**\
WINNEBAGO RESPONSE TO CRISIS**

**CHILD ABUSE/ SEXUAL ABUSE OF A MINOR**

comfort the child; reporting *possible* or known abuse is mandatory

do not ask the child 1. call Child & Family Services: Winnebago at

questions 878-2379; Macy at 837-5331

OR

call law enforcement: Winnebago at 878-2245;

Macy at 837-5906

2\. after hours, call law enforcement: Winnebago at 878-2245; Macy at
837-5906

**DOMESTIC VIOLENCE**

ensure victim's 1. call law enforcement: Winnebago at 878-2245;

immediate safety Macy at 837-5906

2\. stabilize medically

comforted by family 3. call 1 800 982-7233 Council on Domestic

or crisis intervention Violence & Sexual Assault in Sioux City whose
staff serves Woodbury, Plymouth, and Monona

Counties in Iowa; Dakota County, Nebraska;

Union County, South Dakota

OR

> call 24 hour HOT LINE in Omaha at 1 402 345-6555 or 1 402 345-7273

refer victim 4. [during business hours]{.underline}: in Winnebago, call
Domestic & Sexual Violence Victim Advocate at Human Services at
878-4308;

in Macy, call Domestic & Sexual Violence Victim Advocate at Four Hills
Wellness Center at

> 837-5304 extension 115\`

court sentences 5. court sentences batterers

**EMOTIONALLY TRAUMATIZED FAMILY MEMBERS [REQUESTING
ASSISTANCE]{.underline} NOT AVAILABLE FROM FIRST RESPONDERS**

such as in death or severe 1. first responders provide comfort,
information,

injury of family members and assurance

2\. ask the family if their spiritual leader needs to be contacted (see
below), or

3\. contact appropriate Mental Health if traumatized individual requests
such help:

a\. in [Winnebago]{.underline}, call 878-2911

b\. in [Macy,]{.underline} call 837-5207

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   **Spiritual Leader/ Home Office**

-   **Spiritual Contact Phone Phone**

    **Jesus Our Savior** Pastor Ricky Jacob 878-2450 878-2522

    **Lutheran Church**

    **Native** Morgan Earth 878-2980 878-4135

    **American**

    **Church** Charles Noble Rice 878-2638 878-2480

    **St. Augustine** Fr. Dave Korth 846-2402 878-2402

    **Indian Mission**

    **Traditional** Georgia Gomez 878-2277

    **Sweats**

    Orville Little Owl 878-2517 878-2245

    Bridgette's

    Office

    **Winnebago** Rev. Darrell Dalman 878-2934 878-2620

    **Reformed**

    **Church**

    \*The names given were representative of leaders. The directory was
    not intended to be a comprehensive listing.

    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

    **FIRST RESPONDERS / EMERGENCY WORKERS NEEDING DEBRIEFING AND / OR
    SUPPORT**

    debriefing emergency personnel 1. Critical Incident Stress
    Debriefing services

    can be obtained from NE State Patrol, Troop B out of Norfolk by
    calling 402 370-3456. Services are available for medical personnel,
    law

    enforcement, dispatchers, fire fighters, hospital

    personnel and correctional officers.

    2\. if the worker desires, you may help him/her

    contact the spiritual leader\* of his/her choice (see below)

    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   **Spiritual Leader/ Home Office**

-   **Spiritual Contact Phone Phone**

    **Jesus Our Savior** Pastor Ricky Jacob 878-2450 878-2522

    **Lutheran Church**

    **Native** Morgan Earth 878-2980 878-4135

    **American**

    **Church** Charles Noble Rice 878-2638 878-2480

    **St. Augustine** Fr. Dave Korth 846-5550 878-2402

    **Indian Mission**

    **Traditional** Georgia Gomez 878-2277

    **Sweats**

    Orville Little Owl 878-2517 878-2245

    Bridgette's

    Office

    **Winnebago** Rev. Darrell Dalman 878-2934 878-2620

    **Reformed**

    **Church**

    \* The names given were representative of leaders. The directory was
    not intended to be a comprehensive listing.

    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**SOBER ADULT WHO IS HOMICIDAL / THREATENING TO HURT OTHERS**

***(TERRORISTIC THREATS)***

has made threats (talking, 1. call law enforcement: in Winnebago at
878-2245;

writing, drawing, or other in Macy at 837-5906

action) to harm another 2. law enforcement transport to appropriate
facility,

person of any age or such as Faith Regional in Norfolk

inflict serious (telephone 402 644-7461) under emergency protective

property damage custody (EPC form is in appendix; note that a

reliable person can confirm the terroristic threats)

3\. refer to Mental Health; a written referral is

preferred:

in Winnebago, fax to 878-2027;

in Macy, fax to 878-4352

4\. [NOTE:]{.underline} This is primarily a public safety concern;
HOWEVER, law enforcement is welcome to consult with a mental health
therapist regarding mental health questions:

a\. in [Winnebago]{.underline} call 878-2911 during business hours;

after business hours; law enforcement

can notify Mental Health

b\. in [Macy]{.underline} call 837-5207 during business hours;

to notify Mental Health after hours,

call 1 800 365-7789; after the recording finishes,

give this PIN number 107922 and leave message

**ADULT HIGH ON SUBSTANCES WHO IS HOMICIDAL / THREATENING TO HURT OTHERS
*(TERRORISTIC THREATS)***

has made threats (talking, 1. call law enforcement: in Winnebago at
878-2245;

writing, drawing, or other in Macy at 837-5906

actions) to harm another 2. transport to IHS to medically stabilize

person of any age or 3. law enforcement transport to appropriate
facility,

inflict serious property such as Faith Regional in Norfolk (telephone

damage 1 402 644-7461) under emergency protective custody

(EPC form is in appendix; note that a reliable person can

confirm the terroristic threats)

4\. refer to Alcohol Program; a written referral is

preferred:

a\. in Winnebago, fax to 878-2204;

in Macy, fax to 837-4069

AND

b\. if appropriate also refer to Mental Health;

a written referral is preferred:

in Winnebago, fax to 878-2027;

in Macy, fax to 837-4352

5\. [NOTE:]{.underline} This is primarily a public safety and substance
abuse concern: HOWEVER, law enforcement or medical staff are welcome to
consult with a mental

health therapist regarding mental health questions:

a\. in [Winnebago]{.underline} call 878-2911 during business

hours;

after business hours, law enforcement

can notify Mental Health

b\. in [Macy]{.underline} call 837-5207 during business hours;

after business hours, call 1 800 365-7789; after the recording finishes,
give this PIN number 107922

**SOBER MINOR WHO IS HOMICIDAL / THREATENING TO HURT OTHERS**

***(TERRORISTIC THREATS)***

has made threats (talking, 1. school personnel, medical staff or law
enforcement

actions) to harm another are urged to consult with a Mental Health
therapist

person of any age or as soon as possible

inflict serious a. in [Winnebago]{.underline} call 878-2911 during
business hours;

property damage after business hours, law enforcement or I.H.S.can

notify Mental Health

b\. in [Macy]{.underline} call 837-5207 during business hours;

after business hours, call 1 800 365-7789; after the

recording finishes, give this PIN number 107922

2\. call law enforcement: in Winnebago at 878-2245; in

Macy at 837-5906

AND

notify parent/guardian (if parent/guardian is not

available, notify Child & Family Services via law

enforcement)

3\. law enforcement transport to an appropriate

facility under emergency protective custody

(EPC form is in appendix; note that a reliable person

can confirm the terroristic threats)

4\. refer to Mental Health; a written referral is preferred:

a\. in [Winnebago]{.underline}, fax to 878-2027

b\. in [Macy]{.underline}, fax to 837-5207

**MINOR HIGH ON SUBSTANCES WHO IS HOMICIDAL / THREATENING TO HURT OTHERS
*(TERRORISTIC THREATS)***

has made threats (talking, 1. call law enforcement: in Winnebago at
878-2245;

writing, drawing, or other in Macy at 837-5906

actions) to harm another AND

person of any age or notify parent/guardian

inflict serious (if parent/guardian is not available, notify Child

property damage & Family Services)

2\. transport to IHS to medically stabilize. 3. law enforcement
transport to an appropriate facility

under emergency protective custody (EPC form is in appendix; note that a
reliable person can confirm the terroristic threats)

4\. refer to Alcohol Program; a written referral is

preferred:

a\. in Winnebago, fax to 878-2204;

in Macy, fax to 837-4069

AND

b\. if appropriate also refer to Mental Health:

a written referral is preferred:

in Winnebago, fax to 878-2027;

in Macy, fax to 837-4352

5\. NOTE: This is primarily a public safety and substance abuse concern;
HOWEVER, medical staff or

law enforcement are welcome to consult with a

Mental Health therapist regarding mental health questions:

a\. in [Winnebago]{.underline} call 878-2911 during business

hours;

after business hours, law enforcement

can notify Mental Health

b\. in [Macy]{.underline} call 837-5207 during business hours;

after business hours, call 1 800 365-7789; after the recording finishes,
give this PIN number 107922

**SOBER MINOR WHO IS HOMICIDAL / THREATENING TO HURT OTHERS**

***(TERRORISTIC THREATS)***

has made threats (talking, 1. school personnel, medical staff or law
enforcement

actions) to harm another are urged to consult with a Mental Health
therapist

person of any age or as soon as possible

inflict serious a. in [Winnebago]{.underline} call 878-2911 during
business hours;

property damage after business hours, call I.H.S. or law enforcement,

either can notify Mental Health

b\. in [Macy]{.underline}, call 837-5207 during business hours;

after business hours, call 1 800 365-7789; after the

recording finishes, given this PIN number 107922

2\. call law enforcement;: in Winnebago at 878-2245; in

Macy at 837-5906

AND

notify parent/guardian (if parent/guardian is not

available, notify Child & Family Services via law

enforcement)

3\. law enforcement transport to an appropriate facility

under emergency protective custody (EPC form is

appendix; note that a reliable person can confirm the

terroristic threats)

4\. refer to Mental Health; a written referral is preferred:

in Winnebago, fax to 878-2027;

in Macy, fax to 837-4352

**ADULT (19 years old and over) WITH PSYCHOSIS \* OR CHRONICALLY
MENTALLY ILL ADULT IN CRISIS**

1\. transport to I.H.S. to medically stabilize

a\. Medical staff checks patient's chart for recent psychiatric PCC to
medically stabilize person who has been prescribed psychotropic
medication (note who wrote the prescription)

b\. if psychosis appears substance-induced, medically stabilize

c\. Mental Health recommends *hospitalization*

2\. law enforcement transports to Faith Regional, Norfolk (telephone 402
644-7461) under emergency protective custody

OR

IHS health care provider admits to Mercy

Medical Center, Sioux City 1 800 352-3559 for observation (ask ER to
give the name of

accepting psychiatrist)

3\. have patient sign release of information to

appropriate Mental Health (copies attached);

if patient has **[LEGAL]{.underline}** guardian, the guardian must sign
the release

4\. send referral to appropriate Mental Health

(including copy of release, if available):

a\. in [Winnebago]{.underline}, fax to 878-2027;

call 878-2911 during business hours;

to notify Mental Health after business hours, call I.H.S. or law
enforcement either can

notify Mental Health

b\. in [Macy]{.underline}, fax to 837-4352; call 837-5207 during

business hours; to notify Mental Health after

business hours, call 1 800 365-7789; after the

recording finishes, give this PIN number

107922

5\. if the psychosis is substance-induced, send

referral to appropriate Alcohol Program

(including copy of release, if available)

in Winnebago, fax to 878-2204

in Macy, fax to 837-4069

**\*Psychotic symptoms may include: strong paranoia, hearing voices,
visual hallucinations and/or chaotic or illogical behavior and/or
thought processes**

**MINOR WITH PSYCHOSIS\* OR CHRONICALLY MENTALLY ILL MINOR IN CRISIS**

1\. transport to IHS

2\. medically stabilize

a\. medical staff checks patient's chart for recent

psychiatric PCC to medically stabilize person

who has been prescribed psychotropic

medication (note who wrote the prescription)

b\. if psychosis appears substance-induced, medically stabilize

c\. Mental Health recommends *hospitalization*

3\. notify parent/guardian

-   a\. if parent/guardian is not available

    or

-   if parent/guardian refuses hospitalization under these
    circumstances, notify

-   Child & Family Services via law enforcement

-   b\. have parent/guardian or

-   Child & Family Services sign release of

    information to appropriate Mental Health (copies attached)

    4\. IHS health care professional admits to hospital

    5\. send referral to appropriate Mental Health

    (including copy of release, if available):

    a\. in [Winnebago]{.underline}, fax to 878-2027;

    call 878-2911 during business hours;

    to notify Mental Health after business hours, call I.H.S. or law
    enforcement either

    can notify mental health

    b\. in [Macy]{.underline}, fax to 837-4352;

    call 837-5207 during business hours; to notify Mental Health after
    business hours

    call 1 800 365-7789; after the recording finishes, give this PIN
    number 107922

    6\. if the psychosis is substance-induced, send

    referral to appropriate Alcohol Program

    (including copy of release, if available)

    in Winnebago, fax to 878-2204

    in Macy, fax to 837-4069

    **\*Psychotic symptoms may include: strong paranoia, hearing voices,
    visual hallucinations and/or chaotic or illogical behavior and/or
    thought processes**

    **RAPE / SEXUAL ASSAULT**

    victim 1. treated by medical staff

    2\. call law enforcement: in Winnebago at 878-2245; in Macy at
    837-5906

    AND

    call BIA criminal investigator during business hours at 878-2483;
    after business hours call cell at 1 712 259-4676 or pager 800
    365-7789, enter PIN

    number, 220139, and enter your phone number

    comforted by family 3. call 1 800 982-7233 Council on Domestic

    or crisis intervention Violence & Sexual Assault in Sioux City whose
    staff

    serves Woodbury, Plymouth, and Monona

    Counties in Iowa; Dakota County, Nebraska;

    Union County, South Dakota

    OR

    call 24 hour HOT LINE in Omaha at 1 402 345-6555 or 1

    402 345-7273

    refer victim 4. [during business hours]{.underline}: in Winnebago,
    call Domestic & Sexual Violence Victim Advocate at Human Services at
    878-4308;

    in Macy, call Domestic & Sexual Violence Victim Advocate at Four
    Hills Wellness Center at

    837-5304 extension 115

    phone referral to 5. call Mental Health: in Winnebago at

    Mental Health 878-2911; in Macy at 837-5207 during

    business hours

    **COMPLETED SUICIDE**

    An individual is found 1. call Winnebago ambulance at 878-2277

    presumable dead AND

    call law enforcement in Winnebago at 878-2245 who contacts
    guardian/family

    of the decedent

    2\. contact Winnebago coroner at 878-2515

    or pager 888 302-5376 who initiates funeral arrangements

    3\. notify mental health: during business day at 878-2911

    **SOBER ADULT (19 years & over) WITH SUICIDAL [ACTIONS]{.underline}
    (SUICIDE ATTEMPT)**

-   has cut self (cut, bitten skin, 1. transport to IHS

-   broken skin, self-inflicted wound, etc.); 2. medically stabilize,
    then

-   has visible rope marks on neck; a. law enforcement transport

-   has ingested ANY amount of to Faith Regional Norfolk

-   pills, liquid medication, cleaning (telephone 402 644-7461)

-   products or other substances under emergency protective
    *inappropriately*; custody (EPC form is in

-   has poured gasoline on self; appendix; note that a reliable

-   has turned on gas; person can serve as a witness)

-   has tried to jump from moving vehicle; b. have patient sign release
    of

-   has been talking about dying/suicide information to appropriate

-   and is seen with a gun, rope, noose or Mental Health (copies

-   other means of self-destruction; attached)

-   OR

-   any other inherently self-destructive actions

-   3\. Mental Health recommends *automatic hospitalization;*

-   notify Mental Health what

-   action was taken: a written

-   referral is preferred-at

-   Winnebago, fax to 878-2027;

-   at Macy, fax to 837-4352;

-   telephone during business hours: at Winnebago 878-2911;

-   at Macy 837-5207

**ADULT (19 years old and over) HIGH ON SUBSTANCES WITH SUICIDAL ACTIONS
(SUICIDE ATTEMPT)**

-   has cut self (cut, bitten skin, 1. transport to IHS

-   broken skin, self-inflicted wound, etc.); 2. medically stabilize,
    then

-   has visible rope marks on neck; a. have patient sign release of

-   has ingested ANY amount of information to appropriate

-   pills, liquid medication, cleaning Alcohol Program

-   products or other substances (copies attached)

-   *inappropriately*; b. law enforcement transport to

-   has poured gasoline on self; Faith Regional, Norfolk

-   has turned on gas; (telephone 1 402 644-7461)

-   has tried to jump from moving vehicle; under emergency protective

-   has been talking about dying/suicide custody (EPC form found in

-   and is seen with a gun, rope, noose or the appendix; note that

-   other means of self-destruction; a reliable person can serve

-   OR as a witness)

-   any other inherently self-destructive actions 3. send referral to
    appropriate

-   Alcohol Program\* (including

-   copy of release of information,

-   if available):

-   in Winnebago, fax to 878-2204;

-   in Macy, fax 837-4069;

-   and then,

-   4\. send copy of referral to Mental

-   Health for follow-up and statistical recording:

-   in Winnebago, fax to 878-2027;

-   in Macy, fax to 837-4352

-   

-   

-   ***\*Note: Winnebago and Macy Alcohol Programs use assessment
    instruments which detect mental health issues, so that a referral
    can be made to mental health when appropriate***

-   **SOBER MINOR WITH SUICIDAL ACTIONS (SUICIDE ATTEMPT)**

-   

-   has cut self (cut, bitten skin, 1. transport to IHS

-   broken skin, self-inflicted wound, etc.); 2. medically stabilize has
    visible rope marks on neck; AND

-   has ingested ANY amount of notify parent/guardian

-   pills, liquid medication, cleaning a. if parent/guardian is not
    available, products or other substances or

-   *inappropriately;* if parent/guardian refuses

-   has poured gasoline on self; hospitalization under these

-   has turned on gas; circumstances, notify Child &

-   has run in front of a moving vehicle; Family Services via law
    enforcement

-   has tried to jump from moving vehicle; b. have parent/guardian or
    Child &

-   has been talking about dying/suicide Family Services give permission
    for

-   and is seen with a gun, rope, noose or care

-   other means of self-destruction; c. have parent/guardian or Child &

-   OR Family Services sign release of

-   any other inherently self-destructive information to appropriate
    Mental

-   action Health program (copies attached)

-   3\. Mental Health recommends

-   *automatic hospitalization;* notify Mental Health what

-   action was taken: a written referral

-   is preferred-at Winnebago, fax to

-   878-2027; at Macy fax to 837-4352;

-   telephone during business hours:

-   at Winnebago 878-2911,

-   at Macy 837-5207

-   

-   **MINOR HIGH ON SUBSTANCES WITH SUICIDAL ACTIONS (SUICIDE ATTEMPT)**

-   

-   has cut self (cut, bitten skin, 1. transport to IHS

-   broken skin, self-inflicted wound, etc.); 2. medically stabilize has
    visible rope marks on neck; AND

-   has ingested ANY amount of notify parent/guardian

-   pills, liquid medication, cleaning a. if parent/guardian is not
    available, products or other substances OR

-   *inappropriately* if parent/guardian refuses

-   has poured gasoline on self; hospitalization under these

-   has turned on gas; circumstances, notify Child &

-   has run in front of a moving vehicle; Services via law enforcement

-   has tried to jump from moving vehicle; b. have parent/guardian or
    Child

-   has been talking about dying/suicide & Family Services give
    permission

-   and is seen with a gun, rope, noose or for care

-   other means of self-destruction; c. have parent/guardian or Child &

-   OR Family Services sign release of

-   any other inherently self destructive information to appropriate

    action Alcohol Program (copies

    attached)

-   3\. send referral to appropriate Alcohol Program\* (including copy
    of release, if available):

-   in Winnebago, fax to 878-2204;

-   in Macy, fax to 837-4069;

-   and then,

-   4\. send copy of referral to Mental

-   Health for follow-up and statistical recording:

-   in Winnebago, fax to 878-2027;

-   in Macy, fax to 837-4352

-   

-   ***\*Note: Winnebago and Macy Alcohol Programs use assessment
    instruments which detect mental health issues, so that a referral
    can be made to mental health when appropriate.***

-   **SOBER ADULT WITH SUICIDAL TALK/THINKING WITH *INTENT* TO HARM SELF
    (SUICIDAL IDEATION WITH *INTENT*)**

-   

-   is talking, drawing, or writing about 1. contact appropriate Mental

-   self-harm/death Health

-   is talking of joining a deceased loved one a. in
    [Winnebago]{.underline} call 878-2911

-   has plan during business hours;

-   has means available to notify Mental Health after business hours,
    call

-   I.H.S. or law enforcement

    either can notify Mental Health

    b\. in [Macy]{.underline} call 837-5207 during

    business hours; to notify Mental Health after hours,

    call 1 800-365-7789; after the

    recording finishes, give this

    PIN number 107922

-   **ADULT HIGH ON SUBSTANCES WITH SUICIDAL TALK / THINKING WITH
    *INTENT* TO HARM SELF (SUICIDAL IDEATION WITH *INTENT*)**

-   

-   is talking about self-harm 1. transport to IHS

-   is talking of joining a deceased loved one 2. medically stabilize,
    then

-   has plan have patient sign release of

-   has means available information to appropriate Alcohol Program
    (copies

-   attached)

-   3\. because lethality

-   is heightened by substances, he/she needs to be placed in a safe,
    well-supervised environment (hospitalization or protective custody)
    until he/she is sober

-   4\. send referral to appropriate Alcohol Program\* (including

-   copy of release, if available):

    in Winnebago, fax to 878-2204;

    in Macy, fax to 837-4069;

    and then,

    5\. send copy of referral to Mental Health for follow-up and
    statistical recording:

    in Winnebago, fax to 878-2027;

    in Macy, fax to 837-4352

-   ***\*Note: Winnebago and Macy Alcohol Programs use assessment
    instruments which detect mental health issues, so that a referral
    can be made to mental health when appropriate.***

    **SOBER ADULT WITH SUICIDAL TALK / THINKING**

    **(SUICIDAL IDEATION)**

-   talking of dying or hurting self 1. for Native Americans living on
    the

-   talking of joining a deceased loved one Winnebago reservation, in
    Dakota

-   may have vague plan or Dixon County, NE. or Woodbury County, IA:

-   a\. call 878-2911 Winnebago Counseling Center during business hours

    b\. to access Winnebago

    Counseling Center after

    hours, call I.H.S. or law

    enforcement either can notify

    Mental Health

    2\. for Native Americans living on

    the Omaha reservation:

    a\. call 837-5207 Macy Mental Health during business hours b. to
    access Macy Mental Health after hours, call

    1 800 365-7789; after the

    recording finishes, enter this

    PIN number 107922

-   

-   **SOBER MINOR WITH SUICIDAL TALK / THINKING WITH *INTENT***

-   **TO HARM SELF (SUICIDAL IDEATION WITH *INTENT*)**

-   is talking, drawing, or writing 1. contact appropriate Mental Health

-   about self-harm/death a. in [Winnebago]{.underline} call 878-2911

-   has plan during business hours;

-   has means available to notify Mental Health

    after business hours, call

    I.H.S. or law enforcement

    either can notify Mental Health

    b\. in [Macy]{.underline} call 837-5207 during

    business hours; to notify Mental

    Health after hours, call

    1 800 365-7789; after the recording

    finishes, give this PIN number 107922

-   **SOBER MINOR WITH SUICIDAL TALK / THINKING (SUICIDAL IDEATION)**

-   is talking, drawing, or writing 1. contact appropriate Mental Health

-   about self-harm/death a. in [Winnebago]{.underline} call 878-2911

-   is talking of joining a deceased loved one during business hours;

-   may have vague plan to notify Mental Health

after business hours, call

I.H.S. or law enforcement

either can notify Mental Health

b\. in [Macy]{.underline} call 837-5207 during

business hours; to notify Mental

Health after hours, call

1 800 365-7789; after the recording

finishes, give this PIN number 107922

-   **ADULT HIGH ON SUBSTANCES WITH SUICIDAL TALK / THINKING**

-   **(SUICIDAL IDEATION)**

-   talking of dying or hurting self 1. transport to IHS

-   talking of joining a deceased loved one 2. medically stabilize, then

-   may have vague plan have patient sign release of

-   information to appropriate alcohol program (copies attached)

-   3\. because of potential lethality, he/she may need to be placed in
    a

-   safe, well-supervised environment (hospitalization or protective
    custody) until he/she is sober

-   4\. send referral to appropriate Alcohol Program\* (including copy
    of release, if available):

    in Winnebago, fax to 878-2204;

    in Macy, fax to 837-4069;

    and then,

    5\. send copy of referral to Mental Health for follow-up and
    statistical recording:

    in Winnebago, fax to 878-2027;

-   in Macy, fax to 837-4352

-   

-   

-   ***\*Note: Winnebago and Macy Alcohol Programs use assessment
    instruments which detect mental health issues, so that a referral
    can be made to mental health when appropriate.***

-   **MINOR HIGH ON SUBSTANCES WITH SUICIDAL TALK / THINKING WITH
    *INTENT* TO HARM SELF (SUICIDAL IDEATION WITH *INTENT*)**

-   is talking, drawing, or writing 1. transport to IHS

-   about self-harm/death 2. medically stabilize

-   has plan AND

-   has means available notify parent/guardian

-   3\. because lethality is heightened by

-   substances, he/she needs to be placed in a safe, well-supervised
    environment (hospitalization or protective custody) until he/she is
    sober

a.  if parent/guardian is not available,

> or
>
> if parent/guardian refuses to cooperate under these circumstances,
> notify Child & Family Services via law enforcement

b\. have parent/guardian or Child & Family Services sign release of
information to appropriate alcohol program (copies attached)

-   4\. send referral to appropriate Alcohol Program\* (including copy
    of release, if available):

-   in Winnebago, fax to 878-2204;

-   in Macy, fax to 837-4069;

-   and then,

-   5\. send copy of referral to Mental

-   Health for follow-up and statistical recording:

-   in Winnebago, fax to 878-2027;

-   in Macy, fax to 837-4352

-   

-   ***\*Note: Winnebago and Macy Alcohol Programs use assessment
    instruments which detect mental health issues, so that a referral
    can be made to mental health when appropriate.***

**MINOR HIGH ON SUBSTANCES WITH SUICIDAL TALK / THINKING (SUICIDAL
IDEATION)**

-   is talking, drawing, or writing 1. transport to IHS

-   about self-harm/death 2. medically stabilize

-   is talking of joining a deceased loved one AND

-   may have vague plan notify parent/guardian

    3\. because of potential lethality,

-   he/she may need to be placed in a safe, well-supervised environment

-   (hospitalization or protective

-   custody) until he/she is sober

    a\. if parent/guardian is not available,

    or

    if parent/guardian refuses to cooperate

    under these circumstances, notify Child & Family Services via law
    enforcement

    b\. have parent/guardian or Child & Family Services sign release of
    information to appropriate alcohol program (copies attached)

    4\. send referral to appropriate Alcohol Program\* (including copy
    of release,

    if available):

-   in Winnebago, fax to 878-2204;

-   in Macy, fax to 837-4069;

-   and then,

-   6\. send copy of referral to Mental

-   Health for follow-up and statistical recording:

-   in Winnebago, fax to 878-2027;

-   in Macy, fax to 837-4352

-   

***\*Note: Winnebago and Macy Alcohol Programs use assessment
instruments which detect mental health issues, so that a referral can be
made to mental health when appropriate.***

**TERMINAL ILLNESS OR CHRONIC DISEASE**

individual diagnosed with terminal 1. ask the ill individual for
permission to contact

illness or chronic disease who may the spiritual leader\* of his/her
choice (see below), or be in denial, struggling, or needing 2. in
[Winnebago,]{.underline} contact PHNs at 878-2258, or

assistance with the issues of life, 3. in [Winnebago,]{.underline}
contact CHR office at 878-2277

death, and relationships for more information or resources available, or

4\. contact appropriate Mental Health if the ill individual requests
such help:

a\. in [Winnebago,]{.underline} call 878-2911

b\. in [Macy,]{.underline} call 837-5207

­­­­­­­­­­­­­­­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   **Spiritual Leader/ Home Office**

-   **Spiritual Contact Phone Phone**

**Jesus Our Savior** Pastor Ricky Jacob 878-2450 878-2522

**Lutheran Church**

**Native** Morgan Earth 878-2980

**American**

**Church** Charles Nobel Rice 878-2638 878-2480

**St. Augustine** Fr. Dave Korth 846-5550 878-2402

**Indian Mission**

**Traditional** Georgia Gomez 878-2277

**Sweats**

Orville Little Owl 878-2517 878-2245

Bridgette's

Office

**Winnebago** Rev. Darrell Dalman 878-2934 878-2620

**Reformed**

**Church**

\*The names given were representative of leaders. The directory was not
intended to be a comprehensive listing.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

FORWARD

August 2005

Winnebago mental health therapists follow-up on every referral. We offer
services, recommend services and encourage the person to work toward a
higher level of functioning. Each person's legal rights and whether he
or she chooses to come for follow-up appointments are respected. Whether
the patient comes in right away or not, we remain available.

When the individual does not choose to come in for services at the time
we think they should, this requires patience on our part. Our follow-up
respects individual and cultural differences. Referred individuals
sometimes come later for services when the time is right for them. Also,
we realize that some individuals have strong connections to cultural
resources which are available for support and guidance. We know that
some individuals prefer to utilize these cultural resources when
possible.

First responders may be unaware of the mental health history of patients
and families in crisis. In some cases, the response of a mental health
therapist to a referral may be tailored to the mental health history of
the individual or family, although reasons for the chosen response
cannot be fully shared with other agencies.

Winnebago Mental Health therapists:

Dr. Marcia Hovland, LMHP, LPC, LMFT

Karen Oaks, MA, LMHP, LPC

Neal Oaks, MA, LMHP, LPC

**Table of Contents** page(s)

# Abuse

A. Child Abuse 1

B. Sexual Abuse of a Minor

**Domestic Violence** 1

**Emotionally Traumatized** **Family Members Requesting Assistance**

**Not Available from First Responders** 2

**First Responders / Emergency Workers Needing Debriefing and / or
Support** 3

**Homicidal / Threatening to Hurt Others** 4-7

**(Making Terroristic Threats)**

A. Sober Adult 4

B. Adult High on Substances 5

C. Sober Minor 6

D. Minor High on Substances 7

**Minor High on Substances** 8

**Person with Psychosis or Chronically Mentally Ill Person in Crisis**
9-10

A. Adult (19 years and over) 9

B. Minor 10

**Petitioning for Civil Commitment** 11

Winnebago Tribal Court-Petition for Civil Commitment 12

**Rape / Sexual Assault** 13

**Suicide**

A. Suicidal Actions (Suicide Attempt) 14-17

1). Sober Adult 14

2). Adult High on Substances 15

3). Sober Minor 16

4). Minor High on Substances 17

B. Suicidal Talk (Suicidal Ideation with Intent) 18-20

1). Sober Adult 18

2). Adult High on Substances 19

3). Sober Minor 20

4). Minor High on Substances 21

C. Suicidal Talk /Thinking (Suicidal Ideation) 22-26

1). Sober Adult 22

2). Adult High on Substances 23

3). Sober Minor 24

4). Minor High on Substances 25

D. Completed Suicide 26

**Terminal Illness or Chronic Disease** 27

**Appendix: How to Use EPC 28**

**E.P.C. Hold 28 a-c**

**Transportation Instructions 28 d**

**E.P.C. Protocol 28 e-f Behavioral Health Unit (B.H.U.) \[Faith
Regional\] 28 g-i**

> **Winnebago Counseling Center**

PO Box 446

Winnebago, Nebraska 68071

\(402\) 878-2911 FAX (402) 878-2027

August 2005

To the user of the manual:

While we realize that each crisis is an individual situation and that
steps to secure appropriate help in every possible situation cannot be
written advance in "cookbook" fashion, we have noticed some things over
the past several years:

1\. It is vital that first responders and other providers know which
types of situations to refer to which programs\--and the most effective
means of making the referral.

2\. Timely referral to the most appropriate agency is important\--for
the sake of the person in crisis or need.

3\. It appears that use of the three-page fluorescent green Crisis
Response Protocol developed in 1995 by Winnebago Counseling Center, in
conjunction with other local programs, has increased the ability of
local agency personnel to quickly determine the most appropriate
program(s) for referral and/or consultation\--and how to best reach
them.

This fifth edition includes a new category: Petitioning for Civil
Commitment. This addition is intended to help relatives and friends who
are worried about a person who is drinking, drugging, or mentally ill
[AND]{.underline} is threatening to hurt self or others. According to
Winnebago Tribal Code any interested person who is concerned about
another's safety and well-being may petition court.

The Winnebago Counseling Center will distribute over 125 copies of this
27-page edition to Winnebago Tribal Council members and Winnebago agency
personnel such as IHS medical personnel, Winnebago Tribal Health Program
personnel, school personnel at Winnebago Public, St. Augustine School,
Winnebago Head Start, and Little Priest Tribal College, Winnebago Human
Services workers, Winnebago Law Enforcement, Winnebago Youth Facility
personnel and spiritual leaders.

We want to thank the many local programs and individuals who have
assisted in the development and updating of the [Winnebago Response to
Crisis: Manual]{.underline}, as well as each service provider who has
faithfully helped individuals and families in crisis.

Sincerely,

Marcia Hovland, EdD, LMHP, LPC, LMFT The Mental Health Therapists of

Neal Oaks, MA, LMHP, LPC Winnebago Counseling Center

Karen Oaks, MA, LMHP, LPC (also known as "Mental Health")

**Using Emergency Protective Custody\***

1\. Is the individual dangerous? Dangerous behaviors include being
gravely mentally ill, alcohol addicted, or drug addicted AND dangerous
to self or others. (For more specific guidelines, see the detailed list
under "Petitioning for Civil Commitment" found on page 11.) Anyone who
has first hand knowledge of another's dangerous behavior can provide
information to a police officer.

2\. The police officer completes and signs the E.P.C. Hold form (Neb.
Rev. Stat. Section 83-1000). Record the name and address of the witness
on the first page of three and list the detailed information provided by
the witness on page 28 a-c. Fax the completed E.P.C. Hold to the
Behavioral Health Unit in Norfolk (fax 402 644-7419).

3\. Call 402 644-7461 before transporting the E.P.C. patient to the
Behavioral Health Unit (B.H.U.) at Faith Regional Health Services, 1500
Koenigstein Street, in Norfolk, Nebraska.

\*This was reviewed and approved by Lt. Rich Greenwald, Winnebago Law
Enforcement