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NIDA5 NIMH4 BPDRF1 TREATMENT NOTES 2003-2008

Generated HOPE and reasons for living OTHER COMMENTS on crisis intervention:

F.

Developed or reviewed existing CRISIS PLAN

(Check in Q6 also)

Committed to a PLAN OF ACTION. Client made credible AGREEMENT for crisis plan and no self-injury or suicide attempts until

“Quote” from client (Optional)

(Check off in Q6)

Client agreed TO REMOVE LETHAL implements (drugs, knife) of

by (how)

H. I.

Did TROUBLESHOOTING of factors that might interfere with effective action:

Increased SOCIAL SUPPORT Planned for client to contact SOCIAL SUPPORT (who): ALERTED NETWORK to risk (describe): Planned a FOLLOW-UP CALL for

J.

REFERRED:

To Primary Therapist : To Clinician-On-Call At

To Crisis Line

(Insured Client Had Phone Number)

To OTHER

for Medication Evaluation:

K.

HOSPITALIZATION CONSIDERED; did not recommend because (check all that apply):

Client is

(see Q6 for documentation)

Other environmental support available Client can easily contact me if condition worsens Client previously hospitalized, benefit not apparent No bed available Client refused Client refused even with persistent argument by me in favor

Client does not meet criteria for involuntary commitment

and/or it would (check all that apply): Increase stigma and isolation which are important issues for this client Interfere with work or school which are important for this client, Violate already agreed to plan, Cause undue financial burden which is an important issue for this client

OTHER: describe

6)

A

Client is

to self and will be safe from serious self-injury or suicide

until next contact with me or with primary therapist for the following reasons: (Check all that apply)

Problems that contribute to suicide risk are being resolved Suicide ideation and/or intent reduced by end of contact Credible agreement for crisis plan and no self-injury or suicide attempts Back to Q5

Adequate crisis plan in place Back to Q5

Suicidality being actively addressed by primary therapist Protective factors outweigh risk factors (Describe if not otherwise noted:

C : \ D o c u m e n t s a n d S e t t i n g s \ e r i n w 6 \ L o c a l S e t t i n g s \ T e m p o r a r y I n t e r n e t F i l e s \ O L K 8 7 \ 2 0 0 8 - 1 0 - 1 0 _ I m m i n e n t _ R i s k _ A n d _ A c t i o n _ P l a n . d o c

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