Common use of Suicide Prevention Clause in Contracts

Suicide Prevention. ‌ (a) Within 60 days of the Effective Date, JCMSC shall develop and implement comprehensive policies and procedures regarding suicide prevention and the appropriate management of suicidal Children. The policies and procedures shall incorporate the input from the Division of Clinical Services. The policies and procedures shall address, at minimum: (i) Intake screening for suicide risk and other mental health concerns in a confidential environment by a qualified individual for the following: past or current suicidal ideation and/or attempts; prior mental health treatment; recent significant loss, such as the death of a family member or a close friend; history of mental health diagnosis or suicidal behavior by family members and/or close friends; and suicidal issues or mental health diagnosis during any prior confinement. (ii) Procedures for initiating and terminating precautions; (iii) Communication between direct care and mental health staff regarding Children on precautions, including a requirement that direct care staff notify mental health staff of any incident involving self-harm; (iv) Suicide risk assessment by the QMHP; (v) Housing and supervision requirements, including minimal intervals of supervision and documentation; (vi) Interdisciplinary reviews of all serious suicide attempts or completed suicides; (vii) Multiple levels of precautions, each with increasing levels of protection; (viii) Requirements for all annual in-service training, including annual mock drills for suicide attempts and competency-based instruction in the use of emergency equipment; (ix) Requirements for mortality and morbidity review; and (x) Requirements for regular assessment of the physical plant to determine and address any potential suicide risks. (b) Within 60 days of the Effective Date, JCMSC shall ensure security staff posts are equipped with readily available, safely secured, suicide cut-down tools. (c) After intake and admission, JCMSC shall ensure that, within 24 hours, any Child expressing suicidal intent or otherwise showing symptoms of suicide is assessed by a QMHP using an appropriate, formalized suicide risk assessment instrument. (d) JCMSC shall require direct care staff to immediately notify a QMHP any time a Child is placed on suicide precautions. Direct care staff shall provide the mental health professional with all relevant information related to the Child’s placement on suicide precautions. (e) JCMSC shall prohibit the routine use of isolation for Children on suicide precautions. Children on suicide precautions shall not be isolated unless specifically authorized by a QMHP. Any such isolation and its justification shall be thoroughly documented in the accompanying incident report, a copy of which shall be maintained in the Child’s file. (f) Within nine months of the Effective Date, the following measures shall be taken when placing a Child on suicide precautions: (i) Any Child placed on suicide precautions shall be evaluated by a QMHP within two hours after being placed on suicide precautions. In the interim period, the Child shall remain on constant observation until the QMHP has assessed the Child. (ii) In this evaluation, the QMHP shall determine the extent of the risk of suicide, write any appropriate orders, and ensure that the Child is regularly monitored. (iii) A QMHP shall regularly, but no less than daily, reassess Children on suicide precautions to determine whether the level of precaution or supervision shall be raised or lowered, and shall record these reassessments in the Child’s medical chart. (iv) Only a QMHP may raise, lower, or terminate a Child’s suicide precaution level or status. (v) Following each daily assessment, a QMHP shall provide direct care staff with relevant information regarding a Child on suicide precautions that affects the direct care staff’s duties and responsibilities for supervising Children, including at least: known sources of stress for the potentially suicidal Children; the specific risks posed; and coping mechanisms or activities that may mitigate the risk of harm. (g) JCMSC shall ensure that Children who are removed from suicide precautions receive a follow up assessment by a QMHP while housed in the Facility. (h) All staff, including administrative, medical, and direct care staff or contractors, shall report all incidents of self-harm to the Administrator, or his or her designee, immediately upon discovery. (i) All suicide attempts shall be recorded in the classification system to ensure that intake staff is aware of past suicide attempts if a Child with a history of suicidal ideations or attempts is readmitted to the Facility. (j) Each month, the Administrator, or his or her designee, shall aggregate and analyze the data regarding self-harm, suicide attempts, and successful suicides. Monthly statistics shall be assembled to allow assessment of changes over time. The Administrator, or his or her designee, shall review all data regarding self-harm within 24 hours after it is reported and shall ensure that the provisions of this Agreement, and policies and procedures, are followed during every incident.

Suicide Prevention. ‌Jail Staff shall ensure that suicide prevention measures are in place at the Jail and shall also develop and implement adequate written policies, procedures¸ and training on suicide prevention and the treatment of special needs inmates. a. These procedures shall include provisions for constant direct supervision of actively suicidal inmates when necessary and close supervision of special needs inmates with lower levels of risk (a) Within 60 days e.g., 15 minute checks). Officers shall document their checks. b. Suicide prevention policies shall include procedures to ensure the safe housing and supervision of inmates based on the Effective Date, JCMSC acuity of their mental health needs. c. Jail Staff shall develop and implement comprehensive policies and procedures regarding an adequate suicide prevention and the appropriate management of suicidal Children. The policies and procedures shall incorporate the input from the Division of Clinical Services. The policies and procedures shall address, at minimum: (i) Intake screening instrument that includes adequate screening for suicide risk factors and other assessment triggers. d. A risk management system shall identify levels of risk for suicide and self- injurious behavior that requires intervention in an adequate and timely manner to prevent or minimize harm to inmates. The system shall include but not be limited to the following processes: i. Incident reporting, data collection, and data aggregation to capture sufficient information to formulate reliable risk assessment at the individual and system levels regarding inmates with mental illness and developmental disabilities. 1. Incidents involving pill hoarding or razor blades and injuries involving pills or razor blades shall be tracked and analyzed by the Jail Staff on a quarterly basis. 2. Incidents involving weapons, self-harm, use of force, suicide, suicide attempts, or inmate-on-inmate assaults shall be tracked and analyzed by the Jail Staff on a quarterly basis. 3. All such incidents shall be reviewed, including a psychological reconstruction for suicides, as part of a regularly scheduled suicide prevention committee composed of security, nursing, medical staff, and qualified mental health concerns staff. Jail Staff shall develop a corrective action plan where appropriate, and the Staff’s response shall be clearly documented. ii. Identification of at-risk inmates in need of clinical or multidisciplinary review or treatment. iii. Identification of situations involving at-risk inmates that require review by a multidisciplinary team and/or systemic review. iv. A hierarchy of interventions that corresponds to levels of risk. v. Mechanisms to notify multidisciplinary teams and the risk management system of the efficacy of interventions. vi. Development and implementation of interventions that adequately respond appropriately to trends. e. Jail Staff shall ensure that placement on suicide precautions is made only pursuant to adequate, timely (within four (4) hours of identification, or sooner if clinically indicated), and confidential environment assessment and is documented, including level of observation, housing location, and conditions of the precautions. f. Inmates requiring crisis level of care will be seen by a qualified individual for the following: past or current suicidal ideation and/or attempts; prior mental health treatment; recent significant loss, such as the death care professional within 4 hours of a family member or a close friend; history of mental health diagnosis or suicidal behavior by family members and/or close friends; and suicidal issues or mental health diagnosis during any prior confinement. (ii) Procedures for initiating and terminating precautions; (iii) Communication between direct care and mental health staff regarding Children on precautions, including a requirement that direct care staff notify mental health staff of any incident involving self-harm; (iv) Suicide risk assessment by the QMHP; (v) Housing and supervision requirements, including minimal intervals of supervision and documentation; (vi) Interdisciplinary reviews of all serious suicide attempts or completed suicides; (vii) Multiple levels of precautions, each with increasing levels of protection; (viii) Requirements for all annual in-service training, including annual mock drills for suicide attempts and competency-based instruction in the use of emergency equipment; (ix) Requirements for mortality and morbidity review; and (x) Requirements for regular assessment of the physical plant to determine and address any potential suicide risks. (b) Within 60 days of the Effective Date, JCMSC shall ensure security staff posts are equipped with readily available, safely secured, suicide cut-down tools. (c) After intake and admission, JCMSC shall ensure that, within 24 hours, any Child expressing suicidal intent or otherwise showing symptoms of suicide is assessed by a QMHP using an appropriate, formalized suicide risk assessment instrument. (d) JCMSC shall require direct care staff to immediately notify a QMHP any time a Child is being placed on suicide precautionsprecautions or crisis level care if during normal business hours, or within 24 hours if outside of normal business hours. Direct care staff shall provide the The on-call qualified mental health professional with all relevant information related to the Child’s placement must be notified within one hour of being placed on suicide precautionsprecautions or crisis level care and advise with regard to course of treatment, housing, observation, medication, property restriction, and other appropriate care. (e) JCMSC g. Jail Staff shall prohibit the routine use develop and implement an adequate system whereby inmates, upon evaluation and determination by a qualified mental health professional, may, where clinically appropriate, be released gradually from more restrictive levels of isolation supervision to less restrictive levels for Children on an appropriate period of time prior to their discharge from suicide precautions. Children Step-down placements should continue to be suicide-resistant and located in such a way as to provide full visibility to staff. Jail Staff shall ensure that inmates are placed on suicide precautions shall a level of observation that is not be isolated unless specifically authorized by a QMHP. Any such isolation and its justification shall be thoroughly documented in the accompanying incident report, a copy of which shall be maintained in the Child’s fileunduly restrictive. (f) Within nine months of the Effective Date, the following measures shall be taken when placing a Child on suicide precautions: (i) Any Child placed h. Inmates on suicide precautions shall be evaluated by a QMHP within two hours after being placed on suicide precautions. In the interim period, the Child shall remain on constant observation until the QMHP has assessed the Childprovided out-of-cell time for clinically appropriate structured activities and showers. i. Qualified mental health staff shall assess and interact with (iinot just observe) In this evaluation, the QMHP shall determine the extent of the risk of suicide, write any appropriate orders, and ensure that the Child is regularly monitored. (iii) A QMHP shall regularly, but no less than daily, reassess Children inmates on suicide precautions to determine whether the level of precaution or supervision shall be raised or lowered, on a daily basis and shall record these reassessments in the Child’s medical chartprovide adequate treatment to such inmates. (iv) Only a QMHP may raise, lower, or terminate a Child’s suicide precaution level or status. (v) Following each daily assessment, a QMHP shall provide direct care staff with relevant information regarding a Child on suicide precautions that affects the direct care staff’s duties and responsibilities for supervising Children, including at least: known sources of stress for the potentially suicidal Children; the specific risks posed; and coping mechanisms or activities that may mitigate the risk of harm. (g) JCMSC j. Jail Staff shall ensure that Children who inmates are removed discharged from suicide precautions or crisis level care as early as possible. Jail Staff shall ensure that all inmates discharged from suicide precautions or crisis level of care continue to receive a follow timely and adequate follow-up assessment by and care, specifically at a QMHP while housed in the Facility. (h) All staff, including administrative, medical, and direct care staff or contractors, shall report all incidents minimum of self-harm to the Administrator, or his or her designee, immediately upon discovery. (i) All suicide attempts shall be recorded in the classification system to ensure that intake staff is aware of past suicide attempts if a Child with a history of suicidal ideations or attempts is readmitted to the Facility. (j) Each month, the Administrator, or his or her designee, shall aggregate and analyze the data regarding self-harm, suicide attempts, and successful suicides. Monthly statistics shall be assembled to allow assessment of changes over time. The Administrator, or his or her designee, shall review all data regarding self-harm within 24 hours after it is reported and shall ensure that 7 days following discharge. A qualified mental health professional may schedule additional follow-ups within the provisions first 7 days of this Agreement, and policies and procedures, are followed during every incidentdischarge if clinically indicated. A qualified mental health professional will develop a treatment plan within 7 days following discharge.

Suicide Prevention. ‌Defendant shall adopt and fully implement policies, procedures, and training curricula to ensure adequate suicide prevention. The remedial measures shall mandate the following: a. Progressive levels of supervision of those identified by the Jail staff as at-risk for suicide (a“at-risk prisoners”) Within 60 days (e.g., constant direct supervisions, 15 minute checks, 30 minute checks); b. Documentation by officers of their checks on at-risk prisoners; c. The safe housing and supervision of prisoners based on the acuity of their mental health needs; d. The removal of suicide hazards from all areas housing at-risk prisoners; e. The housing of at-risk prisoners in close proximity to staff who can hear and/or see them. To every extent possible, the isolation of at-risk prisoners should be avoided, and except where the prisoner is actively engaging in self-destructive behavior, the Jail shall ensure that suicidal prisoners are not denied routine privileges such as showers, visits, telephone calls, and recreation; f. The availability of cut-down tools to all Jail staff who may be first responders to suicide attempts; g. The availability of emergency response equipment stored in emergency response bags located in close proximity to the Jail’s housing units. Equipment shall include a first aid kit, a CPR mask or Ambu bag, and an emergency rescue tool. Defendant shall train all Security and Medical Staff on the location(s) of emergency response bags in the vicinity of their work areas, and on how to use the emergency response equipment; h. An adequate self-harm screening instrument that includes adequate screening factors and assessment triggers; i. A risk management system, which shall be part of the Effective Dateoverall quality assurance system, JCMSC shall develop for identifying levels of risk for suicide and implement comprehensive policies self-injurious behavior that requires intervention in an adequate and procedures regarding suicide prevention and the appropriate management of suicidal Childrentimely manner to prevent or minimize harm to prisoners. The policies and procedures system shall incorporate include the input from the Division of Clinical Services. The policies and procedures shall address, at minimumfollowing processes: (i1) Intake screening for suicide risk Incident reporting, data collection, and other mental health concerns in a confidential environment by a qualified individual for the following: past or current suicidal ideation and/or attempts; prior mental health treatment; recent significant loss, such as the death of a family member or a close friend; history of mental health diagnosis or suicidal behavior by family members and/or close friends; and suicidal issues or mental health diagnosis during any prior confinement. (ii) Procedures for initiating and terminating precautions; (iii) Communication between direct care and mental health staff regarding Children on precautions, including a requirement that direct care staff notify mental health staff of any incident involving self-harm; (iv) Suicide data aggregation to capture sufficient information to formulate reliable risk assessment by at the QMHP; (v) Housing individual and supervision requirements, including minimal intervals of supervision system levels regarding prisoners with mental illness and documentation; (vi) Interdisciplinary reviews of all serious suicide attempts or completed suicides; (vii) Multiple levels of precautions, each with increasing levels of protection; (viii) Requirements for all annual in-service training, including annual mock drills for suicide attempts and competency-based instruction in the use of emergency equipment; (ix) Requirements for mortality and morbidity review; and (x) Requirements for regular assessment of the physical plant to determine and address any potential suicide risks. (b) Within 60 days of the Effective Date, JCMSC shall ensure security staff posts are equipped with readily available, safely secured, suicide cut-down tools. (c) After intake and admission, JCMSC shall ensure that, within 24 hours, any Child expressing suicidal intent or otherwise showing symptoms of suicide is assessed by a QMHP using an appropriate, formalized suicide risk assessment instrument. (d) JCMSC shall require direct care staff to immediately notify a QMHP any time a Child is placed on suicide precautions. Direct care staff shall provide the mental health professional with all relevant information related to the Child’s placement on suicide precautions. (e) JCMSC shall prohibit the routine use of isolation for Children on suicide precautions. Children on suicide precautions shall not be isolated unless specifically authorized by a QMHP. Any such isolation and its justification shall be thoroughly documented in the accompanying incident report, a copy of which shall be maintained in the Child’s file. (f) Within nine months of the Effective Date, the following measures shall be taken when placing a Child on suicide precautionsdevelopmental disabilities: (i) Any Child placed on suicide precautions shall be evaluated by a QMHP within two hours after being placed on suicide precautions. In the interim periodi. Incidents involving weapons, the Child shall remain on constant observation until the QMHP has assessed the Child. (ii) In this evaluation, the QMHP shall determine the extent of the risk of suicide, write any appropriate orders, and ensure that the Child is regularly monitored. (iii) A QMHP shall regularly, but no less than daily, reassess Children on suicide precautions to determine whether the level of precaution or supervision shall be raised or lowered, and shall record these reassessments in the Child’s medical chart. (iv) Only a QMHP may raise, lower, or terminate a Child’s suicide precaution level or status. (v) Following each daily assessment, a QMHP shall provide direct care staff with relevant information regarding a Child on suicide precautions that affects the direct care staff’s duties and responsibilities for supervising Children, including at least: known sources of stress for the potentially suicidal Children; the specific risks posed; and coping mechanisms or activities that may mitigate the risk of harm. (g) JCMSC shall ensure that Children who are removed from suicide precautions receive a follow up assessment by a QMHP while housed in the Facility. (h) All staff, including administrative, medical, and direct care staff or contractors, shall report all incidents of self-harm to the Administrator, or his or her designee, immediately upon discovery. (i) All suicide attempts shall be recorded in the classification system to ensure that intake staff is aware of past suicide attempts if a Child with a history of suicidal ideations or attempts is readmitted to the Facility. (j) Each month, the Administrator, or his or her designee, shall aggregate and analyze the data regarding self-harm, use of force, suicide, suicide attempts, and successful suicides. Monthly statistics or prisoner-on-prisoner assaults shall be assembled to allow assessment tracked and analyzed by the Jail on a quarterly basis. ii. All such incidents shall be reviewed as part of changes over timea regularly scheduled suicide prevention committee composed of Security, Nursing, Medical Staff, and Qualified Mental Health Staff. The AdministratorJail shall develop a corrective action plan where appropriate, and the Jail’s response shall be clearly documented. (2) Identification of at-risk prisoners in need of clinical or interdisciplinary review or treatment. (3) Identification of situations involving at-risk prisoners that require review by a interdisciplinary team and/or systemic review. (4) A hierarchy of interventions that corresponds to levels of risk. (5) Mechanisms to notify multidisciplinary teams and the risk management system of the efficacy of interventions. (6) Development and implementation of interventions that adequately respond appropriately to trends. j. Criteria and procedures for designating a prisoner as at-risk of suicide that ensure prisoners are identified in a timely manner (within four hours of admission, or his or her designeesooner if clinically indicated), shall review all data regarding self-harm and that confidential assessments are documented appropriately; k. An evaluation by a psychiatrist within 24 hours after it is reported of being identified by staff as at-risk for suicide or requiring crisis level care; l. The development and implementation of an adequate step-down level of observation whereby prisoners, upon evaluation and determination by a Qualified Mental Health Professional, may, where clinically appropriate, be released gradually from more restrictive levels of supervision to less restrictive levels for an appropriate period of time prior to their discharge from suicide precautions. Step-down placements should continue to be suicide-resistant and located in such a way as to provide full visibility to staff. The Jail shall ensure that prisoners are placed on a level of observation that is not unduly restrictive; m. Adequate out-of-cell time, including clinically appropriate structured and unstructured activities, for all at-risk prisoners; n. Daily and meaningful interactions with a Qualified Mental Health Staff for each at- risk prisoners; and o. Timely and adequate follow-up assessment and care for each prisoner discharged from the provisions Jail’s suicide precaution list. Specifically, each such prisoner shall receive follow-up within four hours of this Agreementdischarge and every day for five days following discharge, and policies and procedures, are followed during every incidentin accordance with a treatment plan developed by a Qualified Mental Health Professional.