OAKLAND COUNTY CHILDREN'S VILLAGE

Employee's Acknowledgement ofStatement of Policy and Procedure

As an employee of the Oakland County Children's Village (either part-time or full-time), Ihave received and reviewed the following statement(s) of policy and procedure entitled:

CLOSE OBSERVATION/SUICIDE PRECAUTIONS

I have had the opportunity to discuss this statement with a supervisor, and to clarify allpoints covered in this statement in order to gain full understanding of thepolicy/procedure.

I understand that, as an employee of the County of Oakland, I am expected to adhere tothe policies and procedures of the Children's VillageDivision of the Department ofHealth and Human Services. I understand that I am responsible for keeping my PolicyManual updated with the most current policies and for discarding outdated policies.Further, I understand that my failure to followprescribed policies and proceduresconsitutes a violation of Oakland County Merit System Rules, thereby making mesubject to disciplinary action as outlined in said rules.

I Send ORIGINALDocument to Manager's Office I

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OAKLAND COUNTY CHILDREN'S VILLAGEPolicy: CLOSE OBSERVATION/ SUICIDE PRECAUTIONCategory: RESIDENTSPolicy Number: Page: 1 of 2

"Close observation" requires that a resident be actively involved in on-groundsprogramming during non-bedtime hours, and the resident is to be closely, visuallyobserved by child care staff at all times during non-bedtime hours. The resident andthe room are to be searched for dangerous objects prior to retiring to bed for theevening. The child is not to participate in any off-grounds programming, includingany passes. After retiring for bed, the resident is to be monitored every fifteenminutes, according to the Children's Villagemonitoring log system.

A child placed on "suicide precaution" requires that all of the followingbe adheredto:

• The resident is to be included in all on-grounds programming during non-bedtimehours.

• The resident is to be encouraged to be active within on-grounds programming, andwith other residents.

• The child is not to participate in any off-grounds activities, including any passeswith family members or volunteers.

• The resident is to be closely observed at all times by childcare staff during awakehours.

• The resident is never to be out of sight of a childcare staff during awake hours.

• Prior to the resident entering his/her room for the evening, the resident and theroom are to be thoroughly searched for any items in which he/she might harmhimself/herself. All such items shall be removed from the room.

• The resident is to be monitored every fiveminutes followingbedtime transition,and the results of this monitoring is to be recorded on the Children's Villagemonitoring log.

e When a resident has been placed on "suicide precaution", the child may have amattress to sleep on and will be issued a stout gown and stout pad. If stout gownsor pads are in any way compromised, they are to be turned in to supervisorypersonnel, and an alternate is to be used.

Whenever a child is placed on "suicide precaution" by the Children's Villagepsychiatrist, the child is to remain on "suicide precaution" status until thepsychiatrist alters the "suicide precaution" directive. Furthermore, all aforementionedprocedures are to be followedwith regard to the "suicide precaution", as well as anyother specific directives given by the psychiatrist, until the psychiatrist authorizes

Effective Date: Upon ReceiptApproved By: Joanna J. Overall- Manager

Updated: March 07, 2006

OAKLAND COUNTY CHILDREN'S VILLAGEPolicy: CLOSE OBSERVATION/ SUICIDE PRECAUTIONCategory: RESIDENTS

Policy Number: Page: 2 of 2

alteration of the "suicide precaution" status. Residents placed on "suicide precaution"are considered priority cases by both the psychiatrist and the Children's Villageadministration.

Any resident placed on "suicide precaution" is to be seen daily (excluding holidaysand weekends) by the appropriate Children's Villageclinician. If in the course of thisdaily clinical review, a Children's Villageclinician finds that the resident hasimproved or worsened clinically with regard to his/her suicidal potential, theclinician is to strictly adhere to the followingprocedures with regard to updating ourpsychiatrist:

• The clinician is to contact the psychiatric coordinator to request aperson-to-person consultation with the psychiatrist.

• Because residents placed on "suicide precaution" are considered priority cases,the psychiatrist willmake himself/herself available for consultation.

After consulting with the Children's Villageclinician, and reassessing the resident onsuicide precaution, the psychiatrist may alter the "suicide precaution" directive inone of several ways. The psychiatrist may determine that the "suicide precaution" belifted altogether; the psychiatrist may determine that the "suicide precaution" bechanged to "close observation" status; the psychiatrist may determine that the child'scondition has worsened, and recommend the child be immediately taken to a hospitalfor assessment for emergency admission; the psychiatrist may choose to make otherspecific changes in his original directive; or the psychiatrist may determine that theoriginal directive remain unchanged. Under no circumstances is any Children'sVillage staff person, including Children's Villageclinicians, case coordinators, orsupervisory staff,-authorized to make any alteration in any medical directive given byour psychiatrist. All directives by our psychiatrist are to be strictly followed, untilsuch time that the psychiatric directive is changed by the psychiatrist.

NOTE: Children's Villagepolicy and procedure discourages and disallows theutilization of "one-on-one" staffing with a potentially suicidal resident. "One-on-one"staffing encourages the suicidal contagion effect. Instead, the appropriateAdministrator is to be notified whenever there is concern about the possible need ofextra support staff, in order to enable staff to fulfill the requirements of a "suicideprecaution" or "close observation."

Effective Date: Upon ReceiptApproved By: Joanna J. Overall - ManagerUpdated: March 07, 2006