Select Language

ลงทะเบียน

Therapy Crisis Initial Assessment Note Template

Description:

This template provides a structured framework for therapists conducting an initial assessment session with a client in crisis, capturing critical information about the immediate situation, risk factors, and stabilization needs to ensure safety and guide urgent intervention. It is designed to assess acute distress and establish a foundation for crisis management, with comprehensive guidance within brackets to support a thorough, rapid evaluation under time-sensitive conditions.

Note:

This template is intended for the first session with a client in immediate crisis. Prioritize safety and brevity, adjusting sections based on the client’s presentation and available information, ensuring sensitivity to their distress and capacity to engage.

Date: [Record the date of the crisis assessment session to establish the precise starting point of the client’s crisis intervention record]

Client Name: [Enter the client’s full legal name for accurate identification and documentation, if known; use a temporary identifier if not immediately available]

Therapist Name: [Enter the therapist’s full name to establish accountability and authorship of the assessment]

Time of Assessment: [Note the specific time the session began, including AM/PM, to track the crisis timeline and response urgency]

Consent and Confidentiality

[Document the client’s understanding and agreement to the crisis intervention process, if possible, including confidentiality limits (e.g., mandatory reporting for imminent harm), noting verbal consent or inability to consent due to distress, as required by ethical and legal standards.]

Client Information

Client Name: [Enter the client’s full legal name as provided, ensuring clarity for record-keeping, or note if unknown pending further information]
Date of Birth: [Record the client’s date of birth in MM/DD/YYYY format, if known, to confirm their age and provide context for risk assessment]
Emergency Contact: [List the name, relationship, and contact information of a designated emergency contact, if provided, to facilitate support or notification in urgent situations]
Current Location: [Note the client’s physical location at the time of assessment (e.g., home, hospital), to assess environmental safety and inform immediate response options]

Presenting Crisis & History

Nature of Crisis: [Describe the immediate crisis prompting intervention, as reported by the client or a third party (e.g., suicidal thoughts, panic attack), capturing the specific event or trigger in their words if possible.]
Onset and Duration: [Record when the crisis began, how long it has persisted, and any escalating factors, to establish the urgency and trajectory of the situation.]
Relevant History: [Detail any recent stressors, mental health history, or prior crises (e.g., suicide attempts, hospitalizations), if known, to contextualize the current event within the client’s background.]
Substance Use: [Note any current or recent use of alcohol, drugs, or medications, including amounts and timing, to assess their role in the crisis and potential medical needs.]

Current Functioning

Behavioral Observations: [Describe the client’s observable behaviors during the session, such as agitation, crying, or lethargy, to provide a snapshot of their presentation under distress.]
Emotional State: [Record the client’s reported or observed emotions (e.g., despair, fear), including intensity and coherence, to evaluate their psychological condition in the moment.]
Cognitive Functioning: [Note the client’s thought processes, orientation, or ability to communicate (e.g., disorganized, lucid), to assess their capacity for decision-making and engagement.]

Risk Assessment

Suicide Risk: [Document any suicidal ideation, intent, plan, or means, including frequency and specificity, to determine the level of immediate danger and need for intervention.]
Self-Harm or Harm to Others: [Record any thoughts, plans, or actions related to self-harm or aggression toward others, including severity and triggers, to prioritize safety planning.]
Protective Factors: [Identify any factors reducing risk, such as support systems, willingness to seek help, or coping resources, to leverage in stabilization efforts.]

Support System

Available Supports: [List individuals or resources the client identifies as supportive (e.g., family, friends, crisis line), including contact status, to assess immediate external assistance options.]
Caregiver/Collateral Input: [Note any observations or information provided by caregivers, friends, or first responders present, to supplement the client’s self-report and broaden the crisis picture.]

Interventions Provided

[Detail the immediate therapeutic actions taken during the session, such as de-escalation techniques, safety contracting, or referral coordination, including their purpose and duration, to document the initial response to the crisis.]

Goals for Crisis Management

Client’s Immediate Needs: [Describe what the client expresses as their urgent needs or desires (e.g., “feel safe,” “stop the panic”), if articulated, to align intervention with their perspective.]
Therapist’s Stabilizing Goals: [Outline short-term objectives for the session, such as reducing acute distress or ensuring safety, to establish a focus for crisis resolution.]

Next Steps

[Specify immediate follow-up actions, such as arranging a safety plan, scheduling a next session, or referring to emergency services, including contact instructions for the client or supports, to ensure continuity and protection post-session.]

Summary and Initial Impressions

[Summarize the therapist’s initial understanding of the crisis, integrating risk level, client state, and intervention outcomes, to provide a concise overview for guiding immediate and future responses.]

Plan for Stabilization

[Outline the preliminary stabilization approach, including specific strategies (e.g., safety monitoring, psychiatric referral), resources involved, and timelines, to address the crisis effectively and transition to longer-term care if needed.]