Prepare a usable difficult-day support sheet
For clinicians, care coordinators and peer staff working with adults. Use this optional sheet ahead of time to help a person keep a chosen contact, backup and existing care instructions within reach.
Use alongside the person’s existing care instructions and your service’s clinical response procedures. This is not a suicide assessment, validated safety-planning intervention, crisis triage protocol or evidence of readiness for discharge. It does not establish consent rules for adolescent care.
Start with the situation
Use your service's established emergency and clinical response when urgent help is needed. Completing this sheet must not delay that response. The take-away keeps 911 and 988 guidance visible, but does not cover every emergency or replace staff training. CDC describes emergency action for possible overdose, including naloxone and staying until help arrives. [1] The 988 Lifeline offers emotional and crisis support, including substance-use concerns. [2]
Prepare it together when the person is able and wants to
- Offer the short or full version. Ask whether the person wants a handy sheet or the fuller difficult-day guide. Offer reading, writing, language and access help. Declining a worksheet does not mean declining support.
- Use the person's words. Ask what tells them they could use support and what help they would want. They may leave this prompt blank. A coping action is optional and should not become a step they must complete before contacting help.
- Make the contact usable. Record the number or method, what help is wanted and known hours or availability. Mark anything not yet agreed as unconfirmed. Do not make a family member an on-call service by writing their name down.
- Add a realistic backup. Ask what happens if the first person is unavailable. Check the backup's availability too. SAMHSA recommends making specific requests and continuing to reach out when someone cannot help. [3] Staff should resolve gaps through their established care process, rather than treating blank boxes as a completed plan.
- Connect to existing clinical instructions. Ask where the person keeps their clinician-developed plan, if they have one, and how they contact the care team. Keep that plan available with the sheet. Bring unclear or conflicting instructions to the responsible clinician. Do not use this sheet to change treatment or judge risk.
Check whether the copy works
Original practice prompt: “Show me where you would find the contact. If they cannot answer, what could you do next? Where are the instructions from your care team?” The person can use the sheet. If the wording is unclear, explain it differently.
Let the person choose paper, PDF or web notes and what they want to share. For a PDF, save and reopen the completed copy. For web notes, download the text or print before leaving. The editor does not send notes to AddictionHelp or save them automatically. Use your organization's shared-device procedures. Do not assume a phone or private device is available.
Review after use, without inventing outcomes
The full guide has a space for what helped and what needs changing. Offer a way to update wrong numbers or unavailable contacts. Keep required clinical documentation in your existing system, using your usual privacy procedures.
In separate patient/family and staff usability sessions, use fictional details. Observe whether participants can find the urgent-help guidance, distinguish a personal contact from emergency support, identify an unavailable contact's backup, and retrieve their saved copy. Ask what feels confusing or burdensome. Record assistance needed. These are proposed usability tasks, not a validated test or proof that the sheet prevents relapse or crises.
Sources and review scope
The worksheet prompts, example and workflow are original adaptations. The sources support the guidance described above, not the effectiveness of this tool. The worksheet has not been evaluated for patient outcomes. Ask users what needs changing after they try it.