Right so I've only worked as an employee at places that had pre-existing policies and legal consultants, this isn't just me winging it. The exact policies have varied state to state, but it's usually some iteration of having the person's name and contact info and in the event they do go suicidal in the screening call, they are directed to the ER or their info is given to 911 as a last resort. That has never happened for me or any of my coworkers during a screening call, but is the backup plan that the legal teams have been satisfied with. What is much more common is that we would refer them to an IOP program or something, which is usually caught in pre-screening but not always. In terms of documentation, the practice has generally been that the admin staff keeps a log of phone contacts, which they pre-screen for basic info before handing to the clinician, but these people are not entered into the larger patient documentation system until they are seen for an evaluation. So there's usually different levels of documentation for patients under our care vs people inquiring about treatment. Which again, the legal teams that are versed in our particular state laws have found to be sufficient. (But we would be specifically UNinterested in any kind of tech to "streamline" this process, which was the point of one of my prior comments about not wanting to systematically track this. Not that we don't document at all.) I do send several people per year to the ER from in person/telehealth sessions at my current job, but have never had to do it from a pre-intake phone call. In fact of the several jobs I've had, only one was the kind where admin would just put people onto my schedule for intakes without me ever interacting with them first, and I feel like I did a lot more crisis management with that set-up, which takes a lot more time and energy than referring someone out before they get to that point.
Edit: Oh and I forgot to address the child/elder abuse thing. So according to my state laws, I am obligated to report any specific information that is offered to me and exceeds certain thresholds of concern. But I am explicitly NOT expected to do detective work about what did or didn't happen. I am supposed to leave that up to child services. So if someone said something too vague to identify that most likely would be a non-starter, but I would seek guidance to see if I should still report the vague tip and let them investigate whatever they have to go on. If someone did swoop into a 10-minute first phone call and drop a name and specific child abuse allegation, I suppose I would have to report that. I guess the hairy part would be whether the person had an expectation of confidentiality during that pre-treatment contact. However, that confidentiality issue has not been a problem in terms of calling 911 for a suicide emergency, so my assumption is that similar rules would apply here. In any case what I would do is seek out my practice's legal consult, and my state board's ethics hotline for specific steps on how to proceed.
