Therese is 33 year old woman who lives in an apartment with 24 hour support. She has a behavior support plan that lists one of the goals as diminishing self injurious behaviors. The plan states that these behaviors usually involve cutting herself with sharp objects or other self- harm and efforts should be made to assure Therese’s safety when she displays self injury. Preventatively, staff are to regularly reflect her feelings for her and help her gain insight into what bothers her. 

1. When you arrive for your shift, you notice that there are broken CD’s in Therese’s room and she has scratches with some slight bleeding at her wrists. What is your first course of action?

 Notify your supervisor of the incident and ask for the next steps to take
 Fill out an incident report including a detailed description of the wounds
 Ask Therese to see the wounds to make sure they are not serious and to apply necessary treatment
 pick up the broken CD’s and remove any other sharp objects

2. During your shift, Therese receives a phone call during which you hear her yelling. You hear her hang up the phone then go into the bathroom, slamming the door loudly. What should you do?

 Wait five minutes then check on Therese in the bathroom.
 Knock on the bathroom door and ask Therese if she is okay.
 Call your supervisor and seek advice.
 Consult with other staff and Therese’s record to see if Therese has ever harmed herself in the bathroom in the past.

3. Therese gets frustrated in the kitchen one night and manages to break a glass and cut her wrist such that she requires medical attention. What are your next steps?

 Provide appropriate immediate first aid, seek out appropriate medical treatment taking necessary information, make arrangements (following her behavior/treatment plan) to evaluate her current intent to continue to harm herself
 Begin talking to Therese about what led her to harm herself, notify your supervisor of the incident, fill out an incident report
 Go through the apartment and put away all sharps, document the incident in the medical record and in an incident report, call the ambulance
 Call the ambulance and your supervisor . Pull the necessary information to send with her on the ambulance. Refuse to talk to Therese in the event that she cut herself in order to gain attention. Clean up the glass in the kitchen. Document the incident both in the medical record and on an incident report.

4. At one point after scratching herself repeatedly with a safety pin, Therese tells you that she has had a bad day and that she is mad at everyone. You have determined that Therese has not been injured significantly and that other sharps have been secured. What is your response to Therese?

 Leave her alone until she tells you she is ready to talk. It is more important to document well.
 Let her know that her care and want to help her understand and cope better.
 Let her know that she is likely to endanger her placement in the community if she continues these behaviors.
 Look for opportunities to reflect how she is feeling and get her to tell you more about what upset her.

5. Therese is repeatedly stating that she feels like harming herself. She has tried to run into the street in front of cars today and has broken a window seeking glass to cut herself with. Your supervisor has asked that you call the police and have her transported to the local emergency room to have her evaluated for suicidal ideation. After calling the police, what is your next step?

 Gather her emergency contacts and medication list. Gather up clothing for a few days at the hospital.
 Determine which staff can go with her to the emergency room and begin documenting the incident in records and incident report
 Begin calling Therese’s emergency contacts to notify them that she is being admitted to the hospital
 Gather necessary information for the evaluation including info in a) and current and historic behavior information.