Safety planning plays a vital role for any mental health clinician, yet many misunderstand or overlook it. A well-designed safety plan offers a strong tool for managing risks, preventing crises, and empowering clients.

However, many therapists treat safety plans as mere formalities rather than meaningful clinical interventions. Some may feel uncertain about when and how to introduce safety planning to their clients.

This guide covers the main elements of an effective safety plan template and offers practical ways to incorporate safety planning into your therapeutic practice. It also clears up common misunderstandings and addresses ethical considerations related to this important tool.

When to Use a Safety Plan: Clinical Indicators and Timing

Therapists typically use safety plans when clients show signs of suicidal thoughts, self-harm urges, or other immediate safety risks linked to trauma, substance use, or severe mental health symptoms. It's crucial to differentiate between high-risk clients needing immediate intervention, moderate-risk clients who benefit from proactive safety planning, and individuals who engage in non-suicidal self-injury (NSSI) who may require focused interventions to address underlying emotional distress and develop healthier coping mechanisms, although some individuals with NSSI may also benefit from engaging in safety planning, depending on the severity of their injurious behaviors.

Before creating a safety plan, therapists should conduct a thorough safety risk assessment to evaluate the severity and immediacy of the client’s risk. This helps ensure that the plan is tailored to the client's specific needs and that appropriate interventions are in place.

Safety plans can be introduced during times of crisis or heightened distress, or during a calm and stable phase of treatment. The timing of introduction depends on factors such as the client's current emotional state and the level of risk.

When engaging in safety plan creation with a client, therapists should highlight that safety planning serves as a proactive and empowering activity, not a punitive or restrictive action. The aim is to provide clients with coping strategies and support systems for managing future crises, while encouraging a sense of control and self-confidence.

Key Elements of an Effective Safety Plan Template

A thoughtfully designed safety plan template should include several key components that support the client's well-being and reduce risk. These elements provide a clear guide for clients to follow when they experience distress or crisis.

Here are the main components to include in your safety plan template:

• Warning Signs: Help the client identify their unique red flags indicating they're starting to experience symptoms that may be a precursor to safety risks This list may include severe lack of sleep, increased alcohol or drug use,  specific thoughts, emotions, behaviors, or physical sensations. Recognizing these early warning signs allows them to take proactive steps to prevent escalation.
• Coping Strategies: Work with the client to brainstorm healthy coping techniques they can use independently when warning signs arise. These might include grounding exercises, reaching out to people in their support network, relaxation techniques, journaling, or engaging in enjoyable activities. Focus on strategies that have worked for them in the past.
• Social Supports: Identify trusted friends, family members, community members, and other supportive individuals the client can reach out to for help or distraction during difficult moments. Include specific names, contact information, and guidance on how to ask for support.
• Professional Resources: List important crisis resources, including 988 and the Crisis Text Line 741-741, and other local and national hotlines, and emergency services.. Clearly outline steps for contacting these supports when needed.
• Safe Spaces: Collaborate with the client to identify safe spaces they can go to when feeling overwhelmed or unsafe. This might involve creating a calming room at home, identifying public places that feel secure, such as a library or community center, or planning activities in nature.
• Making the Environment Safer: Assess the client's access to lethal means and work together along with the client’s family or other social supports, if appropriate, to develop a plan for reducing risk, such as removing firearms from the home, securing medications, or limiting access to other potential dangers.
• Client Agreement: Including a Client Agreement in a safety plan can be useful in some situations, such as when there’s an established therapuetic relationship, as it outlines the client's commitment to follow through with the safety plan, but it may not be necessary or helpful for every case. Therefore, the inclusion of a signed client agreement should be optional and based on the therapist's judgment of the client's needs and readiness.

How to Collaboratively Develop a Safety Plan with Clients

Working together with clients to create a personalized safety plan template requires empathy, transparency, and a non-judgmental approach. It's important to provide a safe, supportive environment where clients feel at ease discussing their unique risks and challenges without fear of judgment or automatic hospitalization.

Use open-ended questions and reassuring language to explore the client's experiences and concerns. Explain that struggling with thoughts of self-harm or suicide is not uncommon, and that seeking help shows strength, not weakness.

Some clients may feel hesitant, ashamed, or afraid to openly discuss their safety risks. Acknowledge their feelings and emphasize that the goal of safety planning is to empower them, not to limit their autonomy or label them as "dangerous."

When developing the content of the safety plan, ensure it is personal, practical, and realistic. Work with the client to identify specific warning signs, coping strategies, and support systems that align with their individual needs and preferences.

• Adapt the language and format of the plan to fit the client's unique communication style and cognitive abilities.
• Concentrate on specific, actionable steps they easily can take during moments of crisis, rather than vague or idealistic concepts.
• Encourage the client to be creative about self-soothing techniques, distractions, and social supports that have helped them in the past.
• Highlight the importance of small, achievable goals rather than setting unrealistic expectations that could lead to frustration or self-blame.

Throughout the process, ensure the client actively engages with and takes ownership of their safety plan. This is not a document to be imposed upon them, but a collaborative tool they can use to navigate difficult moments and build confidence in themselves.

Writing the Progress Note about Safety Planning

When documenting the establishment of a safety plan in a progress note, it's important to provide a clear and detailed account of the process and the client's involvement. Begin by noting the reason for creating the safety plan, such as a specific crisis, recent suicidal ideation, or other safety concerns discussed during the session. Document the steps taken in the safety planning process, including identifying warning signs, coping strategies, and emergency contacts, as well as the client’s input and agreement to the plan. It's important to emphasize the collaborative nature of the plan, reflecting any discussions around the client’s strengths, concerns, and preferences.

Additionally, document any key elements that were included in the plan, such as the use of a Client Agreement (if applicable), specific coping skills the client agreed to use, and their commitment to follow through with the steps outlined. If applicable, note any discussion about the client’s ability to implement the plan during times of distress and their comfort level with the safety measures. Be sure to include any follow-up plans or next steps, such as scheduling a check-in for the safety plan or additional support resources. Lastly, record the client's emotional response to the plan, any resistance or concerns they expressed, and how those were addressed within the session.

While typical progress notes may be more vague, documenting specifics in safety planning may benefit the therapist and client by providing a clear, actionable framework for addressing potential crises. Detailed documentation ensures that both the therapist and client have a shared understanding of the safety measures in place, which can help guide future sessions and interventions. It also serves as a helpful record to track the effectiveness of the safety plan over time and allows the therapist to review the client’s progress in managing distressing situations. Additionally, in the event of a crisis, having a comprehensive safety plan documented can be crucial for ensuring continuity of care and facilitating communication with other healthcare providers if necessary.

Documentation and Ethical Best Practices

Recording the creation and updates of a client's safety plan is an important part of the clinical record. Progress notes should clearly outline why the plan was implemented, the client's involvement in the process, and the specific risks being addressed.

Reviewing and revising the safety plan regularly is vital, especially after any changes in the client's risk status or life circumstances. Aim to revisit the plan at least every few months, or more frequently for clients at high risk.

When storing safety plans, whether digitally or on paper, therapists must follow HIPAA regulations to ensure the confidentiality and security of client information. This may involve using encrypted digital storage systems or keeping physical copies in a locked filing cabinet.

Some therapists opt to create separate versions of the safety plan: a client-facing copy that focuses on practical coping strategies, support system contact info, and resources, and a therapist-facing copy that includes additional clinical notes and details of risk assessment. If using this approach, clearly distinguish between the two versions and ensure that the client has easy access to their copy.

Other key ethical considerations for safety plan documentation include:

• Collaboration and consent: Actively involve the client in developing and updating their plan, ensuring they understand and agree with its contents.
• Clear emergency protocols: Include specific instructions for contacting emergency services or other supports during a crisis, and ensure the client knows how to access these resources.
• Balanced approach to lethal means: While it's important to limit access to potentially dangerous items, approach this topic with sensitivity and respect for the client's autonomy.
• Training and monitoring: Ensure that you and all clinical staff are properly trained in safety planning procedures and regularly monitor clients' risk levels and plan effectiveness.
• Timely updates and communication: Quickly document any changes to the safety plan and communicate relevant information to other healthcare providers involved in the client's care.

Safety Plans in Different Settings and Populations

While the fundamental parts of a safety plan remain consistent, it's important to modify the template and process to fit various clinical settings and client populations. Adjusting safety plans to suit the specific needs and contexts of each group helps therapists make this intervention more relevant and effective.

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For example, school-based therapists face unique challenges and opportunities within the educational setting when creating safety plans. This may involve collaborating with school staff, identifying on-campus resources, and ensuring the plan aligns with school policies and procedures. Additionally, school-based therapists should include parents and caregivers in safety plan collaboration, which may be difficult if the parent/caregiver has a difficult time making it to daytime appointments at the school. In such cases, therapists can explore alternative communication methods, such as phone calls, email, or virtual meetings, or holding the session after school hours to engage parents and caregivers in the safety planning process, ensuring their input and involvement despite scheduling barriers. 

Adapting safety plans for specific populations requires an approach that is culturally sensitive and developmentally suitable. When working with adolescents, it's important to involve family members and other supportive adults while respecting the teenager's growing independence and privacy needs. Safety plans for LGBTQ+ clients should include affirming resources, such as the Trevor Project and the Trans Lifeline, and consider the effects of minority stress on mental health.

Trauma survivors may benefit from a trauma-informed approach to safety planning that prioritizes emotional safety, choice, and empowerment. This may involve working with the client to identify trauma-specific triggers, coping strategies, and grounding techniques. For neurodivergent individuals, such as those on the autism spectrum, safety plans may need to be adjusted to accommodate sensory needs, communication preferences, and unique cognitive profiles.

For all populations, cultural sensitivity is necessary for creating effective and inclusive safety plans. This means actively learning about the client's cultural background, values, and beliefs, and ensuring that the language and options in the plan are accessible and relevant to their lived experience. Partnering with clients to create culturally responsive safety plans shows respect, builds trust, and strengthens the therapeutic relationship.

Beyond the Paper: Integrating Safety Planning into Ongoing Therapy

A safety plan should not remain a static document; instead, it should be an active part of ongoing therapy. By updating the plan regularly, therapists can ensure it continues to meet the client's needs and supports their progress.

Here are some ways to weave safety planning into your therapeutic process:

1. Link to Therapeutic Goals: Connect the safety plan to the client's main treatment objectives, such as increasing use of emotional regulation skills or decreasing suicidal ideation. Present the plan as a step toward these broader goals, rather than as a separate task.
2. Teach Early Warning Signs: Assist clients in recognizing their unique warning signs that suggest increasing distress or risk. Encourage them to use the safety plan early when these signs appear, instead of waiting until a crisis occurs.
3. Practice in Session: Use role-playing or walk through the safety plan together during therapy sessions to boost the client's comfort and confidence in using it. This practice can help reveal any obstacles or concerns and allow for immediate problem-solving.
4. Encourage Real-World Use: Assign "homework" that involves clients practicing specific coping strategies, such as reaching out to supports between sessions. Discuss their experiences and make collaborative adjustments to the plan based on what they found helpful or challenging.
5. Celebrate Successes: Recognize and validate the client's efforts in using their safety plan, regardless of size. Emphasize the strengths and skills they showed in handling difficult situations, and view any setbacks as chances for learning and growth.
6. Continuously Assess and Revise: Regularly assess the safety plan's effectiveness, such as at the start of each session. Update the plan as needed to reflect changes in the client's circumstances, insights, or preferences. Consider it a flexible guide that can change to fit their unique path.

Integrating safety planning into therapy aims to help clients internalize these coping strategies and support systems, enabling them to use them in their daily lives. A safety plan is not just a tool for crisis intervention but forms the foundation for building resilience, self-awareness, and independence that extends beyond the therapy room.

Conclusion: Safety Planning as a Clinical Act of Care and Empowerment

Safety planning goes beyond being just an administrative task or a means to reduce liability; it serves as a crucial act of care that strengthens the therapeutic bond and offers hope to clients during vulnerable times. When approached with empathy, cooperation, and a focus on empowerment, safety planning becomes an invaluable tool for therapists.

As mental health professionals, we hold the privilege and responsibility to guide our clients through creating a personalized roadmap to navigate crises and build resilience. This journey involves us:

• Listening deeply and without judgment, recognizing our clients' unique experiences and perspectives.
• Working together as equal partners, respecting our clients' autonomy and their expertise in their own lives.
• Providing unwavering support and validation, reminding clients they are not alone and recovery is possible.
• Offering practical tools and strategies that clients can use to manage distress and stay safe.
• Encouraging a sense of agency and self-efficacy, empowering clients to take an active role in their own well-being.

With this approach to safety planning, we create a space for healing, growth, and change. We convey to our clients that their lives are important, that they have the strength to face challenges, and that we are committed to supporting them throughout their journey.

Ultimately, a well-crafted safety plan is more than just a document; it represents the therapeutic relationship and symbolizes hope. It serves as a reminder that even in the darkest times, there is a path forward, and clients have the tools and support they need to find their way back to brighter days.

As therapists, let us view safety planning as a fundamental part of our practice and a significant opportunity to make a positive impact on the lives of those we serve. Together, we can help our clients build a foundation of safety, stability, and resilience that will benefit them long after they leave our care.

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