Assignment:
As a counselor, being competent and familiar with risk assessment is essential to the therapeutic process; both in giving a client's context related to treatment of their psychological symptoms and in helping the clinician prioritize short- and long-term treatment outcomes. This assignment contains three parts, as identified, and described below. Please complete each part with a combined essay of 950-1,700 words.
Part 1: Create a (300-700-words) scenario that involves a client that you believe requires a risk assessment. The risk should be related to either risk of harm to self or others. Need Assignment Help?
Part 2: Describe (150-250-words) specific behaviors that lead you to create a risk assessment. Identify specifically what the client did say or exhibit to warrant a risk assessment.
Part 3: Describe (500-750-words) how you would assess the client. Include the following in your discussion:
- Identify at least two evidence-based tools to help assess the client for risk. Describe the rationale behind the tools you chose.
- Describe the protocol you would follow based on the client's answers to the risk assessment, including documentation.
Include at least three scholarly references in your paper.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment meets the following NASAC Standards:
24) Establish rapport, including management of crisis situations and determination of need for additional professional assistance.
26) Screen for alcohol and other drug toxicity, withdrawal symptoms, aggression or danger to others, and potential for self-inflicted harm or suicide.
70) Describe and document treatment process, progress, and outcome.
87) Apply crisis management skills.
94) Describe and summarize client behavior within the group for the purpose of documenting the client's progress and identifying needs/issues that may require modification of the treatment plan.
Risk Assessment Essay:
Part 1: Scenario
I am currently working with a 28 year old African American male client named Darius, who was referred to counseling by his primary care physician after reporting increased anxiety, irritability, and difficulty managing stress. During our first session, Darius presented as guarded but cooperative. He maintained minimal eye contact and appeared physically tense, frequently tapping his foot and clenching his jaw. He shared that he works full time as a warehouse supervisor and is the primary financial provider for his mother and younger sister. Over the past two months, he has been experiencing escalating work stress due to mandatory overtime, staff shortages, and pressure from upper management.
As the session progressed, Darius disclosed that he has been "on edge all the time" and feels like he is "carrying everything alone." He described chronic sleep disturbances, including waking up multiple times throughout the night and experiencing nightmares related to past community violence he witnessed as a teenager. Although he denied a formal trauma diagnosis, he acknowledged that he has "never really dealt with" those experiences.
When discussing his coping strategies, Darius admitted that he has been drinking more heavily on weekends-up to a fifth of liquor between Friday and Sunday-to "numb out" and "get a break from everything." He denied daily alcohol use but acknowledged that his drinking has increased significantly over the past month. He also reported withdrawing from friends, skipping church (which he previously attended weekly), and isolating in his room after work.
The turning point in the session occurred when Darius stated, "Sometimes I get so overwhelmed I just want to disappear." When I gently asked him to elaborate, he hesitated before saying, "I don't want to hurt myself, but I've been thinking that people would be better off without me." He then shared that last week, after an argument with his supervisor, he drove home "recklessly fast" and thought, "If something happened to me right now, maybe it wouldn't be the worst thing."
Although he denied having a specific plan or intent to harm himself, he admitted that these thoughts have been occurring more frequently. He also reported feeling increasingly angry and irritable, stating, "I'm scared I might snap on somebody at work one day." He clarified that he has not threatened anyone, but he worries that his temper is becoming harder to control.
Throughout the session, Darius's affect was constricted, and he appeared emotionally exhausted. He expressed deep feelings of failure, guilt about not being able to "hold everything together," and hopelessness about his future. He also described cultural pressures to appear strong and self reliant, noting that "Black men don't get to break down."
Given the presence of passive suicidal ideation, increased alcohol use, emotional dysregulation, and concerns about potential aggression, a formal risk assessment is necessary. As the counselor, it is my responsibility to evaluate both self harm and potential harm to others, determine the level of risk, and implement appropriate interventions to ensure Darius's safety and well being.
Part 2: Behaviors Warranting a Risk
Several specific behaviors and statements made by Darius clearly indicate the need for a comprehensive risk assessment. First, he expressed passive suicidal ideation through statements such as "I just want to disappear" and "People would be better off without me." These comments reflect hopelessness and perceived burdensomeness, both of which are well established predictors of suicide risk (Joiner, 2005). Additionally, his admission that he drove home "recklessly fast" while thinking that "maybe it wouldn't be the worst thing" suggests a form of indirect self harm or diminished concern for his own safety.
Darius also reported increased alcohol use as a coping mechanism, which can heighten impulsivity and lower inhibitions-factors associated with elevated suicide and aggression risk (American Psychiatric Association, 2022). His growing irritability and fear that he might "snap on somebody at work" indicate emotional dysregulation and potential risk of harm to others, even if he has not made explicit threats.
His physical presentation-tension, agitation, and withdrawal-combined with functional decline (social isolation, disrupted sleep, increased substance use) further supports the need for a structured risk assessment. These behaviors collectively signal that Darius is struggling to regulate his emotions and may be at risk for self harm or impulsive aggression without appropriate intervention.
Part 3: Assessment Process
Evidence Based Tools and Rationale
To assess Darius's level of risk, I would use two evidence based tools: the Columbia Suicide Severity Rating Scale (C SSRS) and the Historical Clinical Risk Management 20, Version 3 (HCR 20 V3).
The C SSRS is a widely validated tool used to assess the severity of suicidal ideation, intent, planning, and past behaviors (Posner et al., 2011). It is appropriate for Darius because he has expressed passive suicidal thoughts, engaged in potentially risky behavior (reckless driving), and is experiencing significant psychosocial stressors. The C SSRS allows for a structured evaluation of whether his thoughts include intent, planning, or preparatory actions, which is essential for determining immediate safety needs.
The HCR 20 V3 is an evidence based structured professional judgment tool used to assess risk of violence toward others (Douglas et al., 2014). Given Darius's increased irritability, emotional dysregulation, and fear that he may "snap," this tool helps evaluate historical factors (e.g., past trauma), clinical factors (e.g., substance use, emotional instability), and risk management factors (e.g., stress, coping resources). The HCR 20 V3 is particularly useful because it integrates clinical judgment with structured assessment, making it appropriate for clients with complex emotional and behavioral presentations.
Using both tools ensures a comprehensive evaluation of risk to self and others, aligning with NASAC Standards 24, 26, and 87.
Assessment Protocol and Documentation
1. Establish Immediate Safety I would begin by administering the C SSRS to determine the presence of suicidal ideation, intent, plan, and behaviors. If Darius endorses intent or a plan, I would classify him as high risk and follow emergency procedures, including contacting crisis services or arranging hospitalization.
2. Assess Risk of Harm to Others Using the HCR 20 V3, I would evaluate his irritability, impulsivity, substance use, and situational stressors. Although he has not made threats, his fear of losing control warrants structured assessment.
3. Develop a Safety Plan If Darius is not at imminent risk, I would collaboratively create a Stanley Brown Safety Plan, which includes:
- Identifying warning signs
- Internal coping strategies
- Social supports
- Crisis resources
- Means restriction strategies (e.g., avoiding driving while distressed, limiting alcohol access)
Safety planning is an evidence based intervention shown to reduce suicidal behavior (Stanley & Brown, 2012).
4. Address Cultural Considerations As an African American man, Darius may experience cultural stigma around mental health, pressure to appear strong, and mistrust of systems. I would validate these experiences and ensure the assessment process is culturally responsive and collaborative.
5. Documentation must be objective, detailed, and clinically defensible. I would record:
- Verbatim statements related to risk
- C SSRS and HCR 20 V3 results
- My clinical judgment and rationale
- Safety planning steps
- Referrals and follow up plan
- Any consultation with supervisors or crisis teams
This aligns with NASAC Standard 70 regarding documentation of treatment processes and outcomes.
6. Follow Up and Monitoring I would schedule weekly sessions and reassess risk regularly. Treatment would focus on emotional regulation, stress management, trauma informed care, and reducing alcohol use. If needed, I would refer him for psychiatric evaluation.
References:
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Douglas, K. S., Hart, S. D., Webster, C. D., & Belfrage, H. (2014). HCR 20 V3: Assessing risk for violence. Mental Health, Law, and Policy Institute.
Joiner, T. (2005). Why people die by suicide. Harvard University Press.
Posner, K., Brown, G. K., Stanley, B., et al. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings. American Journal of Psychiatry, 168(12), 1266-1277.
Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264.