Mid-Valley Behavioral Care Network

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MVBCN Overview > OHP MEMBERS > Personal Action/Crisis Prevention Plan

Personal Action/Crisis Prevention Plan

This Plan is meant to help clients/consumers, their support persons and providers prepare for times when life seems too hard to manage. This Plan is designed to support conversations about what would help when additional support or action is needed. It is not just another form to fill out! It may be helpful to talk about this Plan with a person who knows you well enough to understand your strengths and your challenges. It is best to complete this Plan when you are feeling better about yourself and your life.
The list of “Ideas to Help Spark Your Thinking” that is included with the Plan is meant only to start a conversation, and to encourage you to be creative and decide what is important to you. We don’t want you to just “choose one or two and fill in the blank”. Use your own ideas and make this Plan truly fit you. You can fill out this Plan by yourself, with a peer support person or family member or friend, or with a mental health provider.
This Plan is best used by professionals as a tool to begin a series of conversations about recovery, how clients experience good times, and what might help them recognize and cope with times of stress or difficulty.
The Plan is most useful if it is available to you and your support people at moments of crisis. Consider having copies in several places:
  • Where you can find it easily as needed
  • In the file kept by your mental health provider
  • On file with the local psychiatric crisis response team – for many people within the BCN region this would be the Psychiatric Crisis Center (503-585-4965). You can fax the form to the MVBCN at 503-585-4989 and we will get it to the crisis team in your county. 
About the downloads below:
The file below labeled "Personal Action/Crisis Prevention Plan (PDF)" includes the instructions, the blank Plan form and “Ideas to Help Spark Your Thinking”.
The blank Plan form is available below in two different file formats. Use the file format that works best for you. There is also a wallet card format.
  • PACPP Form (PDF): Print out this form and fill it out in handwriting.
  • PACPP Form (Word): Type in the highlighted fields and print out the completed form.
  • Wallet Card Format (PDF): The wallet card is a form to write on which gives an easy-to-carry copy of the plan. Print this as a 2 sided-form, 3 cards to a page, and fold twice. If you print on paper heavier than normal copier paper, they will last longer.


Adult crisis plan (fillable Word)

Adult crisis plan (fillable Word) Spanish

Adult crisis plan (PDF)

Adult crisis plan (PDF) Spanish

Crisis plans guidelines (PDF)

Ideas to Help Spark Your Thinking (PDF)

Ideas to Help Spark Your Thinking (PDF) Spanish

Youth crisis plan (fillable Word)

Youth crisis plan (fillable Word) Spanish

Youth crisis plan (PDF)

Youth crisis plan (PDF) Spanish


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