Self-Disclosure Card Templates

BE SAFE

Self-Disclosure Card Templates

It is impossible to understate the importance of safely self-disclosing a disability to law enforcement professionals or other first responders. Self-disclosure can be very helpful in everyday situations to improve communication, clear up confusion and secure appropriate accommodations for someone with a developmental disorder, acquired cognitive impairment, behavior disorder or mental illness.

Making sure that police and justice officials have a clear and complete understanding of the person’s disability is especially important if the person with a disability is accused of a crime. The self-disclosure card can be an important first step to alert officials to the person’s exceptional needs.

Note: The use of these materials is at the responsibility and risk of the user. Camino Cinema disclaims all responsibility for the use of these actual or adapted materials or outcomes thereof.

Remember, if you are going to provide a self-disclosure card to an individual, always teach the person when and how to present the card. The person needs to know and demonstrate a safe way to present the card. The person needs to know why he or she should never reach into a pocket bag or purse to get the card without asking permission. If the person cannot demonstrate the understanding of these two points, a self-disclosure card is not a safe option! In these cases, choose medical alert jewelry (in tolerable materials) or other appropriate options.

Use these cards as a starting point to provide the exact information desired, for these conditions or any other special need.

o These cards are in Microsoft Word format so that they can be edited and changed. Adapt the content in any way you see fit. Copyright is released for these items. Feel free to share widely.

o In the case of Autism Spectrum Disorder, you may wish to indicate a specific diagnosis on the spectrum, like Asperger Syndrome, Pervasive Developmental Disorder, etc.

o The physical format can be expanded or reduced to suit those who will carry it.

You may also want to use the same templates to create CAREGIVER CARDS. Especially in case of an emergency (an accident, for example) when parents, caregivers or staff are not able to speak up, it is helpful to carry an information card that helps others interact with the person in your care. For example, you can create a card that says, “I am the caregiver for a non-verbal man with autism,” and then lists the features of ASD and how to help the individual.

Attention Deficit Hyperactivity Disorder

Autism Spectrum Disorder

Bipolar Disorder

Fetal Alcohol Spectrum Disorder

Intellectual Disability

Seizure Disorder

I have Seizure Disorder, a medical condition
I take medication for seizures
Seizures last from a few seconds to a few minutes.
Symptoms range from convulsions and loss of consciousness to blank staring, or jerking movement of arms and legs.
Seizures produce a variety of involuntary, unorganized movements that can look like aggression but are NOT
Seizures cloud awareness and block normal communication, during and after the event
How to HELP me
1. Call for medical attention if I have a seizure
2. Do not try to restrain my movements during a seizure, it can seriously hurt me
3. If I am taken into custody for any reason I must continue to get my medication.
4. Do NOT put me face down, in a choke hold and/or hog-tie me during or after a seizure- this can obstruct breathing and cause death.
Source: Epilepsy Foundation of America

Tourette’s

I have Tourette Syndrome (TS)
“Tourette’s” is a neurological disorder that lasts a lifetime.
You can see my repetitive, stereotyped, involuntary movements like eye blinking or grimacing.
You can hear my repeated vocalizations called tics, (throat-clearing, grunting, barking or repeated words and phrases).
I have coprolalia, and utter socially inappropriate words (swearing). This is part of my disorder and beyond my control.
I have echolalia (repeating the words or phrases of others). This is involuntary, and is NOT meant as disrespect.
My tics get worse when I am excited or anxious.
A police encounter can trigger or worsen my tics.
How to HELP me
1. Use a CALM voice.
2. Be CLEAR. Use simple words. Give one instruction at a time.
3. WAIT, be patient. I need more time to think, and help to respond.
4. Use CALMING TECHNIQUES to avoid “fight or flight.”
WARNING: DANGER of SUFFOCATION. DO NOT hold in face-down position

Traumatic Brain Injury

I have Traumatic Brain Injury
A medical condition and disability
I am sometimes confused, restless or agitated, and I can lose self-control because of trauma to the brain. I can have trouble with
o Memory, concentration, attention, and thinking
o Talking, and explaining feelings and thoughts
o Understanding you and interacting with you
How to HELP me
1. Use a CALM voice.
2. Be CLEAR. Use simple words. Give one instruction at a time.
3. WAIT, be patient. I need more time to think and respond.
4. Use DE-ESCALATION and CALMING TECHNIQUES to avoid “fight or flight”

BE SAFE Teaching Edition Bonus Material: Self-Disclosure Card Templates