One-on-One Crisis Response Dialogue Script

1. Establish Safety and Rapport (2 minutes)

Teacher: "Hi [Student Name], it’s just you and me here. I want you to know you’re safe and I’m here to support you. Can you tell me if there’s anything you need right now—like more space, water, or anything else?"

Student:

Teacher (if needed): "Thank you for letting me know. I’ll make sure you have exactly what you need to feel safe."

2. Introduce Crisis Code Script (3 minutes)

Teacher: "Today, we’re going to use our Crisis Code. It’s a simple set of steps to help you regain calm and control when things feel overwhelming. I’ll guide you through each step, and you can let me know how it feels along the way. Does that sound okay?"

Student:

Teacher: "Great. We’ll move at your pace. Whenever you’re ready, we’ll begin with a breathing exercise."

3. Guide Through Self-Regulation Steps (10 minutes)

Step 1: Deep Breathing (2 minutes)

Teacher: "Let’s start by taking three deep breaths together. Breathe in slowly through your nose for 4 seconds… hold for 2… then exhale through your mouth for 6. I’ll count us in. Ready?"

Teacher (counting): "In… 1, 2, 3, 4. Hold… 1, 2. Out… 1, 2, 3, 4, 5, 6."

(Repeat two more times)

Teacher: "How did that feel? Did your body notice anything different?"

Student:

Teacher (possible follow-up): "Sometimes you may feel your shoulders drop or your heart slow. That’s a good sign you’re starting to calm down."

Step 2: Label Your Emotions (3 minutes)

Teacher: "Now I’d like you to name the emotion you’re feeling right now. Sometimes just giving it a name makes it less overwhelming. What word comes to mind?"

Student:

Teacher (follow-up prompts):

• "Can you tell me more about when you first noticed this feeling?"
• "If you picture the feeling as a color or shape, what would it be?"

Student:

Step 3: Grounding Exercise (5 minutes)

Teacher: "Next, let’s bring our attention to right here, right now. We’ll do a 5-4-3-2-1 exercise. Ready?"

1. "Name 5 things you can see around you."
   Student:
   
   
   
2. "Name 4 things you can feel or touch."
   Student:
   
   
   
3. "Name 3 things you can hear."
   Student:
   
   
   
4. "Name 2 things you can smell."
   Student:
   
   
   
5. "Name 1 thing you can taste—maybe the mint in the air or your last sip of water."
   Student:
   
   
   

Teacher: "How is your body feeling now—any different from before?"

Student:

4. Reflection and Next Steps (3 minutes)

Teacher: "You’ve done a great job. Which of these steps—breathing, naming your emotion, or grounding—felt most helpful to you?"

Student:

Teacher: "That’s valuable to know. We’ll note that in our Progress Monitoring Rubric. On a scale of 1 to 5, how calm do you feel now compared to when we started?"

Student:

Teacher: "Perfect. Remember, you can use these steps any time you need. You might also want to keep the Step-by-Step Self-Regulation Checklist Worksheet with you as a reminder."

5. Wrap-Up and Reinforce (2 minutes)

Teacher: "To wrap up, our Crisis Code steps are: Breathe, Label, Ground. You did all three today and made real progress. I’m proud of you."

Teacher: "We’ll check back in [next session] to see how you’re using these tools on your own. You’re not alone in this—let’s keep building on what you’ve done today."

Step-by-Step Self-Regulation Checklist Worksheet

Use this checklist to guide yourself through the Crisis Code steps independently. Check off each item as you complete it. Reference the One-on-One Crisis Response Dialogue Script or the Progress Monitoring Rubric if you need support.

1. Breathe: Deep Breathing
   [ ] Take 3 deep breaths (In 4s, hold 2s, Out 6s)
   Observations: How did your body feel?
   
   
   
   
   
   
   
   
   
   
   
   
2. Label: Name Your Emotion
   [ ] Write the word for what you’re feeling right now:
   
   
   
   
   
   
   
   
   
   
   
   
   [ ] When did you first notice this feeling?
   
   
   
   
   
   
   
   
   
   
   
   
   [ ] If you picture it as a color or shape, what would it be?
   
   
   
   
   
   
   
   
   
   
   
   
3. Ground: 5-4-3-2-1 Exercise
   [ ] 5 things you can see:
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   [ ] 4 things you can touch:
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   [ ] 3 things you can hear:
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   [ ] 2 things you can smell:
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   [ ] 1 thing you can taste:
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
4. Reflect and Rate
   On a scale of 1 (not calm) to 5 (very calm), how do you feel now? ____
   
   
   
   
   
   
   Which step helped you the most?

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Remember, you can revisit these steps anytime you need. Keep this worksheet with you and track your progress on the Progress Monitoring Rubric.

Progress Monitoring Rubric

Use this rubric to track the student’s mastery of each Crisis Code step over multiple sessions. Circle the score that most closely matches the student’s performance and note observations.

Notes/Observations: