Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment

Transcription

1 Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Part One-Chapter One: Information You Need To Know Suicide is a leading cause of death among people who abuse alcohol and drugs, and compared to the general population, individuals treated for alcohol abuse or dependence are at about times greater risk to eventually die by suicide compared with the general population, and people who inject drugs are at about times greater risk for eventual suicide. a. 6; 10 c. 10; 14 b. 8; 12 d. 12: People with substance use disorders who are in treatment are at especially high risk of suicidal behavior for many reasons. All of the following are reasons that the authors include for this EXCEPT: a. They enter treatment at a point when their substance abuse is out of control, increasing a variety of risk factors for suicide b. They enter treatment when a number of co-occurring life crises may be happening c. They enter treatment at peaks in depressive symptoms d. Many have a co-occurring disorder, most commonly borderline, dependent, or avoidant personality disorder, which may increase suicide risk 3. Clients in substance abuse treatment should be screened for suicidal thoughts and behaviors routinely at intake and at specific points in the course of treatment, and counselors need to be direct with their clients, learning to ask such questions as, Are you thinking about killing yourself? 4. Good counselors are empathic, warm, and supportive, and trust their experience and intuition, and they need to use these skills when dealing with suicidal clients. Which of the following accurately describes how counselors should interact and work with suicidal clients? a. Counselors must aggressively question these clients on their thoughts and feelings related to suicide b. It is a good idea for counselors to ask every one of their clients about suicidality, not only for the clients sakes but also to help the counselor become more c. Clients should be involved in their own suicide prevention plan, and if they realize the therapist is truly alarmed about the possibility of suicide, they will likely be willing to work collaboratively on a plan d. All of the above

2 comfortable with the subject matter 5. Although clients who are seriously suicidal have likely already made up their mind that they want to die, being conflicted about wanting to live or die is typical of most other individuals who have suicidal thoughts and ideations. 6. The consensus panel believes that suicide contracts are a very important part of suicide intervention, and they should be used to ensure client safety and to help prevent future litigation whenever possible. 7. In working with suicidal clients, an empathic attitude can assist you in engaging and understanding people in a suicidal crisis, and a negative attitude can cause you to miss opportunities to offer hope and help or cause overreaction to people who are contemplating suicide. Each of the following is a correct statement about attitudes and behavioral issues to consider when working with the client EXCEPT: a. Expressions of suicidality indicate significant distress and must be taken seriously except in the circumstances where clients appear to be purposefully using reports of suicidal thoughts or plans to manipulate their treatment regimen b. Talking about a client s past suicidal behavior can provide information about triggers for suicidal behavior c. Suicidal people in substance abuse treatment settings often need additional services to ensure their safety d. Therapists should give clients who are at risk of suicide the telephone number of a suicide hotline, as it does no harm and could actually save a life 8. Alcohol s acute effects include disinhibition, intense focus on the current situation with little appreciation for consequences, and promoting depressed mood, all of which may increase risk for suicidal behavior, and acute alcohol intoxication is present in about percent of suicide attempts and suicides. a. 15 to 25 c. 25 to 35 b. 20 to 30 d. 30 to Intense, short-lived depression is prevalent among treatment-seeking people who abuse cocaine, methamphetamines, and alcohol, and even transient depression is a potent risk factor for suicidal behavior among people with substance use disorders. 10. A suicide attempt is a deliberate act of self-harm that does not result in death and that has at least some intent to die. When a client aims to make a suicide attempt and drafts a note or takes precautions against discovery at the time of an attempt, this is known as:

3 a. Suicidal ideation c. Suicidal preparation b. Suicide intention d. None of the above 11. Non suicidal self injury (NSSI) or deliberate self harm such as self mutilation or cutting is different from a suicide attempt or suicide because NSSI does not include suicidal intent. Additionally, although both NSSI and suicidal behaviors can lead to serious bodily injury, they usually do not exist in the same person. 12. Prior history of suicide attempts and family history of suicide are both risk factors for suicidal thoughts and behaviors. Which of the following are NOT additional factors mentioned by the authors? a. Severe substance use and a co-occurring disorder b. History of childhood abuse and rigid personality disorders c. Stressful life circumstances such as unemployment and low level of education, divorce, or legal difficulties d. Lack of spiritual guidance and a tendency to look at the negative side of life 13. Age, gender, and race are factors in suicide attempts and completions. Which of the following is an accurate statement about these factors? a. Adolescents and young adults are more likely to make nonfatal suicide attempts than older individuals, while older individuals are more likely to die by suicide b. Women are more likely to attempt suicide than men, but men are more likely to die, carry out more suicidal acts, and tend to show higher intent to die c. Whites and African Americans have higher rates of suicide than Native Americans, and males are at highest risk in all of racial groups except African Americans d. All of the above 14. The consensus panel formulated procedures for substance abuse counselors in addressing suicidal thoughts and behaviors, which they identified by the acronym GATE. Which of the following is NOT part of the GATE process? a. Gather information c. Access supervision and/or consultation b. Ask direct questions d. Extend the action 15. When the client answers yes to a screening question about suicide during the intake process, it is important to follow up with an open ended question such as, Can you tell me about the suicidal thoughts?, as this may provoke the client to give all the information that is needed.

4 16. Screening questions should be asked of all new clients when you note warning signs and any time you have a concern about suicide, as long as you can pinpoint the reason. In addition, routine monitoring of suicide risk throughout treatment should be a basic standard in all substance abuse treatment programs. 17. Mental health clinicians who deal with suicidal clients need to obtain regular supervision or consultation from other professionals. Circumstances that require immediate consultation include all of the following EXCEPT: a. Direct warning signs are evident such as suicidal communication, seeking access to a method, and making preparations b. Followup questions to suicide screening questions or indirect warning signs suggest that there is current risk c. The client with a history of suicidal thoughts or behavior experiences an acute stressful life event or a setback in treatment, even if there are no accompanying warning signs or other indications to suspect current risk for suicidal behavior d. Additional information from the referral source, family member, or medical record suggests that there is current risk 18. When working with a suicidal client, professionals should take responsible actions that cover the intensity and immediacy of the situation. The key factor in considering which action to take is: a. The history of suicide attempts c. The support system of the client including other mental health professionals and the client s family b. The seriousness of the risk involved d. None of the above 19. As part of the action plan, the clinician and client can create a safety card that the client can use in the event of a return of acute suicidality. Which of the following is NOT one of the minimum items to include on the card? a. A reminder to call 911 immediately when feeling suicidal b. The phone number and address of the nearest hospital emergency department c. The counselor s contact information and the number of a 24-hour crisis number d. Contact information for additional supportive individuals that the client may turn to when needed 20. Suicide prevention efforts are not one-time actions, and they should be ongoing because suicidal clients are vulnerable to a recurrence of risk. A team approach is also essential, as it requires you to follow up on referrals and coordinate with other providers in an ongoing manner.

5 21. Documentation of suicidality entails providing a written summary of any steps taken pertaining to GATE, along with a statement of conclusions that shows the rationale for the resultant plan. The summary is critical in coordinating care among professionals, establishing a solid medical and legal record, and: a. Formulating a treatment plan c. Increasing the clinician s general knowledge about suicidality b. Promoting client safety d. All of the above 22. In the gathering information phase of addressing suicidal thoughts and behaviors in substance abuse treatment, clinicians should try to understand the client s distress and point of view and mange the anxiety that arises when listening to clients. 23. As the counselor takes action by developing and implementing a treatment plan to address suicidality and coordinating the plan with other providers, which of the following is NOT one of the skills competencies that is recommended? a. Respond to positive screens and warning signs at intake, during treatment, and at transitions in care b. Participate in the development and implementation of a written assessment and treatment plan that addresses the client s risk for suicide and as well as substance abuse problems c. Apply principles of crisis management with actively suicidal clients d. Help clients accept and follow through on community referrals 24. It is important that clinicians honor and respect the beliefs, language, interpersonal styles, and behaviors of the cultures of individuals and families receiving services. In demonstrating cultural competence in working with suicidal clients, clinicians should: a. Recognize that clients need to present their dilemma in the context of their cultural norms b. Appreciate that different cultures use and represent suicide differently c. Ask questions and make referrals in a culturally sensitive manner d. All of the above 25. Part One: Chapter Two The consensus panel uses examples of various counseling approaches for people with substance use disorders who are experiencing suicidal thoughts and behaviors. These approaches include motivational interviewing, cognitive-behavioral therapy, and: a. Group psychotherapy c. Crisis intervention methods

6 b. Brief systemic therapy d. All of the above 26. In this chapter s case of Clayton, the 61 year old addict and alcoholic who has had recent suicidal thoughts, the three types of action demonstrated include each of the following EXCEPT: a. Removing the potential suicide weapon c. Involving the family in treatment b. Making a referral to a specialized community resource for further assessment d. Showing Clayton the relationship between substance abuse and suicidal behavior 27. In working with Clayton, the counselor is careful to acknowledge the physical pain that Clayton feels as a result of his liver disease, and then connects this pain to hopelessness and thoughts of suicide. 28. As the counselor probes, he begins to realize that Clayton has taken some steps that may indicate that he his preparing to die. The counselor thinks about calling in his supervisor to help work with Clayton on this serious issue, but decides against it because he is worried about damaging his relationship with Clayton. 29. As in treatment of substance abuse illnesses, family and significant others can be an important recovery resource. Some of the steps the counselor can take with family members of clients who may be suicidal include: a. Providing information about suicide, particularly dispelling misconceptions and providing accurate information c. Making suggestions for how to recognize the need for and provide emotional support to a person who might be feeling overwhelmed, and planning for how to access and possibly remove suicide methods, such as guns or pills, to reduce the likelihood of high-risk behaviors b. Increasing awareness of signs and symptoms that a loved one might be experiencing suicidal thoughts and/or behaviors, especially recognizing warning signs or a significant change in risk factors d. All of the above 30. The second case study outlines the story of Angela, who has also struggled with substance abuse and a suicide-related history. Which of the following is an accurate statement about Angela s difficulties? a. Angela has a long history of cocaine dependence with relatively brief periods of abstinence, and was hospitalized for cocaine dependence three times in the past two years, all of which has greatly complicated her borderline illness c. Angela s family has just notified her that they are not willing to have her return to their home and be with their children if there is a risk of drug relapse, and this, along with other environmental stressors and her illness indicate a high potential for

7 b. Angela has made two suicide attempts, the first one while in her thirties and a recent attempt, which precipitated her admission to the co-occurring disorders unit, and was made while coming off cocaine relapse and resultant crises, and possibly a return of suicidal thoughts d. Angela s family refuses to speak to Angela and her counselor, which negatively impacts the treatment plan 31. Clients with an active mental illness who relapse with alcohol or drugs are at significant risk for suicidal thoughts and behaviors. A relapse plan should be included in part of the treatment process, and elements of the plan should include all of the following EXCEPT: a. Develop a plan for safety in the event of relapse in individuals who you have reason to believe will be at risk for suicide upon relapse such as calling or coming to the clinic to see the counselor, calling the National Suicide Prevention Lifeline, or going to the hospital c. Use mental health interventions to aid in relapse prevention and encourage the client to be actively involved in a 12-Step or other supportive program b. Be aware of and address client speech that projects a suicidal result from relapse such as, If I relapse, that will be the end for me d. Make suggestions on how to talk to a loved one who is experiencing suicidal thoughts: what to say, and equally important, what not to say 32. Sometimes family members experience reactions toward suicidal clients that can be counterproductive and interfere with recovery. While some family members may want to withdraw from the clients, it is more beneficial if they can watch closely so that clients don t attempt again, and frequently talk to them about what they are feeling. 33. Leon is a young African American Iraq war veteran who is seen at his college counseling center after being rushed to the local hospital in a stuporous state. After initially speaking to Leon, his counselor is very concerned about his risk for suicide, especially since high rates of suicide and nonfatal suicidal behavior among Black males, particularly among youth, are cause for alarm. Research indicates that depending on the age, the suicide rate among Black males ranges from times higher than among Black females. a. One to six c. Three to eight b. Two to seven d. Four to nine 34. Leon is in need of an integrated treatment plan that must address his suicidal thoughts and behaviors, his drinking, his PTSD and depressive symptoms, and his disconnection or isolation from friends and family. Which of the following is NOT one of decisions that the counselor and his supervisor reach regarding Leon? a. Further evaluation for suicidality is important, including consultation with the emergency department where Leon was c. Intensive substance abuse treatment and case management are important over the next few weeks until Leon has stabilized,

8 seen this morning b. After the referral process, the counselor needs to continue to maintain contact with Leon to ensure that he accepts the referral and continues to participate in treatment and this can best be accomplished in the local VA treatment facility d. Although Leon s potential for suicide does not seem to be directly linked to his mental health symptoms and substance abuse, both issues need to be addressed in treatment 35. On most college campuses, mental health resources are limited, but it is important to develop a campus suicide prevention team. The team should create policies and procedures to support both voluntary and involuntary medical leave processes for at-risk students. 36. The case study of Rob illustrates how a counselor must intervene after a client has made the statement, I might be better off dead during a group session. Although the counselor realizes that clients who have relapsed to substance use are particularly susceptible to suicidal thinking and, potentially, to suicidal behavior, she is careful not to ask him about his current substance use at the beginning of the session because she does not want to alienate him. 37. Early in the session, the counselor needs to determine if Rob is minimizing his suicidality or if he really just made an impulsive statement in group to express his frustration. Once she is satisfied that there is little data to indicate current risk, she switches the focus to his impact on the group. 38. The break-up by a partner or a threat to a partner relationship is a common precipitant of suicide among vulnerable males with substance use disorders. In addition, studies show that men who abuse alcohol and/or drugs and are confronted with a break-up or threat to their relationship, particularly those showing a pattern of jealousy, domestic violence, legal difficulties, or prior suicidal behavior, may also be prone to committing homicide followed by suicide. 39. In some cases, a clinician may make the decision that a client is in such distress that he or she may need an immediate emergency room evaluation for suicide risk. Although the counselor should focus on eliciting as much cooperation from the client as possible to obtain the emergency evaluation, it should be clear that the need for such an evaluation is nonnegotiable.

9 40. While rates vary widely among tribes, American Indian and Alaska Native people, as a whole, have significantly higher rates of suicidal behavior than people of other races and ethnicities. Which of the following accurately describes suicidal behavior among these populations? a. Some of the variables that seem to affect this elevated suicide rate include high rates of substance abuse, major psychiatric illness and cultural alienation that can increase risk factors and lower protective factors for suicide c. Those who live on geographically isolated reservations may have limited educational and employment opportunities, and poor access to mental health or substance abuse services, which are factors in the high rates of suicide, particularly among American Indian males, ages b. A higher percentage of American Indian suicides are related to illicit drug use, compared with the general population d. All of the above 41. A hope box is a cognitive-behavioral intervention that is used to challenge suicidal clients to think of actions they can take other than suicide. This is accomplished by having them put something in the box that reminds them of people, events, activities, or times that have given them hope or that have prevented them from attempting suicide. Each of the following is an accurate statement about the use of the hope box EXCEPT: a. Clients should describe a time in their lives when they felt proud of themselves or something they did and put an item in the box to remind them of that time b. When they have a new item for the hope box, clients should explain to the counselor what it is, its significance, and in what way it makes them feel hopeful c. The clients should be encouraged to add one new item to the hope box on a regular basis, usually at least two to three times per week d. Clients should go to the help box when they feel hopeless or sad, an pick an item that can help them regain the positive feelings they have experienced in the past 42. Children tend to be a tangible marker of hope for clients, so it is important for clients to recognize and understand the impact of suicidal behavior on their children and the vulnerability and risk it can create. Similarly, it is critical to emphasize that in their role as parent, they are protector and nurturer and can provide safety, protection, and love. 43. Shame-based people often feel they don t deserve help so it is critical that the therapist works to convince people of their self-worth and value while working with them substance abuse and suicide related issues. 44. Crisis phone calls provide clients an opportunity to vent, and it is important that the crisis worker or professional does not argue with the client. Which of the following is NOT a true statement about these phone calls? a. The most critical thing to remember about crisis phone calls is to remain calm and c. It is important to remain on the phone long enough to engage the client, but if the call

10 patient throughout, as a calm, patient, and persistent orientation facilitates hope b. The crisis call is about effective regulation of emotions and problem solving goes on for too long, crisis diffusion will likely become ineffective d. Curing the crisis call, it is imperative to make sure that the client s method for suicide has been removed 45. Since in most states it is not permissible to violate confidentiality during a suicidal crisis, it is important to consider having the patient sign crisis management consent forms early in the treatment process, allowing the clinician to contact specific family members if and when a suicidal crisis emerges. 46. Part Two-Chapter One: The Administrative Response to Suicidality in Substance Abuse Treatment Settings People with substance use disorders who are in treatment are at especially elevated risk for a number of reasons including the fact that they enter treatment at a time when their substance abuse is out of control and when stress from marital, legal, job, health, or interpersonal problems is exceptionally high. Additionally, they may have other issues that increase their risk for suicide, including co-occurring mental health problems and substance-abuse effects such as substance-induced depression, anxiety, or psychosis. 47. There are twp pivotal areas regarding services for substance abuse clients exhibiting suicidal thoughts and behaviors. Each of the following is a correct statement about these services EXCEPT: a. The most critical role of the substance abuse treatment program is to provide security and sanctuary for its clients c. It is imperative that counselors have a consistent clinical protocol, supported by strong and effective agency policies and clinical supervision, that allows them to act effectively when clients who are suicidal are identified b. Treating suicidal thoughts and behaviors is often beyond the scope of services in substance abuse programs, but nevertheless, these programs have an obligation to recognize suicidal ideation and behaviors, to address those symptoms, and to assist clients in getting the help they need d. Service providers must recognize suicidality when it appears, have policies and procedures for addressing suicidal thoughts and behaviors, and ensure that treatment for the substance use disorder is not lost in the suicidal crisis 48. Proactively addressing suicidality in substance abuse treatment programs is advantageous from a number of perspectives. It saves lives, keeps clients from dropping out of treatment, and leads to positive programmatic efforts for the program.

11 49. Level One program involvement in suicide prevention and interventions includes which of the following? a. The program has the capability to continue substance abuse treatment services for clients with suicidal thoughts and behaviors while monitoring those clients for suicidal symptoms and an exacerbation of psychiatric symptoms c. The program has at least one staff member who is specifically skilled in providing suicide prevention and intervention services and in providing clinical supervision to other program staff working with clients with suicidal thoughts and behaviors b. The program s clinical staff recognize that clients in substance abuse treatment are at increased risk for suicidal thoughts and behaviors d. The program has the capability to continue substance abuse treatment services for clients with suicidal thoughts and behaviors while monitoring those clients for suicidal symptoms and an exacerbation of psychiatric symptoms 50. Level Three programs have the ability to provide services to acutely suicidal clients that allow the client to continue receiving substance abuse treatment while in the midst of a suicidal crisis and are most commonly implemented on an outpatient or residential basis. 51. Clinical supervisors and senior counselors play a critical role in responding to clients suicidal thoughts and behaviors in substance abuse treatment settings, and they are typically the go-to staff when a counselor suspects that a client is suicidal. Which of the following most accurately describes their role in supporting programming for clients with suicidal thoughts and behaviors? a. They work to create an environment that fosters rapid identification of and quality services to clients with suicidal thoughts and behavior b. They inspire others in the organization to become aware of and committed to reducing the incidence of clients suicidal thoughts and behaviors in the program c. They communicate a vision of how the program can benefit by providing services to clients who are suicidal d. They make clinical decisions that affect client care and the overall functioning of the clinical services component of a substance abuse treatment agency 52. The legal issues regarding suicidality for substance abuse programs are primarily related to standards of care, maintaining appropriate confidentiality, and obtaining informed consent. Which of the following is NOT one of the three common malpractice failures for work with suicidal clients? a. Failure in assessment c. Failure in followup b. Failure in treatment d. Failure to safeguard

12 53. There is an expectation that a practitioner in the mental health or substance abuse field should be able to anticipate the potential suicidal risk that a client might experience. This is known as the counselor s in regards to suicide. a. Forecastability c. Perceivability b. Predictability d. Forseeability 54. Maintaining safety for clients with suicidal thoughts and behaviors means making reasonable efforts to promote their immediate and long-term well-being. Which of the following is NOT a true statement about these efforts? a. Since there is little evidence that no-suicide contracts are effective in preventing suicide attempts and deaths, a more contemporary approach to client contracting called a Commitment to Healing Agreement is recommended b. Commitment agreements can support and enhance engagement with the client, possibly lowering risk, by conveying a message of collaboration c. Every agency should have a written policy and procedure for removing weapons that might be used to cause bodily harm or death d. Program policies and procedures to match the level on this continuum with the applicable safety needs and concerns for clients with suicidal thoughts and behaviors should be established 55. Program policies should be clear that simply acknowledging suicidal thoughts or behaviors is not sufficient cause for violating a client s rights to confidentiality by contacting family members, friends, or another treatment agency without first obtaining a consent for release of information. 56. Informed consent for substance abuse treatment is an ongoing process in which the client is an active participant in defining what treatment methods and approaches will be undertaken, the expected outcomes of that intervention, the risks and expected efficacy inherent in the care, and: a. Specific factors that will lead to c. Ethical considerations in treatment termination of treatment b. Alternative treatments that might be used d. None of the above 57. Clients cannot be discharged from substance abuse treatment simply because they are discovered to have suicidal thoughts and behaviors. It is unethical and may be illegal to discharge a client in clear distress without guaranteed and subsequently confirmed followup with an appropriate provider. 58. Chapter Two: Building a Suicide Prevention and Intervention Capable Agency

13 Substance abuse treatment programs need to work hard to become Level Two programs so that clients can remain in substance abuse treatment even though co-occurring problems like suicidality are present. The accrued benefits of becoming a Level 2 substance abuse treatment program include all of the following EXCEPT: a. The Level 2 substance abuse program can be responsive to a variety of crisis states related to suicide that might otherwise disrupt functioning for the client who is suicidal, other clients, and program staff b. The responsiveness of the program to issues of suicidality may increase the capacity of the program to respond to other client crises that present in the treatment program c. These treatment program has formalized referral relationships with programs capable of addressing the needs of clients with suicidal thoughts and behaviors and specific protocols for how a referral is made d. Being a Level 2 substance abuse treatment program means staff have additional skills and diversity that can benefit the overall treatment program 59. Historically, organizational change organizational change in substance abuse treatment settings has tended to occur as a result of pressure from the outside: mandates from funding resources, rules and regulations from state agencies, or standards from accrediting bodies. But more and more, as programs and management become increasingly skilled and sophisticated, the perception of organizational assessment and change as an ongoing, internal, data-based, quality improvement-focused process has evolved. 60. In order to get a snapshot of an organization s current ability to address suicidal thoughts and behaviors, which of the following questions must be asked? a. How are clients with suicidal thoughts and behaviors currently identified in the treatment population? b. What might be done to identify those clients whose suicidality is under the program radar? c. How do suicidal thoughts and behaviors among clients in the program affect treatment in the program? d. Are the client s suicidal thoughts and behaviors and the organization s response (including consultations) integrated as a clinical issue into the treatment plan? 61. Organizations should consider what other programs in the area are already doing and the efforts they made to arrive at their current level of competence in meeting the needs of clients who are suicidal, but must never duplicate services or create overlapping environments. 62. In organizing a team or work group to become a Level Two program for addressing suicidality, each of the following should be considered EXCEPT: a. Obtain the commitment of the chief executive officer of the agency to c. Choose two people to lead the effort so that al least one will always be available,

14 articulate the vision for implementation throughout the agency, with all stakeholders, and to the public b. Convene an implementation work group consisting of key leaders from different stakeholder groups: consumer leaders, family leaders, team leaders, clinical leaders, and program and administrative leaders and make sure they have the backing of senior administration and the respect of clinical staff d. Identify the program oversight committee to which the work group will report its findings, recommendations, strategic plans, and modifications 63. The organizational work group should include some issues specific to suicide in the planning process and should be able to: a. Arrive at specific targets for change c. Be willing to make organizational changes in large chunks b. Have a general plan for strengthening the d. None of the above substance abuse treatment program 64. It is very unlikely that existing programs already have policy and programmatic elements that will translate to suicidal crises or will help in the care of clients who acknowledge suicidal thoughts and behaviors, so it is usually necessary to implement entirely new policies. 65. In establishing new program policies such as determining clinical staff training and competence or special considerations for observing clients in a residential facility, the authors recommend that policies include each of the following EXCEPT: a. The topic c. Procedures b. A policy statement d. Goals 66. In training professionals to develop skills to work with clients with suicidal thoughts and behaviors, which of the following is an important consideration? a. A single full day session is the preferred format for initial training b. Trainers should understand the needs and limits of practice of substance abuse counselors and not offer skills that most counselors are not prepared to use c. Training should focus on introducing new skills sets for working with suicidal clients d. All of the above 67. Most clients expressing suicidal thoughts and behaviors are likely in an acute crisis and warrant crisis management by trained professionals. Even though the situation is crisis driven, it should be managed adequately in a matter-of-fact, methodical manner.

15 68. In addition to active suicidality on the part of the client, the consensus panel reports that other types of crises that are likely to occur in a substance abuse treatment program include all of the following EXCEPT: a. Backsliding and relapse c. Severe injuries or health crises with clients b. Threats of violence toward others d. Death of a client 69. The goal of agency policy for managing clients who are acutely suicidal is to give enough direction to clinicians and clinical supervisors to guide them in crisis situations, while at the same time attempting to anticipate every kind of crisis situation related to suicidal thoughts and behaviors that may occur. 70. The aftermath of suicide must be dealt with for all survivors including family, friends, fellow students, teachers, coworkers, supervisors, fellow patients, counselors, physicians, or any other people who knew the individual and may be affected by the suicide. This is known as: a. Debriefing c. Postvention b. Followthrough d. None of the above 71. Because of the elevated risk of suicidality among clients in substance abuse treatment, it is important for programs to have a clear policy statement affirming that all clients entering substance abuse treatment are screened for suicidal thoughts and behaviors. Indirect warnings that should be assessed include all of the following EXCEPT: a. Ideation and purposelessness c. Hopelessness and feeling trapped b. Anxiety and withdrawal d. Aggression and impulsivity 72. Clinical supervisors should make sure that all clinical staff are aware of the policy and that the policy procedures are followed. They should also conduct a periodic review of all staff to ensure that they are current on suicide policy in the agency. 73. An example of a tool for rating a client s current suicidal thoughts and behaviors by evaluating the areas of suicidal ideation, behavior, general mood, and cognition/perception is called: a. The 24-Hour Suicide Assessment Tool c. Beck Scale for Suicide Risk b. Scale for Suicide Ideation d. Self Monitoring Suicide Ideation Scale 74. As a program becomes more experienced in working with clients with suicidal thoughts and behaviors, it can be expected that a more consistent repertoire of responses to suicidality will evolve, and responses to clients will become more stereotyped and efficient.

16 75. It is important for counselors and program administrators to understand that program responsibilities do not end with a client s referral to another agency. Which of the following does NOT correctly demonstrate this point? a. The counselor and administrators continue to have a responsibility to ensure that the client follows through on the referral, that the referring agency accepts the client for treatment, and that treatment is actually implemented b. Clinicians have an ethical responsibility to ensure that the client s substance abuse treatment needs do not get lost in the process of referral c. The program needs to have a standardized system of documenting followup, just as it does with documentation of clinical interventions undertaken by the counseling staff d. Clinicians must always check in with the client and significant others to ensure that care is progressing