Free checklist for executive directors, HR and training leads

How to start crisis management at your agency

A starter plan for group homes, day programs and community behavioral-health providers: OSHA’s five building blocks, a checklist you can print, and the source behind each item.

Special Learning · November 15, 2026

Short answer

How do you start crisis management?

Updated November 15, 2026

A crisis management program has two parts: an agency-wide safety program, and each person’s own plan from the clinician or team who wrote it. For the agency part, start with OSHA’s five building blocks of a violence prevention program for healthcare and social service settings, including group homes and community mental health clinics. OSHA’s guidelines are advisory, not a regulation (OSHA, 2016).

Commit and involve staff (OSHA: management commitment and worker participation). Leaders back a written program; managers, supervisors and frontline staff take part.
Look at your worksite (OSHA: worksite analysis). Records, procedures for different jobs, staff surveys and security.
Prevent and plan (OSHA: hazard prevention and control). Prevention measures and a standard way for staff to get help.
Train everyone (OSHA: safety and health training). Before staff start their duties and every year, with hands-on practice.
Record and review (OSHA: recordkeeping and program evaluation). After every incident, and once a year.

For the people you support, each person’s own plan comes first, written by the clinician or team responsible for it. In an ICF/IID, less intrusive or more positive approaches must be tried systematically, and shown not to work, before more restrictive techniques are used (42 CFR 483.450(b)(1)(iii)). In home and community-based settings, each person has the right to “freedom from coercion and restraint” (42 CFR 441.301(c)(4)(iii)).

How to start crisis management: OSHA’s five building blocks for healthcare and social service employers, including group homes: commit and involve staff, look at your worksite, prevent and plan, train everyone, record and review. Each step is written out in the checklist below. Source: OSHA 3148-06R, 2016. — The five building blocks on one page, from OSHA’s guidelines. Open the full-size image to share with your leadership team.

Why it matters

Health care and social assistance has the most injuries from violence at work

In 2021 and 2022, health care and social assistance had the highest rate of injuries from violence by another person that needed time away from work, job restriction or transfer: 14.2 a year per 10,000 full-time workers, against 2.9 across private industry. That sector had 72.8% of all such cases in private industry, 41,960 over the two years (BLS, 2024). In 2018, counting only injuries that needed days away from work, the rate per 10,000 full-time workers was 21.1 in nursing and residential care facilities and 12.4 in social assistance, against 2.1 across private industry (BLS, 2020). These figures do not say who caused an injury or why.

Bar chart: workplace violence injury rates in US private industry. 2021 to 2022, injuries from violence by another person that needed days away from work, job restriction or transfer, per 10,000 full-time workers a year: health care and social assistance 14.2; all private industry 2.9. 2018, injuries from violence by another person that needed days away from work, per 10,000 full-time workers: nursing and residential care facilities 21.1; social assistance 12.4; all private industry 2.1. 72.8% of these private-industry injury cases in 2021 to 2022 were in health care and social assistance, 41,960 cases over the two years. Sources: U.S. Bureau of Labor Statistics, Workplace Violence 2021 - 2022 fact sheet, and Workplace Violence in Healthcare, 2018, Table 1. — Injury rates from violence at work, health care and social assistance compared with all private industry.

Free checklist

The crisis management starter checklist

Tick each item as it is in place. The boxes work on screen; print the page for a paper copy for your team meeting. Nothing you tick is saved or sent.

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1. Commit and involve staff

OSHA: management commitment and worker participation. Leadership support and frontline involvement come first (OSHA, 2016, section 1).

Leadership states the policy and its goals, and puts the program in writing as part of your safety and health program.
Someone is given responsibility and authority for the program, with the time and resources to run it.
Senior managers, supervisors and DSPs or other frontline workers take part. Frontline staff name the daily tasks they feel put them most at risk.
Staff can report incidents and near misses with no reprisal for reporting in good faith.
The people you support help shape the policy where they can. In an ICF/IID this is required “to the extent possible.” (42 CFR 483.450(a)(2))

2. Look at your worksite

OSHA: worksite analysis. Find what puts staff at risk, using records, procedures, surveys and a security review (OSHA, 2016, section 2).

Review your incident reports, injuries and near misses.
Review the procedures for different jobs, and run a short staff survey.
Review security: how staff call for help, alarms, and safe rooms where staff can find shelter.
Set how often to repeat it. OSHA’s example: a full review every year, and a look after every incident or near miss.

3. Prevent and plan

OSHA: hazard prevention and control. Write down your agency’s policies: how staff get help, who decides, and where each person’s own plan takes over (OSHA, 2016, sections 3 and 4).

If you run an ICF/IID: written policies must specify the interventions the facility approves, set them on a hierarchy from most positive or least intrusive to least positive or most intrusive, address which staff members may authorize them, and include a way to monitor and control their use. (42 CFR 483.450(b)(1))
In home and community-based settings, each person has the right to “freedom from coercion and restraint.” (42 CFR 441.301(c)(4)(iii))
Where a provider-owned or controlled residential setting modifies one of the additional conditions in 441.301(c)(4)(vi)(A) to (D), the modification must be supported by a specific assessed need and justified in the person-centered service plan, with the positive supports used first, the person’s informed consent and regular review of data. (42 CFR 441.301(c)(4)(vi)(F))
Each person whose plan includes crisis supports has that plan where the staff who support them can use it, written by the clinician or team responsible for it. (Our recommendation.)
A standard response plan for violent situations: how staff get help, how alarms work, and how staff communicate. (OSHA, 2016, section 4)
Care for staff after an incident: first aid, medical care, and counseling or an employee assistance program. (OSHA, 2016, section 3)

4. Train everyone

OSHA: safety and health training. NADSP also lists crisis prevention and intervention as a DSP competency area (NADSP).

New and reassigned staff have an orientation before they start their duties. Every worker is trained every year; in high-risk settings, refreshers may be needed perhaps monthly or quarterly. (OSHA, 2016, section 4)
Training includes role-play, simulations and drills. (OSHA, 2016, section 4)
DSPs learn the NADSP crisis skills: identify the crisis, defuse the situation, choose an intervention strategy and contact supports; then keep monitoring, discuss the incident, adjust supports and the environment, and report. (NADSP, area 10)
Staff train on each person’s own plan. In an ICF/IID, staff “must be able to demonstrate the skills and techniques” to carry out interventions and each person’s program plan. (42 CFR 483.430(e)(3) to (4))
Supervisors are trained to recognize high-risk situations and to encourage staff to report incidents and get care. (OSHA, 2016, section 4)

5. Record and review

OSHA: recordkeeping and program evaluation. Learn from each incident, then improve the program (OSHA, 2016, sections 3 and 5).

After an incident: first aid and emergency care for injured staff first, then find the root cause.
Discuss the incident with authorized staff and the person supported, as that person’s plan and team direct. Adjust supports and the environment, and report as regulations require. (NADSP, area 10)
Keep records of incidents, injuries, corrective actions and training.
At least once a year, review the training’s content, methods and frequency, using interviews, testing and observation.

What to train: during a crisis, a DSP identifies it, defuses the situation, chooses an intervention strategy and contacts supports; after it, the DSP keeps monitoring, discusses the incident with authorized staff and the person supported, adjusts supports and the environment, and reports as regulations require. Train at orientation, every year, and in high-risk settings perhaps monthly or quarterly, with role-play, simulations and drills. Sources: NADSP Competency Areas, area 10; OSHA 3148-06R, 2016. — What a direct support professional does during and after a crisis, and how often to train it.

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Questions

Starting crisis management: common questions

Is OSHA’s workplace violence guidance a law?

No. OSHA calls its guidelines “advisory in nature and informational in content”; they are not a standard or regulation and create no new legal obligations (OSHA, 2016). Employers still have to follow OSHA standards and the OSH Act’s General Duty Clause, Section 5(a)(1), and OSHA asks agencies to check their own state’s requirements. For state-required DSP training topics and hours, see the state DSP training finder.

How often should staff get crisis training?

OSHA’s guidelines say new and reassigned workers should have an orientation before they start their duties, all workers should be trained every year, and high-risk settings may need refreshers more often, “perhaps monthly or quarterly.” Training should include role-play, simulations and drills, and OSHA says de-escalation and self-defense training should include a hands-on component (OSHA, 2016). Those are taught by qualified trainers, in line with each person’s plan.

Who writes the crisis plan for a person we support?

The clinician or team responsible for that person’s plan. In an ICF/IID, the use of systematic interventions must be incorporated into the person’s individual program plan (42 CFR 483.450(b)(4)). In home and community-based settings, each person has the right to “freedom from coercion and restraint” (42 CFR 441.301(c)(4)(iii)). Staff then train on the person’s plan and follow it.

What should we track to know the program is working?

Keep records of incidents, near misses, injuries, corrective actions and training, and review them for patterns by location, job or department. At least once a year, review the training’s content, methods and frequency, using supervisor and employee interviews, testing and observation (OSHA, 2016).

Sources

Read November 15, 2026. Figures and rules are quoted as published; the checklist wording is ours.

Occupational Safety and Health Administration, Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, OSHA 3148-06R, 2016. https://www.osha.gov/sites/default/files/publications/osha3148.pdf
U.S. Bureau of Labor Statistics, “Workplace Violence 2021 - 2022” fact sheet, last modified October 8, 2024. https://www.bls.gov/iif/factsheets/workplace-violence-2021-2022.htm
U.S. Bureau of Labor Statistics, “Workplace Violence in Healthcare, 2018,” April 2020, Table 1. https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm
National Alliance for Direct Support Professionals (NADSP), Competency Areas, area 10: Crisis Prevention and Intervention. https://nadsp.org/resources/competency-areas/
42 CFR 483.430(e), Intermediate care facilities for individuals with intellectual disabilities (ICF/IID): staff training program. https://www.ecfr.gov/current/title-42/section-483.430
42 CFR 483.450, ICF/IID: client behavior and facility practices. https://www.ecfr.gov/current/title-42/section-483.450
42 CFR 441.301(c)(4), Home and community-based services: settings requirements and plan modifications. https://www.ecfr.gov/current/title-42/section-441.301