Using the Substance Abuse and Choices Scale (SACS) and suicide screening/assessment tools

Updated: 22 September 2013

What's Important To Us

Children and young people can find it difficult to talk about how they are feeling and coping with life challenges. Developing a warm and trusting relationship with a child or young person will ensure that these tools gather the right information to meet the needs of the child or young person.

This key information provides guidance on the use of the Substance Abuse and Choices Scale (SACS), the Kessler and Suicide screen, and the suicide risk assessment.

The tools work in conjunction with other available information and are used to inform the child or young person's assessment.

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The Substance Abuse and Choices Scale and Kessler and Suicide screens

Substances and Choices Scale (SACS): is an instrument for assessing and monitoring the pattern of use and impact of alcohol and drugs in children and young people

Kessler screen: gives an indication of current psychological distress and possible mental health issues.

Suicide screen: helps to identify whether the child or young person has active thoughts about suicide. The screen is not a risk level indicator, but it helps to determine the necessity of a more thorough assessment of acute suicide risk.

Together, the scale and screens are commonly referred to as SKS.

Resource:

Substances and Choices Scale (SACS)

 

Suicide risk assessment

The suicide risk assessment is a measure of acute suicide risk and isshould be used whenever there are concerns that a child or young person is considering suicide. The focus is on suicidal ideation and planning, but the assessment also considers current mental health, the presence of stressors and protective resources.

Points of caution when using these tools

The Substance Abuse and Choices Scale, Kessler and Suicide screens and suicide risk assessment should be used with caution with children under 12 and with children or young people of low level intellectual ability. In these situations professional judgment is required to determine whether the child or young person is able to understand and answer questions presented in the tools. The use of other appropriately worded questions may be more appropriate than relying on the tools. Staff members from the Towards Wellbeing programme are able to assist with determining the best way of obtaining the necessary information (including provision of appropriate questions).

Given the difficulties in determining suicide risk information and assessing suicide risk in these populations, lowering the threshold for specialist assessment referral would be warranted.

The validity of responses is further dependent on:

  • the rapport between the child or young person and their social worker, and the motivation of the child or young person to respond openly and honestly to all questions (e.g. an uncommunicative male may under-report distress because they believe that doing so is a sign of weakness)
  • the child or young person's intellectual ability and their comprehension of the questions
  • the child or young person's emotional maturity and their insight into and ability to articulate, their own emotions and feelings
  • whether the tools have been used recently with the child or young person. If they have recently completed the scale or screens they are more likely to give less thought to their responses. Consider using the prompt questions in the following section
  • whether the child or young person is acutely distressed. If this is the case they may not be able to concentrate on the content of the questions or engage sufficiently with the person administering them. In these situations acknowledge the child or young person's observable distress (real or potential), and consider the use of prompt questions in the following section.

Behavioural indicators, third party information (from parents/caregivers, other family/whānau and other people who know and work closely with the child or young person must also be taken into consideration.

When the child or young person is acutely distressed or tools have recently been used

These questions are best introduced as part of a broader discussion regarding how the child or young person is handling a potentially stressful situation (such as a significant change in circumstances, period of transition, incarceration, loss, etc). A discussion on how to best manage their current distress/situation should follow.

If there are any serious concerns regarding possible suicidal ideation, then specific questions from the suicide risk assessment regarding planning and intent must be asked.

Screening for level of distress
Ask the child or young person to rate their general level of distress (e.g. on a scale of 1 to 10 - 1 being terrible, 10 being great - how are you doing/feeling right now?)

Screening for thoughts of self-harm or suicide
Are you having any thoughts about harming/hurting yourself?
Are you having any thoughts about suicide/killing yourself?

Important information gathering questions with children and young people

Rather than ask closed questions think about how you might turn these into scaling questions and use the response to explore why they scaled it there and when it might have been different

For presence of psychological distress and risk factors

  • How have you been getting on with your friends and family/whānau?
  • Has anything happened recently which has been upsetting to you or your family/whānau?
  • Have you recently had a problem with feeling sad, having trouble sleeping, not feeling hungry, losing your temper easily or feeling tired all of the time?
  • Have you been using drugs or alcohol recently?

For determining suicidal ideation and behaviour

  • Have you ever felt so upset that you wished you were dead?
  • Have you ever knowingly done something so dangerous that you could have gotten hurt or killed?
  • Have you ever hurt yourself, or tried to hurt yourself?
  • Have you thought, or tried, to kill yourself?

For understanding suicidal intent

  • Did you tell anyone that you wanted to die or were thinking about killing yourself?
  • Did you do anything to prepare for killing yourself?
  • Was anyone near you or with you when you tried to kill yourself?
  • What did you think would happen when you … (describe suicidal action e.g. took the pills/jumped out the window)?
  • After you tried to kill yourself, did you still want to die, or did you want to live?
  • What would happen if you died? What would that be like?

Gathering information from parents/caregivers

Obtaining information from other sources, especially parents/caregivers, is important. However, caution should be exercised as parents/caregivers may have difficulty acknowledging their young person's suicidal tendencies, thereby minimising the actual risk perceived.

Questions for parents/caregivers

  • What exactly happened (step by step) on the day that your child spoke of wanting to hurt themselves?
  • How did you find out that your child was thinking about or trying to hurt themselves?
  • What were you doing when your child was thinking about or trying to hurt themselves?
  • What happened after your child thought about/tried to hurt themselves?