Crisis escalation policy

The crisis protocol is initiated when a teen shares concerning information with their Bloom Buddy. Concerning information includes situations where the teen discloses thoughts of self-harm, suicide, or harming others, expresses feeling unsafe or in danger, describes having access to means of harm, or when the Bloom Buddy observes concerning behavioral changes or statements.

Upon recognizing these crisis indicators, the Bloom Buddy takes immediate action by remaining calm and supportive while continuing active listening without judgment. They begin gathering essential safety information and ensure they do not leave the teen unattended in the conversation, maintaining continuous engagement throughout the crisis response process.

The Bloom Buddy conducts a systematic safety assessment using a validated Ask Suicide-Screening Questions (ASQ) Tool or similar tool by asking targeted questions to evaluate immediate risk level. Bloom Buddies administering the ASQ have completed standardized training in suicide risk screening. 

These questions explore whether the teen is having thoughts about self-harm right now ("thoughts"), whether they have developed a specific plan for how they might hurt themselves ("plan"), whether they have access to the means they've mentioned ("means"), and most critically, whether they have formed an intent to act - meaning they've made a decision to move forward with self-harm and may have specific timing in mind ("intent"). Intent represents the most concerning level as it indicates concrete forward movement beyond just considering or planning. We also collect the teen’s current location, whether they are alone, and if they have used drugs or alcohol that day, as these factors can significantly amplify risk.

Throughout this process, comprehensive documentation begins with the Bloom Buddy recording all responses verbatim, noting the time, date, and platform location of the interaction. This documentation continues throughout the entire crisis response process to ensure accurate record-keeping and proper follow-up care. If the Bloom Buddy does not feel comfortable conducting the safety assessment, then they will immediately escalate the ongoing conversation to a supervisor who will join the conversation.

Immediate escalation to a supervisor occurs in several critical situations such as when the teen expresses active suicidal thoughts with or without a plan or means, describes intention to harm others, reports active self-harm behavior, or expresses feeling unsafe in their current environment.

The escalation process involves contacting the supervisor immediately through the secure platform and providing them with a real-time summary of the conversation. The Bloom Buddy remains connected with the teen while the supervisor joins the conversation and follows all guidance provided by the supervisor throughout the remainder of the crisis intervention.

The supervisor conducts a comprehensive risk evaluation using established indicators to determine the appropriate level of response. 

• High risk indicators include active suicidality with or without accessible means, active psychosis or severe mental health crisis, active threats to harm specific individuals, immediate access to lethal means, or substance use that impairs judgment. 

• Moderate risk indicators encompass suicidal thoughts without a specific plan, self-harm urges or recent self-harm behavior, feeling unsafe but not being in immediate danger, and experiencing significant life stressors with poor coping mechanisms. 

• Lower risk indicators include general emotional distress, passive thoughts of death without a plan, actively seeking help and support, and strong protective factors present in their life such as caring or trusted adults who are aware of the teen’s current distress, accessible, and responsive. 

When conducting risk assessments, supervisors should consider the teen's perspective, cultural context, and identified support systems. The goal is collaborative safety planning that maintains the teen's sense of agency while ensuring appropriate protection. Assessment should include the teen's own safety preferences and comfort level with various intervention options.

Immediate Crisis Response is implemented for high-risk situations and involves contacting emergency services (911) immediately while notifying the teen's emergency contact without delay. The team stays connected with the teen until first responders arrive, provides location and relevant safety information to responders, and works to remove or limit access to means of harm when possible.

Urgent Response is deployed for moderate-risk situations and includes developing an immediate safety plan with the teen and determining emergency contact notification through collaborative decision-making (for teens aged 16-17) or immediate notification (for teens under 16). Emergency contacts must be reached within 30 minutes of the decision to notify. This level also involves providing crisis resource information, considering mobile crisis team referral, scheduling follow-up within 24 hours, and increasing monitoring frequency to ensure continued safety.

Enhanced Support is provided for lower-risk situations through collaborative development of a safety plan, scheduling follow-up within 48-72 hours, and working with the teen to identify trusted support people and appropriate resources. Emergency contact notification is considered based on the teen's age, specific situation, and their input on who feels safest to involve. Regular monitoring continues to track progress and ensure stability while respecting the teen's autonomy in their healing process.

Immediate Notification Required (No Collaborative Decision Making Required)

Emergency contacts must be notified immediately in the following circumstances:

• High-risk situations that require emergency services

• Any safety concerns involving teens under 16 years of age

• Situations where the teen expresses intent to harm others or is in an unsafe environment

• Connection is lost during a high-risk intervention and cannot be reestablished

Collaborative Decision-Making Process (Ages 16-17, Moderate Risk)

For moderate-risk situations involving teens aged 16-17, supervisors engage in collaborative decision-making before determining whether to notify emergency contacts by:

• Acknowledging concerns: "I understand you're worried about telling your parents. Can you help me understand what you're most concerned about?"

• Exploring support options: "Who in your life feels safest to you right now? Who do you think would be most understanding?"

• Discussing implications: "Let's talk through what might happen if we involve [responsible adult]. What are you worried about? What might be helpful?"

• Offering choices: "Would it feel better if you told them yourself with me here for support, or if I helped explain the situation?"

• Validating autonomy: "You know your family/situation better than I do. Help me understand what approach might work best."

• Being transparent about boundaries: "I want to work with you on this, and I also need to make sure you're safe. Let's figure out how to do both."

• Allowing processing time: "This is a big decision. Do you need a few minutes to think about it, or should we talk through the options together?"

When Connection is Lost or Teen Becomes Non-Responsive:

• Immediate Action: Attempt reconnection through all available platform channels

• High-Risk Situations: If no reconnection within 5 minutes, immediately notify emergency contacts and consider emergency services engagement

• Moderate-Risk Situations: If no reconnection within 15 minutes, contact emergency contacts to verify teen's safety and location

• If Emergency Contact Cannot Locate Teen: Contact emergency services when moderate-to-high risk indicators were present

When Emergency Contacts Are Non-Responsive:

• High-Risk Situations: Do not delay emergency services contact while attempting to reach emergency contacts

• Moderate-Risk Situations: Attempt to reach all listed emergency contacts within 30 minutes; if no contact is established within 2 hours, consider mobile crisis team intervention

Emergency Services Engagement Required

Direct engagement of emergency services (911) is mandatory when:

• A high-risk situation occurs and connection is lost with no successful reconnection within 5 minutes

• The teen's location is known, risk level is moderate to high, and neither the teen nor emergency contacts can be reached

• The supervisor determines that immediate professional intervention is necessary to ensure teen safety

Safety as Primary Consideration

Teen safety remains the paramount concern in all notification decisions. When there is any doubt about a teen's immediate safety, or when collaborative approaches cannot adequately address identified risk factors, supervisors will prioritize protective action. We consistently err on the side of caution to ensure no teen is left in a potentially dangerous situation.

Immediate documentation requirements include completing a comprehensive crisis incident report that captures risk assessment findings, all actions taken and by whom, emergency contacts made, resources provided, and specific follow-up requirements established during the crisis intervention.

The follow-up protocol ensures continuity of care through multiple touchpoints: within 24 hours, the supervisor contacts both the teen and emergency contact; within 48 hours, the safety plan is reviewed and adjusted as needed; within one week, a comprehensive situation assessment is conducted; and ongoing regular check-ins continue until stability is achieved and maintained.

Continued care coordination involves maintaining regular safety check-ins with the teen while collaborating with their other healthcare providers to ensure comprehensive support. The support level is adjusted based on progress and recovery, with active follow-through on resource connections and referrals, and emergency contact information is updated as needed to maintain current and accurate crisis response capabilities.

This ongoing monitoring ensures that teens receive consistent, appropriate care that adapts to their changing needs and circumstances while maintaining the highest standards of safety and support throughout their recovery process.

When teens contact Bloom Buddies outside of regular business hours, they receive an automated response that immediately directs them to crisis resources including the 988 Suicide & Crisis Lifeline, 911 for emergencies, and the Crisis Text Line where they can text "HELLO" to 741741 for immediate support.

On the next business day, both the Bloom Buddy and Supervisor review all after-hours messages as their first priority. If crisis content is detected in any of these messages, an immediate risk assessment is conducted and the standard escalation protocol outlined above is followed to ensure no safety concerns are overlooked or delayed.