Risk Assessment

Photo image for Risk Assessment module

Soldiers who suffer from physical and behavioral health issues are in particular need of oversight and risk mitigation from leadership, as well as potential medical intervention. Each Warrior Transition Unit (WTU) Commander should seek input from subject matter experts (SMEs) such as the U.S. Army Medical Command’s (MEDCOM’s) behavioral health staff , the U.S. Army Public Health Command and the U.S. Preventative Services Task Force (USPSTF) to identify and manage high risk Soldiers.

Additional tools and resources are available to help you determine a Soldier’s risk level and mitigate risks such as the Composite Risk Management and Environmental Considerations section of AR 350-1 or contacting your local military treatment facility (MTF) Risk Management Team for additional information on monthly risk utilization meetings and hospital resources.

Roles and Responsibilities

Reminder: Never leave a Soldier that you suspect is suicidal unattended. Always escort the Soldier to his/her next point of contact or remain with him or her until you can get additional help.

Whenever a Soldier at risk is identified, the following persons are typically involved in gathering the information:

  • Squad Leader (SL)
  • Nurse Case Manager (NCM)
  • Licensed Clinical Social Worker (LCSW)
  • Medical provider (typically the Primary Care Manager (PCM))

Squad Leaders, NCMs, and behavioral health and medical providers are each responsible for conducting an independent evaluation of the Soldier’s risk level and informing the Company Commander, who is responsible for developing the Commander’s Risk Assessment. For additional information on the Commander’s Risk Assessment, reference Warrior Care and Transition Program (WCTP) Policy Memo 13-010 .

Once screening is complete, the Commander, in collaboration with the Soldier’s Triad of Care, should decide upon and implement any necessary mitigation measures. Risk assessments and mitigation actions should be recorded in the Army Warrior Care and Transition System (AWCTS), with risk levels (low-green, moderate low-amber, moderate-red, high-black) recorded.

Events that cause consideration of immediate reassessment:

  • Broken relationships
  • Pending Uniform Code of Military Justice (UCMJ) action
  • Significant financial difficulties
  • Alcohol and drug abuse/misuse
  • Acting out behaviors
  • Social withdrawal or isolation, giving away belongings
  • Milestones (Medical Evaluation Board (MEB)/Physical Evaluation Board (PEB) results, pending separation from the Army)
  • News of significant combat in the Soldier’s unit, or anniversary of past action
  • Change in level of behavioral health care
  • Suicidal or homicidal thinking or statements

The following risks assessments should be performed:

  • 24 Hour Screening Assessment: The initial risk assessment screening (composed of fifty questions) is completed by the NCM, PCM and LCSW within 24 hours of the Soldier’s arrival at the WTU/Community Care Unit (CCU). This is done to ensure that the Soldier will be safe until the formal intake appointments occur and that no emergent or urgent conditions are missed. If the Soldier is presented as high-risk, the LCSW must notify the Soldier’s Commander via phone or in-person within one hour of conducting the screening. The NCM and LCSW are responsible for documenting the results of every assessment in the Armed Forces Health Longitudinal Technology Application (AHLTA) and AWCTS. For additional guidance on AHLTA and AWCTS risk assessment data entry, refer to the Psychological and Behavioral Health-Tools for Evaluation, Risk and Management (PBH-TERM) clinical evaluation tool.
  • Full Intake Assessment: No later than five days after the Soldier’s PCM, NCM and LCSW conduct comprehensive intake evaluations of the newly arrived Soldier. The information gathered at these visits builds upon what was gathered in the 24 hour screening assessment. The Commander uses this new information to update the Soldier’s risk assessment and mitigation plan as appropriate.
  • Regularly Scheduled Assessments: The Company Commander and the interdisciplinary team review all WTU Soldier risk assessments and mitigation plans monthly and all high-risk Soldiers weekly. These reviews occur at the Triad meetings.
  • Events that cause consideration of immediate reassessment:

    • Broken relationships
    • Pending Uniform Code of Military Justice (UCMJ) action
    • Significant financial difficulties
    • Alcohol and drug abuse/misuse
    • Acting out behaviors
    • Social withdrawal or isolation, giving away belongings
    • Milestones (Medical Evaluation Board (MEB)/Physical Evaluation Board (PEB) results, pending separation from the Army)
    • News of significant combat in the Soldier’s unit, or anniversary of past action
    • Change in level of behavioral health care
    • Suicidal or homicidal thinking or statements
  • Reassessments: The process of risk assessment, mitigation and reassessment repeats whenever significant changes or new information for a Soldier occurs.  The process continues as long as the Soldier remains in the WTU.
  • Special Actions for Evaluations of High Risk: Any provider or interdisciplinary team member who makes a new assessment of a Soldier as high risk in any category will notify the Soldier’s Company Commander within one hour.  No later than 24 hours thereafter, the Company Commander will notify the Battalion Commander, or the first Lieutenant Colonel in the chain of command, of a new assessment of high risk.

Identifying Risks

Cadre should attempt to get to know their Soldiers, which is the first line in identifying and mitigating risk. Cadre should recognize their Soldiers’ involvement in high risk behaviors such as substance and alcohol use, as well as multi-medication use and family issues. Awareness, early recognition and intervention can mitigate risk.

The LCSW uses PBH-TERM, to determine a Soldier’s risk level. This tool uses standardized, evidence-based informed screening questions and a behavioral health case complexity scale to support clinical decision-making for risk estimation, assessment and management. This information should be entered into AWCTS to communicate the identified behavioral health risks to members of the Triad of Care, so that they can mitigate and monitor risks.

Risk Mitigation

Soldiers’ answers to questions in the assessment tool can trigger red flags that may signal future behavior that Cadre should continue to investigate. Commanders can help mitigate risk by learning the coping mechanisms of their Soldiers and selecting risk mitigations actions specific to the Soldier’s level of risk and extenuating circumstances. Soldiers at any risk level may have the following mitigation actions:

  • Issue a no alcohol order
  • Refer to chaplain
  • Initiate safety counseling
  • Refer to behavioral health for evaluation and follow-up
  • Refer to the emergency room for suicidal or homicidal ideation
  • Refer to WTU/CCU social worker for weekly follow-up risk assessments and for appropriate behavioral health referral for evaluation and follow-up
  • Receive one-to-one escort
  • Increase case manager contact
  • Refer to social worker for marital counseling referral
  • Refer to Family Advocacy Program
  • Require move onto post, move into barracks, or return to a WTU from CCU, etc. to remove Soldier from risk stressors or to be more closely monitored
  • Initiate meeting with interdisciplinary team
  • Include Family/significant other in plan (HIPAA precautions)
  • Refer to PCM for evaluation
  • Refer to the Army Substance Abuse Program (ASAP )

For high-risk Soldiers, specific mitigation actions may include:

  • Command and control  contact with Soldier two times per day, seven days per week (in person or  direct phone conversation)
  • Medication reconciliation at least weekly and each time there is a change in medication regimen
  • Refer to the PCM for enrollment in the Army’s Sole Provider Program (SPP)
  • Contract for safety
  • Roommate/non-medical attendant/Family member as battle buddy per DAIM-ZA Policy Memo dated October 14, 2009
  • Issue a no alcohol order
  • Require a battle buddy to travel off post (sign in/out with Staff Duty Noncommissioned Officer (SDNCO)

Related Policies and Resources

For additional information on Soldier risk assessments, reference the following policies and resources:

Frequently Asked Questions

When must the initial risk assessment be completed?
Who must complete/enter risk assessment information in AWCTS?
How often should the Licensed Clinical Social Worker (LCSW) conduct the risk assessment?
Who is responsible for designating the overall risk for the risk assessment and the risk mitigation plan?

When must the initial risk assessment be completed?

The initial risk assessment must be completed within 24 hours of a Soldier’s arrival at a WTU.

Who must complete/enter risk assessment information in AWCTS?

The Squad Leader, Nurse Case Manager, LCSW, and the Commander must enter risk assessment information in AWCTS.

How often should the Licensed Clinical Social Worker (LCSW) conduct the risk assessment?

The LCSW should conduct a risk assessment weekly for high -risk, monthly for moderate-risk, and every three months for low-risk Soldiers.

Who is responsible for designating the overall risk for the risk assessment and the risk mitigation plan?

The Commander is responsible for making the risk level designation and finalizing the risk mitigation plan.

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