A risk-informed approach supports a clinically focused and applied understanding of the various factors that may influence safety, clinical decision-making, and treatment planning. This begins at intake and continues throughout treatment as the client’s presentation, circumstances, needs, and level of risk evolve.
A comprehensive, risk-informed approach supports:
- Establishing rapport and building trust
- Developing an understanding of the client’s clinical baseline
- Setting appropriate expectations, boundaries, and treatment goals
- Identifying risk and protective factors
- Recognizing meaningful changes in symptoms, functioning, or circumstances
- Responding to risk or safety concerns in a timely and proportionate manner
- Ongoing monitoring and assessment to determine if treatment needs are being met
Key Risk Components to Consider
Current Risk & Safety Factors
- Presence of suicidal ideation, self-harm, and violence risk
- Intent, planning, and access to means
- Current protective factors
- Ability to maintain safety and utilize supports
History of Risk
- Prior suicidal ideation, suicide attempts, or self-harm behaviors
- History of violence, aggression, or violent/homicidal ideation
- Prior psychiatric emergencies, hospitalizations, or Higher Level of Care (HLOC) admissions
- Previous safety plans, interventions, or treatment responses
Clinical and Contextual Factors
- Symptom severity, acuity, and changes from baseline
- Substance use, misuse, withdrawal, or intoxication
- Trauma history (as clinically appropriate/relevant)
- Medical, cognitive, or psychiatric factors that may affect judgment or functioning
- Current or recent stressors, losses, or significant life changes
Environmental & Situational Circumstances
- Access to means (e.g., medications, weapons, other potential risks)
- Living environment, housing stability, and interpersonal dynamics
- Socioeconomic and psychosocial factors
- Exposure to violence, coercion, exploitation, or other safety concerns
Treatment and Continuity of Care Factors
- Engagement in treatment (e.g., attendance, participation)
- Adherence to medications or other treatment recommendations
- Barriers to accessing care or support
- Changes in services, providers, or level of care
- Gaps in communication or coordination among providers
Telehealth-Specific Considerations
- Client Location
- Emergency contact information
- Awareness of local crisis and emergency resources
- Privacy and safety factors related to the client’s environment
- Plans for managing technology disruptions
- Client's understanding of how to access support outside of sessions
These areas are not exhaustive and should be considered within the context of clinical judgment and the individual client's presentation.