Writer’s Guide for Developing an Individualized Discharge ...



*Items in blue indicate trauma/adverse events related considerations for individualized crisis safety planning

• Individualized Crisis Safety plan should be written or revised when the following occurs:

➢ Within the first week of meeting a family; sooner if needed.

➢ Within 24 to 48 hours of a major crisis.

➢ Whenever a youth or family moves to a new residence, placement or school.

➢ When a new team member joins the team and will be part of the crisis intervention plan.

➢ When the youth or family experience a major life event; such as the death of a loved one, divorce, witnesses or is part of a violent act, pregnancy, birth, etc.

➢ When a youth has run away.

➢ When youth has had new charges filed against him/her.

➢ When new safety concerns arise (even if a crisis has not occurred).

• Family Definition of Crisis

In the family or caregiver words, what do they define/describe as the issues that may lead to a crisis in the future? (Families may need you to remind them of the event that lead up to the recent referral or may need help exploring any patterns around past contacts). This should also include or relate to why a youth or family is on a CHIPS or Delinquency court order, any observable safety concerns. Consider whose crisis it is and create a definition accordingly. For example, if a youth runs away, the fact that the youth is missing may be a crisis for the parent because he or she is concerned for the safety of their child. The youth’s crisis might be what occurred just before they left, i.e. when they do not feel heard, or are overcome with anxiety and do not have the support needed to manage it safely. The behavior is often a byproduct of or response to the crisis, which may be felt or perceived vs. seen. Also, consider fight, flight, freeze survival responses and the function of the behavior to help identify viable replacement behaviors or reduce triggers. Discuss the function of the defined crisis behavioral response so the team understands how the youth benefits from it and can aim to meet the need in safer ways.

• Interests and Strengths

List functional strengths that will actually be used in the plan to prevent or resolve the crisis defined above. Include strengths of any family or team member that will be instrumental in diffusing or preventing the crisis. Consider resilience or protective factors: relationships, spirituality, connections to people/places that feel safe. Identify current coping skills, even if they are disruptive (i.e. running away or ripping up assignments) in order to provide opportunities for them to be used in safer ways (going for a jog together, ripping up a phone book).

• Risk Factors

➢ Precipitating events, triggers or warning signs that lead to an escalation of the crisis. Trauma triggers can include: people (facial expressions, body language, tone of voice, power difference, unfamiliar or unpredictable relationships) places (rooms in the home such as bedrooms, bathrooms, or basements, rooms with reduced supervision or access to potentially harmful items, areas of the city that are linked to adverse experiences such as houses, streets, parks, schools, etc.).

➢ Life changing events such as death, divorce, marriage, removal of a family member, new place to live, new baby, domestic violence, loss of employment, etc. The anniversary of events can also be a trigger. History of specific safety concerns or frequent hospitalizations.

➢ Intense fears, such as being in the dark, closed spaces, being touched, etc. Fears may have been generalized from a specific experience.

➢ Potentially dangerous affiliations, such as gangs, cults, etc.

➢ Concerns related to caregivers ability to respond to crisis, such as physical or cognitive limitations, mental health, or substance abuse, supervision limitations.

➢ Behaviors that indicate dysregulation and could lead to a crisis if anxiety is not alleviated; for example, youth pacing the floor, refusing to talk, and inconsistent sleeping patterns, etc. Trauma impact can significantly affect eating, sleeping, and stress patterns.

➢ Court ordered supervision and safety requirements (for example, youth adjudicated of a sex offense cannot be around children under the age of twelve, or a youth who has been adjudicated for carrying a concealed weapon cannot possess or be around any firearms or weapons). On-going events such as court ordered visits, court hearing, testifying, etc. can also be a trigger.

• Relevant Medical Information

Be sure to include the following:

➢ Ongoing medical concerns or conditions and any prescribed medications to treat them, i.e. diabetes and insulin.

➢ Allergies (seasonal allergies, bee stings, foods, latex, medications, etc.); indicate treatment, if necessary.

➢ Recent changes in medications and reason.

➢ Recent injuries or current physical challenges.

➢ If pregnant – indicate due date.

➢ Asthma.

➢ History of any major surgery.

➢ If the youth is not at their legal placement, how will they access medication and/or their insurance card?

• What Helps the Caregiver (“Caregiver” includes placement staff or Treatment Foster Parent, if youth is placed out of his/her home.)

Questions to ask the caregiver:

➢ What is helpful for you to do, or not do, when a specific crisis occurs? How can we support you in crisis?

➢ When past crisis situations have occurred, what has worked for you?

➢ When your child is in crisis, what do you normally do? Have you noticed if that makes the situation better or worse? Consider the caregiver’s trauma history and triggers (i.e. a DV history with the youth’s father who looks and sounds just like the youth when upset)

➢ What helps you stay calm in a crisis? Support the caregiver’s calming process as a model for the youth. If the adults are upset, the youth may not feel safe to calm down or relax and lower his guard.

➢ Who do you contact to help you through a crisis?

• Family and Community Supports

This section can act as the “phone list” for any users of the crisis plan.

➢ List full name, role or relationship, contact number and address, if available. Be sure these people and places feel safe for the youth and can provide a predictable and calming response.

➢ List names in order of suggested use. The youth in crisis should have a choice about where and with whom they feel supported and find calming. A place that feels “safe” to the youth may not be deemed “appropriate” by the team, so this should be proactively addressed.

➢ Include family members, friends and community resources that can support the family at the time of crisis. Some education might be necessary to help others involved understand the trauma triggers and responses.

➢ Include any mobile crisis service or community help lines or on-line support systems.

• Resources to use in a Crisis - What places in the community might help?

List places in the community where the youth can go to help diffuse a crisis situation. This should be specific to the youth and family. General community resources/places, safe havens that have no connection to the identified crisis would not be beneficial for the youth or family. The community places/resources that are selected should be practical and accessible to the youth, family and child and family team members (within walking distance, on a bus route, etc.).

➢ May include a neighbor’s, relatives, or friend’s home, Boys & Girls Club with an identified support staff, etc.

➢ Team members must agree on where the youth can go.

➢ The intention is to allow/provide alternatives for the youth to cool off and feel safe.

Consider places that offer regulating activities (physical activity, rhythmic/repetitive movement, connects to culture or spirituality, and familiar relationships) and offer a helpful amount of sensory input; not under or over stimulating.

➢ Can be used as a place to go for several hours or overnight, if necessary.

➢ May include formal respite (it is best to introduce the family to the place before the crisis occurs).

➢ Include address and phone contact, if not listed above.

➢ Consider places a parent or siblings might go for respite or safety vs. the youth leaving

• Specific Strategies to Prevent/Resolve Crisis

What specific steps should we use? Clear steps to take for each specific crisis situation identified in question #1.

For example:

1. If youth needs to separate from others and cusses out his teacher to create distance:

A.

B.

C.

2. If youth feels overwhelmed and uses marijuana to clear his head:

A.

B.

C.

3. If youth is embarrassed at school and creates a distraction by throwing things around the room:

A.

B.

C.

General guidelines:

➢ List steps in order, with the least restrictive strategies first. Prioritize relaxing activities at regular intervals throughout the day for a few min. at a time, and identify what feels safe for the youth and family and prioritize those types of interactions, routines, and activities to enhance safety and security to prevent crisis.

➢ Steps have to be realistic in a crisis situation – state who will be doing what steps.

➢ Include steps for caregivers/adults in all environments – school, home, placement and community. This provides accountability and helps clarify individual responsibility.

➢ Family and team members must agree to the steps – be careful not to list steps that sound right to you. (Note: It will not help to list “Call Police”, if the police do not respond quickly in their neighborhood or if the family does not feel protected by the police).

➢ All steps should be based on functional strengths of the family and team.

➢ Provide consistency and structure as much as possible while allowing flexibility to respond to the person’s emotional state and safety needs.

➢ Allow choices and options as often as possible to help the youth and family feel in control of their environment and interactions.

➢ Consider the developmental age of the person and base interventions and expectations on the developmental age instead of chronological age.

➢ Account for the fact that we all lose the ability to think rationally and futuristically, control impulses, and creatively problem solve when we are in high emotional or stress states. Generally, non-verbal communication is more powerful in calming than words in those states. Mutual engagement in calming activities (breathing, dancing, singing, drawing, drumming, etc.) is beneficial for all parties involved and promotes a connection between the adult and youth around safety and calming that strengthens the relationship.

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