Next up in our ASWB exam content walk-through: The indicators and risk factors of the client's/client system's danger to self and others. After exploring the topic, we'll try out a practice question.
Assessing a client’s danger to self or others is a critical aspect of social work and mental health practice. It requires understanding the indicators, risk factors, and protective factors that can influence behavior. What follows is an overview of common indicators, key risk factors, and the importance of assessing the context and severity of these risks.
Indicators of Danger to Self
Indicators of self-harm or suicidal ideation often emerge through behaviors, verbal cues, and emotional states. These include:
Behavioral Indicators
- Direct or indirect verbal statements indicating suicidal ideation (e.g., "I can’t go on like this anymore," "It would be better if I weren’t here").
- Engaging in reckless or risky behaviors (e.g., driving dangerously, substance abuse).
- Withdrawal from friends, family, and activities that previously brought joy.
- Giving away possessions or settling affairs, such as writing a will or saying goodbye.
- Sudden calmness or euphoria after a period of severe depression, which may indicate the decision to attempt suicide.
- Self-harming behaviors, such as cutting, burning, or other forms of self-injury.
Cognitive and Emotional Indicators
- Expressions of hopelessness, helplessness, or worthlessness.
- Preoccupation with death or dying, as evidenced by drawings, writings, or conversations.
- Loss of interest in future plans or goals.
- Overwhelming feelings of shame, guilt, or despair.
Situational Indicators
- Recent traumatic experiences, such as job loss, relationship breakups, or bereavement.
- Exposure to suicide in the family, peer group, or community.
- Sudden or chronic financial difficulties.
- Diagnosis of a terminal illness or significant physical health problems.
Indicators of Danger to Others
The potential for harm to others often stems from aggression, poor impulse control, or externalizing behaviors. Indicators include:
Behavioral Indicators
- Threats or verbalizations of harm toward specific individuals or groups.
- Fascination with weapons, violence, or aggressive behavior.
- History of physical altercations, assaults, or bullying.
- Property damage or vandalism.
- Aggression toward animals or cruelty to pets.
Cognitive and Emotional Indicators
- Intense anger, resentment, or hostility directed toward others.
- Preoccupation with revenge, justice, or retribution.
- Grandiose thinking or an inflated sense of entitlement to harm others.
- Paranoia or delusions involving perceived persecution.
Situational Indicators
- Recent legal problems or conflicts, such as restraining orders or charges of domestic violence.
- Social rejection, isolation, or marginalization.
- Access to firearms or other lethal means.
- Substance use, particularly when combined with aggressive tendencies.
Risk Factors for Danger to Self or Others
Risk factors are characteristics or conditions that increase the likelihood of harmful behavior. They can be categorized into individual, relational, community, and societal levels:
Individual Risk Factors
- Mental Health Disorders: Depression, bipolar disorder, schizophrenia, borderline personality disorder, or PTSD.
- Substance Use Disorders: Alcohol and drug use can impair judgment, increase impulsivity, and worsen mood disorders.
- Chronic Pain or Illness: Physical health challenges can lead to despair and feelings of being a burden.
- History of Suicide Attempts or Aggression: Prior behavior is one of the strongest predictors of future risk.
- Impulsivity and Poor Problem-Solving Skills: Difficulty managing frustration or stress can escalate dangerous behaviors.
Relational Risk Factors
- Family Dysfunction: Abuse, neglect, or domestic violence within the home.
- Loss of a Significant Relationship: Divorce, breakup, or death of a loved one.
- Social Isolation or Lack of Support: Limited access to a supportive network.
- Exposure to Violence or Aggression: Witnessing or experiencing interpersonal violence.
Community and Environmental Risk Factors
- Availability of Means: Easy access to firearms, drugs, or other methods of harm.
- Exposure to Traumatic Events: Community violence, natural disasters, or systemic oppression.
- Economic Stressors: Unemployment, poverty, or lack of housing.
Societal Risk Factors
- Stigma Around Mental Health: Reduces the likelihood of seeking help.
- Normalization of Violence: Media portrayals of aggression or suicide can influence behavior.
- Lack of Access to Healthcare: Difficulty obtaining mental health or substance abuse treatment.
Protective Factors
Protective factors can mitigate the risk of harm to self or others and should be considered alongside risk factors:
Individual Protective Factors
- Strong problem-solving and coping skills.
- Optimism or hope for the future.
- Access to mental health care and adherence to treatment.
- A sense of purpose or life meaning.
Relational Protective Factors
- Strong connections to supportive family, friends, or community members.
- Responsibility for dependents (e.g., children, pets).
- Positive peer influences or mentors.
Community and Societal Protective Factors
- Safe and supportive school or work environments.
- Community-based resources, such as crisis hotlines or counseling services.
- Cultural or religious beliefs that discourage self-harm or violence.
Assessment Strategies
When evaluating a client’s risk of harm to self or others, a social worker should use the following steps:
Direct Assessment of Risk
- Ask direct questions about thoughts of self-harm or harm to others. Examples:
- "Have you thought about hurting yourself or others?"
- "Do you have a plan for how you would do it?"
- "What is keeping you safe right now?"
Evaluate Intent, Plan, and Means
- Intent: Does the client express a desire to act on their thoughts?
- Plan: Is there a detailed plan, and is it feasible?
- Means: Does the client have access to the tools or resources necessary to carry out the plan?
Assess Protective Factors
- Explore factors that reduce the client’s risk or increase their likelihood of seeking help.
- Example: "Who can you turn to for support right now?"
Collateral Information
- Obtain information from family, caregivers, or other professionals when possible.
Structured Tools
- Commonly used tools include:
- Columbia-Suicide Severity Rating Scale (C-SSRS)
- Beck Depression Inventory (BDI)
- Danger Assessment Tool (for violence in intimate relationships)
Action Steps Based on Risk Assessment
- Low Risk: Provide counseling, strengthen protective factors, and ensure ongoing monitoring.
- Moderate Risk: Develop a safety plan, increase the frequency of contact, and involve supportive systems.
- High Risk: Consider hospitalization, involve emergency services, and ensure removal of means (e.g., firearms).
By understanding these indicators and risk factors, social workers can effectively assess and manage risk, ensuring the safety and well-being of clients and those around them.
On the Exam
A question about this material on the ASWB exam may look something like this:
A 14-year-old client shares feelings of hopelessness and expresses that “nothing really matters anymore.” They deny having a plan but admit they think about dying “a lot.” What is the MOST appropriate intervention for the social worker?
A. Establish a safety plan and schedule regular check-ins with the client.
B. Notify the client’s parents immediately about their disclosure.
C. Refer the client to a psychiatrist for a medication evaluation.
D. Explore the client’s reasons for feeling hopeless and consider therapy options.
What's your answer?
A safety plan is crucial for addressing the immediate risk of harm and ensuring the client knows how to seek help if suicidal thoughts worsen. While involving parents (B) may be necessary depending on laws and ethics, this should come after safety planning and a discussion with the client. Referrals (C) and exploring underlying issues (D) address long-term needs but are not immediate interventions.
Get lots more practice like this on SWTP's full-length practice exams.
