a suicide risk assessment; adding that, in facilities with a TJJD-employed mental health professional who is on call or on duty, the assessment must be conducted within an appropriate time frame, as established in agency procedures, based on the youth's assigned observation level and screening result; removing the provision that required, in cases where the time frame to conduct a suicide risk assessment has been exceeded, at least constant observation for the youth until assessed; and removing a reference to the ability of the facility administrator or designee to secure emergency psychiatric care to obtain an evaluation of the youth.
The amendments to §380.9189 related to the time after a suicide risk assessment include clarifying that the documentation requirements following a suicide risk assessment apply to TJJD-employed mental health professionals; adding that the facility administrator or designee ensures appropriate facility staff are notified of the results of an assessment; removing a requirement for the mental health professional to communicate the results to the facility administrator or designee; and adding that the youth's case manager is also notified if the youth was assessed but not placed on suicide alert.
The amendments to §380.9189 related to supervising youth on suicide alert include adding that, in addition to maintaining visual observation and documenting status, the staff member assigned to monitor a youth must follow any precautions set by the mental health professional; clarifying that, for youth on the constant observation level, the requirement to not let the youth out of the monitoring staff member's sight applies only during waking hours (such youth are on maximum five-minute checks during sleeping hours); adding breasts and buttocks to the list of body parts that staff are prohibited from observing when a youth is in the bathroom or shower and is also on one-to-one or constant observation; removing the provision stating who may approve a youth on suicide alert to have access to off-site activities and added that such decisions must be approved on a case-by-case basis; and adding that youth must be supervised on one-to-one observation (rather than at least constant observation) during any such off-site activities.
The amendments to §380.9189 related to treatment and reassessment include specifying that the responsibilities concerning a treatment plan, modifications to the case plan, schedule for reassessment, and required components of each assessment apply only to TJJD-employed mental health professionals; and specifying that the requirement to notify a youth's psychiatric provider of the youth's placement on suicide alert and other related information applies only when the youth is receiving routine psychiatric services.
The amendments to §380.9189 related to other placement options include adding that emergency psychiatric placement may be obtained at a TJJD crisis stabilization unit or in a private psychiatric hospital; removed the provision stating that obtaining such placement must be in accordance with §380.8771; adding the facility administrator or designee (rather than just the administrator) may seek temporary admission to the protective custody program in a high-restriction TJJD facility in certain circumstances; and removing the requirement for the facility administrator to initiate alternate placement in a more secure facility if the emergency psychiatric placement exceeds five days.
The amendments to §380.9189 related to reducing observation levels and removing youth from suicide alert include adding that the suicide observation level may be lowered by no more than one level every 24 hours; adding that only youth on the lowest observation level may be removed from suicide alert; removing the requirement for the facility staff to notify the psychiatric provider when a youth's observation level is lowered or when a youth is removed from suicide alert; and adding that TJJD-employed mental health professionals must identify in the treatment plan any needed follow-up mental health services when a youth is removed from suicide alert.
The amendments to §380.9189 related to release or discharge of youth while on suicide alert include removing a listing of which specific steps are taken by the mental health professional when a youth on suicide alert will be released or discharged; and adding that the facility administrator or designee is responsible for ensuring a mental health professional has arranged for appropriate continuity of care in these situations, when possible.
The amendments to §380.9189 related to training and other changes include specifying that staff who have regular, direct contact with youth (rather than direct care staff) receive initial and annual suicide prevention training; adding self-harming behavior to several components of the new-hire suicide prevention training; moving the reference to annual training to a separate item from the new-hire training, which clarifies that the listing of topics for new-hire training does not apply to the annual training; removing wording that allowed only mental health professionals to make decisions about exceptions to regular programming, community access, housing, or clothing for youth determined to be at risk for suicide; specifying that at least one rescue kit (rather than multiple rescue kits) must be present in the facility; and removing a reference to notifying parents/guardians after a completed suicide, which is addressed in a separate TJJD rule.
The new amendments to §380.9189 include clarifying that staff designated to conduct suicide screenings receive annual training from a mental health professional regarding suicide alert policy, suicide indicators, and suicide screening; and adding that all training described shall be accompanied by a test or demonstration to establish competency in the subject matter.
PUBLIC COMMENTS
TJJD received public comments from two organizations, Disability Rights Texas and the Texas Council for Developmental Disabilities.
Comment 1, relating to §380.9187, Suicide Alert Definitions: Regarding the definition of Trained Designated Staff Member, language should be added to the rule to specify which entity provides the training and mandate the frequency of the training.
TJJD Response: The proposed rule text at §380.9188(n)(3) and §380.9189(m)(3) says, "Staff designated to conduct suicide screenings receive training from a mental health professional regarding suicide alert policy, suicide indicators, and suicide screening." TJJD believes this language is sufficient. TJJD agrees that the rule should include a requirement regarding the frequency of the training. However, TJJD believes this requirement would better fit within §380.9188 and §380.9189. Language requiring annual training has been added to the adopted rule text.
Comment 2, relating to §380.9188, Suicide Alert for High-Restriction Facilities: The rule should include information about counseling or trauma care being provided to the youth when, as a last resort, force is used to remove clothing.
TJJD Response: Although the rule is not a comprehensive listing of all the assessments performed, each facility has the ability to deliver trauma reduction therapy and trauma assessments. While it is rare that force is used to remove clothing for youth who are physically engaging in suicidal and/or self-harming behavior and such actions will be allowed only upon the recommendation of a mental health professional and approval of the directors over treatment and facility operations or their designees, TJJD agrees that the rule should address the provision of trauma symptom care in such instances. Language regarding provision of trauma symptom care has been added to the adopted rule text.
Comment 3, relating to §380.9188, Suicide Alert for High-Restriction Facilities: Regarding subsection (e)(1)(B), the rule should include language to address the screening and documentation of individuals with intellectual or developmental disability, which professional is responsible for the screening, and that the risk of suicide or self-harm and referrals for follow-up treatment or further assessment be documented.
TJJD Response: The screening described in the rule is specific to the youth's arrival at the Orientation and Assessment Unit, which is administered by a mental health professional, as defined in §380.9187. While TJJD has rules on assessing all youth for specialized treatment needs, including intellectual disability, while at the Orientation and Assessment Unit (see §380.8751), the initial screening described by §380.9188 must be administered within the first hour after the youth's arrival for the purpose of identifying any youth at immediate risk for suicide and self-harm. TJJD believes this rule appropriately addresses the need to screen all youth, including those with intellectual or developmental disability, for immediate risk of suicide or self-harm.
Comment 4, relating to §380.9188, Suicide Alert for High-Restriction Facilities: The rule should mandate that all training relating to suicide prevention and response be competency-based.
TJJD Response: TJJD acknowledges the importance of suicide prevention and response training and evaluating whether participants have learned the material. Language requiring competency-based training has been added to the adopted rule text.
Comment 5, relating to §380.9188, Suicide Alert for High-Restriction Facilities: The rule should mandate that a debriefing also be conducted with the family or the legally authorized representative.
TJJD Response: Debriefing is for the purpose of identifying insufficiencies for internal institutional operation and safety. The purpose of this provision is specific to agency staff, what might have led to the given situation, and how to prevent such situations in the future. It is not intended to be a way of communicating with the family or legally authorized representative.
STATUTORY AUTHORITY
The amended sections are adopted under Section 242.003, Human Resources Code, which requires TJJD to adopt rules appropriate to the proper accomplishment of TJJD's functions and to adopt rules for governing TJJD schools, facilities, and programs.
No other statute, code, or article is affected by this adoption.
§380.9187.Suicide Alert Definitions.
(a) Purpose. This rule establishes definitions of terms used in the Texas Juvenile Justice Department's (TJJD's) suicide prevention policies as set forth in §§380.9188, 380.9189, 380.9190, and 380.9745 of this chapter.
(b) Definitions.
(1) Completed Suicide--a death resulting from deliberate actions to harm oneself.
(2) Critical Incident Review--a review conducted by a multi-disciplinary team designed to critically review the circumstances surrounding a death or serious incident and to recommend corrective action where necessary. The critical incident review may consider information such as incident reports, training/personnel records, policies/procedures, other relevant documents, facility practices, any non-confidential information resulting from a morbidity and mortality review, and any other information the review team determines is necessary for a comprehensive review.
(3) Critical Incident Support Team--a team used to provide support to youth, employees, and families involved in or adversely affected by the death of a TJJD youth or staff member.
(4) Designated Mental Health Professional--a doctoral-level psychologist who has primary responsibility and accountability for the evaluation, monitoring, and treatment of youth referred for suicide risk in high-restriction facilities. In the absence of a doctoral-level psychologist, a licensed mental health professional may be appointed to serve as the designated mental health professional with the approval of the Central Office director over treatment services.
(5) Life-Threatening Suicide Attempt--a suicide attempt that a health care professional determines would have likely resulted in death except for circumstances beyond the youth's control.
(6) Mental Health Professional--a doctoral-level psychologist, masters-level mental health specialist, licensed professional counselor, licensed psychological associate, or licensed clinical social worker.
(7) Morbidity and Mortality Review--an assessment of the overall clinical care provided and the circumstances leading up to a death or certain serious medical incidents. Its purpose is to identify program strengths and opportunities for improvement in clinical care.
(8) Protective Custody--a temporary program in high-restriction facilities designed for the placement of youth who cannot be safely managed in the current dorm or living unit due to risk of suicidal and/or self-harming behavior, as determined by a mental health professional.
(9) Psychiatric Provider--a:
(A) Texas-licensed psychiatrist; or
(B) Texas-licensed physician assistant or psychiatric nurse practitioner acting under the authorization of a psychiatrist.
(10) Rescue Kit--emergency medical items such as a CPR pocket mask, disposable gloves, and a tool capable of cutting ligatures.
(11) Self-Harming Behavior--behavior that causes harm, such as self-laceration, self-battering, taking overdoses, or exhibiting deliberate recklessness. Self-harming behavior is not considered a type of suicidal behavior, unless designated as such by a mental health professional.
(12) Staggered Intervals--periods of time that are irregular and unpredictable.
(13) Suicidal Behavior--includes suicide attempts or taking deliberate action toward carrying out a specific plan or strategy to injure oneself or to cause one's own death.
(14) Suicidal Ideation--thoughts of engaging in suicide-related behavior. This means a youth expresses thoughts or fantasies about committing suicide or expresses a desire to commit suicide.
(15) Suicide Alert--a status that begins following a suicide risk assessment by a mental health professional, indicating that a youth is at risk to attempt suicide or self-harming behavior and requires increased supervision and/or precautions designed to limit the risk.
(16) Suicide Attempt--an act apparently intended to end one's life. A suicide attempt is a type of suicidal behavior.
(17) Suicide Observation Folder--a folder containing completed and/or active suicide observation logs/check sheets and any other pertinent information as determined by a mental health professional.
(18) Suicide Observation Level--levels of observation determined by a mental health professional to provide enhanced supervision for youth who are awaiting a suicide risk assessment or who have been placed on suicide alert. General criteria for determining the appropriate level of observation are provided in subparagraphs (A) - (C) of this paragraph, however the mental health professional may assign any level of observation deemed appropriate under the circumstances based on the professional's clinical judgment.
(A) One-to-One Observation--generally considered appropriate for a youth who is actively suicidal, either by threatening or engaging in suicidal and/or self-harming behavior, and who may require emergency psychiatric placement. One-to-one observation includes the following:
(i) Assigned staff may not have any other concurrent duties.
(ii) Assigned staff remains within six feet of the youth and maintains continuous, direct visual observation of the youth at all times, including while the youth is in the youth's room or while the youth is sleeping.
(iii) Assigned staff documents the youth's status at least once every five minutes.
(iv) Assigned staff must be formally relieved by another staff or by the discontinuation of the one-to-one status.
(v) Doors to individual rooms remain unlocked, except when a youth presents an imminent danger to staff due to aggressive behavior.
(B) Constant Observation--generally considered the appropriate level of observation for a youth who is actively suicidal, either by threatening or engaging in suicidal and/or self-harming behavior, but does not appear to require emergency psychiatric placement. Constant observation includes the following:
(i) During waking hours, the youth is within 12 feet and within sight of assigned staff at all times. Staff may have concurrent duties if the duties do not interfere with observation of the youth. The assigned staff documents the youth's status at staggered intervals not to exceed every five minutes.
(ii) During sleeping hours, assigned staff observes and documents the youth's status at staggered intervals not to exceed every five minutes.
(iii) For youth in a security unit or crisis stabilization unit, doors to individual rooms remain locked.
(C) Close Observation--generally considered the appropriate level of observation for a youth who is not actively suicidal and would be considered a lower risk for suicide but expresses suicidal ideation and/or has a recent history of suicidal and/or self-harming behavior. In addition, close observation would be appropriate for a youth who denies suicidal ideation or does not threaten suicide but demonstrates other concerning behavior (through actions, current circumstances, or recent history) indicating the potential for self-harm. With close observation, the assigned staff is generally involved in concurrent duties that do not interfere with required observation of the youth. The frequency of checks for youth on close observation is as follows:
(i) for youth in a security unit or crisis stabilization unit, assigned staff observes and documents the youth's status at staggered intervals not to exceed every five minutes; and
(ii) for all other youth, assigned staff observes and documents the youth's status at staggered intervals not to exceed 10 minutes.
(19) Suicide-Resistant Clothing--tear-resistant, single-piece attire designed to promote a youth's safety while still providing warmth and coverage.
(20) Suicide-Resistant Room--a room that provides a safe environment and has no obvious materials or possessions that can be used in suicidal and/or self-harming behavior or any item that can be used for hanging. The room is free of all obvious protrusions and any items that provide an easy anchoring device for hanging. Lighting is tamper-proof, and there are no switches or electrical outlets in the room. The door of the room has a heavy-gauge, clear panel that provides staff an unobstructed view of the room.
(21) Suicide Risk Assessment--a standardized assessment by a mental health professional that:
(A) is conducted in-person or via remote computer service that allows both parties to see and hear one another; and
(B) contains specific lines of inquiry regarding suicide risk, a mental status examination, and clinical observations and recommendations.
(22) Suicide Risk Screening--a standardized interview to determine the appropriate suicide observation level until a suicide risk assessment is conducted. The screening is conducted in-person or via remote computer service that allows both parties to see and hear one another.
(23) Trained Designated Staff Member--a staff member trained to conduct a suicide risk screening.
§380.9188.Suicide Alert for High-Restriction Facilities.
(a) Purpose. This rule establishes procedures for identification, assessment, treatment, and protection of youth in high-restriction facilities who may be at risk for suicide.
(b) Applicability. This rule applies to all youth currently placed in high-restriction facilities operated by the Texas Juvenile Justice Department (TJJD).
(c) Definitions. Definitions pertaining to this rule are under §380.9187 of this chapter.
(d) General Provisions.
(1) Treatment for youth determined to be at risk for suicide is provided within the least restrictive environment necessary to ensure safety.
(2) Youth determined to be at risk for suicide participate in regular programming to the extent possible, as determined by a mental health professional. Only a mental health professional may make exceptions to the provision of regular programming, housing placement, or clothing.
(3) Using force to remove clothing shall be avoided whenever possible and used only as a last resort when the youth is physically engaging in suicidal and/or self-harming behavior.
(4) Designated staff carry rescue kits at all times while on duty for use in the event of a medical emergency caused by a suicide attempt. Rescue kits are also placed in designated buildings or areas of the campus that are not accessible to youth.
(5) As soon as possible, but not to exceed two hours, after a suicide attempt, the youth's parent or guardian is notified (with the youth's consent if the youth is age 18 or older).
(e) Intake Screening and Assessment.
(1) Upon Initial Admission to TJJD.
(A) Upon arrival to a TJJD orientation and assessment unit, designated intake staff keep youth within direct line-of-sight supervision until the youth is screened or assessed for suicide risk.
(B) Within one hour after the youth's arrival to a TJJD orientation and assessment unit, a mental health professional initiates an initial mental health screening and documents the results.
(C) If the mental health professional identifies the youth as potentially at risk for suicide, the mental health professional immediately conducts a suicide risk assessment.
(D) Within 14 days after arrival at the orientation and assessment unit, all youth receive a comprehensive mental health evaluation conducted by a mental health professional. The mental health evaluation will include a suicide risk assessment if one has not already been completed.
(E) The suicide risk assessment completed upon initial admission includes, at a minimum:
(i) a mental status exam;
(ii) a review of all mental health and medical records submitted from the courts, county juvenile detention facilities, or any other medical or mental health provider, to include any assessments by mental health professionals relating to prior suicide alerts during confinement;
(iii) a review of all other available screenings and assessments; and
(iv) referrals for follow-up treatment or further assessment, as indicated.
(F) The designated mental health professional reviews the suicide risk assessment.
(2) Upon Arrival at a TJJD Facility after Intake.
(A) Except for youth who are on suicide alert at the time of arrival, the following actions must occur within one hour after a youth's arrival at a high-restriction facility following an intrasystem transfer, any period of time spent out of TJJD's physical custody due to a significant life event, or a period of at least 48 hours spent out of TJJD's physical custody for any reason:
(i) a trained designated staff member initiates a suicide risk screening; or
(ii) a mental health professional initiates a suicide risk assessment.
(B) The youth is kept within direct line-of-sight supervision until the youth is screened or assessed.
(C) If a screening is conducted:
(i) the trained designated staff member immediately contacts a mental health professional to assign an observation level, if appropriate, based on results of the screening; and
(ii) the youth is immediately placed on the observation level directed by the mental health professional; and
(iii) the mental health professional conducts a suicide risk assessment within an appropriate time frame, as established in agency procedures. Procedures will assign time frames based on the youth's assigned observation level and screening result.
(D) The suicide risk assessment conducted upon a youth's arrival at a TJJD facility includes, at a minimum:
(i) a mental status exam;
(ii) a review of the youth's masterfile and medical record, as indicated;
(iii) referrals for follow-up treatment or further assessment, as indicated;
(iv) a determination of whether to place the youth on suicide alert, and if placed, designation of the appropriate observation level and other safety precautions; and
(v) a review by the designated mental health professional of the assessment.
(3)Additional Screening by Infirmary for Intrasystem Transfers.
(A) Upon arrival of a youth from another high-restriction TJJD facility, a nurse completes an intrasystem health screening, including questions relating to suicidal ideation and suicidal behavior.
(B) If the youth is identified by the screening as potentially at risk for suicide, the nurse immediately contacts a mental health professional and communicates the results of the screening.
(f) Responding to Suicidal Ideation, Self-Harming Behavior, or Suicidal Behavior.
(1) A staff member who has reason to believe that a youth has verbalized suicidal ideation or demonstrated self-harming or suicidal behavior must:
(A) immediately use the rescue kit if appropriate and seek medical attention if there is a medical emergency;
(B) verbally engage the youth;
(C) provide constant observation unless a mental health professional directs a higher observation level;
(D) begin a suicide observation log to document status checks of the youth;
(E) immediately notify the campus shift supervisor and document the notification; and
(F) refer the youth for a suicide screening.
(2) As soon as possible, but no later than one hour after notification, the campus shift supervisor ensures a trained designated staff member initiates a suicide risk screening or a mental health professional initiates a suicide risk assessment. This screening or assessment is not required when deemed inappropriate due to a medical emergency.
(3) If a screening is conducted:
(A) the trained designated staff member immediately contacts a mental health professional to assign an observation level based on results of the screening; and
(B) the mental health professional conducts a suicide risk assessment within an appropriate time frame, as established in agency procedures. Procedures will assign time frames based on the youth's assigned observation level and screening result.
(4) If the youth is transported to the emergency room:
(A) upon return to the facility, the youth is placed on one-to-one observation until assessed by a mental health professional; and
(B) a mental health professional initiates a suicide risk assessment within four hours after the youth's return to the facility.
(5) The suicide risk assessment conducted in response to suicidal behavior or ideation includes:
(A) a mental status exam;
(B) a review of the youth's masterfile and medical record, as indicated;
(C) referrals for follow-up treatment or further assessment, as indicated;
(D) a determination of whether to place the youth on suicide alert, and if placed, designation of the appropriate observation level and other safety precautions; and
(E) a review by the designated mental health professional of the assessment.
(6) Whenever possible, suicide risk screenings and assessments are conducted in a confidential setting.
(g) Actions Taken Upon Completion of Suicide Risk Assessment.
(1) Documentation Requirements.
(A) Upon completion of a suicide risk assessment, the mental health professional documents the results of the assessment, including any changes in the youth's observation level.
(B) If the youth is placed on suicide alert, the mental health professional ensures the youth's name is placed on the facility's suicide alert list. The designated mental health professional ensures the updated list is distributed to facility staff.
(2) Notification of Assessment Results.
(A) If the youth is placed on suicide alert:
(i) as soon as possible, infirmary staff, the youth's case manager, staff responsible for supervising the youth, and the campus shift supervisor are notified of the youth's observation level, other safety precautions, and any additional instructions; and
(ii) the youth's parent or guardian is notified as soon as possible after the youth is placed on suicide alert (with the youth's consent if the youth is age 18 or older).
(B) If the youth is not placed on suicide alert, the mental health professional notifies the referring staff and the youth's case manager that the youth was assessed but not placed on suicide alert.
(3) Assignment of Staff to Monitor Youth. If the youth is placed on suicide alert, the campus shift supervisor ensures a specific staff member is assigned to monitor the youth and carry the suicide observation folder.
(h) Supervision of Youth on Suicide Alert.
(1) Unless the youth is already placed in a suicide-resistant room, the campus shift supervisor or trained designated staff member coordinates a search of the youth's room or personal area and removes any potentially dangerous items.
(2) The suicide observation folder must be in the possession of the monitoring staff member at all times while the youth is on suicide alert.
(A) At no time may the youth possess the suicide observation folder.
(B) Each time the youth is transferred to the supervision of another staff member, the receiving staff member must take possession of the folder and document the transfer of supervision in the folder.
(3) As required by the suicide observation level and other safety precautions assigned to the youth, the monitoring staff member must:
(A) maintain direct visual observation of the youth;
(B) document the youth's status at the required interval; and
(C) follow any precautions set by the mental health professional.
(4) The monitoring staff member must not leave a youth assigned to one-to-one observation unattended or let the youth out of the staff member's sight.
(5) During waking hours, the monitoring staff must not leave a youth assigned to constant observation unattended or let the youth out of the staff member's sight.
(6) Any time a youth on one-to-one or constant observation is in the bathroom or shower, the monitoring staff must remain within six feet of the youth, and:
(A) observe at least a portion of the youth's body (i.e., head, feet, or other observable parts, excluding genitalia, breasts, and buttocks); and/or
(B) maintain verbal contact.
(7) When a youth on one-to-one or constant observation is engaged in regular programming (e.g., education, group sessions, recreation), the monitoring staff will accompany the youth to the activity and remain within the required distance (i.e., 6 or 12 feet). If the youth cannot be maintained within the required distance without disrupting the program, a mental health professional must be consulted to consider possible modifications to the youth's supervision plan or scheduled routine to ensure the youth can be appropriately monitored.
(8) Issuing suicide-resistant clothing and removing a youth's clothing, as well as canceling programming and routine privileges, will be avoided whenever possible and used only as a last resort for periods during which the youth is physically engaging in suicidal and/or self-harming behavior.
(A) Decisions regarding issuance of suicide-resistant clothing and restrictions in programming and/or routine privileges may be made only by a mental health professional.
(B) A decision to conduct a strip search if criteria in §380.9709 of this chapter are met may be made only in consultation with a mental health professional.
(C) A decision to use force in order to remove a youth's regular clothing after a youth has been issued suicide-resistant clothing may occur only upon the recommendation of a mental health professional and with the approval of the directors over treatment and facility operations or the directors' designees.
(D) If force is used to remove a youth's regular clothing as provided by subparagraph (C) of this paragraph, a mental health professional must evaluate the youth's need for trauma symptom care and ensure the care is provided if appropriate.
(9) Unless approved by the designated mental health professional in consultation with the facility administrator, youth on suicide alert are not allowed access to off-campus activities or non-medical appointments. Decisions regarding off-campus medical appointments are made by medical staff.
(i) Treatment and Reassessment of Youth on Suicide Alert.
(1) A mental health professional develops a written treatment plan (or revises an existing care plan) that includes treatment goals and specific interventions designed to address and reduce suicidal ideation and threats, suicidal and/or self-harming behavior, and suicidal threats perceived to be based upon attention-seeking or manipulative behavior. The treatment plan describes:
(A) signs, symptoms, and circumstances under which the risk for suicide or other self-harming behavior is likely to reoccur;
(B) how reoccurrence of suicidal and other self-harming behavior can be avoided; and
(C) actions the youth and staff can take if the suicidal and other self-harming behavior does occur.
(2) The mental health professional consults with the youth's case manager, as needed, to recommend modifications to the youth's individual case plan based on issues identified in the treatment plan. The mental health professional consults with staff responsible for supervising the youth regarding the youth's progress.
(3) While the youth is on suicide alert, a mental health professional assesses the youth at least once every 48 hours, unless the youth is placed on one-to-one observation, in which case the mental health professional assesses the youth at least once every 24 hours.
(4) For each assessment, the mental health professional:
(A) reviews the contents of the suicide observation folder, as well as suicide risk assessments and progress notes from other mental health professionals as applicable;
(B) determines whether any changes should be made to the youth's observation level or other safety precautions, in consultation with the designated mental health professional;
(C) documents any changes in the observation level or other safety precautions in the suicide observation folder; and
(D) documents the assessment, including a sufficient description of the youth's emotional status, observed behavior, recommended observation level, justification for decision, and any special instructions for staff.
(5) Each time a change is made to the youth's observation level or other safety precautions, staff responsible for supervising the youth are notified and updated information regarding the youth is distributed to designated facility staff, including infirmary staff.
(6) During routine meetings between the psychology department and the psychiatric provider, the designated mental health professional or designee discusses information concerning youth on suicide alert who are on the psychiatric caseload.
(j) Protective Custody or Emergency Psychiatric Placement.
(1) Youth who cannot be safely managed in their assigned living units may be referred for placement in a suicide-resistant room in the protective custody program, in accordance with §380.9745 of this chapter. All treatment, reassessment, and observation requirements established in this rule will continue to apply while a youth is assigned to protective custody unless otherwise noted in §380.9745 of this chapter.
(2) If the designated mental health professional or psychiatric provider determines that a youth is in serious and imminent risk of suicidal and/or self-harming behavior and cannot be safely or appropriately managed within TJJD custody, the designated mental health professional or psychiatric provider may seek emergency psychiatric placement in accordance with §380.8771 of this chapter. The youth will be placed on one-to-one observation until received at the emergency placement.
(k) Intrasystem Transfer of Youth on Suicide Alert.
(1) Prior to transferring a youth on suicide alert to another high-restriction TJJD facility:
(A) within 24 hours prior to transfer, a mental health professional at the sending facility sends a summary of the youth's suicidal and/or self-harming behavior, assessments, and treatment to the designated mental health professional and facility administrator or their designees at the receiving facility and any stopover facilities en route to the receiving facility; and
(B) staff assigned to monitor the youth at the sending facility provide the suicide observation folder to the transporting staff.
(2) A mental health professional at the receiving facility:
(A) as soon as possible, but no later than four hours after the youth's arrival, reviews the transfer summary and initiates a suicide risk assessment;
(B) places the youth on the facility's suicide alert list;
(C) ensures the suicide observation log is provided to the staff assigned to monitor the youth; and
(D) consults with the designated mental health professional or designee regarding the plan for treatment and assessment.
(3) Before the youth is moved to the assigned dorm or living unit at the receiving facility, staff responsible for supervising the youth and nursing staff are notified of the youth's suicide observation level.
(l) Moving a Youth on Suicide Alert to a Less Restrictive Placement.
(1) Prior to moving a youth on suicide alert to a less restrictive placement (i.e., medium-restriction facility or home placement), the mental health professional:
(A) provides the youth (or parent/guardian if the youth is under age 18) with a referral for follow-up care;
(B) coordinates with appropriate clinical staff to schedule a follow-up appointment;
(C) communicates observation level and precautions to facility staff, if applicable;
(D) identifies emergency resources, if needed; and
(E) notifies the youth's parole officer, if applicable.
(2) Mental health records are sent to the receiving mental health provider upon request.
(m) Reduction of Observation Level and Removal from Suicide Alert.
(1) The observation level for a youth on suicide alert may be lowered or discontinued only after a suicide risk assessment by a mental health professional, in consultation with the designated mental health professional.
(2) A mental health professional may lower a youth's suicide observation level by no more than one level every 24 hours unless otherwise approved by the designated mental health professional on a case-by-case basis.
(3) Only a mental health professional or the designated mental health professional may authorize removal of a youth's name from the suicide alert list. Only youth on the lowest available observation level may be removed from suicide alert.
(4) The mental health professional notifies appropriate staff when a youth's observation level is lowered and when a youth is removed from suicide alert. Infirmary staff notify the psychiatric provider of all such changes for youth on the psychiatric caseload.
(5) The youth's parent or guardian is notified when the youth is removed from suicide alert (with the youth's consent if the youth is age 18 or older).
(6) Upon removal from suicide alert, the mental health professional identifies in the treatment plan any needed follow-up mental health services.
(n) Training.
(1) All staff who have regular, direct contact with youth (including, but not limited to, security, direct care, nursing, mental health, and education staff) receive initial training in suicide prevention and response during new-hire training. Training addresses topics including, but not limited to:
(A) identifying the warning signs and symptoms of suicidal and/or self-harming behavior;
(B) high-risk periods for suicidal and/or self-harming behavior;
(C) juvenile suicide research, to include the demographic and cultural parameters of suicidal behavior, incidence, and precipitating factors;
(D) responding to suicidal youth and youth experiencing mental health symptoms;
(E) communication between correctional and health care personnel;
(F) referral procedures;
(G) housing, observation, and suicide alert procedures; and
(H) follow-up monitoring of youth who engage in suicidal behavior, self-harming behavior, and/or suicidal ideation.
(2) All staff who have regular, direct contact with youth receive annual suicide prevention training.
(3) Staff designated to conduct suicide screenings receive annual training from a mental health professional regarding suicide alert policy, suicide indicators, and suicide screening.
(4) All training described by this subsection shall be accompanied by a test or demonstration to establish competency in the subject matter.
(o) Post-Incident Debriefing and Analysis.
(1) After a completed suicide or a life-threatening suicide attempt, the facility administrator or designee coordinates a debriefing with appropriate facility staff as soon as possible after the situation has been stabilized, in accordance with agency procedures.
(2) After a completed suicide, the executive director or designee may dispatch a critical incident support team to provide counseling for youth and staff, coordination of facility activities, and assistance with follow-up care.
(3) After a completed suicide, the medical director conducts a morbidity and mortality review in coordination with appropriate clinical staff. The medical director may conduct a morbidity and mortality review after a life-threatening suicide attempt.
(4) After a completed suicide or a life-threatening suicide attempt, a critical incident review is convened to determine if the incident reveals system-wide deficiencies and to recommend improvements to agency policies, operational procedures, the physical plant, and/or training requirements.
(5) In the event of a completed suicide, all actions, notifications, and reports required under §385.9951 of this chapter must be completed.
§380.9189.Suicide Alert for Medium-Restriction Facilities.
(a) Purpose. This rule establishes procedures for identification, assessment, treatment, and protection of youth in medium-restriction facilities who may be at risk for suicide.
(b) Applicability.
(1) This rule applies to all youth currently placed in medium-restriction facilities operated by the Texas Juvenile Justice Department (TJJD).
(2) Responsibilities assigned to mental health professionals in this rule apply only to mental health professionals employed by TJJD.
(3) For facilities that do not have a mental health professional employed by TJJD and during periods when a TJJD-employed mental health professional is not on call or on duty:
(A) TJJD uses community resources such as local mental health authorities and psychiatric hospitals for all required clinical services;
(B) TJJD staff will attempt to obtain guidance from the mental health professional regarding any enhanced precautions or supervision requirements (consistent with §380.9187 of this chapter when possible) and frequency of follow-up assessments. TJJD staff follow the guidance and instructions provided by the community mental health professional regarding precautions and supervision for youth even when such differ from this rule; and
(C) TJJD staff are authorized to seek additional instruction, guidance, or assessments from mental health professionals within TJJD or in the community at any time if there are concerns about the appropriateness of precautions or required supervision level.
(c) Definitions. Definitions pertaining to this rule are under §380.9187 of this chapter.
(d) General Provisions.
(1) Treatment for youth determined to be at risk for suicide is provided within the least restrictive environment necessary to ensure safety.
(2) Youth determined to be at risk for suicide participate in regular programming to the extent possible.
(3) A rescue kit for use in medical emergencies is placed in at least one designated location within the facility that is not accessible to youth.
(4) As soon as possible, but not to exceed two hours, after a suicide attempt, the youth's parent or guardian is notified (with the youth's consent if the youth is age 18 or older).
(e) Intake Screening.
(1) Upon a youth's admission to a medium-restriction facility, a trained designated staff member conducts a health screening, which includes a review of the youth's file and questions relating to suicidal ideation and behavior. The results of the health screening are documented.
(2) If a youth is identified during the screening as potentially at risk for suicide:
(A) the staff member who conducted the screening immediately notifies the facility administrator or designee;
(B) the facility administrator or designee contacts a mental health professional to conduct a suicide risk assessment; and
(C) the youth is placed on the one-to-one suicide observation level until assessed by a mental health professional.
(3) If a TJJD-employed mental health professional is contacted to conduct the suicide risk assessment, the assessment must be completed as soon as possible, not to exceed 72 hours.
(f) Responding to Suicidal Ideation, Self-Harming Behavior, or Suicidal Behavior.
(1) A staff member who has reason to believe that a youth has verbalized suicidal ideation or demonstrated suicidal or self-harming behavior must:
(A) immediately use the rescue kit if appropriate and seek medical attention if there is a medical emergency;
(B) verbally engage the youth;
(C) immediately notify the facility administrator or designee and document the notification;
(D) provide one-to-one observation;
(E) begin a suicide observation log to document status checks of the youth; and
(F) refer the youth for a suicide screening.
(2) As soon as possible but no later than one hour after notification, a trained designated staff member initiates a suicide risk screening or a mental health professional initiates an assessment. If a screening is conducted:
(A) the staff member who conducted the screening immediately communicates the results of the screening to the facility administrator or designee; and
(B) the facility administrator or designee ensures the youth is assessed by a mental health professional.
(3) This screening or assessment is not required when deemed inappropriate due to a medical emergency.
(4) If a TJJD-employed mental health professional is contacted to conduct the suicide risk assessment, the mental health professional assigns an observation level based on the results of the suicide screening.
(5) Youth who are waiting for a suicide risk assessment are not allowed community access (e.g., community service, employment, academic attendance) unless TJJD staff supervise the youth on one-to-one observation.
(6) If the youth is transported to the emergency room, upon return to the medium-restriction facility, the youth is placed on one-to-one observation until assessed by a mental health professional.
(7) In facilities with a TJJD-employed mental health professional who is either on call or on duty, the mental health professional conducts a suicide risk assessment within an appropriate time frame, as established in agency procedures. Procedures will assign time frames based on the youth's assigned observation level and screening result.
(g) Actions Taken Upon Completion of Suicide Risk Assessment.
(1) Documentation Requirements. Upon completion of a suicide risk assessment conducted by a TJJD-employed mental health professional, the mental health professional documents the results of the assessment, including any changes in the youth's observation level.
(2) Notification of Assessment Results.
(A) Upon completion of a suicide risk assessment, the facility administrator or designee ensures appropriate facility staff are notified of the results.
(B) If the youth is placed on suicide alert:
(i) the facility administrator or designee immediately notifies facility staff of the youth's enhanced supervision requirements and any additional instructions; and
(ii) the youth's parent or guardian is notified as soon as possible after the youth is placed on suicide alert (with the youth's consent if the youth is age 18 or older).
(C) If the youth is not placed on suicide alert, the facility administrator or designee notifies the referring staff and the youth's case manager that the youth was assessed and not placed on suicide alert.
(3) Assignment of Staff to Monitor Youth. If the youth is placed on suicide alert, the facility administrator or designee assigns a specific staff member to monitor the youth and document status checks.
(h) Supervision of Youth on Suicide Alert.
(1) The facility administrator or designee coordinates a search of the youth's room and removes any potentially dangerous items.
(2) A suicide observation monitoring sheet must be in the possession of the monitoring staff member at all times while the youth is on suicide alert.
(A) At no time may the youth possess the suicide observation sheet.
(B) Each time the youth is transferred to the supervision of another staff member, the receiving staff member must take possession of the observation sheet and document the transfer of supervision.
(3) The monitoring staff member must:
(A) maintain direct visual observation of the youth if required;
(B) document the youth's status at the required interval; and
(C) follow any precautions set by the mental health professional.
(4) The monitoring staff member must not leave a youth assigned to one-to-one observation unattended or let the youth out of the staff member's sight.
(5) During waking hours, the monitoring staff must not leave a youth assigned to constant observation unattended or let the youth out of the staff member's sight.
(6) Any time a youth on one-to-one or constant observation is in the bathroom or shower, the monitoring staff must remain within six feet of the youth, and:
(A) observe at least a portion of the youth's body (i.e., head, feet, or other observable parts, excluding genitalia, breasts, and buttocks); and/or
(B) maintain verbal contact.
(7) Youth on suicide alert are not allowed access to off-site activities or appointments unless it is approved on a case-by-case basis. In such cases, the youth must be supervised on one-to-one observation.
(i) Treatment and Reassessment of Youth on SuicideAlert.
(1) Subparagraphs (A)-(D) of this paragraph apply to TJJD-employed mental health professionals.
(A) A mental health professional prepares a written treatment plan for each youth on suicide alert, updating or revising the plan as necessary. The treatment plan includes:
(i) identification of the crisis stabilization issues to be addressed in ongoing assessment sessions;
(ii) a plan of action to address these issues; and
(iii) the degree of community restriction necessary to provide for the youth's safety.
(B) The mental health professional consults with facility staff to recommend modifications to the youth's individual case plan based on issues identified in the treatment plan.
(C) While the youth is on suicide alert, the mental health professional assesses the youth as needed, but at least once every two calendar days.
(D) For each assessment, the mental health professional:
(i) reviews relevant suicide alert documentation and information;
(ii) determines whether any changes should be made to the youth's observation level or other precautions; and
(iii) documents any changes in the observation level, community restrictions, or other safety precautions.
(2) Each time a change is made to the youth's observation level or other safety precautions, the facility administrator or designee ensures the changes are documented and facility staff are notified.
(3) If the youth is receiving routine psychiatric services, the facility administrator or designee ensures the psychiatric provider is notified of the youth's placement on suicide alert and of any relevant information concerning the youth's treatment and supervision while on suicide alert.
(j) Youth Who Cannot Be Safely Managed in Current Placement.
(1) If the facility administrator or mental health professional determines that a youth cannot be safely managed within the structure of the current placement due to behavior that indicates imminent risk of suicide or serious self-injury, the facility administrator or designee:
(A) ensures one-to-one observation for the youth until an emergency psychiatric placement is obtained;
(B) obtains emergency psychiatric placement at a TJJD crisis stabilization unit or in a private psychiatric hospital. For youth not on parole status, the facility administrator or designee may also seek temporary admission to protective custody in a high-restriction TJJD facility pending emergency psychiatric placement if no such placements are immediately available; and
(C) maintains communication with staff at the emergency placement to obtain current mental status information and to assess the length and suitability of the current placement.
(2) For youth maintained on constant and/or one-to-one observation longer than seven days in a medium-restriction facility, the facility administrator or designee must pursue an alternative placement with longer-term stabilization, clinical resources, and increased supervision.
(k) Reduction of Observation Level and Removal from Suicide Alert.
(1) The observation level for a youth on suicide alert may be lowered or discontinued only after an assessment by a mental health professional.
(A) A youth's suicide observation level may be lowered by no more than one level every 24 hours.
(B) Only youth on the lowest available observation level may be removed from suicide alert.
(2) The facility administrator or designee notifies facility staff when a youth's observation level is reduced and when a youth is removed from suicide alert.
(3) The youth's parent or guardian is notified when the youth is removed from suicide alert (with the youth's consent if the youth is age 18 or older).
(4) For youth being treated by a TJJD-employed mental health professional, the mental health professional identifies in the treatment plan any needed follow-up mental health services when the youth is removed from suicide alert.
(l) Release or Discharge of Youth on Suicide Alert. Prior to releasing or discharging a youth on suicide alert to a community placement (i.e., another non-secure placement or home placement), the facility administrator or designee ensures a mental health professional has arranged for appropriate continuity of care when possible.
(m) Training.
(1) All staff who have regular, direct contact with youth receive initial training in suicide prevention and response during new-hire training. Training addresses topics including, but not limited to:
(A) identifying the warning signs and symptoms of suicidal and/or self-harming behavior;
(B) high-risk periods for suicidal and/or self-harming behavior;
(C) juvenile suicide research, to include the demographic and cultural parameters of suicidal behavior, incidence, and precipitating factors;
(D) responding to suicidal youth and youth experiencing mental health symptoms;
(E) communication between correctional and health care personnel;
(F) referral procedures;
(G) housing, observation, and suicide alert procedures; and
(H) follow-up monitoring of youth who engage in suicidal behavior, self-harming behavior, and/or suicidal ideation.
(2) All staff who have regular, direct contact with youth receive annual suicide prevention training.
(3) Staff designated to conduct suicide screenings receive annual training from a mental health professional regarding suicide alert policy, suicide indicators, and suicide screening.
(4) All training described by this subsection shall be accompanied by a test or demonstration to establish competency in the subject matter.
(n) Post-Incident Debriefing and Analysis.
(1) After a completed suicide or a life-threatening suicide attempt, the facility administrator or designee coordinates a debriefing with appropriate facility staff as soon as possible after the situation has been stabilized, in accordance with agency procedures.
(2) After a completed suicide, the executive director or designee may dispatch a critical incident support team to provide counseling for youth and staff, coordination of facility activities, and assistance with follow-up care.
(3) After a completed suicide, the medical director conducts a morbidity and mortality review in coordination with appropriate clinical staff. The medical director may conduct a morbidity and mortality review after a life-threatening suicide attempt.
(4) After a completed suicide or a life-threatening suicide attempt, a critical incident review is convened to determine if the incident reveals system-wide deficiencies and to recommend improvements to agency policies, operational procedures, the physical plant, and/or training requirements.
(5) In the event of a completed suicide, all actions, notifications, and reports required under §385.9951 of this chapter must be completed.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April 19, 2023.
TRD-202301431
Christian von Wupperfeld
General Counsel
Texas Juvenile Justice Department
Effective date: August 1, 2023
Proposal publication date: October 28, 2022
For further information, please call: (512) 490-7278
The Texas Juvenile Justice Department (TJJD) adopts amendments to Texas Administrative Code Chapter 380, Subchapter F, §380.9745 without changes to the proposed text as published in the October 28, 2022, issue of the Texas Register (47 TexReg 7253). The amended section will not be republished.
SUMMARY OF CHANGES
The amendments to §380.9745, concerning Protective Custody for Youth at Risk of Self-Harm, include removing the requirement for the suicide risk assessments required by this rule to be conducted face-to-face; clarifying that one of the admission criteria is based on protection from suicidal and/or self-harming behavior (rather than solely self-harm); clarifying that the maximum stay in the protective custody program without director-level approval is 120 hours (rather than 5 calendar days); adding that the director over facility operations or designee may approve an extension in the protective custody program beyond 120 hours only after consultation with and agreement of the director over treatment or designee; adding that, if it is determined that a youth is being held in this program in violation of policy, the facility administrator and the designated mental health professional (rather than the facility administrator or duty officer) must be immediately notified; specifying that, if the security dorm supervisor or designee determines that a youth is being held in the protective custody program in violation of policy, the youth must be released from the program (rather than returned to the general population) unless the facility administrator finds that there was no violation (rather than unless the facility administrator or duty officer instructs otherwise); adding that youth may challenge being placed in the program by filing a grievance (rather than an appeal) in accordance with the rule on grievances; and removing the requirement for the director of treatment or designee to consult with the designated mental health professional when reviewing the youth's appeal.
PUBLIC COMMENTS
TJJD did not receive any public comments on the proposed rulemaking action.
STATUTORY AUTHORITY
The amended section is adopted under Section 242.003, Human Resources Code, which requires TJJD to adopt rules appropriate to the proper accomplishment of TJJD's functions and to adopt rules for governing TJJD schools, facilities, and programs.
No other statute, code, or article is affected by this adoption.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April 19, 2023.
TRD-202301432
Christian von Wupperfeld
General Counsel
Texas Juvenile Justice Department
Effective date: August 1, 2023
Proposal publication date: October 28, 2022
For further information, please call: (512) 490-7278
CHAPTER 461. INCIDENT COMMANDER
The Texas Commission on Fire Protection (Commission) adopts §461.7 concerning International Fire Service Accreditation Congress (IFSAC) Seal for Incident Commander. The purpose of the new §461.7 is to outline requirements for obtaining an IFSAC seal for Incident Commander. §461.7 is adopted without changes to the text as published in the March 3, 2023, issue of the Texas Register (48 TexReg 1271). The rule will not be republished.
No comments were received from the public regarding the adoption of the new section.
The rule is adopted under Texas Government Code §419.008, which authorizes the commission to adopt or amend rules to perform the duties assigned to the commission. The rule is also adopted under Texas Government Code §419.032, which authorizes the commission to adopt rules establishing the requirements for certification; and §419.0325, which authorizes the commission to obtain the criminal history record information for the individual seeking certification by the commission.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April 24, 2023.
TRD-202301472
Mike Wisko
Agency Chief
Texas Commission on Fire Protection
Effective date: May 14, 2023
Proposal publication date: March 3, 2023
For further information, please call: (512) 936-3841