Preparedness and response are key components of effective emergency and/or adverse incident management.
Make sure to take the necessary precautions and communicate them clearly to your clients so you can respond effectively if an emergency arises.
Adverse Incident Reporting Timeframe
In the event of an Emergency faced by a client or Adverse Incident (for example, client suicide ideation, client suicide attempt, risk of harm to others, etc), you are required to alert Ruh Care via the the Risk Management Reporting Form within one (1) business day of becoming aware of the incident.
Please be aware that this form is a post-incident reporting system that does not alert an emergency response or provide immediate support from the Ruh Care team.
What Is An Emergency or Adverse Incident?
An emergency, crisis, or adverse incident involves immediate suicidal or homicidal behavior, aggressive conduct with potential for violence, or a psychotic episode characterized by unusual thoughts and actions, which may or may not include violence.
Emergency Preparedness
Clients should add an emergency contact person to their account. This person should be able to quickly reach the client's location if necessary. Ensure that you have access to the emergency contact information in the client’s profile.
Confirm the client's physical location at the start of each session. If they are not at the address noted in their profile, note their current location. This information is essential in case you need to send help in an emergency.
Consider whether teletherapy is appropriate for your client, particularly if they are experiencing paranoia, dissociation, panic attacks, or need immediate help to stabilize.
If you are under supervision, have a method to communicate with your supervisor, the client's emergency contact, or emergency services without leaving the client unattended. Keep a backup communication method, such as a phone, nearby, but make sure it does not interrupt the session.
Emergency Assessment
Therapists must conduct a thorough assessment of the immediate risk their client poses to themselves or others. This assessment includes evaluating:
The presence of suicidal or homicidal thoughts.
Whether there is a concrete plan for suicidal or homicidal actions.
Access to the means for carrying out the plan, and any existing security measures to prevent it.
The intent to execute the plan imminently.
Risk factors such as previous suicide attempts, substance abuse, impulsivity, and other related concerns.
Protective factors, including pets, children, religion, values, or other supportive influences in the client’s life.
The client’s support network, such as friends, family, and emergency contacts.
Proper assessment helps determine the level of risk and appropriate measures to take, ensuring the safety of the client and others.
Emergency Response
When a client contacts you during a crisis, follow these steps:
Immediate Safety Measures:
If you detect imminent signs of suicide, direct the client to their nearest emergency room or to call 911 or local emergency services.
If there are no imminent signs of suicide, refer the client to call 988, the number for the Suicide Crisis Helpline.
Communication and Confidentiality:
Express concern for the safety of the client or others and explain your intention to consult with a clinical supervisor.
Remind the client that if they do not cooperate, you are required by law to break confidentiality.
Stay Connected:
For online sessions, stay in touch with the client throughout the crisis.
Contacting Your Supervisor:
If applicable, notify your clinical supervisor about the situation as soon as possible.
Consider bringing in additional support immediately if needed, such as having your supervisor, manager, or clinical director join the video session to provide assistance and guidance.
Emergency Contacts:
If you cannot reach your supervisor, contact one of the designated individuals in the appropriate order.
Intervention Options:
Create a safety plan to address the client's immediate needs, such as securing means they might use to harm themselves or others.
Involve a third party, such as an emergency contact or a trusted person, to stay with the client and ensure their safety.
Arrange for the client's safe transport to a medical facility if needed.
Follow-Up:
Keep your clinical supervisor informed about the situation and the steps taken.
Document the emergency incident, including nature, contacts, and actions taken, in the client’s file within 24 hours and notify Ruh's Clinical Operation team by submitting the info in the Risk Management Reporting Form.
Continue to follow up with the client as necessary and agreed upon.
Debrief and Documentation:
After the emergency has been resolved, you may conduct a debrief session with our Clinical Director or Clinical Manager to review the incident, assess the response, and identify any areas for improvement. Document the emergency incident thoroughly in the client’s file, including the nature of the crisis, actions taken, communication with emergency contacts or authorities, and any follow-up plans.
In any crisis, ensure the safety of the client while maintaining confidentiality and following legal and ethical guidelines.
What events / incidents should be reported?
Here are some examples of when a provider would or would not need to complete an Risk Management Reporting Form. Please note, this list is not exhaustive, your clinical judgment and assessment of the situation are ultimately the best guide:
Suspected abuse of a child, elderly, or dependent individual-Agency report
Client presents with imminent danger toward self and emergency contact is notified
Client presents with imminent danger toward others and per license/state requirements police are notified
Client harms self and needs medical intervention
Client checks self into a hospital for mental health concerns
The death of a client
What happens after an incident report is submitted?
A member of the Ruh Care Clinical Operations Team will review the Adverse Incident Report. If necessary, we may request your cooperation with Ruh Care staff and/or the client’s insurance to facilitate an investigation of the incident and engage in any recommended corrective actions.