Emergencies & Crises

Clients experiencing depression or hopelessness must be assessed for suicidal ideation.  The assessment should focus on depression (in particular feelings of hopelessness), suicide ideation, suicide plans, self-control and intention.  The suicide checklist below can be used as a guide for evaluation.

If there is reason to suspect the possibility of a suicide attempt student therapists should:

• consult with their supervisor

• work therapeutically to open other options for the client

• supply the client with emergency phone numbers, such as CONTACT 315-251-0600 (24-hour hotline) and St. Joe's Comprehensive Psychiatric Emergency Program (CPEP) 315-448-6555

• develop a safety plan and give a copy to the client before they leave
  
  

If a safety plan is developed:

• Clients should keep the safety plan with them, a copy is made for the file with the case number and date

• Scan plans to attach in Titanium
  
  

If the student therapist does not trust the client will follow the safety plan, the student therapist should:

• Enlist the help of family or friends for a suicide watch, use Crisis Plan.

AND

• encourage the client to go to the emergency room of a hospital, or

• encourage the client to admit to a psychiatric hospital, or

• encourage the client to call St. Joe's Emergency Psychiatric Program (CPEP) 315-448-6555.

Never drive a suicidal client to a hospital.  If the client is willing to go to a hospital but needs transportation, call 911.

If the client seems at risk of suicide and will not agree with the above guidelines, it may be necessary for the student therapist to involuntarily admit the client to an inpatient facility.  This is only done in consultation with the student therapist's supervisor or the supervisor in the Center at the time.

The session must be documented immediately in a session summary.  Documentation of the session includes: the suicide assessment, historical information, consultation with supervisor, discussion of limits of confidentiality, appropriate suicide interventions used, resources given to client (i.e. telephone numbers listed above) and contact with hospital or family/friends if suicide risk is high.  The record should include a release of information for previous treatment records and the safety plan and/or crisis plan.  In high suicide risk situations, previous treatment records are to be obtained.

Any known or suspected past or present abuse or neglect of minors under the age of 18 must be reported to New York State Mandated Reporter Hotline (800) 342-3720.  The student therapist is to discuss with their supervisor the most appropriate method of responding to this situation.  If a report is to be made, students should print out and complete the LDSS 2221 form prior to the hotline call.  The form can be found below or through an online search.

If the report is taken via the hotline, the student therapist must send the original form to the local Child Welfare office.  A copy of the form is to be made and given to the Clinic Director.  (The copy is not to be placed in the client file)

A hard copy is to be mailed within 48 hours to:

Dept. of Child & Family Services

Attn: Child Welfare

John H. Mulroy Civic Center

421 Montgomery St. 12th Floor

Syracuse, NY 13202-2903

Document immediately all of the following in the case file: the conference with the supervisor, the reported abuse or neglect, and the process of responding to the situation.  Therapists should indicate they “contact appropriate authorities” when referring to the hotline call.  We should not state a call was made to CPS, as there is only suspicion at that point.

Duty to warn refers to an exception to client confidentiality rights when a client expresses intent to cause harm.  Typically, duty to warn begins when the provider reasonably believes that a patient is dangerous or potentially dangerous, that a victim or victims are reasonably identifiable, that the potential harm is foreseeable, and that the psychotherapist reasonably believes that the potential harm is imminent.

As a student therapist, you are obligated to protect your client’s confidentiality, including the things they say about others in therapy, unless there is a clear, imminent intent to cause harm and a risk to self or others.  The student therapist is to assess the situation carefully and thoroughly, discuss with their supervisor whether this instance meets duty to warn or duty to report criteria and the most appropriate method of responding.  If a student’s supervisor is not immediately available, the on call supervisor should be consulted. Document immediately all of the following in the session summary: the conference with the supervisor, the threat, and the process of responding to it.

It is important for student therapists to check their voicemail on a daily basis and respond quickly to clients. Clients may need the assistance of their student therapist or other emergency resources during a crisis.   (Supervisors are available in the Center to offer assistance to therapists responding to a crisis).

When clients call the Center after closing hours, the recorded message will furnish them with the 24-hour emergency support number at Contact (315-251-0600).  Staff members at Contact will work with the client to reduce anxiety, encourage the client to call the student therapist, provide referral sources, and in the case of potential physical harm to self or others, call 911.  The number 911 is reserved for the most severe cases; all others are told to call the Psychiatric Emergency Room at St. Joseph's Hospital (CPEP 315-448-6555).

Emergency telephone messages left on the clinic voicemail will be directed to the student therapist as soon as possible.  If the student therapist cannot be reached, the supervisor or Clinic Director will be notified.

If a crisis develops during a session and assistance is needed, the student therapist will follow emergency procedures.  This may mean texting the supervisor on call, the client’s emergency contact, or 911.

If sessions are in Peck Hall, therapists may also call the font desk staff (3-3023).  They will ask whether a supervisor or security is needed and locate the appropriate personnel. If the student therapist is not able to be explicit but needs the police or emergency personnel to be called, there are panic buttons installed in each therapy room.  They are underneath the computer tables, positioned closest to the wall.  Depress the button in the center, and the security officer as well as DPS will come to the room within minutes.  These buttons are silent alarms.

If an outburst breaks out in session between clients and verbal means do not de-escalate it, the student therapist should seek assistance.  If in Peck Hall, call the front desk staff (3-3023) and ask to have a supervisor come to the room.  If the outburst becomes physical, contact the Peck Hall security officer at 3-9402 or use the panic button.  If an outbreak occurs during Zoom and safety is at risk, call 911.  Your response to escalation during Zoom sessions should be thoroughly discussed during the Intake session.

When a student is exposed to, witnesses or is targeted with hate speech, a variety of reactions by the student therapist is common.  To foster the students’ continued development as a therapist, while centering safety, there are several support options available to the student such as pausing the session for a quick break, seeking an on-call supervisor, or seeking direct supervisor.  While taking a break, it is encouraged that the student engages in grounding or regulation strategies, and/or seeks supervisory support to return to their window of tolerance to best prepare them in returning to the therapeutic relationship.

While therapy is not always comfortable, student safety is always a priority. Supervisors will work directly with student therapists to determine what needs to occur in a therapeutic relationship where the student is the target of hate speech.  In consultation with the student’s supervisor and the Clinic Director, referral of services may be an option in these circumstances.

Syracuse University has a clear weapons policy: “While on University owned or controlled property, unauthorized possession or use of any firearm or other weapon, instrument, or material that can be used to inflict bodily harm on an individual or against University property regardless of whether the individual possesses a valid permit to carry the firearm or weapon is prohibited.” Clients should be informed of this during Intake.  If the student therapist notices a concealed weapon during a session, they are to excuse themselves from the therapy room and contact the supervisor on-call.