Standardizing Risk Assessment Documentation

There are no established formats for documenting a formulation of suicide risk. I have taken some steps to standardize this documentation in the clinical service I direct, but it needs further development. I'll be helping our department arrive at a common format. Thankfully, I'll be working with some really bright people who can view this documentation need from a variety of perspectives (compliance/QA, acute services, research). Here are some working principles:

1. Check boxes will not do. We can prompt clinicians with keywords, but like it or not, suicide risk formulation will always need narrative.

2. Our format needs to feel friendly and familiar to clinicians with a wide range of education and clinical experience.

3. The following elements should be present:

  • specific risk factors for suicide

  • non-specific risk factors for suicide

  • clinical data that mitigates risk

  • protective (or potentially protective) factors upon which to build treatment

  • summary clinical judgement about (a) chronic and (b) acute/imminent risk (there are some examples of metrics that define "low, medium, or high" or at least provide examples of each)

4. The format should eventually be standardized across our continuum of care.

5. Formulations with anything other than low risk, should somehow be addressed in treatment planning process.

6. We need to provide lots of documentation examples for clinicians to use as reference.

I'd be eager to hear from anyone who has a narrative format that satisfies some or all of these principles.