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Escalation rule card

Keep this on hand during every session. It lists the red flags, what to do the moment one appears, what to escalate to a licensed supervisor and how fast, and the rules that never bend.

This card is a research prototype aid. It does not replace your organization's crisis policy, mandated-reporting duties, or supervisor's instructions. Fill in your site's supervisor name, phone, and local crisis line before use, and follow your organization's policy wherever it is stricter.
Crisis routing (use immediately)

Call or text 988 for the Suicide and Crisis Lifeline. Interpreters are available; ask for the client's language. Call 911 if there is immediate danger to life. Crisis is always handled by a person, never by the chatbot.

A red flag appears
Stay with the client
Loop in the supervisor within the agreed window
Immediate danger to life? Call or text 988, or 911 now. This branch never waits.
The routing below is the same for every red flag: stay, escalate within the window, and split off to a crisis line the moment life safety is in question.

Red flags and what to do

If any of these appears, act now and escalate. Do not wait for the session to end.

  • Suicidality or self-harm

    Signs: talk of not wanting to be here, plans or means to harm oneself, giving things away, hopelessness paired with intent.

    Do now: stay calm, stay with the person, ask directly and simply about safety, and move to crisis routing (988, or 911 for immediate danger).

    Escalate: licensed supervisor immediately, same session, by phone.

  • Psychosis signs

    Signs: hearing or seeing things others do not, strong fixed false beliefs, speech that is hard to follow, appearing frightened or disconnected from reality.

    Do now: stay calm and non-confrontational, do not argue with the beliefs, keep the person safe, and route to crisis support if there is any danger.

    Escalate: licensed supervisor same day; same session if the person is distressed or unsafe.

  • Abuse disclosure

    Signs: disclosure of child, elder, or intimate-partner abuse, or immediate danger from another person.

    Do now: listen, do not promise secrecy, ensure immediate safety, and call 911 if someone is in danger now. Follow your organization's mandated-reporting policy.

    Escalate: licensed supervisor immediately, same session, and file any required report per policy.

  • Medication questions

    Signs: asking whether to start, stop, taper, or combine medication, or acting on an AI dosing answer.

    Do now: do not advise. Help the client write the question for their prescriber and help them reach an appointment with an interpreter. If the client has already stopped a medication and seems at risk, treat as urgent.

    Escalate: licensed supervisor within 24 hours; same day if there is any sign of risk from stopping.

  • Legal or immigration advice

    Signs: asking the CHW to interpret law, advise on an immigration case, or rely on an AI answer about legal rights.

    Do now: do not give legal advice or interpret law from an AI answer. Refer to a qualified legal resource and, for language, a qualified interpreter.

    Escalate: licensed supervisor within 24 hours for a referral; sooner if there is an urgent legal deadline or safety concern.

The standing rules

These never change, no matter how confident an AI answer sounds or how much a client asks.

1. AI output is never medical advice. An AI answer about symptoms, conditions, or medication is information to bring to a clinician, never a clinical recommendation and never a reason to change care.
2. The client always keeps the right to a free qualified interpreter. For consent, diagnosis, treatment, or insurance, a human interpreter is the client's right. AI translation, an app, or a family member does not replace it.

Fill in for your site

  • Licensed supervisor: name and direct phone.
  • Backup supervisor or on-call contact.
  • Local crisis line (if your area has one in addition to 988).
  • Your organization's mandated-reporting steps and any reporting number.
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