Student Crisis Response Protocols

Dean of Students

Introduction

Successful crisis response requires planning and preparation. Effective crisis management is the responsibility of all members of the university community. While there are specific individuals on-campus who have been identified as playing a key role in crisis response and intervention, any faculty or staff member may encounter a student in distress. It is important to be familiar with the procedure that will take place if any of these protocols are activated, as well as to understand what your role is in the process. Each department/unit should have an internal crisis response protocol that was created in collaboration with the Mental Health Critical Incident Response Team (MH-CIRT). If not, please contact the Dean of Students and/or Director of the Counseling Center to request consultation around developing your procedures.

Faculty and staff should all familiarize themselves with the Faculty and Staff Guide for Supporting Students in Distress. Additionally, all ETSU employees are encouraged to attend a Question.Persuade.Refer. (QPR) training to learn necessary skills for risk identification, support, and referral. Several scheduled trainings are available each semester and can be requested for individual units upon request. Contact Dr. Kevin Smith, Counseling Center Assistant Director for Clinical Services for more information at smithkm18@etsu.edu.

A crisis is a “traumatic event that seriously disrupts our coping and problem-solving abilities. It is typically unpredicted, volatile in nature and may even threaten our survival.”

Examples of a crisis include, but are not limited to: 

  1. Death, injury, or illness: in residence hall or on campus, at ETSU-sponsored event or activity, or of student or staff away from campus
  2. Health or welfare-threatening situations, such as: natural disasters; assaults (e.g. bomb threats, active shooter, physical or sexual assaults, etc.); missing persons; suicide attempts; civil disobedience (e.g., political or religious protests); events which could adversely alter public perception of the University or create an atmosphere of fear or unrest.
  3. Or any other situation that has widespread implications for or potential impact on students and the university community.

Crises on campus will not always necessitate the involvement of a team of professionals. Any faculty/staff member involved in crisis intervention should attempt to remain calm and appropriately address the situation. Reactionary approaches can be negatively impactful, so it is important to think before acting.

To allow for timely and effective intervention when crises occur, all ETSU students must provide an emergency contact, as well as an updated address and phone number, at orientation. Students are encouraged to review and update this information each semester.

Intervention Options

The following are examples of intervention options on-campus for students of concern. It is important that students receive services that are indicated for their level of need. Unintended consequences of treatment options that aren’t the best fit for them include: unnecessary medical bills and increased financial stress, familial/relational conflict, decreased likelihood to seek services in the future, and lack of trust in mental health care system. Faculty/staff are not responsible for determining the appropriate course of care. While the outcome of the intervention may not always be what is expected at the time of referral, faculty/staff should trust the clinical judgment of the professional staff involved in the evaluation. The information provided by the student of concern, as well as relevant laws and treatment guidelines, will determine the course of action taken. Professional staff cannot rely on information provided by third parties and must find a balance between student autonomy/rights and their safety. Tennessee law (described in the Hospitalization section) provides guidance for designated authorities in these circumstances.

Care Reports

Concerned others can submit a CARE Report online for anyone they feel would benefit from additional on-campus support. Reasons a CARE Report might be submitted include (but are not limited to): a previously engaged student is no longer attending class or completing assignments, you received an email from a student expressing mental health concerns, you have noticed someone becoming more isolated, or you became aware of a recent loss/difficult experience for the student. CARE Reports can be completed anonymously, but it is often helpful to include your information so that the Dean of Students office can follow up with additional questions. All CARE Reports received are reviewed by the Dean of Students office and appropriate action is taken based on the nature of the concerns noted. You should receive notice of receipt of the CARE Report. Most students are encouraged to attend a meeting with the Dean of Students office if they require additional support; however, meetings are not mandated unless it is a matter of student conduct or safety. All students receive an email with resources that may benefit them based on their circumstances. The reporting party will not always receive communication from the Dean of Students office regarding actions taken, as most actions are protected by the student’s right to privacy.

Wellness Check

Concerned others can contact Public Safety 24/7 regarding students living on-campus to request a
“wellness check.” A wellness check is a visit by Public Safety officers to confirm a student’s safety and well-being. These visits are usually requested following prolonged lack of communication from the student or recent communication from the student expressing intent to harm oneself. Public Safety officers are trained to conduct a preliminary safety and suicide risk assessment. Public Safety may choose to contact after-hours counseling services for further evaluation, as needed. Public Safety can transport students to local mental health and emergency facilities as indicated by the evaluation.

Typically, local law enforcement officers (e.g., Johnson City Police Department) will conduct similar types of checks for students living off campus if they have the resources available to do so. Public Safety and JCPD may coordinate responses in these instances.

BucsPress2

For students unable to access the Counseling Center’s physical location and for all after-hours contacts, ETSU contracts with Protocall Services (“BucsPress2”), who provide trained counselors to conduct phone-based risk assessment and support for students in distress. The student of concern should contact BucsPress2 directly to allow for proper assessment and stabilization. If the student does not consent to evaluation by a professional, they can decline this service. In these instances, students should be made aware that ETSU staff will act based on limited information and take preventative measures to ensure the safety of the student and the community. If the student declines evaluation, the Counseling Center staff on-call may be notified/consulted if deemed necessary by Public Safety.

If a Public Safety Officer is already present, they will remain on the scene until the evaluation is complete and the appropriate intervention has been determined. Protocall Services or Counseling Center staff may speak with responding officials (RAs, Public Safety) to relay this plan and ensure proper follow-up. The Counseling Center receives reports of all calls handled by Protocall Services.

Emergency Appointment at the Counseling Center

Students can come to the Counseling Center during business hours from 8:00AM-4:30PM. There are counselors on-call to support students who meet emergency criteria and are able to attend an in-person appointment.

Emergency is defined as “an acute clinical situation in which there is an imminent risk of serious psychological or physical harm to self or others unless there is some immediate intervention.” Please note that anxiety attacks (high stress, feeling overwhelmed, difficulty navigating emotions or distress) are not considered emergencies. If you are experiencing high anxiety or distress but do not meet the following emergency criteria, information will be shared about visiting a Let’s Talk session, requesting time in our Relaxation Room, or contacting BucsPress2.

Emergency situations would include a recent experience (within the last two weeks) of any of the following:

  • active thoughts of suicide where physical safety is a concern (e.g., plan, intent to act)
    thoughts of killing others with intent to act and/or fear of inability to control one’s actions toward others
  • active panic attack (sudden onset of physical symptoms such as hyperventilation, uncontrollable crying)
  • identity-based trauma, discrimination, or violence (e.g., race, gender, sexual orientation)
  • sexual assault or rape
  • domestic violence
  • death of loved one
  • natural disaster or serious accident

Most often, emergency appointments will focus on stabilization and support versus counseling. These appointments will typically last 60 minutes.

When polled, staff shared the following approaches to these appointments:

  • Providing a safe, non-judgmental, and supportive space
  • Sharing information about options available for next steps
  • Providing grounding skills and attempting to reduce in-the-moment distress
  • Creating a plan for engaging with supports (immediate and longer-term)
  • Connecting to case management and/or sharing resources for ongoing support
  • Scheduling a follow-up appointment as necessary

Potential Resolutions of Appointments (where risk is involved):

  • Safety Planning: As long as a student can commit to staying safe, this is the most common resolution of an emergency appointment. They will receive a plan containing steps to take and contacts for support, as well as coping skills to use when distressed.
  • Hospitalization: This happens fairly rarely. This is only in instances when students cannot keep themselves safe. Students can decline hospitalization unless their level of risk reaches that of an involuntary hospitalization (this is an extensive process that requires several professionals and legal intervention). 

Hospitalization

Voluntary: Voluntary hospitalizations are, by far, the most common type of hospitalization. When an individual’s safety is at risk, hospitalization can be self-initiated or encouraged by a mental health professional. Students who believe they are a risk to themselves can self-admit to either their local Emergency Room (ER) or to a local mental health facility (e.g., Turning Point, Woodridge). Students who present to the Counseling Center, Public Safety, or BucsPress2 with heightened safety risk may be referred to the hospital if unable to successfully engage in safety planning. Mobile Crisis units are available throughout the state and can come to the student’s location for an evaluation if the student cannot find appropriate and safe transportation to a facility for further evaluation. (Note that mobile crisis services are often understaffed and may have long response times – 4+ hours.)

Involuntary: Students who are unable to commit to their safety and who, mental health professionals believe pose a “substantial likelihood of serious harm,” may require a petition for involuntary admission. The law for involuntary admission is quite restrictive, intensive, and requires that all criteria be met for a petition to be approved. Wrongful petitions (those not done in good faith or in adherence to the criteria noted) for involuntary admission are considered a Class E felony.

TN Code § 33-6-403

IF AND ONLY IF
a person has a mental illness or serious emotional disturbance, AND

  • the person poses an immediate substantial likelihood of serious harm, under § 33-6-501, because of the mental illness or serious emotional disturbance, AND
  • the person needs care, training, or treatment because of the mental illness or serious emotional disturbance, AND
  • all available less drastic alternatives to placement in a hospital or treatment resource are unsuitable to meet the needs of the person,

THEN the person may be admitted and detained by a hospital or treatment resource for emergency diagnosis, evaluation, and treatment under this part.

TN Code § 33-6-501

IF AND ONLY IF

  • a person has threatened or attempted suicide or to inflict serious bodily harm on the person, OR the person has threatened or attempted homicide or other violent behavior, OR
  • the person has placed others in reasonable fear of violent behavior and serious physical harm to them, OR
  • the person is unable to avoid severe impairment or injury from specific risks, AND
  • there is a substantial likelihood that the harm will occur unless the person is placed under involuntary treatment,

THEN the person poses a “substantial likelihood of serious harm” for purposes of this title.

Specific Procedures for Critical Incidents

Public Safety is staffed on-campus 24/7. Student Life and Enrollment operates an after-hours on-call rotation to respond to incidents on campus that occur after-hours. Public Safety keeps the schedule and emergency contact information for individuals on-call. Those with a need to notify the on-call providers should contact Public Safety and request to be connected with the on-call.

Most incidents where the SLE on-call is notified encompass students being transported to a hospital for medical or mental health care. During this type of emergency, FERPA makes an exception to allow a university to contact next-of-kin and provide any relevant information. The call also allows staff an opportunity to gain information that is relevant to the emergency, such as past medical or mental health history, any current care (therapy, counseling), and any other insights. The duration of the emergency may allow staff to make additional calls to provide and gather info to the end of supporting the student.

On-call staff can relay this task to the Dean of Students office for follow-up.

Student Death

  • Notify ETSU Public Safety in the event of any death on campus.
  • Secure the scene until the arrival of officers.
  • Refrain from disclosing information to anyone other than officers or those with a need to know.
  • Unique situations: 
    • Death while traveling: If a student, faculty, or staff member dies while traveling on university-related business, notification should be made to the local law enforcement agency. In general, the same steps as outlined above apply. If the death is that of a student, the Dean of Students office should be notified by the reporting party (if university-affiliated) or by Public Safety.
    • Death while studying abroad: If a student dies while studying abroad, notification should be made to the local law enforcement agency, the student study abroad representative at ETSU, and the Dean of Students office. The U.S. Embassy or Consulate in the respective location will be contacted by local law enforcement or the study abroad representative.

The full postvention protocol can be found in the ETSU Suicide Prevention Plan.

Student Exhibiting Harm to Self-Behavior

  • For life-threatening behaviors, Public Safety will be contacted immediately. Please note that suicide attempts are medical emergencies.
  • A CARE meeting with DOS Office will be scheduled. Meeting may be required as determined on a case-by-case basis.
  • Counseling Center may be consulted. If so, Center recommendations will be shared with the Dean of Students Office for follow-up with the student.
  • Parental notification will occur if student required medical care or other intervention, unless a determination is made and supported by the Counseling Center that notification is contraindicated.
  • Any Center recommendations may be completed at the student’s discretion.
  • Student will be informed of behavioral expectations and that disruptive behavior may result in possible disciplinary action. 

Suicide Attempt in Progress

While the nature of suicide attempts varies greatly, each suicide attempt must be taken seriously. In order to protect a student’s privacy, suicide attempts should be addressed with discretion. In all instances, the best interests of the student as well as the university's aim to protect the student’s welfare must be considered paramount. When a suicide attempt is in progress, Public Safety should be notified immediately. (Issues of confidentiality do not apply when a person's life is in danger). A suicide attempt constitutes a medical emergency.

Public Safety will arrange for emergency medical transport. In most instances, the student will be transported to the Emergency Department of Johnson City Medical Center. Once medically cleared, the student may be referred for additional mental health care at a local inpatient unit or other form of stabilization facility. 

Active Shooter

Public Safety is the primary contact for concerns regarding potential danger to the ETSU community. Public Safety will enact their protocols and respond to the scene. The protocols include notification of all faculty, staff and students via ETSU Alert with instructions.

ETSU follows the Run. Hide. Fight. model for active shooters.

Run

  • Have an escape route and plan in mind
  • Leave your belongings behind
  • Keep your hands visible

Hide

  • Hide in an area out of the active shooter's view
  • Block entry to your hiding place and lock the doors

Fight

  • As a last resort and only when your life is in imminent danger
  • Attempt to incapacitate the active shooter
  • Act with physical aggression and throw items at the active shooter

Run. Hide. Fight. Training can be scheduled for your department/unit by contacting Officer Robinette in Public Safety at robinettecc@mail.etsu.edu. More information on Run. Hide. Fight. 

Sexual Assault

The actions of ETSU staff may vary depending on the timeline of the assault and when/why the student is seeking services and support. The primary concern is the immediate safety of the student, followed by their emotional well-being, which may include establishing a plan for follow-up and counseling services. Public Safety should be contacted in situations involving active safety threats. The Counseling Center is the only confidential resource available on-campus to process these experiences. All other offices and staff are considered mandatory reporters and must share this information with Title IX officials to ensure the safety of the ETSU community. More information about reporting and available resources .

Individuals of the ETSU community can report discrimination, harassment, retaliation, sexual misconduct, or divisive concepts online.

Family and Student Emergencies

In the case of an emergency or family crisis (e.g., death, illness) which requires a student to leave campus and/or miss classes or employment obligations for an extended period, the Dean of Students office should be contacted.

The Dean of Students will consult with the student regarding the emergency and advise them about various resources available. An email will be sent to the student’s professors with the understanding that the student, when able, will also contact each professor concerning the absence.

Missing Student

In the event of a determination that the student is missing (i.e., after a reasonable search), the University will attempt to notify the listed Emergency Contact within 24 hours of becoming aware of the student’s status. This information is confidential but may be released to Public Safety and other University staff as necessary to carry out the purposes of this policy. Public Safety will be responsible for filing all related missing person reports with other agencies as may be required and conduct an investigation.

Crisis Response Teams

There are three teams on campus whose role is to support students in distress. These teams have distinct functions that are directly connected with the nature of the concern about the student. CARE Team meets to discuss students who have been identified by others as requiring additional support. The Mental Health Critical Incident Response Team (MH-CIRT) responds once an event occurs that may have a large-scale impact on campus. Finally, the Threat Assessment Team (TAT) is designed to evaluate potential risk for harm to others once a student threat has been identified. More information, including membership of each team, is outlined below.

CARE Team

The CARE Team is comprised of staff members in all Student Life and Enrollment units (e.g., Housing, Counseling Center, Disability Services, Campus Recreation). CARE Team meets on a biweekly basis to discuss students of concern and collaborate on a plan of care.

Examples of cases for review:

  • A CARE report is submitted that provides info that a student may be having mental health issues A student is hospitalized for extended illness
  • Conduct concerns beyond typical violations, or repeated conduct issues
  • A student suffers the loss of an immediate family member
  • A student is in significant need of housing, food, or other basic necessities

Mental Health-Critical Incident Response Team

The Mental Health-Critical Incident Response Team (MH-CIRT) is responsible for coordinating and providing mental health assistance in the event of a campus or community emergency. The team will endeavor to effectively mitigate the impact of traumatic events impacting individuals within the ETSU community. The goal is to assist people in effectively coping with traumatic events and return to normal functioning. The team will maintain a “pulse” on the reactions of students, faculty/staff, and the community and are responsible for estimating the size and nature of the impact on the campus community based on this information.

Student Life and Enrollment and/or the Counseling Center is responsible for activating and assembling the MH-CIRT members. The number of members utilized will be dependent on the nature and severity of the incident. With smaller scale emergencies, a team of two or three members may be sufficient. For larger scale emergencies, the entire team may be mobilized. 

The team will work collaboratively in a unified manner to ensure that the campus:

  • quickly convenes and organizes resources;
  • provides prompt response;
  • sets up communication channels on campus and with relevant off-campus offices and agencies;
  • supports campus safety and healing; and
  • provides support to the complex mental health issues for individuals and groups that may arise after a student death.

While Dining Services and Facilities may not be overtly involved in the crisis response process, it is important in times of campus disruption that food and space be readily available for those in distress and those responding to the crisis.

The Mental Health Critical Incident Response Team (MH-CIRT) will convene for the following meeting types:

  • Standing Meetings: Semesterly meetings to discuss postvention strategies and campus updates and to explore opportunities for improvement.
  • Ad Hoc Incident Meetings: In the event of a campus sudden death, the Postvention Committee convenes within 48 hours to coordinate and plan a response.
    • Dean of Students may call a meeting to review the circumstances approximately two weeks after the event. In addition to a review of the interventions used, postvention efforts and support strategies will be discussed as well as recommendations for an enhanced response to similar future incidents.

Threat Assessment Team

The Threat Assessment Team (TAT) meets as needed to review escalated cases involving student distress, disruption, or concern. The purpose of the Threat Assessment Team is to help preserve the safety and security of the University community. The Team meets when there is a concern that someone or something poses a danger of harm to others. The Team reviews situations that involve students, visitors, and others in the vicinity of the University community. Our goal is to identify concerns as soon as possible; gather as much information as quickly as possible; and to work constructively and collaboratively to address problems before they escalate.

Safety is the responsibility of every member of our community. If you see or hear something of concern, report it. Faculty, staff, and students may contact the Office of the Dean of Students or ETSU Public Safety. 

In an emergency, please call 9-1-1 from a campus phone or 423-439-4480 or 423-439-6900 from your cell phone in order to reach ETSU Public Safety.

Threat Assessment Team Members (composition is based on the details of the potential threat) 

  1. Chief of Police
  2. Assistant Vice President of Student Life and Enrollment
  3. Assistant Dean of Students
  4. Director of the Counseling Center
  5. Other law enforcement or emergency management personnel, as appropriate

Threat assessment is the practice of determining the credibility and seriousness of a potential threat, as well as the probability that the threat will become a reality. The ETSU Threat Assessment Team currently employs an extensive questionnaire alongside a background review to determine risk. The questionnaire and review assists threat management teams in developing appropriate responses to perceived or real threats of violence.

Threat management is an on-going process which is coordinated by the team for appropriate and reasonable oversight of person who has threatened violence, or who is considered to be on a path towards violence. Intervention strategies are key to preventing violence and the campus community is encouraged to play a key role in noticing and reporting behavior that may suspect.

Communications

  • In situations involving risk to other members of the campus community, an ETSU Alert will be issued by Emergency Management or Public Safety to provide necessary safety information. If no risk to others is identified, there may be no campus-wide communication regarding an incident that has occurred, including a student death.
  • Rumors can exacerbate chaos and confusion. Individuals should avoid assumptions and speculation about the nature of the crisis. Involved personnel should be the primary source of information and will disseminate this information on a need-to-know basis.
  • The Dean of Students will contact students’ faculty members to share relevant information and resources.
  • Decisions about the University's notification of parents or family members will be made by the Dean of Students based on: (1) available information regarding the current situation, (2) whether additional information is needed, (3) the extent to which health and safety are at risk, and (4) the recommendations of the appropriate licensed health care providers (e.g., University Health, Counseling Center).
  • The Dean of Students will work with the Dean of Student Engagement to determine whether the student was affiliated with any on-campus organizations and will contact organization leaders as indicated to offer support to other students who may be impacted.
  • If the student is military-affiliated, Military and Veterans Services will be contacted by the Dean of Students.
  • Requests for comment by local media will be coordinated through University Marketing and Communications.

Helping Ourselves in the Aftermath of a Crisis

  • Realize that you will be exposed to a trauma by helping others through a crisis.
  • Monitor your own reactions and tend to those to the best of your ability.
  • Trauma may impact your ability to make decisions.
  • It is okay to not be okay. Displaying your emotions can reinforce students doing so as well.
  • Repetitive thoughts about the event and sleep difficulties are common reactions.
  • Avoid excessive media exposure.
  • Give yourself time and permission to rest and recover.
  • Spend time with and connect with others.
  • Seek psychological or spiritual support as needed.