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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.

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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.

Episode Transcript

Eric (00:03):
Hello and welcome to today's Licensure Exams podcast.
We're continuing our series ofhelpful interventions.
Hi, my name is Eric Tworkman.

Linton (00:12):
And I'm Dr Linton Hutchinson, and in this edition
we're going to take a look atsafety plans what they are, what
they do and how to create oneand what they are not.

Eric (00:24):
But what I meant was they're distinct from a safety
contract, which are meant to dothe same thing but have not
proved as effective.

Linton (00:32):
So what is a safety plan then?

Eric (00:36):
Well, think of it as a document that lays out warning
signs of trouble for a clientand what steps they might take
to follow when danger arises,and the resources those people
might need to make that planwork.
Okay, it sounds like a safetyplan is something for clients
that are at risk, exactly thoseat risk for suicide or self-harm

(00:59):
, or those in danger fromdomestic abuse or other forms of
violence.

Linton (01:04):
And so you say it's like a document right.

Eric (01:06):
Yes, and there are six elements to a safety plan
Concrete warning signs of acrisis.
What coping strategies theymight need.
Means of distraction throughsocial engagement or maybe even
a change of environment.
Social supports to help themresolve the crisis.
Professional and or communityresources to contact during the

(01:28):
crisis.
And, finally, what plans torestrict lethal access to means
of violence.

Linton (01:35):
Okay, so they all have an element that a client may
need if they're facing some kindof really dangerous situation
for either themselves or forsomeone else some kind of really
dangerous situation for eitherthemselves or for someone else?

Eric (01:48):
Yes, and the therapist and the client will work together
to tailor a plan for thatclient's specific needs.

Linton (01:52):
Okay, so if you do that, you do it so the client
recognizes that it's not justsomething that you're doing, but
it's more of a collaborativekind of a process, right?
And if you do that, it's morelikely that they'll take steps
that would work to keep them outof trouble.
So how long does it take towork up one of these?

Eric (02:11):
Well, actually, really, it only takes about an hour.
That's it.
Even less if the therapist hasresearched sources of social
support or whatever communityresources there might need
beforehand.
In a private practice sessionit could flow right along with
the rest of the conversation.

Linton (02:28):
So not only in therapy, but it also could be something
that someone in an emergencyroom would use, or urgent care
clinics, police, women's crisiscenter or shelters right, that's
right.

Eric (02:41):
Any number of places where they would meet somebody you
know in a situation where they'dneed to have a plan to help
them stay safe.

Linton (02:48):
OK, so how does this one differ from a safety plan?

Eric (02:53):
The safety contract, or also called a no suicide
contract, generated for theclient that specifically has
them sign on the dotted linesaying that they won't hurt
themselves and that they'llcontact help if they feel like
their situation is deteriorating.
Studies have shown that safetyplans are more effective than

(03:14):
contracts or no-suicidecontracts, and in fact, the
safety plan can reduce the riskby as much as 50% more than just
a contract.

Linton (03:23):
So it does that because it's not as specific as the
non-suicide contract right.

Eric (03:30):
That's right.
The non-suicide contracts don'thave the actual steps to follow
that you're going to take tostay out of harm or to get out
of harm once you're in it.

Linton (03:40):
So let's say I'm in a therapy session, all right.
What would a safety plan looklike?

Eric (03:46):
Okay, let's take the case of a client who has been
assessed at being high risk ofsuicide.
The plan might include warningsigns such as negative thoughts,
worried or depressed mood,self-isolating behavior.
The coping strategies wouldinclude individual activities
such as mindfulness, meditation,exercising, spending time with
a pet, listening to music.

(04:06):
Means of distraction would besocial activities that take the
client away, mentally orphysically, from the risky
thoughts and behaviors.
Those could be like going tochurch, a coffee shop, game of
basketball, taking your cat tothe vet, and social support
would be friends and familymembers that the client could
reach out to for help throughthe crisis, often someone that

(04:29):
the client can share the safetyplan with spouse, sibling, close
friend and professional andcommunity resources would
include the therapist or even asuicide hotline.
And then the plans to restrictaccess to lethal means would
include, of course, removing anyguns or likely weapons from the
house and restricting access todangerous drugs.

Linton (04:53):
Okay, so I see that you know it wouldn't be really a big
deal to go ahead and work up asafety plan that covers all the
six criteria that you justmentioned.

Eric (05:03):
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 differentcircumstances.
So now let's have you put onyour own thinking cap.
If you were providing therapyfor someone who's a victim of
domestic violence, what wouldyou do to work up a plan?

Linton (05:22):
Okay, let me think.
I suppose that the warningsigns would focus on things that
would trigger the abuser right,such as a child having problems
at school, or a baby crying, orthe client that you have just
didn't have dinner prepared ontime.

Eric (05:40):
Right, all of those situations Right.

Linton (05:43):
So coping strategies could include both ways that the
client would address their ownstress and their own fears and
different ways that they coulduse to calm their abuser.
Means of distraction could beways that the client could get
out of the abusive environmentor somehow distract the abuser

(06:05):
from the triggers that make themcreate the abusive situations.
Social support would be thosepeople that the client could
turn to for support and also fora place that they can go that
would be safe.
Professional and communityresources could still include
the therapist, but they wouldalso obviously have to include,

(06:28):
like shelters, emergencyresponders and law enforcement.
Plans to restrict access tolethal means or violence would
focus on access by the abuser.

Eric (06:42):
Right, getting rid of anything that they might use.
Exactly, and it would addressthe safety of others who might
be at risk, like it wouldinclude children who live with
the client and consider the riskto third parties, such as
parents and friends, if theclient should attempt to leave
the abuser.

Linton (07:01):
Okay.
So it's important to rememberthat it's not a one and done.
You just do it once and it'sdone.
It's not that kind of thing.

Eric (07:08):
Yes, it's not just boxes, you fill on a form right.

Linton (07:14):
Research shows that the most effective plans include the
therapist doing follow-up withthe client, reviewing the plan
and helping the client revisethe plan as their mental state
and environments change.

Eric (07:27):
Exactly.
Cultural factors alsosignificantly impact the
planning.
So what key considerationswould you keep in mind about
cultural values?

Linton (07:37):
Cultural values can significantly impact safety
planning.
What key considerations wouldyou keep in mind?

Eric (07:47):
Well, you'd think of like.
In some communities, lawenforcement might not be seen as
a viable option due tohistorical trauma or current
concerns, and of course, therewould also be language
considerations, right.

Linton (08:01):
Right right.
So you need to ensure that allplan resources are accessible in
the client's preferred language.
This includes hotlines, writtenmaterials and community
services.
Sometimes you might need toidentify specific cultural
organizations that can provideappropriate support.

Eric (08:22):
Right Now, let's talk about how you document safety
plans while maintaining clientconfidentiality and safety.

Linton (08:30):
Okay, this is really major and it'd be something that
might be addressed on yourlicensing exam, so you need to
consider whether having awritten copy of the plan might
put the client at more risk,particularly in domestic
violence situations.
Some clients may prefer tostore the plan digitally, while

(08:51):
others may need to memorize whatthose key elements are, and
that's something you could helpthem with.

Eric (08:57):
Yes, exactly Now.
What about the legalconsiderations?

Linton (09:01):
Okay.
You need to be clear about yourobligations as a mandated
reporter, while stillmaintaining the client's trust.
It's also important to documentyour risk assessment and the
rationale for the safety plan inyour clinical notes, separate
from the plan itself.
Keep in mind that questionsabout being a mandated reporter

(09:24):
are ones that you might expectto see on your licensure exam
right, the mandated reporter andthe confidentiality, all of
those you know.

Eric (09:33):
ethical concerns are prime contact for um Tests, you're
right.
So you mentioned that a safetyplan is not one, and done so,
tell me what follow-up mightlook like Okay.

Linton (09:46):
as I said before, research shows that the most
effective plans include regularreview and modification.
Typically, you should schedulea follow-up.
How often?
Probably within the next weekof creating the initial plan.
That allows the client toidentify what's working and what

(10:06):
needs to be improved, and whatspecific aspects would you
review about it?
You'd want to know if they needto use the plan Right, had they
implemented it at all, yeah whatstrategies worked, what
barriers they encountered andwhether any circumstances have
changed that might requireadjustment to that plan Based on

(10:29):
their experiences.
Sometimes you need to add newresources or modify the
strategies that they're using.

Eric (10:38):
That's right, and in today's digital age, technology
plays a big role in safetyplanning.
How would you address thedigital 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 seeyou're really up to date on

(10:59):
things.
Yes, I am Right.
Yes, as a matter of fact, Ityped this up on my Commodore 64
.

Linton (11:07):
Okay, well, obviously, given that statement, technology
can be a help or, for somepeople, a hindrance.
On one hand, iphones make iteasier to access help really
quickly.
You might recommend apps forquick access to emergency
contacts or resources, but youneed to also consider digital

(11:30):
safety.
And what would that look like?

Eric (11:33):
Well, because abusers, might you know, plant tracking
software or monitor your phones,emails, social media.
So right, you need to take thesteps to protect their devices.

Linton (11:45):
Right, so that might include password protection,
two-factor authentication, andbeware, like you said, of
tracking devices like AirTags.
Some people may even need toget a burner phone that their
abuser doesn't know about.
It's also important to explainhow to quickly delete browsing
history and tech messages ifnecessary, so you need to be up

(12:07):
to date on all those digitalassets.

Eric (12:11):
That's right.
You really do know how to usethem and not use them if you
know, safety dictates Exactlythat.
Back to memorizing plansinstead of writing them down
Precisely.
It's where you have to thinkabout all those you know moving
parts to the whole thing.
You can't just give them a youknow a printed out document and

(12:32):
think you've done the job Right.
So, in summary, safety planningis most effective when it's
truly client centered.
It should reflect the client'sspecific circumstances, their
resources and what they'recapable of.
There it is.

Linton (12:47):
So any last words Don't forget to consider comorbid
conditions like PTSD or physicaldisabilities that might impact
how clients can implement theirsafety plan.
Perfect.

Eric (13:03):
Yes, and, as always, thank you all for listening and for
helping to make the world abetter place.
And remember, as we always sayit's in there, it's in there.
Thank you, bye-bye, see ya.