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Crisis Procedures

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Document Number: COUNS--116p
Revision #: 2.0
Document Owner: Dean of Students
Date Last Updated:12/22/2017
Primary Author: Director of Counseling/Disability Services/Disability Services Center
Status: Approved
Date Originally Created: 02/21/2012
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General Description
Description / Scope: Information about crisis procedures relative to Counseling Center policy, procedure, and process.

Purpose: Delineation of procedure.

Who Performs / Responsibility: Counseling Services
When to Perform: As needed
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Requirements
Pre-Knowledge: Before performing this task you must know:
Current University policy
Standards of good practice
Terms and Definitions: Additional training

Corrective Action
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Overview of Steps
1.
Crisis Procedures


2.
Emergency Crisis Procedures


3.
Transporting


4.
After Hours Meetings with Clients in Crisis


5.
Intoxicated Students


6.
Volatile Clients


7.
Suicide Attempts/Self Injurious Gestures: Notification of Appropriate Parties


8.
Threat to Others


9.
Sexual Assault




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Detailed Steps
1. Crisis Procedures

How to Do:
Daytime crisis and emergencies are handled by the Director of Counseling Services.

2. Emergency Crisis Procedures

How to Do:
A mental health emergency is an emotional or behavioral crisis that warrants same-day attention by a mental health professional. This may include, but is not limited to, significant changes in behavior that are not characteristic of a person, the presence of disruptive symptoms that interfere with the responsibilities of daily living, direct or indirect expressions of the intent to harm self or others, or the experience of a trauma.

2.1 Daytime Emergency Services

How to Do:
During office hours, students may call the Counseling Center and ask to be scheduled for an emergency appointment. If no one is available and it is a crisis situation, the following guidelines apply:
  • If a student has attempted suicide, call 911 for emergency transport to the emergency room.
  • If a student is in crisis and no one answers or is available at the Counseling Center, there are four options:
  • Call Campus Security for help, who can call 911 or the CUCC Director.
  • Call 911 for assistance.
  • Call the assessment coordinator at McFarland Hospital at 615-449-0500.
  • Call the Crisis Intervention Center (615-244-7444).
  • Wilson County Mobile Crisis (800-704-2651).
  • Call Vanderbilt Respond (615-327-7000).

2.2 After Hours Crisis Procedures

How to Do:
Students in crisis after hours can call:
  • Campus Security, who can call 911 or the CUCC Director.
  • 911
  • The assessment coordinator at McFarland (615-449-0500)
  • The Crisis Intervention Center (615-244-7444)
  • Wilson County Mobile Crisis (800-704-2651)
  • Vanderbilt Respond (615-327-7000)

Regardless of what time of day or night an emergency occurs, if a student is actively suicidal and/or homicidal 911 should be called immediately or the student should be taken immediately to the emergency room or to McFarland Hospital. No Cumberland University Counseling Center staff member will attempt to transport a potentially suicidal and/or homicidal individual. If the person does not have a family member or friend who can transport him/her, the Lebanon Police Department or an ambulance will be contacted to transport.

If CU Campus Security or a university community member or employee calls the CUCC Director to discuss a potential emergency situation, the following steps should be taken:
1. The Director will speak to Campus Security and/or CU community member or employee at the scene to determine what action is needed.
2. If immediate on-site assessment of the crisis situation is needed, the counselor may either come to campus to conduct an on-site evaluation or recommend that Wilson County Mobile Crisis be called to conduct a crisis evaluation.

After hours contacts will be recorded on the After Hours Contact Report (Appendix S). These reports will be filed in the client’s chart if the client has been or is later seen at the Counseling Center. They will be filed in the confidential Consultation folder for all other situations.



3. Transporting

How to Do:
Cumberland University, including Counseling Center staff, does not transport students or employees in crisis situations. In cases that require transporting to the hospital, a family member, friend, the Lebanon Police Department, or an ambulance is called depending on the particular situation.


4. After Hours Meetings with Clients in Crisis

How to Do:
To ensure the highest level of Counseling Center staff member safety, counselors do not see clients who are in crisis in the Counseling Center after hours when there are no Cumberland University employees available to provide assistance. In most cases, if immediate onsite assistance is needed, the Center director will recommend that Wilson County Mobile Crisis be contacted to conduct a crisis evaluation.

Counseling Center staff members do not see students in his/her residence hall room even if there is a crisis. If a student living in the residence halls needs urgent assistance after hours, either a professional member of the Residential Life staff and/or Campus Security will walk the student in question to the Counseling Center office. If the student refuses to go to the Counseling Center and there is reason to believe that the student is actively suicidal or homicidal, either the Lebanon Police department or an ambulance will be called to respond to the scene to transport the student to the hospital.

When a student who lives off campus needs urgent assistance after hours, the Director will recommend that Wilson County Mobile Crisis be contacted to conduct a crisis evaluation with the client at his/her residence.

5. Intoxicated Students

How to Do:
Counseling Center staff members do not intervene with students who are intoxicated or under the influence of drugs. A counselor can have little impact on students who are “high.” Some such individuals may need medical attention or to be kept safe in a hospital or other secure environment, but a psychological intervention would serve little purpose. Intervention will be offered when the student is sober or no longer under the influence of drugs, when such services may be of some benefit to the student.


6. Volatile Clients

How to Do:

In the unlikely event that a client should become volatile in a counselor’s office, Campus Security and/or 911 will be contacted immediately for assistance. Specific guidelines for handling such situations are outlined in Appendix T.

7. Suicide Attempts/Self Injurious Gestures: Notification of Appropriate Parties


How to Do:
Unless clinically contraindicated, parents, next of kin, or the person identified as “emergency contact” by a client on his/her paperwork may be called if any life-threatening attempt is made or if the counselor evaluates a student to be at immediate and substantial risk of serious harm to him/herself. All clinical staff members should seek consultation and inform the Director about all such notifications. It may also be necessary to inform other agencies on campus and/or administrative personnel.

The counselor will complete the Risk Assessment Summary – Self (Appendix U) when information obtained on the Self-Report Form or during the clinical interview indicates potential risk. In cases where a student has reported a level 3 or above on suicidal ideation on the Self-Report Form or when speaking with the clinician, a Risk Assessment Summary should be completed unless information obtained during interview clearly indicates minimal risk. Rationale for not completing the Risk Assessment Summary in such cases is to be documented.

If a student has evidenced suicidal ideation or behavior and refuses service either at the Center or an outside resource and the student does not meet the legal standard for involuntary treatment, the counselor will document that a risk assessment summary was completed and what services were recommended, offered and refused by the student. The counselor will then contact parents or next of kin unless clinically contraindicated.



8. Threat to Others

How to Do:
The clinician will complete a Risk Assessment Summary – Other (Appendix V) when a student has evidenced homicidal ideation or potential threat to physically harm another. The clinician will consult with the Director and respond as required by law. It may also be necessary to inform other agencies on campus and/or the Dean of Students or other administrative personnel.


9. Sexual Assault

How to Do:
1. Find a safe location away from the perpetrator. Call 911 and/or CU Security (2222 or 615/476-3061) for help as needed to get to safety. Ask a trusted friend to be with you for moral support.
2. Know that what happened was not your fault.
3. Preserve all evidence of the assault.
4. Do not bathe, wash your hands, brush your teeth, eat, or smoke.
5. If you are still in the location at which the crime occurred, do not clean or straighten up or remove anything.
6. Write down all the details you can recall about the attack and the perpetrator.
7. Report the attack to law enforcement immediately (local authorities can be reached by calling 911 or you can call CU Security at 2222 or 615/476-3061 for assistance in reporting)
8. Seek medical care as soon as possible. Even if you do not have any visible physical injuries, you may be at risk of acquiring a sexually transmitted disease (women may also be at risk for pregnancy).
9. To find a local hospital or healthcare facility that is equipped to collect forensic evidence, contact the National Sexual Assault Hotline (800.656.HOPE). The hotline will connect you to your local crisis center, which can provide information on the nearest medical facility, and in some instances, send an advocate to accompany you through the evidence collection process.
10. Ask the health care professional to conduct a Sexual Assault Forensic Exam (SAFE).
11. If you suspect you have been drugged, request that a urine sample be collected to preserve evidence.
12. If you decide to file an on-campus report of sexual assault OR if you want to discuss your options for filing an on-campus report, please see the Dean of Students in Labry Hall 206. You can schedule an appointment by calling 547-1387.

Recognize that healing from an attack takes time. Give yourself the time you need and know that it is never too late to get help.
1. For free, confidential help 24/7 from a rape crisis counselor, contact the National Sexual Assault Hotlines (800.656.HOPE or online.rainn.org).
2. For free counseling on campus, please contact the Cumberland University Counseling Center at 547-1397.
Associated Documents:

COUNS--116p_APPENDIX T CUCC Guidelines for Managing Volatile Clients

COUNS--116p_APPENDIX U CUCC Risk Assessment Summary--Self

COUNS--116p_APPENDIX V CUCC Risk Assessment Summary--Other


Subject Experts

The following may be consulted for additional information.
Director of Counseling/Disability Services/Disability Services Center