Updated: 22 September 2013
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.
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.
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.
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:
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.
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?
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
For determining suicidal ideation and behaviour
For understanding suicidal intent
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