Family Crisis Plan Template With Instructions

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Helping
you create an effective plan: tips for individuals/families
1. Select the format that works best for you or your family from the following options:
a) A formatted page with headings to help you
b) A blank page
c) A pocket plan that allows you to carry your plan with you
2. Include what you know is most helpful for you now.
3. Update your plan as you learn what is working, your goals change or you decide on new actions to take.
4. As you complete your plan, consider including the following information:
list of people you can contact in a crisis (see WHEN I NEED HELP, I CAN CALL)
describe when you will use the plan and what you hope the plan will do (see GOALS OF THIS PLAN)
list actions you or other others are willing to take (see WHAT I OR OTHERS CAN DO)
When I need help, I can call:
Is there anyone you feel you MUST notify if there is a crisis? (employer, volunteer agency, partner)
Are there other people that may help calm the situation? (family, friend, neighbour, faith leader, Elder)
Are there any professionals you might want to contact? (current treatment provider, family doctor, community crisis service, hospital emergency
department, poison control, 911)
Is there anyone to help you manage other priorities while you focus on the crisis (child care, pets, transportation, covering a shift, etc.)?
Goals of this plan:
What would happen in the crisis situation, if the plan you made worked really well?
If you feel you cannot prevent a crisis, what is it you can do to reduce the chance of harm or injury?
What would you like to accomplish as a family member/partner/friend in managing the crisis?
What I and/or others can do:
What things can you see yourself doing that will help you achieve your goal? Others?
What has worked in the past that you could try again?
What are the ways you think you and/or others could calm down the situation?
If you think about trying the actions, does it feel like they would work?

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