Helping High-Risk Clients Who Need Urgent Care

SonderMind’s commitment to improving access to therapy includes helping high-risk clients who are eligible for urgent or emergent care. Read on for tips on how to manage high-risk situations and how SonderMind supports our clinicians who provide care for high-risk clients.

What’s the difference between “urgent” and “emergent” needs?

High-risk  clients are those who have “urgent” and “emergent” needs. SonderMind’s client intake process screens for clients who may be experiencing urgent needs who could benefit from a scheduled session within 48 hours. Clients with emergent needs are supported with referrals to immediate care for crisis intervention and stabilization. 

Clients with urgent needs:

• Are not in immediate crisis
• Are in a situation that can benefit from support 
• Can wait up to 48 hours for an appointment

Clients with emergent needs:

• Are actively in crisis
• Have active suicidal ideation
• Are in a situation with immediate safety concerns
  

Identify risk: The Columbia Protocol (C-SSRS)

As an organization committed to providing the highest-quality clinical services to our clients, SonderMind encourages our provider group to refer to the Columbia Protocol. When assessing and treating clients, utilizing the Columbia-Suicide Severity Rating Scale (C-SSRS) is part of our clinical best practice guidelines. 

The Columbia Protocol supports suicide risk assessment through a series of simple, plain-language questions that anyone (clinicians and non-clinicians alike) can ask. This series of straightforward questions help identify individuals at varying levels of risk, from those with only fleeting thoughts of suicide to those with a detailed plan and intent to harm themselves. Questions include:

• If and when they have thought about suicide (ideation)
• What actions they have taken — and when — to prepare for suicide
• Whether and when they attempted suicide or began a suicide attempt that was either interrupted by another person or stopped of their own volition

The answers help identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs. 

Create a safety plan

A safety plan is a collaboration between a client and clinician. It is a clinical document that outlines strategies for helping a client maintain safety. Sometimes individuals such as a parent, guardian, or partner may participate in the development of the document, as they may play an active part in the plan. A copy of the plan should always be dated and given to the client. The original should be kept in your records.

Some clients may never require a safety plan, but you should always be prepared to develop one if safety concerns arise. A safety plan can include the following:

• Triggers: Situations, people, or things that make a client feel upset, angry, sad, anxious, or uncomfortable.
• Warning signs: Thoughts, images, situations, behaviors that indicate a client is experiencing or about to experience unsafe thoughts or behaviors.
• Coping skills: Things a client has identified that they can do on their own to self-soothe.
• Support system: Someone a client has identified that they can ask for help.
• Professional support: Resources a client can use if they are unable to maintain their safety on their own.
• Acknowledgment: A copy of the plan is dated and given to the client. The original is kept in your records.

For more on what constitutes a safety plan and free templates and resources, see our safety plan article. 

Document your work

As a clinician, you use clinical decision-making to assess client needs and potential benefits of therapy. This is never more important than when treating high-risk clients. 

The “Golden Thread” is a concept in health care related to clinical documentation and best clinical practice. It “ties together” or creates a cohesive narrative of a client’s experience in an episode of care and provides clear evidence of medical necessity. The narrative is documented by the clinician in the client’s record. 

The Golden Thread is a critical component in providing quality care and meeting accreditation, compliance, and reimbursement requirements. You can find documentation templates and more resources here. These notes provide evidence of medical necessity and should be used throughout the intake and treatment process. SOAP notes are one form of medical record documentation, and the SOAP format is incorporated in the templates provided. Entering notes in the medical record is a different process than using psychotherapy notes (which are kept separately).

Connect with your peers

We know there can be many challenges with seeing high-risk clients and the work can feel isolating at times. Connecting with other clinicians for peer consultation is essential to good ethical practice. At SonderMind, the High-Risk Client Preferred Provider Group is a community group that offers our clinicians targeted education to deepen their learning and expand their ability to support clients with urgent needs. As part of this group, SonderMind clinicians have access to a private forum where they can ask questions and share resources with peer clinicians. The SonderMind clinical team is available for consultation on more complex situations.

Know the laws

It’s your responsibility to know and comply with the laws and standards applicable to your profession. The laws, protocols, and procedures for managing high-risk situations may differ based on your location, work environment, and licensure. That’s why it’s important to stay up to date with the laws in your community and state when you are caring for high-risk clients. Check with your professional licensing board websites, state and national professional associations, the American Counseling Association, or the American Psychological Association. ‍

Take care of yourself

When you care for yourself, you can best care for others. This is especially true when you are providing care to high-risk clients. It’s important that you keep a good “baseline” with sufficient sleep and healthy foods. Whether it’s taking time to exercise, meditate, enjoy the outdoors, or spending time with others, find what works for you so you can be your best for clients. After managing a high-risk situation, it’s important to restore your mind and body to baseline.

Clinicians need to monitor their responses when dealing with high-risk clients. You can feel a number of things ranging from feeling numb, rage, helplessness, excessive control, distancing, and/or detachment. If these feelings occur frequently or interfere with your professional and personal lives, you should seek consultation or therapy from another mental health professional. 

Support, resources, education: How SonderMind supports clinicians in high-risk care

We understand there can be challenges in seeing high-risk clients, from the effect  clients’ experiences may have on clinicians, to the isolation of being in individual practice. That’s why we provide comprehensive support and resources to help our clinicians, including continuing education courses, community provider peer groups, consultation events, clinical practice guideline resources, and more, so our clinicians can give the best care in high-risk situations. 

Join SonderMind and be part of a community of clinicians dedicated to giving people needing urgent care the quality mental health care they need, at the time when they need it most.