What about Safety Plans for the exam?

Safety planning emerges as a crucial therapeutic intervention for clients facing suicidal thoughts or domestic violence situations in this detailed exploration by Eric Tworkman and Dr. Linton Hutchinson. Unlike traditional safety contracts that simply have clients promise not to harm themselves, safety plans provide structured, actionable steps that research shows reduce risk by as much as 50%.

The hosts break down the six essential components of an effective safety plan: identifying specific warning signs of crisis, developing personalized coping strategies, creating means of distraction through social engagement, establishing social supports, connecting with professional resources, and restricting access to lethal means. Through practical examples for both suicide prevention and domestic violence scenarios, they demonstrate how these components work together to create a comprehensive safety net for vulnerable clients.

What makes this approach particularly valuable is its collaborative nature and adaptability. Rather than being a one-size-fits-all solution, safety plans are developed with the client's active participation, ensuring the strategies reflect their specific circumstances, resources, and capabilities. The podcast emphasizes the importance of cultural considerations, confidentiality concerns, and documentation practices that prioritize client safety. In our digital age, technology presents both opportunities and risks that must be carefully navigated—from helpful apps that provide quick access to emergency resources to the potential dangers of digital monitoring by abusers.

Whether you're a mental health professional preparing for licensure exams or a practitioner seeking to enhance your crisis intervention skills, this episode provides practical guidance for creating effective, client-centered safety plans. Remember to schedule regular follow-ups to review and modify these plans as circumstances change, and always consider comorbid conditions that might impact implementation. By embracing these evidence-based practices, you'll be better equipped to support clients through their most vulnerable moments.

If you need to study for your national licensing exam, try the free samplers at: LicensureExams


This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.

Chapters

• 0:12 Introduction to Safety Plans
• 1:17 Six Elements of Effective Safety Plans
• 3:19 Safety Plans vs. Safety Contracts
• 3:55 Creating a Suicide Prevention Plan
• 5:31 Developing Plans for Domestic Violence
• 7:26 Cultural Considerations and Documentation
• 10:05 Follow-up and Digital Safety Planning
• 12:36 Final Thoughts and Conclusion

Transcript

Eric: 0:08

Hello and welcome to today's Licensure Exams podcast. We're continuing our series of helpful interventions. Hi, my name is Eric Tworkman.

Linton: 0:17

And I'm Dr Linton Hutchinson, and in this edition we're going to take a look at safety plans what they are, what they do and how to create one and what they are not.

Eric: 0:29

But what I meant was they're distinct from a safety contract, which are meant to do the same thing but have not proved as effective.

Linton: 0:37

So what is a safety plan then?

Eric: 0:40

Well, think of it as a document that lays out warning signs of trouble for a client and what steps they might take to follow when danger arises, and the resources those people might need to make that plan work. Okay, it sounds like a safety plan is something for clients that are at risk, exactly those at risk for suicide or self-harm, or those in danger from domestic abuse or other forms of violence.

Linton: 1:09

And so you say it's like a document right.

Eric: 1:11

Yes, and there are six elements to a safety plan Concrete warning signs of a crisis. What coping strategies they might need. Means of distraction through social engagement or maybe even a change of environment. Social supports to help them resolve the crisis. Professional and or community resources to contact during the crisis. And, finally, what plans to restrict lethal access to means of violence.

Linton: 1:40

Okay, so they all have an element that a client may need if they're facing some kind of really dangerous situation for either themselves or for someone else some kind of really dangerous situation for either themselves or for someone else?

Eric: 1:53

Yes, and the therapist and the client will work together to tailor a plan for that client's specific needs.

Linton: 1:57

Okay, so if you do that, you do it so the client recognizes that it's not just something that you're doing, but it's more of a collaborative kind of a process, right? And if you do that, it's more likely that they'll take steps that would work to keep them out of trouble. So how long does it take to work up one of these?

Eric: 2:16

Well, actually, really, it only takes about an hour. That's it. Even less if the therapist has researched sources of social support or whatever community resources there might need beforehand. In a private practice session it could flow right along with the rest of the conversation.

Linton: 2:33

So not only in therapy, but it also could be something that someone in an emergency room would use, or urgent care clinics, police, women's crisis center or shelters right, that's right.

Eric: 2:46

Any number of places where they would meet somebody you know in a situation where they'd need to have a plan to help them stay safe.

Linton: 2:53

OK, so how does this one differ from a safety plan?

Eric: 2:58

The safety contract, or also called a no suicide contract, generated for the client that specifically has them sign on the dotted line saying that they won't hurt themselves and that they'll contact help if they feel like their situation is deteriorating. Studies have shown that safety plans are more effective than contracts or no-suicide contracts, and in fact, the safety plan can reduce the risk by as much as 50% more than just a contract.

Linton: 3:28

So it does that because it's not as specific as the non-suicide contract right.

Eric: 3:34

That's right. The non-suicide contracts don't have the actual steps to follow that you're going to take to stay out of harm or to get out of harm once you're in it.

Linton: 3:45

So let's say I'm in a therapy session, all right. What would a safety plan look like?

Eric: 3:51

Okay, let's take the case of a client who has been assessed at being high risk of suicide. The plan might include warning signs such as negative thoughts, worried or depressed mood, self-isolating behavior. The coping strategies would include individual activities such as mindfulness, meditation, exercising, spending time with a pet, listening to music. Means of distraction would be social activities that take the client away, mentally or physically, from the risky thoughts and behaviors. Those could be like going to church, a coffee shop, game of basketball, taking your cat to the vet, and social support would be friends and family members that the client could reach out to for help through the crisis, often someone that the client can share the safety plan with spouse, sibling, close friend and professional and community resources would include the therapist or even a suicide hotline. And then the plans to restrict access to lethal means would include, of course, removing any guns or likely weapons from the house and restricting access to dangerous drugs.

Linton: 4:57

Okay, so I see that you know it wouldn't be really a big deal to go ahead and work up a safety plan that covers all the six criteria that you just mentioned.

Eric: 5:07

That's right, and those are things that you'd probably talk about in a regular session, so it's proved to be a good choice in a lot of different circumstances. So now let's have you put on your own thinking cap. If you were providing therapy for someone who's a victim of domestic violence, what would you do to work up a plan?

Linton: 5:27

Okay, let me think. I suppose that the warning signs would focus on things that would trigger the abuser right, such as a child having problems at school, or a baby crying, or the client that you have just didn't have dinner prepared on time.

Eric: 5:45

Right, all of those situations Right.

Linton: 5:48

So coping strategies could include both ways that the client would address their own stress and their own fears and different ways that they could use to calm their abuser. Means of distraction could be ways that the client could get out of the abusive environment or somehow distract the abuser from the triggers that make them create the abusive situations. Social support would be those people that the client could turn to for support and also for a place that they can go that would be safe. Professional and community resources could still include the therapist, but they would also obviously have to include, like shelters, emergency responders and law enforcement. Plans to restrict access to lethal means or violence would focus on access by the abuser.

Eric: 6:47

Right, getting rid of anything that they might use. Exactly, and it would address the safety of others who might be at risk, like it would include children who live with the client and consider the risk to third parties, such as parents and friends, if the client should attempt to leave the abuser.

Linton: 7:06

Okay. So it's important to remember that it's not a one and done. You just do it once and it's done. It's not that kind of thing.

Eric: 7:13

Yes, it's not just boxes, you fill on a form right.

Linton: 7:18

Research shows that the most effective plans include the therapist doing follow-up with the client, reviewing the plan and helping the client revise the plan as their mental state and environments change.

Eric: 7:32

Exactly. Cultural factors also significantly impact the planning. So what key considerations would you keep in mind about cultural values?

Linton: 7:42

Cultural values can significantly impact safety planning. What key considerations would you keep in mind?

Eric: 7:52

Well, you'd think of like. In some communities, law enforcement might not be seen as a viable option due to historical trauma or current concerns, and of course, there would also be language considerations, right.

Linton: 8:06

Right right. So you need to ensure that all plan resources are accessible in the client's preferred language. This includes hotlines, written materials and community services. Sometimes you might need to identify specific cultural organizations that can provide appropriate support.

Eric: 8:27

Right Now, let's talk about how you document safety plans while maintaining client confidentiality and safety.

Linton: 8:34

Okay, this is really major and it'd be something that might be addressed on your licensing exam, so you need to consider whether having a written copy of the plan might put the client at more risk, particularly in domestic violence situations. Some clients may prefer to store the plan digitally, while others may need to memorize what those key elements are, and that's something you could help them with.

Eric: 9:02

Yes, exactly Now. What about the legal considerations?

Linton: 9:06

Okay. You need to be clear about your obligations as a mandated reporter, while still maintaining the client's trust. It's also important to document your risk assessment and the rationale for the safety plan in your clinical notes, separate from the plan itself. Keep in mind that questions about being a mandated reporter are ones that you might expect to see on your licensure exam right, the mandated reporter and the confidentiality, all of those you know.

Eric: 9:38

ethical concerns are prime contact for um Tests, you're right. So you mentioned that a safety plan is not one, and done so, tell me what follow-up might look like Okay.

Linton: 9:51

as I said before, research shows that the most effective plans include regular review and modification. Typically, you should schedule a follow-up. How often? Probably within the next week of creating the initial plan. That allows the client to identify what's working and what needs to be improved, and what specific aspects would you review about it?

Linton: 10:18

You'd want to know if they need to use the plan Right, had they implemented it at all, yeah what strategies worked, what barriers they encountered and whether any circumstances have changed that might require adjustment to that plan Based on their experiences. Sometimes you need to add new resources or modify the strategies that they're using.

Eric: 10:43

That's right, and in today's digital age, technology plays a big role in safety planning. How would you address the digital aspect of it, the digital age, today's digital age? That's what I said. Yes, right now it's digital. Okay, today, All right, I see you're really up to date on things. Yes, I am Right. Yes, as a matter of fact, I typed this up on my Commodore 64.

Linton: 11:12

Okay, well, obviously, given that statement, technology can be a help or, for some people, a hindrance. On one hand, iphones make it easier to access help really quickly. You might recommend apps for quick access to emergency contacts or resources, but you need to also consider digital safety. And what would that look like?

Eric: 11:38

Well, because abusers, might you know, plant tracking software or monitor your phones, emails, social media. So right, you need to take the steps to protect their devices.

Linton: 11:49

Right, so that might include password protection, two-factor authentication, and beware, like you said, of tracking devices like AirTags. Some people may even need to get a burner phone that their abuser doesn't know about. It's also important to explain how to quickly delete browsing history and tech messages if necessary, so you need to be up to date on all those digital assets.

Eric: 12:16

That's right. You really do know how to use them and not use them if you know, safety dictates Exactly that. Back to memorizing plans instead of writing them down Precisely. It's where you have to think about all those you know moving parts to the whole thing. You can't just give them a you know a printed out document and think you've done the job Right. So, in summary, safety planning is most effective when it's truly client centered. It should reflect the client's specific circumstances, their resources and what they're capable of. There it is.

Linton: 12:52

So any last words Don't forget to consider comorbid conditions like PTSD or physical disabilities that might impact how clients can implement their safety plan. Perfect.

Eric: 13:08

Yes, and, as always, thank you all for listening and for helping to make the world a better place. And remember, as we always say it's in there, it's in there. Thank you, bye-bye, see ya.