90 Session 3: Safety Plan & Contract

Purpose The purpose of this session is develop a safety plan and contract. This is derived from a Wellness Action Recovery Plan (WRAP) (Copeland, 2002). Typically, a WRAP plan is used for people with identified psychiatric problems (Copeland, 2002). However, given that this program is designed to be used with at-risk populations, a full WRAP plan is not relevant. Instead, the parts of the WRAP plan that can be used for populations without an actual diagnosis will be used, and some steps will be modified to fit the population. The use of a safety contract will be implemented as well. The parts of the WRAP plan that can be incorporated with populations without a diagnosis will be sections 1 – 3, and section 4 & 5 will be adapted to fit the population. Additionally, the safety contract will be used to promote a commitment to safety.

The first part of the WRAP plan, not included in the sections, is to develop an Wellness Toolbox, which is a list of activities that the person has done in the past, or can do in the present to stay well, and things to do when not well to become well again (Copeland, 2002). This is a list that will be used to develop the other parts of the safety plan, which can be located at the front of the binder (Copeland, 2002).

1) Section one is a daily maintenance list, which has three parts to it (Copeland, 2002). The first part is a description of how the person feels when they are well, part two is everything a person needs to do in a day to feel well, and part three is a list of everything a person should consider doing in a day (Copeland, 2002). The difference between this and the Wellness Toolbox is the list is of things the person needs to do every day to feel well. 2) Section two is dealing with triggers, and it involves identifying triggers and potential solutions to react to the triggers (Copeland, 2002).

3) Section three is dealing with early warning signs, and it includes identifying early warning signs that the situation could worsen and actions to address the early warning signs (Copeland, 2002). This section focuses on putting a name to the warning signs such as anxiety, getting frustrated, and uncaring (Copeland, 2002).

4) Section four is when symptoms continue to worsen and making a list of indicators that symptoms have worsened and possible actions to take to address the symptoms (Copeland, 2002).

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5) Section five is normally crisis planning for when the person no longer can make decisions for themselves and designates a plan for people to carry out to assist the individual (Copeland, 2002). This will be modified to picking a person that the student feels they trust to talk with.

The safety contract will be developed by the students individually and sign for safety. The key for this type of contract is the focus on prevention. It should emphasize to prevent the development of maladaptive coping skills. For example, the students should think of a contract that states how they want to use positive coping skills instead of starting maladaptive coping skills. If the occupational therapist is using this with teenagers who have likely participated in maladaptive coping skills such as substance use, the safety contract should instead emphasize to choose positive strategies over already explored maladaptive strategies.

The purpose of this session in the emotional unit is to recognize that emotions can lead to the development of either positive or negative coping strategies. This session is to help explore ideas for positive strategies, as well as acknowledge that it can be difficult to deal with strong emotions.

Preparation/

Supplies Binders for each student

Empty lined paper for students to list triggers, strategies, and warning signs. Pens/Pencils

Paper for safety contracts

*Note: A an example of what the papers for the Safety Plan and Safety Contract may look like is provided at the end of this session.

Group size &

Timeline Group size:

• 3-10

• Age should be taken into account. The younger the clients, the smaller the group size.

• This particular session is best suited for older students. It can be used for younger students (11 and under, but needs to be adapted to developmental level)

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Timeline:

This may take several sessions of 30-45 minutes. The steps worked on for the safety plan and contract can be broken up into multiple sessions. Additionally, other session content such as coping skills in mental health may be utilized as ideas for the safety plan.

Goals By the end of the session:

1. The student will explain how emotions can lead to actions, and how those actions can be positive or maladaptive

2. The student will identify their current positive and negative coping habits

3. The student will complete sections 1-3 of the WRAP and discuss strategies for addressing emotions in a healthy way

4. The student will express increased understanding of emotional health.

5. The student will develop a safety contract that promotes mental health

Rationale of Activity

This activity is in line with the prevention aspect of the program. It helps the students develop strategies to prevent the worsening of risk factors and helps promote positive strategies. This type of session is also important to acknowledge that choosing adaptive strategies is powerful and having options is important.

Cultural

Components The types of strategies chosen to address risk factors, warning signs, as well _{as chosen daily maintenance activities will likely involve culture specific}

activities. The therapist can incorporate culturally relevant activities by providing suggestions such as the brainstormed generosity activities in the previous session.

Precautions Some older students may already have experimented with maladaptive coping strategies or may have had it modeled by their parents in response to strong emotions. It is important to ensure that the student does not promote the behavior as a positive experience.

Steps 1) Begin with explanation of the connection between emotions, behaviors, and promoting emotional health

2) Introduce the 3 sections of the WRAP

3) Facilitate development of the individualized WRAP plan for each students

4) Describe the safety contract for prevention and promotion of positive choices

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5) Facilitate development of the safety contract individually

6) Discuss application and emphasize importance of choosing to engage in positive strategies and how it leads to improved emotional health and mental health

Adaptations This session should be adapted for ages. The session used as written would be best suited for students ages 12-18. To adapt this for students ages 7-11, use age appropriate language and may want to exclude the third section of the WRAP and instead focus on only sections one, two, and the safety contract.

Outcome Criteria

The outcomes of this session should:

a. Facilitate knowledge about how emotions, emotional health, and strategies to promote mental health

b. Increased awareness of risk factors and triggers

c. Increased development of positive strategies and prevention of maladaptive strategies

Resources Copeland, M. E. (2002). Wellness recovery action plan: A system for monitoring, reducing and eliminating uncomfortable or dangerous physical symptoms and emotional feelings. Occupational Therapy in Mental Health, 17(3-4), 127-150. doi: 10.1300/J004v17n03_09

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