Crisis Management Protocols

1. Definition of a Crisis

A crisis includes any situation where a client or someone else is at immediate risk of harm to self or others, or is experiencing a severe psychological or behavioral emergency, such as:

• Suicidal ideation with intent or plan

• Homicidal ideation or violent behavior

• Severe dissociation or psychotic episode

• Domestic violence or abuse disclosure requiring immediate intervention

• Medical emergencies during session

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2. Immediate Response Protocol

Step 1: Ensure Safety

• Remain calm and nonjudgmental

• Maintain a supportive, grounded presence

• Assess immediate physical safety of the client and environment

• Remove or secure potentially harmful objects if safe to do so

• For minors or incapacitated clients, engage emergency contacts or responsible adults promptly

• Maintain client dignity and privacy during emergency interventions

Step 2: Conduct Brief Risk Assessment

• Use structured tools such as:

  • Columbia Suicide Severity Rating Scale (C-SSRS)

  • SAFE-T (Suicide Assessment Five-Step Evaluation and Triage)

  • HCR-20 or Violence Risk Appraisal Guide (for homicidal ideation)

• Use clinical judgment alongside structured tools

Step 3: Determine Level of Risk

• Low Risk: Suicidal thoughts with no plan, intent, or means → Create/Review Safety Plan

• Moderate Risk: Suicidal ideation with some intent or unclear means → Increase session frequency, notify emergency contact, consult supervisor

• High/Imminent Risk: Active plan, intent, or means → Do not leave client alone. Initiate emergency services (e.g., 911, mobile crisis team)

• Document client agreement or refusal of safety plans and interventions

• Consult supervisors for ambiguous risk presentations

Step 4: Documentation

• Record all steps in clinical notes, including:

  • Client presentation and statements

  • Risk assessment results

  • Interventions made and referrals provided

  • Follow-up plan

• Ensure timely and secure storage of documentation per HIPAA standards

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3. Client Safety Plan Template (for Bold Within)

Purpose: Collaborative plan developed when a client is in distress but not in immediate danger.

Components:

• Warning Signs: “When I start to feel hopeless, I notice…”

• Internal Coping Strategies: “Things I can do to calm or distract myself.”

• Social Support: “People or places I can go to for support…”

• Professional Support Contacts: Therapist, Crisis Hotline (988), Local Crisis Line (855-625-4657), Emergency (911)

• Making the Environment Safe: “I will remove or secure…”

• Reasons for Living: “Things that are meaningful to me include…”

• Review: At every session with elevated risk, or at minimum every 3–6 months

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4. Referral Network — Bold Within Psychotherapy

Purpose: Ensure clients have access to appropriate, immediate, or specialized care beyond the scope of services.

Service Type	Contact	Notes
Emergency Services	911	Immediate response for imminent danger
988 Suicide & Crisis Lifeline	Dial 988	24/7 mental health support
Local Crisis Stabilization Unit (CSU)	714-834-6900	24-hour crisis care
Mobile Crisis Team	800-832-1200	Regionally available

 

5. Telehealth Crisis Response and Jurisdiction Considerations

5.1 Jurisdictional Scope and Applicable Laws

• Telehealth services are governed by the laws of the jurisdiction where the client is physically located at the time of service.

• Clinicians must be licensed in the client’s jurisdiction and comply with all state and federal regulations regarding crisis intervention, mandatory reporting, and privacy.

5.2 Informed Consent for Telehealth Crisis Interventions

The following language will be included in the telehealth informed consent form:
“I understand that in the event of a mental health crisis during telehealth sessions, my clinician will verify my physical location and contact local emergency services if I am deemed at risk of harm to myself or others. I consent to the clinician reaching out to my emergency contacts or local crisis resources for immediate support. I acknowledge the limitations of telehealth, including potential technology disruptions during emergencies.”

5.3 Clinician Obligations

• Verify and document the client’s physical location and jurisdiction at the start of every telehealth session.

• Obtain and confirm emergency contact information accessible within the client’s vicinity.

• Maintain an updated resource list of local emergency services and crisis intervention teams corresponding to client locations.

• In case of telehealth disconnection during a crisis, attempt immediate alternate contact methods and activate emergency protocols if client safety is compromised.

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6. Crisis Management Procedural Checklist

Step	Action	Completed (✓)	Notes
Step 1: Ensure Safety	Remain calm, assess client and environment safety
	Remove harmful objects if safe
	Engage emergency contacts if client is minor/incapacitated
Step 2: Conduct Risk Assessment	Use C-SSRS, SAFE-T, HCR-20 tools
	Apply clinical judgment
Step 3: Determine Level of Risk	Categorize as Low, Moderate, or High risk
	Review/Create Safety Plan if low risk
	Increase sessions, notify emergency contact if moderate
	Initiate emergency services if high risk
Step 4: Documentation	Document client presentation, assessments, interventions
	Store securely per HIPAA
Telehealth Specific	Verify client’s location and jurisdiction
	Confirm/update emergency contacts
	Maintain local crisis resource lists
	Follow-up on telehealth disconnections during crisis
Follow-Up	Review safety plan within 3–6 months or with clinical changes

This comprehensive protocol integrates trauma-informed care principles, legal compliance, and practical crisis response steps for both in-person and telehealth therapy services.

If you would like, I can provide this policy as a formatted PDF or editable document optimized for staff training use.

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References:

• California Board of Behavioral Sciences (BBS) Crisis Management Guidelines

• SAMHSA 2025 National Behavioral Health Crisis Care Guidelines

• California Telehealth Laws & Regulations (2025)

• Columbia Suicide Severity Rating Scale (C-SSRS)

• Suicide Assessment Five-Step Evaluation and Triage (SAFE-T)