Referring High-Risk Clients

RSA Interview and Safety Plan Guide

Risk and Resource Interview Guide1 1. Disruptions and Demands Client Client’s Significant Others

Risks A) Loss or failure of relationship. B) Overwhelming expectations and

obligations. C) Loss of social position and

financial status. D) Legal or disciplinary troubles. E) Abuse, bullying, peril.

a) Distressing expectations and demands of the client.

b) Abandoning the client. c) Abuse or bullying of the client.

Resources 1) Effective problem solving. 2) Positive personal and spiritual

connections.

i) Reasonable expectations and encouragement of the client.

ii) Helping the client meet obligations.

2. Suffering Client Client’s Significant Others

Risks F) Depressed or manic mood. G) Anxiety, anger, obsessive thinking. H) Conflicted identity, shame,

burdensomeness. I) Hallucinations or delusions. J) Insomnia or nightmares. K) Pain, illness, injury.

d) Viewing the client as flawed or a burden.

e) Limited awareness of or unhelpful response to the client’s suffering.

Resources 3) Engagement in medical or mental health treatment.

4) Variability in psychological and physical symptoms.

5) Effective response to suffering.

iii) Empathic response to the client’s suffering.

iv) Supporting the client’s medical and mental health treatment.

1 Source: Flemons, D., & Gralnik, L. (2013). Relational suicide assessment: Risks, resources, and possibilities for safety. New York, NY: W. W. Norton & Company.

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RSA Interview and Safety Plan Guide

3. Troubling Behaviors Client Client’s Significant Others

Risks L) Withdrawing from activities and relationships.

M) Substance abuse or disordered eating.

N) Impulsive or compulsive behaviors. O) Harming self or others.

f) Participating in the client’s troubling behaviors.

g) Unhelpful attempts to regulate the client’s troubling behaviors.

Resources 6) Engaging in activities and relationships.

7) Participating in therapy or rehab. 8) Finding alternative behaviors.

v) Reaching out to the client vi) Facilitating recovery and safety.

4. Desperation Client Client’s Significant Others

Risks P) Hopelessness. Q) Intense desire for relief. R) Intention or plan to act on suicidal

thoughts. S) Communicating about suicidality. T) Having or gaining access to means. U) Preparing for or attempting suicide.

h) Suicidality. i) Ignorance or denial of the client’s

suicidality. j) Dismissive response to the client’s

suicidality.

Resources 9) Hope and reasons for living. 10) Variability in suicidality. 11) Willingness not to conceal

suicidality. 12) Active participation in developing

and implementing a safety plan.

vii) Compassionate response to the client’s suicidality.

viii) Active participation in a safety plan.

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RSA Interview and Safety Plan Guide

Safety Plan Construction Guide I. Identify any significant others who could assist in implementing relevant details of the safety

plan. If they are in the waiting room, bring them into the session. If not, phone them. Determine their willingness and ability to help, and engage them accordingly.

II. Work out how the client and resourceful significant others can prevent or restrict access to the means for making a suicide attempt. Put measures in place to safeguard against any method the client has been considering (for example, shooting, hanging, jumping, overdosing, suffocation, carbon monoxide or pesticide poisoning, cutting, drowning, crashing a car or stepping in front of a vehicle, or electrocution).

III. Identify troubling behaviors the client has been using to cope with distress (for example, withdrawing from activities and relationships, substance abuse, disordered eating, impulsive or compulsive actions, and harming self or others. If appropriate, explore temporary alternatives (for example, walking, exercise, music, meditation, prayer, reading, writing, and reaching out).

IV. Identify safe havens the client could, if necessary, access for a limited time (include contact information, if relevant):

• In the client’s, a family member’s, or a friend’s house. • In the hospital.

V. Consider enlisting the client’s work supervisors or school administrators to at least temporarily alter the client’s schedule, reduce his or her workload, or grant a leave of absence.

VI. Determine, if warranted and appropriate, if the client would consider initiating, resuming, or continuing relevant treatment:

• Therapy. • Medications. • Detox or rehab. • Inpatient or outpatient programs.

VII. Generate a list of personal resources the client could call if necessary (include contact information for each):

• Family members and friends. • Members of the client’s religious or spiritual community. • Peers and mentors.

VIII. Identify emergency resources the client could access if necessary (include contact information for each):

• Doctors. • Therapists. • Crisis lines and 9-1-1. • A nearby emergency room or hospital.

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