Creating a Safety Plan

Having a safety plan in place is vitally important when you are dealing with a child who struggles with mental illness, whether it is a threat of suicide, manic or aggressive/threatening behavior, knowing what to do when in the midst of crisis needs to be second nature to ensure everyone's safety.

When developing the safety plan it is important to have input not only from any family members or caregivers who it may effect, but also additional third parties such as counselors, therapists, first responders, etc.  It is important to know what your options are and what supports are available to you before a crisis occurs.  Having input from other trained professionals can help you find other available supports you may not know about as well as determining the best course of action for your particular child.  Involving others also protects you in the future and helps you to explain to first responders/hospitals/treatment centers the actions you took before contacting them and how the family has gotten to this point in the safety plan. Most importantly don't forget to include your child in this process.  Keeping the discussion open may help them recognize their own warning signs for crisis and respond better. asking your child about what would help them in crisis is a great place to start.

Having a written safety plan is only helpful if everyone in the family knows their role and what to do in an emergency.  It is extremely important that all family members participate in "practice" runs much like a fire drill.  In our house we have a code word we use to indicate that they are to go to the play room, lock the door, and pick a TV show to watch.  I use the code word every once in awhile when they least expect it and give out treats for good listeners.  By making it fun and non threatening I think it reduces any stress or fear when an actual need arises. 

Our safety plan includes a page (front and back) of basic/background/summary information including:

Child’s information

Family information 

Common Behaviors including known triggers/antecedents, things that can escalate/calm the behavior, strategies that may work.

Medications both current and past

Treatment and Interventions

Professional Team

Other Outside Supports/Resources

Safety Concerns

      YOU CAN GET A COPY OF THE CUSTOMIZEABLE SAFETY PLAN HERE

The second page includes the actual plan "If child is doing X, then you do Y."  This will be very child-specific, but here is a copy of ours so you can get an idea.

So now that you have your safety plan, you can just stick it on a shelf and forget about it right?  NO, the safety plan will have to constantly be amended and changed based on your families current needs and support systems.  It is also important to reflect on the safety plan and any changes that need to be made following a crisis.  You may want to ask What situations or triggers led to the crisis? What worked and didn't work?  What can we do differently to keep everyone safe and calm?
I like to make notes right on my safety plan and then develop a revised version based on my notes for the next crisis.

CRISIS BAG:

If any of you have ever sat in a psychiatric emergency room for hours on end, you know how boring, stressful and unproductive you can feel.  Creating a bag that can be left in the car or near the door is a great idea to prepare for a crisis.  Things are happening so fast when you reach the point of transporting or having your child transported to a hospital or emergency unit.  The last time we were in crisis the first responders wouldn't even give me the time to find my youngest kids shoes!!

This bag should include your crisis plan, documentation binder and some snacks, games, music or books for both yourself, the child in crisis, and any others who may be waiting for long periods of time.

You may also want to pack an emergency bag that includes a change of clothes and basic hygiene supplies in case it is determined the child in crisis will be admitted or transferred to another unit.





RESOURCES:
http://www.childcrisisresponsemn.org/resources/#t1
www.namihelps.org/MHCrisisplanbkltCH.pdf
http://kidslinkcares.com/mentalhealth/sample-safety-plans/
http://www.conductdisorders.com/forum/f13/must-read-creating-safety-plan-your-family-238/

Update on James

James has been working with a BHRS (Behavior specialist) and Mobile Therapist for about three months now. I really like them, they don't totally get it, but nonetheless they have given me some things to think about and implement at home.  We've focused our house rules on three things:  Be Kind, Be Respectful, Be Safe.  Ive tried to stop talking as much and just focus on these three rules.  So instead of a long rambling lecture I just say, "That's not safe".  I think it has been helpful, not so much with James actual issues, but helpful when trying to wrangle all three boys and in a general household control and structure way.

Im still waiting on James' medication to go through the insurance.  That has been a complete debacle of back and forth, however I think something should come through this week.

We had a three month check in with the counseling agency in order for insurance to continue funding the BHRS and Mobile Therapist.  Once again I had to go through James' life story.  Why cant these people just read the freaking file.  After talking for awhile I mention that at one point Matthew was diagnosed as RAD.  A big sigh of relief came over her and she said "OH so you wouldn't be SUPRISED if I tell you I think James has some attachment issues?!"  LOL surprised??  NO.  She proceeded to tell me in front of both Matthew and James that I had taken on a "burden" and they were "brain-damaged".  I was livid at that point, I really cant stand some of these therapists! She then proceeded to tell me how I should parent him with a one page summary sheet, cause you know, she went to a training once......

Whatever, over and done with and insurance approved therapy for the next three months.

James has been doing better than expected in preschool.  There have been a few incidents like choking a peer and hitting the teacher at the beginning. It seems as though he really wants friends.  The other kids in the class will not play with him when he is "rough" and will flat out tell him.  He seems to get that the other kids don't like it, but still struggles with what behaviors he can replace it with to get them to play with him.  Despite this the kids seem to quickly forgive and invite him to play.  He has trouble focusing and listening during group time.  He is more apt to try and push his chair into the person next to him or look around the room.  Im hoping the medicine will help with this.  He is "behind" academically, but does show interest in learning things that seem fun to him.  Right now he likes writing.  The teacher thinks it is more so the fact that they get to work one on one with her, which I'm sure is true, but works for me.

We've got a meeting Wednesday with James' BHRS and Mobile Therapist to update the plan of action for the next three months.

James' Medication Appointment

We have been trying to get James started on medication for the past two years.   We are constantly told he is too young by the doctors/psychiatrists who see him for all of 10 minutes and are constantly told by the therapists/counselors/teachers/behavior specialists that work with him on a daily basis that they don't think he will make much progress without the medication piece.  Yesterday we finally had the medication appointment with a psychiatrist at the mental health agency we work with. I had to go through his history for the fifth time with this mental health agency.  It is so irritating and a complete waste of time, read the file people!  Of course if they actually read the file and reports from everyone working with him the appointment would last about 15 minutes and then they couldn't charge the insurance an exorbitant amount of money.  After an hour of going through his history, concerns, and issues she started to say he was too young for medication and that he would need to be in a special class next year in Kindergarten.   After slowly counting to ten so as not to explode, I as calmly as I could told her she was completely wrong.  The reason we are here now is to try and get all of the pieces together BEFORE he gets in Kindergarten next year.  This is not my first rodeo, I waited two years to get all the pieces in place with Matthew.  If I would have stood my ground and told the "experts" they were wrong maybe Matthew would have made more progress sooner, I was NOT doing this dance again.  She gave me a long speech about how he certainly shouldn't be on a stimulant and in the end she recommended to start him on Tenex after he had an EKG. If she would have asked me at the beginning of the appointment what I wanted for him.....I would have said Tenex, the appointment would have lasted 10 minutes and we would have been at the same place.  BUT what do I know, I'm just a highly educated, experienced therapeutic parent.