Crisis Plan Template - Quick Handoff Form - Step by Step Crisis Plan Section

Sep 22, 2026

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Crisis Plan template for individuals with neurodevelopmental and behavioral dual diagnoses, designed to help families identify, prepare for, and prevent behavioral crises. It includes a quick information Quick Handoff Form for caregivers and first responders, a Planning section to document triggers, de-escalation techniques, and crisis events, and a Step by Step Crisis Plan organized into prevention, escalation, and full crisis stages with specific family actions. A Reflection section supports post-crisis adjustment, alongside personalized medical, behavioral, and calming guidance.

LanguageEnglish

CategoryForms

FormatPDF

Pages7

Reading Time3 min

AccessFree to download

Quick Handoff Form

About Us

Planning

Step by Step Crisis Plan

Stage 1: Prevention

Stage 2: Escalation

Stage 3: Full Crisis

Reflection

Crisis Plan (Visibility and completion guidance)

COMIRB \#: 17-0845 Project Title: Assessing the Utility of a Crisis Plan for Individuals with Neurodevelopmental and Behavioral Dual Diagnoses PI: Cordelia Robinson Rosenberg, PhD, RN Version Date: v06 .07.2017 Crisis Plan Template This Crisis Plan template is meant to help you and your family identify, prepare for, and prevent behavioral crises with your son or daughter. The recommended components of the template include: Quick Handoff Form: This page is meant to be used as a quick information form that can be given to anyone who may interact with your son or daughter in a crisis. Examples include first responders, teachers, babysitters, and hospital/clinic staff. If possible, it is advised to give these forms to these people in advance, so they may read it and learn about your son or daughter prior to a crisis. Planning: This section is meant to be completed during a time of calm. You are encouraged to include the opinions of other family members and if possible, a professional who knows your son or daughter well. This section should help you identify the triggers, de-escalation techniques, and crisis events specific to your son or daughter and family. These answers can be used to complete the "Step by Step Crisis Plan Section. " Step by Step Crisis Plan: This is your actual Crisis Plan. It is divided into three stages of crisis: prevention, escalation, and full crisis. You will describe what each stage may look like for your son or daughter and then list what each member of the family should be doing during each stage. These two pages should be placed somewhere that is visible to all family members and can be easily accessed during a crisis. Reflection: The final section is a place for reflection following a crisis. This information can be used to adjust the Crisis Plan if necessary. Quick Hand-Off Form: About Us | Name of son or daughter:
John Smith | Date of Birth:
04/21/2002 | | Gender:
Male | | --- | --- | --- | --- | | Address:
1234 Smith St., Denver, CO 80220 | | Phone Number:
303-123-4567 (Mom’s cell) | | | Mental Health/Behavioral Diagnoses:
Autism
ADHD Depression/Anxiety | | Current Medications and Dosage:
Methylphenidate sustained release, 30 mg, 1x/day Fluoxetine 10 mg, 1x/day
During a Crisis, these medications help my son or daughter:
Valium | | | Other Medical Problems:
Celiac disease | | Allergies:
Penicillin | | Interacting with My Son or Daughter: Because of John’s diagnoses, he/she will act and respond differently than others. Please use these tips when interacting with my son or daughter: My son or daughter is verbal/non-verbal. Please communicate with my son or daughter by: • Speak slowly in short sentences. • Use “First Then” language (Ex: First you need to stop hitting, then you can sit with your mom. ) • Use picture charts Please avoid doing/saying this: • Use a calm, low voice • Move slowly • Say what you are going to do before you do it Things that help calm my son or daughter: Things that will upset my son or daughter: • Watching a cartoon • Too much noise/stimulation • Holding a yellow blanket • Moving too quickly • Sitting alone in a dark, quiet room • Being touched without warning Typical behaviors of my son or daughter while they are in crisis. • Hitting and scratching • Throwing items • Running away Other things to know or expect about my son or daughter when they are in a crisis: • Risk of elopement Planning Describe what a crisis looks like and feels like to you. | He yells, hits, scratches, and has difficulty listening and following directions. He sometimes | | --- | | runs away. | | | | | How does your son or daughter’s behavior differ from other times in his or her life? How do you respond? Does it help? | Trigger for Behavior (if known): | Behavior During a Crisis: | What I did: | Was it helpful? | | --- | --- | --- | --- | | I took away the iPad | John repeats himself o

FAQs

What is the Quick Handoff Form used for during a crisis?

It serves as a fast information page that can be given to anyone interacting with the individual in a crisis, such as first responders, teachers, babysitters, and hospital/clinic staff.

When should the Planning section be completed?

It should be completed during a calm time. The family is encouraged to include input from other family members and, if possible, a professional who knows the individual well.

How is the Step by Step Crisis Plan structured?

It is divided into three crisis stages: prevention, escalation, and full crisis, describing what each stage may look like and listing what each family member should do during each stage.

Sep 22, 2026

Upload by Logic