SAFETY PLAN - CRISIS PREVENTION PLAN

Problem Behaviors

These are behaviors I sometimes show, especially when I’m stressed:

Losing my temperFighting / Assaulting peopleFeeling suicidalRunning awayUsing other drugsInjuring myselfAttempting suicideThreatening othersUsing alcoholFeeling unsafeOther (please describe)

Triggers

When these things happen, I am more likely to feel unsafe and upset:

Not being listened toFeeling pressuredBeing touchedLack of privacyPeople yellingLoud noisesFeeling lonelyArgumentsNot having controlBeing isolatedDarknessBeing stared atBeing teasedParticular time of dayParticular time of yearContact with familyParticular personOther (please describe)

Warning Signs

These are things other people may notice me doing if I begin to lose control:

SweatingBreathing hardRacing heartClenching teethClenching fistsRed facedWringing handsLoud voiceSleeping a lotSleeping lessActing hyperSwearingBouncing legsRockingCan’t sit stillBeing rudePacingCryingSquattingDamaging thingsEating moreEating lessNot taking care of myselfIsolatingLaughing loudly / giddySinging inappropriatelyBecoming very quietOther (please describe)

Interventions

These are things that might help me calm down and keep myself safe when I’m feeling upset:

Time out in my roomListening to musicReading a bookSitting with staffPacingTalking with friendsTalking with an adultColoringMolding clayHumorExercisingCold cloth on faceWriting in a journalPunching a pillowHugging stuffed animalHot showerCold showerPlaying cardsVideo gamesLying downRipping paperScreaming into pillowHolding iceGetting a hugUsing gymBouncing ballMale staff supportFemale staff supportDeep breathingSpeaking w/ therapistDrawingStory readingMaking collageCryingSnapping bubble wrapCalling familyDoing choresCold water on handsHot teaRocking chairOther (please describe)

Things That Make It Worse

These are things that do NOT help me calm down or stay safe:

Being aloneBeing around peopleHumorNot being listened toPeers teasingBeing disrespectedLoud tone of voiceBeing ignoredStaff supportTalking to an adultBeing reminded of the rulesBeing touchedOther (please describe)

CRISIS PLAN

CRISIS PLAN:	RESPONSE	SAFETY CONTACT
1) I will try to notice the following warning signs and triggers:		Safety Plan Contacts and Resources (People I Can Ask for Help) 1). Name/Role Contact # 2). Name/Role Contact # 3). Name/Role Contact #
2) I’d like staff/my family to notice the following warning signs:
3) When I notice these triggers or warning signs, I will take action to prevent a crisis from developing by doing the following:
4) When staff/my family notice that I’m getting upset, I’d like them to help me prevent a crisis by doing the following:
5) When I handle a potential crisis without doing anything to make it worse, I can reward myself by:
6) Other ideas about what to do if a crisis develops:

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