What is a Contingency?

• Contingencies are things that happen in response to particular sets of circumstances: "If John becomes aggressive beyond simple verbal abuse, then the Police are to be called." They are usefully manipulated in Cognitive Behavioural work (see Contingencies).

• Contingency plans are about what to do if, IN SPITE OF OUR RISK MANAGEMENT PLAN, an untoward incident occurs...
• N.B. This is slightly different from intervention plans that we draw up in the Care Plan to AVOID predictable risks.

What needs doing?

• Go to your Care Plan to review/identify the plans that are in place to cover the most likely crises to affect your client.
• In particular look at your Formulation and Treatment Aims and your RiskAssessment

If you are using this manual in its ICR capacity (NOT ACTIVE AT Oct 2014), then you can record a NEW contingency plan you do this via Make or View Client Notes or by clicking here:

• Ensuring that you have completed contingency plans for the most likely crises is included in Starting a NEW CASE - CheckLists

Co-construction:

• Plans are only likely to be effective if they are co-constructed with the young person, and the family/immediate carers.
• Often some work on developing a robust netwrok of support for the other family members is required: for instance negotiating to recruit nearby uncles, friends, or neighbours to be "on call" and to act as "referees" (NB - obvioulsy it is important to clarify that we are NOT asking anyone to act as police or to involve themselves in any aggression to quell violence.)
• For instance, a plan may look like this:

Contingency: Aggression or violence in the family home.
Response: 1. Try to use the de-escalation techniques as discussed. 2. Ensure paper information sheets about managing violence, and recording these plans, are available at home. 3. See Manage Violence) 4. First, try to avoid violence erupting by doing (a), (b), (c). 5. If violence does erupt, then family members are to avoid getting drawn into any physical confrontations. 6. Family members are to remove themselves from the area, meanwhile orienting X to the situation with a statement such as: "We are all at home, but we are feeling afraid right now, so we are following the plan we all made to help us all calm down and think straighter." 7. If the situation is not rapidly calmer, then escalate to calling your neighbour John for help, and/or the Police.

• Share written copies of these plans with family, friends, and the young person, as required.
• The RiskAssessment and Formulation and Treatment Aims will help determine the most likely/serious risks to plan for.

Generic crises - Endings, and specific "suicide spots"

• Some crises, rather than being "specific" to a certain young person, may be will be "generic" for the local team
• The team's contingency plan may thus be edited into the local team-based template of the manual - see + Manualize our work

• For instance if there are particularly well known "suicide spots" that a young person may head for (a railway line, a road bridge, etc.)

• Planning Before Treatment Endings:
• There are likely to be a number of predictable "stress points" in the weeks or months following discharge from your service.
• As much as possible the KeyWorker and young person should try to predict and "map" these, and then to devise ways to practice or rehearse solutions.
• For instance, making the journey several times to a new clinic, so that the directions/bus routes/etc are clear, or arranging to attend initial appointments together.
• Handovers to new workers/new teams
• It is often powerful for a young person to see a trusted KeyWorker standing beside a new worker, and thus in a rather concrete way showing the connection and professional trust between them.
• Sometimes a brief conversation with a new worker before such a meeting can help to prime them to make the most of the positive attachment that exists.
• Positive/Secure attachments can in this sense be seen as "rubbing off" on other workers in close proximity.)