Crisis Planning with Clients

Creating a plan to address your clients’ potential crises can be daunting, especially for solo clinicians in remote parts of Vermont.  The Vermont Psychological Association and community partners, including NASW-VT, VTMHCA, and emergency crisis teams around the state, have developed a suggested protocol for establishing crisis plans.

1.  Collaborate with your local Emergency Services team.

This is key:  Create a relationship between you and your local Emergency Services team to help smooth communication in times of client/patient crisis.  Local Emergency Services teams are often embedded in hospital Emergency Departments, but if yours is not and you refer clients to the Emergency Department as part of your crisis plan (which should be a last resort), create a relationship with your local Emergency Department personnel as well.

• Get emergency services’ input into the best way to direct clients to them and what information they need to perform crisis services most effectively–that may be different for your geographic region than for others.
• Make sure your local Emergency Services team has your after-hours contact information.
• Talk about how you will work together if a client is in crisis.
• What if the client is a minor?
• What about patients who stop treatment but still report they are seeing a private practitioner?
• Provide information about how you can be reached, such as via confidential voice mail.

2.       Create a written plan to give to your clients

•  Get a release in writing ahead of time to allow you to speak with emergency personnel (even if it’s not technically needed).
•  Consider getting a release to talk to parents, family, or support people for follow-up, including psychiatrists or other health care providers.
•  Give written instructions about resources available and what they should do if they are in crisis.
•  Identify support people that clients know they can call in a crisis.
• Define “crisis” and explain when it is appropriate to call emergency personnel (such as the local Emergency Services team or Emergency Department), a hotline or other helpline, or to make an extra appointment with the clinician.
• Consider giving clients, or clients at high risk, a “summary” of their record—diagnosis, your contact information, etc.—to carry with them at all times. Include a space for clients to write down their current medications, supplements, etc.
• Consider how this may change with clients who are minors—are the parents involved?
• Provide a list of available “hotline” resources (see the list at the end of this document).
• Provide instructions about follow-up after they’ve been to an emergency department or called ES.

3.  Create your own process for when clients call you in crisis.

Consider doing the following:

• Providing a list of resources on your website to which you can refer clients.
• Calling ahead to an emergency department or emergency services team before telling the client to go there.
• Changing your plan if your client is a minor (seeing you with or without parental involvement or consent).
• Exchanging “covering” or “on-call” services with a nearby colleague when you’re out of town or on vacation.

4.  Follow up with emergency personnel and clients when crisis services are provided.

•  Follow up with the emergency personnel your client contacted—consider making it a habit to ask clients if they have called Emergency Services or the Emergency Department each time you see them.
• Follow up with other relevant specialists, such as a psychiatrist.
• Follow up with parents, family, or other support people if you have a release to do so.

Following these procedures can help ensure continuity, coordination of information and services, and better care for your patients.