There are times when a loved one may experience a behavioral crisis. Behaviors that can be considered a crisis include any behaviors that are any that are more extreme, violent or non-compliant than his or her typical behaviors. You may see the following leading up to a behavioral crisis:

  • Increased vocalizations, yelling or screaming; 

  • Pacing and fidgeting; 

  • Sleeplessness; 

  • Increased or decreased appetite; 

  • Refusing to adapt to minor schedule changes; 

  • Heightened displays of aggression; and

  • More


You are the expert on your loved one, and know when he or she is unable to keep him or herself, or others around them, safe. Think of the following questions:

  • Is my loved one in control of his or her actions?

  • Can my loved one follow simple instructions and use learned strategies to calm down?

  • Has he or she threatened to hurt him or herself?

  • Have they threatened another family member or pet?

  • Have they destroyed property?

  • Am I or my loved one in immediate danger?

If the answers to many of these questions are yes, your loved one may be experiencing a behavioral crisis. You should seek support immediately. 


Many families ask themselves if they should call 9-1-1 when their loved one experiences a behavioral crisis. It is important for families to understand the severity of the crisis before making the call to emergency services. Below you will find two options on how to respond to behavioral crises, as well as a description of each service and when they are most appropriate.

If you or your loved one are in immediate danger, call 9-1-1

Signs that your or your loved one may be in immediate danger and need to contact 9-1-1-: 

  • Your loved one is aggressive and unable to follow simple directions; 

  • Your loved one is threatening to harm him or herself or another person; and

  • Your loved one is unable to follow simple instructions or requests

What happens when I call 9-1-1?

How quickly will I receive a response?

Law enforcement officers and paramedics will be dispatched to your location as soon as possible. 

I'm afraid law enforcement will not know how to help my loved one

There are law enforcement officers who have been trained in crisis intervention techniques. You can ask for a CIT trained officer to respond if possible. 

Additionally, you can create a document that specifies how to respond to emergencies specific to your loved one that law enforcement, fire and rescue and paramedics know how to best respond to your loved one. Click here to download a sample form

What will happen when law enforcement and paramedics arrive?

The main objective for law enforcement is to maintain the safety of your family and loved one. Paramedics seek to identify any medical emergencies. 

If your loved one requires psychiatric assistance, he or she may be transported to the hospital by law enforcement or paramedics. It is important to note that for safety reasons, your loved one may be placed in handcuffs regardless of disability. 

What can I expect if my loved one is taking to the emergency room?

  • You will be asked to sign a consent to treat your loved one

  • You will be asked to provide insurance information

  • You will be asked about the circumstances that preceded your loved one's visit to the emergency room

  • You will be asked what you would like to see happen, such as hospitalization

  • Your loved one will be examined to determine if he or she is having a medical issue that may be responsible for your loved one's behaviors

  • Your loved one may be screened by a certified psychiatric evaluator to determine if he or she requires hospitalization

  • If your loved one requires hospitalization, he or she will remain at the emergency room until a treatment becomes available to him or her, such as a bed in a psychiatric unit. This can take several hours to several days and your loved one will not be permitted to leave the hospital. Hospitalization generally will be out of your local area, and at times, in another state

  • If a treatment center is found, your loved one will be transported by either law enforcement or paramedics to the facility to receive treatment

  • After treatment, such as medication monitoring and changes in medication, your loved one will return home

If you or your loved one are NOT in immediate danger, contact REACH

The REACH program is the statewide crisis system of care that is designed to meet the crisis support needs of individuals who have a developmental disability and are experiencing crisis events which put them at risk for homelessness, incarceration, hospitalization, and/or danger to self or others.

Who is eligible for REACH services?

Individuals with a developmental disability with co-occurring mental illness and/or significant behavioral challenges are eligible for REACH services. REACH serves both children and adults. 

What services are offered through REACH?

  • 24/7 crisis assessment and intervention

  • Post-crisis mobile/community-based direct services to help prevent future escalations

  • Crisis Therapeutic Homes for adults (children's homes coming soon) to stabilize or prevent a crisis

  • Creation of a Crisis Education and Prevention Plan (CEPP) which includes description of interventions in the event of behavioral crisis

  • Training on the interventions in the Crisis Education & Prevention Plan

  • Linkages to community services specific to a person's community

How quickly can REACH respond to a crisis situation?

REACH services have up to two hours to respond to a crisis situation in rural areas and one hour in urban areas.

Are REACH services expenses?

REACH services are provided and paid for through Developmental Disability Medicaid Waivers. If your loved one has a DD waiver, he or she will not be turned away for services, regardless of ability to pay. 

How can I contact REACH services?

If you need REACH services in the Northern Shenandoah Valley, you will need to contact Region 2 services. Crisis hotline: 855-897-8278

Additional Resources and Links

Documents, Forms & Manuals

The Arc of Northern Shenandoah Valley

PO Box 124

Middletown, VA 22645

P: 540.692.9650

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© 2023 by The Arc of Northern Shenandoah Valley.