Suicide, Violence, and Abuse Risk Assessment on the LMSW Exam

If you are thinking about suicide, or you are worried about someone, you can call or text 988 to reach the 988 Suicide & Crisis Lifeline in the U.S. In a life-threatening emergency, call 911.

Assess first, and assess directly

Three outline statements meet in these items. Competency IIB lists methods of assessing risk of harm to self and others. Competency IIA lists indicators of abuse, neglect, and exploitation and the characteristics of people who perpetrate them. Competency IB lists the legal and ethical issues of mandatory reporting, including threats of harm and duty to warn.

When a stem raises possible harm, the FIRST step is usually a direct assessment, not reassurance and not an automatic referral. NIMH advises asking directly whether a person is thinking about suicide, and it states that studies show asking people whether they are suicidal does not increase suicidal thoughts or behavior. A vague check-in or a change of subject is the near miss.

One exception changes the order. If the stem already shows immediate danger, for example a client who says they took a large number of pills an hour ago, immediate safety action comes before further assessment.

The risk ladder

Use this sequence as a study aid for reading a suicide stem. It is not a clinical protocol or a validated scoring tool. Each rung is a question the social worker would ask or a fact the stem might give you.

1. Thoughts. Is there ideation, and is it passive ("I wish I wouldn't wake up") or active ("I've thought about killing myself")?
2. Plan. How specific is it: method, place, time?
3. Means. Does the person have access to the method, such as a firearm or stockpiled medication?
4. Intent. Do they intend to act, and when?
5. History. Prior attempts, prior violence, recent losses, substance use.
6. Warning signs. NIMH lists signs such as talking about wanting to die or being a burden, making a plan or researching ways to die, giving away important possessions, withdrawing, and using alcohol or drugs more often. NIMH says to get help as soon as possible, especially when a sign is new or has increased.
7. Protective factors. Supports, reasons for living, engagement in care, and anything that can be strengthened.

Then match the response to what you found, consult, and document.

SAMHSA's SAFE-T card for clinicians organizes the same work into five steps: identify risk factors, identify protective factors, conduct a suicide inquiry into thoughts, plans, behavior, and intent, determine the risk level and intervention, and document. SAFE-T is a clinical framework, not a published ASWB rule for ordering answers. Use the stem's facts to decide what information and protective action are needed, and do not postpone immediate safety measures to finish a checklist. Document the reasoning.

Violence risk: assess the threat itself

For a threat toward someone else, assess the threat directly, using the agency's violence-risk procedures. The ladder above is a study aid for suicide stems, not a validated violence-risk tool, but several of the same questions apply with a target added. Is there an identifiable person? A plan, the means, a timeline? A history of violence? A statement of anger without those elements calls for more assessment. A specific threat with means and a timeline can reach what the NASW Code calls a serious, foreseeable, and imminent risk, the point at which disclosure without consent becomes ethically permissible (1.07(c)). What the law then requires, whether a warning, a notification, or another protective step, depends on the state. Confidentiality, mandated reporting, and duty to warn covers that legal layer.

Abuse, neglect, and exploitation: assess, report, protect

Keep three verbs separate, because distractors blur them.

• Assess means recognizing indicators and gathering enough to form a concern: injuries that do not match the explanation, a caregiver who will not let the person speak alone, sudden financial changes, fear of a household member.
• Report means making the report the law requires when that concern exists. Mandated reporters act on suspicion as their state defines it. They do not wait for proof or investigate.
• Protect means safety planning and services. For a competent adult, such as a survivor of intimate partner violence, this respects the adult's own decisions. Whether any report is required for a competent adult depends on state law and the setting.

Reporting rules for children, older adults, and dependent adults are state law. The exam rewards knowing the principle and following the law, not one state's statute.

Four stems, read in order

Passy wrote these scenarios to show exam reasoning only. They are not ASWB items and not a guide to handling a real crisis.

1. "Tired of everything." A social worker on a medical unit meets a 61-year-old man admitted with pneumonia. He lost his job last month, says he is "tired of everything," and mentions he has been giving his tools away to his nephews. What should the social worker do FIRST? Ask him directly whether he is thinking about suicide. Giving away possessions and hopeless talk are warning signs. Referring him to job services or reassuring him that things will improve skips the assessment.

2. The same man, one answer later. He says yes, he has thought about using the hunting rifle he keeps at home. What should the social worker do NEXT? Assess intent and timing, and involve the treatment team under hospital protocol for a full evaluation and safety planning, including reducing his access to the rifle. NIMH's action steps include asking about a plan and reducing access to highly lethal items. Leaving the next step to discharge planning is the near miss.

3. The roommate. A community college counseling client says he is "going to make" his roommate "pay" after a fight over rent. He has no weapon, says he would never actually hurt anyone, and plans to move out at the end of the month. What should the social worker do FIRST? Assess further: what "pay" means, any intent or plan, access to weapons, and any history of violence. Calling the police or warning the roommate now acts on a threshold the stem has not shown. Document the assessment either way.

4. The bruises. A social worker at an after-school program notices finger-shaped bruises on both upper arms of a 6-year-old. Asked gently what happened, she says she "fell off the couch" and changes the subject. What should the social worker do FIRST? Make the report that state law requires without waiting on internal steps, notify a supervisor as the program's policy requires, and record exactly what was seen and said. An injury that does not fit the explanation is enough to suspect abuse. Calling the parent to ask what happened, questioning the child repeatedly, or waiting to see whether more bruises appear are the near misses, because each one investigates or delays instead of reporting.

Document what you assessed and why

A risk note records what was asked, what the client said, the risk and protective factors, the decision and the reasoning behind it, who was consulted, the plan, and the follow-up. On the exam, "document" is rarely the FIRST answer, but an option that acts without documenting is weaker than one that does both.

Traps to watch for

• Reassuring or problem-solving before asking about harm.
• Promising to keep a plan of self-harm secret.
• Treating every angry statement as an imminent threat.
• Investigating abuse yourself, or confronting the person suspected.
• Waiting until the next session when the stem shows current risk.

The free mixed LMSW set includes a teenager's suicide warning signs and abuse indicators in both a child and an older adult, so work the free LMSW set's risk items rung by rung → and check each explanation. Ethics vs safety priorities covers the items where safety collides with self-determination, and FIRST, NEXT, BEST questions covers the sequencing words these stems rely on. For the wider area, see assessment and planning.