Support Line Record Form You must work through and complete each question, otherwise you will not be able to submit. OPERATOR NAME(required) Clients FULL Name (required) This call was (required) Incoming Outgoing – client answered Call was DNA Informed caller that call is recorded for training and monitoring purposes?(required) Yes DNA /Not Applicable Caller has given their permission re the above(required) Yes – carry on with call as normal No – advise caller that we can not proceed with call unless they consent DNA/Not Applicable [If outgoing] Check client is present at the address listed on the call schedule is this the case?(required) Yes No – enter current location below DNA / Not applicable Only complete this section if it is an incoming call OR client is not present at address listed on call sheet. Clients Phone Number Clients First Line of Address Clients Post Code I have made the client aware of our counselling service and Wellbeing/Mentoring Services, as well as our other online services(required) Yes – complete necessary referral forms or instruct client how to do so Unable to inform / DNA I HAVE EXPLORED THE CLIENTS CALL BACK SCHEDULE WITH THEM – INFORMED THEM WE ARE OPEN SUNDAYS – EXPLICITLY DO THIS DO NOT MAKE ASSUMPTIONS(required) They are happy with their schedule and want it to remain as is No -COMPLETE AN UPDATED SUPPORT LINE REFERRAL DNA/Not Applicable Indicate here areas covered during the call(required) Sexuality / Gender Bereavement / Grief / Loss Loneliness / Isolation Anxiety / Depression Family Problems & Relationships Addictions / Substance Dependence Work Related / Employment Issues / Unemployment / Financial Issues Health / Physical and or Mental Legal Issues / Including Family Disputes / Custody etc / Other court appearances Domestic Violence & Sexual Assault Crime / Hate Crime – IF THIS IS THE CASE PLEASE REPORT VIA 101/999 OR OUR CASUAL HATE CRIME REPORTING TOOL ON OUR VOLUNTEER PORTAL AND SUPPORT LINE PORTALS ABUSIVE CALLER DNA/Not Applicable Other[s] – detail below Other RISK ASSESSMENT: You should now asses risk and explicitly ask if any of the following are present: During this interaction, were any of the the following elicited? YOU MUST EXPLICITLY ASK ABOUT THESE:(required) Suicidal Ideation Self Harm Medical Problem that present as urgent DNA / Not Applicable Unable to assess call ended suddenly If you have ticked any of the above, you must now complete a risk assessment. SUICIDE RISK ASSESSMENT: Does the client currently have any active thoughts? Yes – proceed to next question No = zero risk no need to continue with the suicide assessment enter n/a for remainder of section Details of thoughts Does the client currently have a plan as to what they will do? Yes – medium risk – enter details and proceed to 111 assessment link below: No – risk remains low – GIVE VERBAL ADVICE TO CLIENT THAT IF THOUGHTS PERSIST, GET STRONG OR THEY MAY ACT ON THEM TO CONTACT 111/999 IMMEDIATELY Details of plan If there are current thoughts and a plan, complete an online assessment via 111: https://111.nhs.uk/ Detail here the outcome of the advice from the above 111 assessment: RELAY THIS INFORMATION TO CLIENT: Have they agreed/are undertaking action? Yes No – see next section Based on the above, do you consider that the client is in danger, or a further risk to themselves or others? Yes – undertake the advice from the 111 assessment yourself, eg call an ambulance, etc No/Not applicable Detail here the actions you have taken to mitigate risk of suicide SELF HARM RISK ASSESSMENT: Does the client currently have any active thoughts? Yes – proceed to next question No = zero risk no need to continue with the self harm assessment enter n/a for remainder of section Details of thoughts Does the client currently have a plan as to what they will do? Yes – medium risk – record plan and proceed to 111 assessment link below: No – risk remains low – GIVE VERBAL ADVICE TO CLIENT THAT IF THOUGHTS PERSIST, GET STRONG OR THEY MAY ACT ON THEM TO CONTACT CONTACT 111/999 IMMEDIATELY Details of plan If there are thoughts and a plan for self harm, click here to complete an online assessment via 111: https://111.nhs.uk/ Detail here the outcome of the advice from the above 111 assessment: RELAY THIS INFORMATION TO CLIENT: Have they agreed/are undertaking action? Yes No – see next section Based on the above, do you consider that the client is in danger, or a further risk to themselves or others? Yes – undertake the advice from the 111 assessment yourself, eg call an ambulance, etc No/Not applicable Detail here the actions you have taken to mitigate risk of self harm MEDICAL RISK ASSESSMENT: Does the client currently have any urgent medical issues? Yes – proceed to next question No = no need to continue with the assessment enter n/a for remainder of section Details of above If the answer above is yes, click here to complete an online assessment via 111: https://111.nhs.uk/ Detail here the outcome of the advice from the above 111 assessment: RELAY THIS INFORMATION TO CLIENT: Have they agreed/are undertaking action? Yes No – see next section Based on the above, do you consider that the client is in danger, or a further risk to themselves or others? Yes – undertake the advice from the 111 assessment yourself, eg call an ambulance, etc No/Not applicable Detail here the actions you have taken to mitigate risk of medical problem Is there a Safeguarding Issue from this call? Yes – detail this below in notes section No / DNA / Not Applicable NOTES – this is only to be used for recording CSI/Safeguarding events. DO NOT write a description of the call here! ALSO – please make sure you verbally hand over any issues to your TL SUBMIT Δ Like this:Like Loading...
