Warning signs, safety measures, plan of action and supports. These are all vital components of crisis response and safety planning in the field of mental health. Safety planning can be considered a helpful resource to assess safety needs for each family member and develop awareness of individual needs by loved ones when participating in discussion.
It can also serve as an empowerment tool to allow advocacy and engagement in positive coping skills when the family is experiencing conflict. Because of family systems becoming more diverse to meet the needs of support and connection, the term family can be defined in non-traditional ways. Not only does it capture the nuclear or biological family, it may also comprise of blended families, extended family, step-parents, foster siblings, or “chosen family.” Chosen family can include but is not limited to, close friends, mentors and godparents.
Bringing individuals together in their roles in the family system, it has become increasingly important to include all members in safety planning when addressing mental health and safety in order to unify the family and achieve meaningful results. In serving at-risk youth and families in the Denver Metro Area, safety planning has proven to be invaluable in exploring awareness of triggers for disruption and conflict, safety needs; thus engaging the family in exploration to foster empowerment and change. Safety planning allows the whole family to explore their needs rather than isolating one individual as the “identified problem.”
The benefits of safety planning can be demonstrated for one family of seven suffering from neglect, domestic violence and substance use that lead to Department of Human Services involvement because of ongoing safety concerns. The family system consisted of mom Jenna* (36), boyfriend David (27), daughters Fiona (16), Margot (14), Patricia (6), and sons Julian (9) and Bobbie (2). Jenna and her family were referred to in-home family therapy because of safety concerns with Jenna’s Post-Traumatic Stress Disorder (PTSD) resulting in substance use, domestic violence with her boyfriend David and neglectful parenting that was negatively impacting each child.
It was the hope of the Department of Human Services to support the family in reuniting and repairing their relationship now that Jenna was sober from substances and ready to actively parent in the household.
Observing and engaging the family in rapport building, it was quickly apparent which role each member played in the family system. Jenna was able to identify her challenges in parenting her children in that they were each struggling with her absence in different ways.
Fiona identified her anger that lead to running away from home and engaging in fights at school. Margot reported being a strong student and keeping to herself in her room when not parenting her younger siblings in Jenna’s absence. Patricia was observed to be childlike with attention-seeking behaviors younger than her biological age, whereas her older brother Julian escaped into video games to remain unseen. The youngest, Bobbie, was observed to struggle with meeting developmental milestones and resorted to screaming and hitting himself and others when emotionally disregulated.
Through engaging Jenna, David, and the kids in a safety planning therapeutic activity, they were able to begin to recognize each of their individual differences regarding warning signs, as well as the coping skills needed to support connection and emotion regulation. Jenna began to learn more about her children and their needs through identifying warning signs such as isolation, anger and behavioral changes signifying distress for each child at his/her developmental level.
Jenna also identified her own triggers and reactions to her children as they related to her trauma and urge to escape.
Tool of Discovery
When Jenna couldn’t escape her PTSD symptoms through work or substances, she was able to recognize the increased risk of conflict and aggression leading to fights with her boyfriend David. The safety planning served as a tool of discovery for family members and empowered each of them to advocate for their needs through healthy communication. For Jenna and her family, the safety plan served as a means of taking action to support the family in times of conflict and crisis.
Through this process, the children felt heard, Jenna identified goals for on-going individual therapy work to maintain sobriety and David and Jenna were able to identify new ways of communicating as a couple in order to bring the entire family closer together. Safety planning can be introduced and implemented early in the therapeutic process to explore family patterns, coping skill needs,and foster trust and safety while empowering families to remain together, connected and aware. A safety plan template is available for professional use along with a suicide risk assessment called the Community Assessment and Coordination of Safety (CACS) at www.cacs-co.com.
*Names have been changed to protect confidentiality
Khara Croswaite Brindle is a Licensed Professional Counselor (LPC) Approved Clinical Supervisor (ACS), and owner of Catalyst Counseling, PLLC, a group private practice in Denver, CO serving at-risk teens and adults. Khara enjoys being an educator with roles as Adjunct Faculty at Red Rocks Community College as well as offering professional workshops on self-harm, suicide assessment and safety planning throughout the Denver Metro area. Khara is also the owner of the Community Assessment and Coordination of Safety (CACS), a user-friendly web application with features of performing a risk assessment, access to a state-wide resource directory and safety planning for mental health professionals and service providers supporting at-risk individuals.