Page 10 - EAP Manual
P. 10
Early Adolescent DBT Program MY SAFETY PLAN
I, , contract for my safety. This means I will use the coping skills and supports listed below to keep safe before acting on thoughts, feelings, and/or urges to hurt myself.
DBT skills I will use to maintain my safety:
1. 2. 3. 4. 5.
Team members, members in my support system, & crisis numbers I will call for help are:
1. Name & Phone:
2. Name & Phone:
3. Name & Phone:
4. COPE LINE @ (612) 596-1223
5. Child Crisis Mobile Team @ (612) 348-2233
6. National Suicide Prevention Lifeline @ 1-800-273-TALK (8255) 7. Emergency 911
Client Signature: Date: Parent/caregiver Signature: Date: Therapist Signature: Date:
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