SESSION 12: PROTOCOLS, LOGS, AND REPORTING

SECTION 14: POST‑SESSION PARTICIPANT DEBRIEF (Individual, 2 minutes per person)

Conduct in order of seating. A second staff member (peer or clinician) must be present to supervise any participant with activation score ≥7 during their 10‑minute grounding period.

Facilitator script (private, one‑on‑one): “Thank you for being here. Before you go, I want to ask you two quick things – just to make sure you leave solid.

First, on a scale of 1 to 10 – where 1 is ‘totally calm’ and 10 is ‘the most stirred up I’ve ever been’ – how much did this session stir up for you?”

If ≥7: “That makes sense. What’s one grounding move you can do in the next 10 minutes?” (Offer: water, walk, 4‑in/6‑out, wall press.) → Second staff member must remain with this participant for the entire 10‑minute grounding period. Primary facilitator continues private debriefs only after coverage is confirmed.

Second, what’s one thing you’re taking with you from today – something that made sense or felt useful?” (Validate briefly. No fixing.)

Final check: “Do you feel safe to leave on your own right now, or do you need me to stay with you or call someone?”

If any hesitation or “no”: Activate SPI warm handoff using the script in Section 15.2. Do not release alone.

Document on S‑12‑SAF log (Section 16).

SECTION 15: SPI HANDOFF PROTOCOL – FULL SCRIPTS FOR ALL SCENARIOS

15.1 SPI Trigger During Main Session (active plan/intent or unmanaged dissociation)

Trigger phrases:

“My kids would be better without me.”
“I’m done.”
“I have a plan.”
Blank stare, no response to grounding, dissociative detachment.
Any “Yes” on C‑SSRS questions 4, 5, or 6 (intent, plan, behavior).

Facilitator response (exact words):

“Thank you for saying that. I want to talk with you privately after we close.”
Continue current section to completion.
During Safety Reference Card, sit nearby (do not isolate).
After session closes, say: “Let’s step into the Safety Zone. I’m going to stay with you.”
Activate site SPI pathway (call on‑call clinician or 988). Do not leave participant alone.
If C‑SSRS positive or active plan/intent present: On‑call clinician must perform CSRE (Section 24) before participant leaves the building. Do not release participant to their own care until CSRE is complete and disposition is made.
Document on S‑12‑SAF.

15.2 SPI Trigger During Post‑Session Debrief (participant says they are not safe to leave)

Facilitator response (exact words):

“Thank you for telling me. I am not going to let you leave alone. I’m going to stay with you and call [988 / on‑call clinician] right now. You are not in trouble. This is what the card is for.” Then follow site SPI pathway. Do not release until connected to ongoing support.

15.3 Participant Refuses to Stay on Call or Disconnects (low‑resource or phone)

Facilitator action:

Call 911 (local EMS) and the participant’s registered emergency contact simultaneously.
Keep the rest of the group muted or have co‑facilitator hold the room.
Continue only after EMS handoff is initiated.
Document on S‑12‑SAF.

SECTION 16: S‑12‑SAF FACILITATOR INCIDENT & SAFETY LOG (Fillable)

| Field | Entry | |——-|——-| | Facility Name | _______ | | Facilitator Name(s) | _______ | | Session Date | __//__ | | Group Size (attended) | _____ | | Delivery Mode | ☐ In‑person ☐ Low‑resource (App C) |

C‑SSRS Results: Number of participants with any “Yes” to 1–5: ___ Number with “Yes” to 6: ___ CSRE Escalations: Number of participants requiring CSRE: ___ CSRE completed: ___ Refused: ___ **SBOR Required?** ☐ Yes ☐ No – Supervisor notified? ☐ Yes ☐ No – SBOR filed (supervisor initials): ___ RGP Activations: Number of participants who received RGP: ___ **SPI Handoffs:** Number of participants who triggered SPI: ___ SPI Handoff Outcomes: Connected: ___ Refused: ___ Lost contact: _____ Post‑Session Debrief:

Participants with activation score ≥7: _____
Participants not safe to leave alone: _____
SPI reactivated during debrief: _____ Means Safety (S‑12‑MS):
Gun locks taken: _____
Lockboxes taken: _____
“Already have a plan” checked: ___ **Adverse Event (within 7 days):** ☐ None ☐ Attempt ☐ Hospitalization ☐ Emergency intervention **Reported to VA contract officer?** ☐ Yes ☐ No – Date: ___ Reported to clinical supervisor? ☐ Yes ☐ No – Date: _____

Facilitator Signature: _______ **Date:** ___ Supervision check completed? ☐ Yes ☐ No ☐ N/A

SECTION 17: FACILITATOR POST‑SESSION SUPERVISION CHECK

To be completed within 24 hours of session, especially if any SPI activation, CSRE, SBOR, or staff distress occurred.

Supervisor asks the facilitator:

“Did any participant require CSRE? Was it completed before they left?”
“Was any SBOR‑level event reported? Have you filed it?”
“Did you experience any freeze, dissociation, or overwhelming emotion during the session?”
“What support do you need right now – debrief, time off, or clinical consultation?”

SECTION 18: FACILITATOR AGREEMENT & SIGNATURE PAGE

I have read and understand the Session 12 Complete Operational Package – Version 7.0.
I agree to adhere to all safety protocols, including C‑SSRS screening, CSRE escalation, and SBOR reporting.
I understand that any deviation, omission, or summarization of this protocol puts lives at risk and violates my contract.

Facilitator Name (printed): _______ **Facilitator Signature:** _______ Date: _______ **Witness (clinical supervisor or contract officer):** _______

SECTION 19: DISRUPTIVE BEHAVIOR / ELOPEMENT PROTOCOL

If a participant becomes agitated, yells, or tries to leave mid‑session:

Do not block the door. Say calmly: “I see you need space. Please take 5 minutes in the Safety Zone. I will check on you.”
Alert the Safety Zone staff (by name or pre‑arranged signal).
Do not chase. Do not physically restrain.
If the participant leaves the building entirely: call the on‑call clinician and document. Do not call 911 unless they are an immediate danger to themselves or others (active plan, weapon, etc.).
After the session, document on S‑12‑SAF under “adverse event” if elopement required emergency response.

SECTION 20: APPENDIX B – LOCAL CRISIS PATHWAY (Must be filled out before each session and test‑called within 24 hours)

SECTION 21: APPENDIX C – LOW‑RESOURCE DELIVERY CONTINGENCY

Use only if on‑site clinician & Safety Zone are unavailable. All conditions below must be met. If any fail → do not deliver Session 12.

Mandatory Pre‑Conditions (PASS/FAIL Checklist)

Session is delivered via live video with VA crisis backup on standby (988 Press 1 on speaker, muted, permission to unmute).
Facilitator has ASIST/SAFE‑T/6‑hr live course ≤24 months.
Each participant has two crisis numbers in phone before start.
Group size ≤5.
Post‑session check‑in call scheduled within 24 hours for every participant.
C‑SSRS must be administered verbally (video visible, participant can nod or say yes/no).
CSRE must be performed via video by on‑call clinician if positive. If not possible → do not run session.
SBOR reporting still required via supervisor call after session.
If VA crisis backup not reached within 2 minutes → stop group, convert to individual safety calls.

Modified RGP for Low‑Resource

Facilitator says at opening: “We don’t have a separate quiet room today, but if anyone needs a break, we will pause the group and you can step off camera for 2 minutes. I will check in with you privately after.”

SPI Handoff in Low‑Resource (if participant endorses active plan/intent or C‑SSRS positive)

“I need to focus on your safety right now. The group will continue without us for a moment.”
Mute others (or co‑facilitator holds room).
Activate 988 on speaker with participant’s consent. Stay on line until counselor takes over. CSRE must be completed via video before ending call.
If participant hangs up or video fails → call 911 + emergency contact simultaneously. Keep others muted. Continue only after EMS handoff initiated.
Document on S‑12‑SAF, including SBOR notification.

Liability Note for Low‑Resource Delivery

Prime contractor assumes additional risk. Document contingency use in after‑action report with justification. Failure to complete CSRE for a C‑SSRS positive participant in low‑resource mode is a reportable safety event.

SECTION 22: CONSOLIDATED METRICS & AFTER‑ACTION REPORT

After each session: Export CSV within 24 hrs; 10‑min self‑regulation + supervision check if activation occurred. Adverse event within 7 days: Report to VA contract officer and clinical supervisor immediately.

SECTION 23: COLUMBIA‑SUICIDE SEVERITY RATING SCALE (C‑SSRS) – BRIEF SCREENER (VA/DoD Required)

(This page is printed separately – one per participant)

C‑SSRS BRIEF SCREENER (VA/DoD Version) | Item | Question | Yes | No | |——|———-|—–|—–| | 1 | Have you wished you were dead or wished you could go to sleep and not wake up? | ☐ | ☐ | | 2 | Have you actually had any thoughts of killing yourself? | ☐ | ☐ | | 3 | Have you been thinking about how you might kill yourself (e.g., taking pills, shooting yourself, or other methods)? | ☐ | ☐ | | 4 | Have you had any intention of acting on these thoughts of killing yourself, as opposed to having the thoughts but no intention? | ☐ | ☐ | | 5 | Have you started to work out or written down the details of how to kill yourself? (e.g., timing, method, setting, access to means) | ☐ | ☐ | | 6 | Have you ever done anything, started to do anything, or prepared to do anything to end your life? (e.g., taken pills, tried to shoot yourself, cut yourself, tried to overdose, researched methods) | ☐ | ☐ |

FOR FACILITATOR USE: If any “Yes” to questions 1–5 OR “Yes” to question 6 → STOP. Activate Section 24 (CSRE Escalation) immediately. Do not proceed with group until on‑call clinician initiates CSRE.

SECTION 24: CSRE ESCALATION PROTOCOL (Comprehensive Suicide Risk Evaluation)

Trigger: Any participant answers “Yes” to C‑SSRS questions 1–5 or 6 – OR exhibits warning signs (active plan, intent, recent attempt, dissociation with suicidal content).

Required Action (VA/DoD CPG 2024, Sec 4.2):

Same‑day CSRE must be performed by a licensed provider (VA clinician, on‑call contract clinician, or 988 crisis counselor with VA privileges).
Do not continue the group session until the CSRE is initiated. The participant must not leave without evaluation.

Facilitator Script (exact words):

“Based on what you just shared, I need to bring in a clinical provider right now to do a safety evaluation. This is not punishment. This is standard VA protocol to make sure you get the right level of support. I will stay with you. The group will pause or continue with the co‑facilitator.”

Steps:

Immediately contact the on‑call clinician (5‑minute reach, per Section 1). If not reachable within 2 minutes, call 988 Press 1 and state: “This is a C‑SSRS positive participant requiring CSRE.”
Do not leave the participant alone – not even to use the restroom. Use the Safety Zone or a private room.
The clinician will perform the CSRE (typically 15–30 minutes). The CSRE must assess: current ideation intensity, intent, plan, means access, protective factors, and acuity.
Based on CSRE outcome:
- Low risk → participant may return to the group (if time remains) or complete the Safety Reference Card individually.
- Moderate/High risk → clinician coordinates next level of care (crisis appointment, mobile crisis, emergency department). Participant does not leave without a disposition.
Document the CSRE trigger and outcome on the S‑12‑SAF log (Section 16). The clinician documents the full CSRE in the EHR.

If participant refuses CSRE: Say: “I understand this is hard. I cannot let you leave without a safety check. If you refuse to speak with the clinician, I will need to call 911 to ensure you are safe.” Then follow site protocol for involuntary evaluation if criteria met.

SECTION 25: SBOR REPORTING (Suicide Behavior and Overdose Report)

Requirement (VHA Directive 1160.07, Sec 5.2): Any suicidal behavior (attempt, preparatory act, interrupted attempt, aborted attempt) or overdose (regardless of intent) identified during the session must be reported via the Suicide Behavior and Overdose Report (SBOR) in the Veteran’s electronic health record (EHR).

Facilitator Responsibility:

The facilitator does not have EHR access. You must notify the clinical supervisor (or on‑call clinician) immediately after the session (or same day) of any:
Self‑injurious behavior with intent to die (even if no injury)
Overdose of any substance (prescription, illicit, or over‑the‑counter) reported by participant or observed
Preparatory acts (e.g., loading a gun, gathering pills, writing a suicide note)
The clinical supervisor is responsible for filing the SBOR within 24 hours.

Facilitator Script for Notifying Supervisor:

“I need to report an SBOR‑level event. [Participant ID] [describe behavior: e.g., reported taking 20 pills yesterday / disclosed they loaded a firearm last week / attempted to hang themselves]. Please file the SBOR within 24 hours.”

Documentation: Note on S‑12‑SAF log (Section 16) that an SBOR was required and the supervisor was notified. The supervisor initials the log after filing.

If the event occurred during the session (e.g., participant attempts to harm themselves in the room): Call 911 first, then the on‑call clinician, then the supervisor for SBOR filing.

SECTION 26: FINAL SIGNATURE BLOCK (For VISN/Contractor Approval)

This complete operational package – Version 7.0 – is approved for use as the sole, non‑abbreviated protocol for Session 12 of What Really Happened: A Trauma Education Series.

VA Contract Officer Signature: _______ **Date:** ___ Clinical Supervisor Signature: _______ **Date:** ___ Prime Contractor Representative Signature: _______ **Date:** ___