Appendix FSample Crisis/Safety Plan

The following is a suggested Crisis/Safety Plan that can be used with a client who has or may have an FASD, or with a family member or caregiver of the client. The plan is designed to help identify safety concerns for the client, actions that can be taken to prevent or address those concerns, and support persons that can assist.

If you have access to an electronic version of this TIP, consider printing this and the following page back-to-back as a way to reproduce the form for your use. This form has been adapted from materials in the Families Moving Forward Program (http://depts.washington.edu/fmffasd/). Check their Web site for additional resources.