The Key Assumptions Check is a simple way to begin an intelligence analysis or research project. Despite its simplicity, it is also extremely powerful, because it allows us to question the underlying assumptions that we make influencing our decisions and thought processes.
Because of confirmation bias, we often exclude information from our worldview or from a decision that does not support a decision, while including information that does support her preconceptions.
The steps to performing a Key Assumptions Check are as follows:
Come up with a “face valid” analysis. This is a final answer that you will work backwards to get to your assumptions
List all the stated and unstated assumptions that must be true for this analysis to be valid. This may take some brainstorming; having other people to help you with this can be useful
Consider alternatives. Ask what would need to be possible for your assumptions to be invalid. Does any of this make sense?
Remove any assumptions that are not 100% necessarily for your analysis to be true.
This process will allow you to examine your spoken and unspoken assumptions. If you find that many of your assumptions are not relevant to your face-valid analysis, or the assumptions are in fact not supported by existing data, then you would be wise to change your analysis.
New! This article has been updated August 9, 2016 to include more information about the scoring and links to useful tools to accompany.
The Nurses’ Global Assessment of Suicide Risk (NGASR) is a tool that nurses can utilize to assess for suicide risk in a clinical, inpatient environment. The tool was originally developed to assist nurses in a UK hospital where suicide risk assessments were originally completed by an intake nurse, without any backup or support to ensure they were done properly.
Suicide risk assessment takes a lot of experience and practice, and the NGASR is one tool that can provide assistance while nurses develop these critical skills.
Indicators of Suicide Risk
The NGASR explored the following indicators. In brackets is the point value if the item is present, which allows you to assess the suicide risk using the score found below.
Feelings of hopelessness (3)
Recent stressful events (1)
Persecutory hallucinations (1)
Withdrawal from social interactions (1)
Verbalization of suicidal intent (1)
Evidence of a specific plan (6)
Family history of mental illness or suicide (1)
Recent bereavement or relationship breakdown (3)
History of psychosis (1)
Prior suicide attempt (3)
History of socio-economic deprivation (1)
History of substance use (1)
Terminally ill (1)
It’s important to note that these elements cover the CPR Risk Assessment elements, starting with the verbalization of suicide intent and following on with:
Current Plan (Evidence of a specific plan)
Previous Exposure to Suicide (family history of mental illness or suicide; recent bereavement; prior suicide attempt)
Resources (withdrawal from social interactions)
Each of the variables identified above for the NGASR are assigned a weighting based on the ones most likely to lead to suicide, with five being assigned a score of 3 (for high-risk) and the others being assigned a score of 1.
The following scoring system has been developed by Cutcliffe & Barker (2004):
0-5 – Low Risk, Level Four
6-8 – Intermediate Risk, Level Three
9-11 – High Risk, Level Two
12+ – Very High Risk, Level One
These supervision levels from Barker & Buchanan-Barker (2005) and reproduced in the RNAO guide.
Level Four: Engagement on a structured daily basis (such as by having nurses available to speak with and providing regular programming)
Level Three: Formal engagement at least three times per day – morning, afternoon and evening (such as by having nurses perform suicide assessments and check in with patients)
Level Two: Regular support (e.g. approximately every 15 minutes, varying between 10 and 20 minutes) from the nursing team throughout the day or night (This is the most common level of “high risk” or “suicide watch” supervision and can help prevent inpatient suicide)
Level One: Constant access to a nurse, or other professional for support (This is for imminent risk situations while a patient is being stabilized, or during transition points such as moving to a higher or lower level of care.)
The purpose of the Caregiver Abuse Screen (CASE) is to detect potential abuse of seniors by caregivers. It is a screening tool, not an assessment tool, so like other screening tools it should be administered to all caregivers whether abuse is suspected or not.
The CASE tool was created by Myrna Reis and Daphne Nahmiash and is designed to be administered to caregivers of elderly individuals. It comprises eight yes or no questions, and can make a handy tool to use in psychosocial assessments if you are a counsellor or a case manager.
The CASE is scored by summing the “Yes” responses; a greater score indicates a greater potential of abuse. There is no cut-off above or below which abuse would or would not be suspected; it must be evaluated in conjunction with other factors as part of your overall assessment.
The CASE reports good psychometric properties. A Cronbach’s alpha of 0.71 was reported for six out of the eight items, 1-4, 6, and 8 (Carver College of Medicine, n.d.) You can download the CASE from NICE, the National Institute for the Care of the Elderly.
A shorter post this Family Day, I thought I would take a few minutes to talk about the Twitter handle @RealTimeCrisis. Started by a Toronto police officer and a street nurse, they trawl Twitter for people demonstrating signs of lethality and reach out to them.
As I’ve written about in the past on my article on responding to suicide on social media, many people give people hints of their behaviour who never receive the support that they need. Sometimes family members and friends don’t know what to do – or, worse, they’re afraid of the answer they might get.
Enter Marie Batten and TPS Constable Scott Mills. Since 2012 they have been tweeting individuals in crisis and offering a helping hand, connecting them to resources in the community. Sometimes the Toronto Police will directly contact them and sometimes they’ll reach out. But either way – it is heartening to see people getting the support they need.
As online crisis chat and SMS/texting services become more common avenues for receiving emotional support and crisis intervention I suspect we’ll see more services like @RealTimeCrisis. For now they represent a best practice – an innovative strategy of reaching out when people need them most.
Helplines are a strange beast: if their utilization is high, one can assume that either the community is really in need of their service and they deserve more money. On the other hand, if they are effective at diffusing crises, one might see their usage drop as fewer people in the community need them.
Most helplines, though, are seeing calls go up year after year, as their populations get bigger and more people find themselves dealing with mental and physical health, financial and relationship issues, suicide and bereavement and all the other things that bring a person to call.
One way that helplines can improve their position is via funding for grants to meet particular populations needs. For instance, Distress Centre Peel operates seniors services, launched in part with funding from the New Horizons for Seniors program.
So here are some marketing ideas you may not have considered for your helpline:
Host a contest – Have individuals in the community (they could be high school students, community college or University students or even adults) participate in building a part of your organization. Offer a prize equal to a little more than you would have paid. For instance, for a $250 prize have individuals suggest a new slogan for your helpline. Work with local media outlets to popularize the contest – which will also popularize your helpline in the process.
Real Time Tweeting – Each time your helpline intervenes in a crisis (for instance, you dispatch an ambulance or police to someone’s location), tweet using your organization’s Twitter. This is a very “in your face” way of letting people know the impact you are having in your community.
Magnets – For organizations who produce magnets with their phone number on them, get creative. For instance, you can place the magnets on pay-phones in your community so that individuals in crisis can still reach you, especially if you have a toll-free line available.
Giving away products – Produce a guide on deep breathing, cognitive thought distortions or stress management (or maybe you already produce these for your workers to use on the phone) and give it away to local community agencies. They’ll be able to support their clients and your organization’s name gets out there.
Reach out personally – This one may run up against some ethical boundaries at your organization so you’ll want to check with your Executive Director/Board of Directors first, but if you see someone in the newspaper or in the community who you think would benefit from your service, reaching out to them rather than you reaching out to you can be very lucrative. I know of one helpline that runs a suicide survivor support group (not Distress Centre Durham, where I currently volunteer now work) that reads the obituaries looking for individuals who have died by suicide, to offer supportive phone calls and a spot in the next support group. Because all of the services are free, they’ve heard nothing but good from this move.
At the end of the the day, it comes down to being proactive rather than reactive. When people are in crisis you don’t want them to have to find you, you want your information already in their pocket, on the payphone, or in their Twitter feed so that you become a no-brainer.
One advantage of this is that if you target your approaches to particular groups (e.g. seniors or youth) you can see a quantifiable increase in the number of calls from those individuals.