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Play therapy and art therapy Video game therapy Cognitive behavioural therapy (CBT)Exposure and response prevention Mindfulness-based therapies Family and filial therapy Collaborative problem solving Safety planning and harm reduction Book on Jane

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Approach • In person in Vancouver • Virtual across B.C.

Safety planning and harm reduction

When thoughts of suicide or self-harm are present, a written safety plan, a practised crisis response plan and collaborative safety-based care help young people and their parents feel safer.

The six steps of a safety plan

In my practice

“A plan made today is a gift to my future self; it is a powerful act of self-care.”

Pamela Wallberg, RCC

Understanding the approach

The Safety Planning Intervention is a brief, structured way to prepare for and reduce harm, and to improve outcomes for children and youth struggling with self-harm or suicidal ideation.

Together we write a plan in your child’s own words, so that when thoughts of suicide or self-harm rise, they know what to do first, next and last. It is kept somewhere easy to find, such as a phone note or a card, and practised in session so it feels familiar when it is needed.

I combine three evidence-informed approaches into one flexible plan of care: the Safety Planning Intervention, Crisis Response Planning and the Collaborative Assessment and Management of Suicidality (CAMS), where your child helps describe what is driving their thoughts and what to do about it. I use the Columbia-Suicide Severity Rating Scale as a screening tool. Parents are involved so the plan works at home too, with copies for parents when your child agrees. I do not provide crisis services. The plan lists who to call and where to go. If this is an emergency, please contact 911 or go to your nearest emergency department.

Origins and evolution

The Safety Planning Intervention was developed by psychologists Barbara Stanley and Gregory Brown and published in 2012, as a brief, practical tool for emergency departments and clinics. Crisis Response Planning, developed by psychologist Craig Bryan and colleagues, was designed as a stronger alternative to ‘contracts for safety’. CAMS was developed by psychologist David Jobes beginning in the 1990s and treats suicidal thoughts as the focus of therapy, with the young person as an active partner. I take a harm reduction-based approach, using the Safety Planning Intervention, Crisis Response Planning or CAMS as appropriate.

Stanley, B., & Brown, G. K. (2012). Safety Planning Intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264.

Bryan, C. J., et al. (2017). Effect of crisis response planning vs. contracts for safety on suicidal behavior among soldiers: A randomized clinical trial. Journal of Affective Disorders, 212, 64–72. link

Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach (2nd ed.). Guilford Press.

Courtney, D. B., Relihan, J., Prebeg, M., & Ameis, S. H. (2023). CARIBOU clinician’s guide for the management of self-injurious thoughts and behaviours: A component of treatment for adolescents with depression. Centre for Addiction and Mental Health. link

Davies, J., Pitman, A., Bamber, V., Billings, J., & Rowe, S. (2022). Young peoples’ perspectives on the role of harm reduction techniques in the management of their self-harm: A qualitative study. Archives of Suicide Research, 26(2), 692–706. link

James, K., Samuels, I., Moran, P., & Stewart, D. (2017). Harm reduction as a strategy for supporting people who self-harm on mental health wards: The views and experiences of practitioners. Journal of Affective Disorders, 67–73. link

Inckle, K. (2011). The first cut is the deepest: A harm-reduction approach to self-injury. Social Work in Mental Health, 9(5), 364–378. link

Lundeen, L. A., & Popejoy, E. K. (2025). Cutting through stigma: Suggested best practices for a harm reduction approach to nonsuicidal self-injury. Journal of Counseling & Development, 103(3), 267–275. link

Gunnarsson, N. V., & Moberg, C. (2025). Walking a tightrope: A scoping review of the use, perceptions and experiences of harm reduction strategies in self-harm management. Discover Mental Health, 5, 125. link

Cliffe, C., Pitman, A., Sedgwick, R., Pritchard, M., Dutta, R., & Rowe, S. (2021). Harm minimisation for the management of self-harm: A mixed-methods analysis of electronic health records in secondary mental healthcare. BJPsych Open, 7, e116. link

Lewis, S. P., & Hasking, P. A. (2021). Self-injury recovery: A person-centered framework. Journal of Clinical Psychology, 77(4), 884–895. link

Kelty Mental Health Resource Centre (BC Children’s Hospital): Self-Harm. link

Read the research

The science

In a large study of adults treated in emergency departments, the Safety Planning Intervention plus follow-up calls was linked to about 45% fewer suicidal behaviours over six months compared with usual care. In children and teens the evidence is less clear. A 2025 review of ten studies found that safety planning on its own did not show a clear benefit for suicidal thoughts, attempts or return visits to hospital, and the studies were few and at risk of bias. A 2023 scoping review of 15 studies described the evidence as promising, and concluded that safety plans work best when they are completed collaboratively, fit a young person’s development and involve parents or carers. Crisis Response Planning was linked to fewer suicide attempts than a ‘contract for safety’ in a randomised trial of soldiers, and CAMS has reduced suicidal thoughts and distress in trials, mostly with adults. Safety planning is one part of care, not a stand-alone treatment. I can support your family in providing appropriate referrals for ongoing treatment once the safety planning and risk assessment is complete and your child or youth is entering a more stable period.

Abbott-Smith, S., Ring, N., Dougall, N., & Davey, J. (2023). Suicide prevention: What does the evidence show for the effectiveness of safety planning for children and young people? A systematic scoping review. Journal of Psychiatric and Mental Health Nursing, 30(5), 899–910. link

Ewell Foster, C., et al. (2025). Collaborative safety planning with youth during a suicide-related emergency: Developmental and family considerations. Evidence-Based Practice in Child and Adolescent Mental Health, 10(1), 90–105. link

Clifton, R. L., McCarty, C. A., Richardson, L. P., & Adrian, M. C. (2025). Safety planning interventions among children and adolescents at risk for suicide: Progress, gaps, and opportunities. Current Pediatrics Reports, 13(1), 27. link

Westers, N. J., & Plener, P. L. (2020). Managing risk and self-harm: Keeping young people safe. Clinical Child Psychology and Psychiatry, 25(3), 610–624. link

Albaum, C., et al. (2025). Safety planning interventions for suicide prevention in children and adolescents: A systematic review and meta-analysis. JAMA Pediatrics, 179(8), 886–895. link

Monahan, M. F., & Stanley, B. (2022). Safety planning and lethal means counseling with youth. In J. P. Ackerman & L. M. Horowitz (Eds.), Youth Suicide Prevention and Intervention (pp. 79–85). Springer. link

National Institute for Health and Care Excellence (2022). Self-harm: assessment, management and preventing recurrence (NG225). link

Stanley, B., et al. (2018). Comparison of the Safety Planning Intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry, 75(9), 894–900. link

Stanley, B., & Brown, G. K. (2012). Safety Planning Intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264.

Canadian Paediatric Society (updated 2019; reaffirmed 2024). Suicidal ideation and behaviour (practice point). link

Adrian, M., Blossom, J. B., Chu, P. V., Jobes, D., & McCauley, E. (2021). Collaborative assessment and management of suicidality for teens: A promising frontline intervention for addressing adolescent suicidality. Practice Innovations, 7(2), 154–167. link

Swift, J. K., Trusty, W. T., & Penix, E. A. (2021). The effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) compared to alternative treatment conditions: A meta-analysis. Suicide and Life-Threatening Behavior.

Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach (2nd ed.). Guilford Press.

Posner, K., et al. (2011). The Columbia–Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277. link

Kelty Mental Health Resource Centre (BC Children’s Hospital): Suicide & Suicidal Thoughts. link

Kelty Mental Health Resource Centre (BC Children’s Hospital): Self-Harm. link

Read the research

What sessions look like

Screening and writing the plan. We start with a screening using the Columbia-Suicide Severity Rating Scale, then build the plan together over one or two sessions, in your child’s words.
Involving parents. With your child’s agreement, parents see the plan and learn their part. We practise what to say.
Understanding what drives the thoughts. Your child helps describe what is behind their thoughts, and together we choose what to focus on first.
Review. We check in on how your child is doing at each session, and revisit and update the plan as things change.

How it works

The steps of safety planning.

Every child is different, so the pace and order change. This is the general path.

Work through the steps in order. If one does not help, move on to the next. Based on the Stanley-Brown Safety Planning Intervention (Stanley & Brown, 2012).

Screening and warning signs

We begin with a screening using the Columbia-Suicide Severity Rating Scale. We then name the thoughts, feelings, situations and body signals that tell your child a crisis may be building.

Coping steps

We list things your child can do alone to ride out the moment, such as music, a walk, drawing or breathing.

People and places that help

We note people and places that provide comfort or distraction.

People to ask for help

We list trusted adults your child can reach out to, and how.

Professionals and crisis contacts

We include contact details for professional and crisis services, such as Kids Help Phone, a family doctor and the nearest emergency department.

Making home safer and practising

We talk through practical steps to make home safer, with parents involved and without blame. We practise the plan so it is familiar, and review it at each session.

Common questions

Is a safety plan the same as a ‘no-suicide contract’?+

No. Contracts are not supported by research and are not used. A safety plan is a practical set of steps that helps in a crisis.

Will my child have to share everything with me?+

We agree together on what is shared, and I encourage young people to involve parents. When there is serious risk to your child’s safety, I will involve you.

What if my child is in danger right now?+

I do not provide crisis services. If this is an emergency, please contact 911 or go to your nearest emergency department. You can also reach Kids Help Phone at 1-800-668-6868 (text 686868).

Where is the plan kept?+

Wherever your child can find it quickly, usually a card in a wallet or a note on a phone, and a copy for parents.

How long does this take?+

It varies. The plan itself is usually written in one or two sessions. After that, ongoing support depends on how your child is doing, and we review regularly until things feel steadier.

Ready to take a first step together?

You do not have to work this out alone. Book a free 15-minute call to talk about your child, your family and whether this approach fits.

Schedule free consultation

Trusted resources

More help for families in B.C.

Free, evidence-informed information from Kelty Mental Health at BC Children’s Hospital. These links open in a new tab.

Safety in the home guide Making your home safer during a crisis.SELF toolkits for children and adolescents Includes help making a personal safety plan.Self-harm Kelty Mental Health: why it happens and how to respond.

Information on this page is provided by Pamela Wallberg, MA, RCC, Registered Clinical Counsellor. Last updated October 2026. This page is general information and is not a substitute for individual care.