Table 1 Recommended changes to intake and case management forms
Intake form | Case management form |
|---|---|
Add question to assess current living arrangements/housing status | Add question: “Do you attend traditional ceremonies?” |
Gender: Add answer choice of “Other: ________” | Add question to learn how client prefers to get information about suicide prevention and resources |
Add question to learn if client is a parent or caregiver | Add answer choice of “meth” to method(s) used options |
Education: Add school client attends | Add question to learn if there is a peer or mentor the person feels comfortable talking with. Collect name and contact information of that person. |
Type of self-harming behavior: Add answer choice of “opioid use”, “experimental drug use”, “substance use” | What was the reason for your act: Add answer choices of: “past experiences of trauma (unreported)”, “past experiences of inflicting trauma or pain on someone else”, “guilt from previous choices”, “meth”, “break-up” |
Method: Add answer choice of “train”, remove answer choice of “jump” | Add question: “How are you administering these drugs?” with answer choices: “pills”, “injection”, and “smoking” |
Add question to learn if there was a triggering event preceding the attempt | Add question “Did you blackout?” to section assessing binge substance use |
Add name of person who made report. Add question about how the reporter learned about CL | Modify referral agencies listed to Fort Peck Reservation services |
Add questions to assess past meth and inhalant use | |
Add question: “Do you know anyone who has attempted suicide in your lifetime?” If yes, “How many people?” and “What was the relationship?” | |
Add prompts of: “How many people?” and “What was the relationship?” to the question “Do you know anyone who has died by suicide in your lifetime?” | |
Add question: “Have you lost a loved one in the past 6 months?” | |
Change question from “Have you ever experienced domestic violence (verbal or physical abuse)? to “Have you ever been hit, kicked, slapped, or punched?” | |
Add question: “Have you ever been the perpetrator of abuse?” | |
Add question: “Have you ever seen your parent be slapped, hit, kicked, or punched? If yes, how many times?” | |
Add questions about sexual activity, consent, rape, and miscarriage |