4: Multiple Method Risk Assessment - MIRECC / CoE
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4: Multiple Method Risk Assessment

Screening and Evaluation » Evaluation
4: Multiple Method Risk Assessment

When evaluating suicide risk, we suggest against the use of a single instrument or method (e.g., structured clinical interview, self-report measures, or predictive analytic models).

Strength:

Weak against

Category:

ReviewedAmended

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Performing suicide risk evaluation is a critical function for clinicians, especially those working in mental health, primary care, and emergency department settings. Though there are many assessment tools and methods available, no single approach is able to address all of the specific needs and circumstances applicable in any given clinical encounter. Hence, risk assessment is best performed using a combination of methods, to include a clinical interview that can be flexibly applied to clinical circumstances, but then augmented with valid and reliable self-report measures.

The combination yields a multifaceted approach to risk assessment, affording multiple opportunities and avenues for identifying thoughts of suicide, and combining the advantages of a flexible and individualized clinical interview with the uniformity and quantifiable data of structed assessment tools. Risk assessment may be further augmented by collateral information from a reliable informant (e.g., family and/or friends familiar with the individual's history).

Training Resources

This section includes links to recommended training resources about multiple method risk assessment.

From the American Psychiatry Association Quick Reference Guide (p. 282 & 283)
Click/Tap for smaller image Image of page 282 from the Quick Reference Guide. Download  full document below.
Page 282: 2. Specifically inquire about suicidal thoughts, plans and behaviors (continued).
Click/Tap for smaller image Image of page 283 from the Quick Reference Guide. Download  full document below.
Page 283: Table 2. Questions That May Be Helpful in Inquiring About Specific Aspectes of Suicidal Thoughts, Plans, and Behaviors
Learn about the Therapeutic Risk Management model for supporting patients at risk for suicide
VISN19 Therapeutic Risk Management (TRM) of the Suicidal Patient
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Webinars

This section includes links to recommended webinars about multiple method risk assessment.

CPG Webinar Why Suicide Risk Assessment Matters Presented by Drs. Bridget Matarazzo & Hal Wortzel
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Books

This section includes links to recommended books about multiple method risk assessment.

The American Psychiatric Association Publishing Textbook of Suicide Risk Assessment and Management, Third Edition
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Articles

This section includes links to recommended articles about multiple method risk assessment.

Brown, G.K . A Review of Suicide Assessment Measures for Intervention Research with Adults and Older Adults. https://www.sprc.org/resources-programs/review-suicide-assessment-measures-intervention-research-adults-older-adults
Grant, C. L., & Lusk, J. L. (2015). A multidisciplinary approach to therapeutic risk management of the suicidal patient. Journal of multidisciplinary healthcare, 8. 291-298. https://doi.org/10.2147/JMDH.S50529
Nazem, S., Matarazzo, B., & Wortzel, H. (2017). Suicide Risk Assessment and Management: Tips for Improving Care and Outcomes. World psychiatry: official journal of the World Psychiatric Association (WPA), 16(1). 28-29. https://doi.org/10.1002/wps.20396
Oquendo, M. A., & Bernanke, J. A. Suicide risk assessment: tools and challenges. Psychiatric Times, Vol 36. Issue 1. https://www.psychiatrictimes.com/view/suicide-risk-assessment-and-management-tips-improving-care-and-outcomes
Petrik, M. L., Billera, M., Kaplan, Y., Matarazzo, B., & Wortzel, H. (2015). Balancing patient care and confidentiality: considerations in obtaining collateral information. Journal of psychiatric practice, 21(3). 220-224. https://doi.org/10.1097/PRA.0000000000000072
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Podcasts

This section includes links to recommended podcasts about multiple method risk assessment.

Rocky Mountain MIRECC Short Takes on Suicide Prevention
Suicide Risk Assessment: A new look at an old tool and why it remains essential. (with Dr. Peter Gutierrez)
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