WV School Mental Health Crisis Planning (WVSMHCP) Template
Download an electronic copy of the WVSMHCP planning template and use the expandable version rather
than this hard copy to develop your crisis plan.
WV School Mental Health Crisis Team Planning Template
School:_______________________________________ Team Manager________________________________________
Contact Phone__________________________ Contact Email________________________________________________
School Mental Health CRISIS PLANNING TEAM (MHCPT)
1. Identify team members - Suggested roles on left
Title
Name
Office Phone
School Counselor
Principal
School Nurse
School-based Mental
Health Provider
Community Mental
Health Provider
Prevention Resource
Officer
Special Educator
Student
Teacher
Parent
Other
Other
2. Define Purpose, Scope and Function of the MHCPT
What are the goals
1.
and purposes of the
2.
MHCPT?
3
4.
5.
6.
7.
Crisis Type:
Resources
What incidents are
you preparing to
address?
What resources will
you use for each
crisis type?
Home Phone
Cellular
Email
How often will the
MHCPT meet?
Who will record
meeting Notes?
3. Delineate Team Member Roles
Use Appendices 1.5.a – 1.5i in the guidebook to describe specific responsibilities of various team members. Include school
specific roles and responsibilities for this crisis plan.
4. Which SCHOOL/COMMUNITY PARTNERS will you invite to assist with planning and training for each crisis stage?
Phase
Assist with Planning
Assist with Training
PLANNING
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
PREVENTION
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
RESPONSE
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
RECOVERY
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
5. Describe steps and resources your school will use to address each crisis phase.
Phase
Action Steps
Resources
PLANNING
Phase
PREVENTION
Action Steps
Include Crisis Prevention Programs/areas
to address and action steps for each:
 Development of comprehensive
school mental health model
 School climate and culture
 Identification of at-risk students
 Bullying and Violence Prevention
 Gang Prevention
 Suicide Prevention
 Other
Resources
Phase
RESPONSE
Action Steps
Resources
Phase
RECOVERY
Action Steps
Resources
6. School Mental Health Crisis Response Team (SMHCRT)
6. Identify Members who will be on your (SMHCRT). Provide your member information here.
Suggested Roles on left.
Title
Name
Office Phone
Home Phone
Cellular
SMHCPT Manager
School Counselors
Social Workers
District Contact Person
Principal or Asst.
SRO Officer
Community Mental
Health Representatives
Faith Based
Representatives
Lead Parent Contact
Incident Command
Leader
Others?
7. How will you evaluate the success of your crisis plan?
Considerations for
evaluating and
improving crisis plan
8. How will you update your crisis plan and train students, staff and families about changes?
This is a living
document. It should
be revisited and
updated annually.
What is your plan to
annually revisit and
update?
Email
9. How will you communicate your school crisis plan with students, staff, families, community stakeholders and SMHCT?
Communication Plan
School Mental Health Crisis Team Communication Plan
How will you activate
and communicate with
your crisis response
team?
How will you share
your plan and ensure
all stakeholders know
what to expect during
each phase of a crisis?
Student Communication Plan
Staff Communication Plan
Family Communication Plan
Community Stakeholder Communication Plan
Resources: Evanston Township High School Crisis Manual and Tucson School Counselor
Crisis Planning Guide