Identify the Plan B provider years before you need one. Tour. Ask about emergency availability. Document the intake protocol. Keep the contact information current. Most respite providers have intake forms that can be pre-completed and held on file, so that activation at three in the morning takes one phone call rather than two hours of paperwork. Ask whether your chosen Plan B provider does this. If not, find one that does.

Plan B’s triggers are written. The most common triggers: caregiver hospitalization, caregiver death, residential provider staff walkout, behavioral incident exceeding home capacity, eviction notice, housing damage (fire, flood), caregiver retirement on a previously planned date. Each trigger should appear in the written Plan B with the activation script.

Plan C: the crisis door.

Plan C is the floor. When Plan A is unavailable and Plan B is also unreachable (the respite unit is full, the provider has changed hands, the bridge is gone), Plan C activates. Plan C contacts include the state crisis stabilization unit, the regional Community Mental Health crisis team, the hospital-to-home program if one operates in the region, and the 988 Suicide and Crisis Lifeline (which, since 2022, includes mobile crisis dispatch in many areas including for behavioral health crises in people with developmental disabilities).

The Plan C contacts need to be in hand, on paper, before they are needed. The 988 system can dispatch mobile crisis response in many regions, but the dispatch effectiveness varies widely. Some regions have well-trained crisis response teams that include developmental disabilities specialists; some regions do not. Know which type your region has. If the local crisis team is not well-suited to autism crises, identify the alternative: the regional CMH, the children’s hospital ER (which often has better neurodevelopmental capacity than general ERs), the private respite unit that takes walk-ins.

Plan C’s triggers are the most severe: imminent risk to safety (the adult’s or others’), behavioral crisis exceeding home capacity, hospitalization of the autistic adult themselves, sudden loss of housing with no other placement available. Activation of Plan C is rare in a well-built three-plan structure, which is the point.

Triggers, written explicitly.

The single most important feature of the three-plan structure is written, explicit triggers. Each plan has an activation condition. The activation conditions are clear enough that a sibling, a successor caregiver, or a case manager can apply them without needing to call the parent for interpretation.

Trigger examples. “Plan A activates when waiver slot is offered.” “Plan B activates if Plan A start is delayed more than 60 days past the offered date, OR if caregiver hospitalization exceeds 24 hours, OR if Plan A provider gives notice of imminent placement change.” “Plan C activates if Plan B respite unit is full or unreachable, OR if hospital ER is the only available bed, OR if imminent safety risk exceeds home capacity in the same hour.”

Triggers prevent paralysis. The morning Beth’s husband fell, Beth did not have to debate whether to call Plan B. The trigger was hit. The activation script was clear. The phone call was the next thing. Three hours of indecision is what bad outcomes are made of.

What goes into each plan, in writing.

Each plan should be one page, signed by the parent (or guardian or successor as applicable), and dated with the most recent review. The contents per plan: target setting (specific provider name, address, contact), funding source, application status (Plan A only), activation triggers in plain language, activation script (who to call, in what order, with what documents), expected duration, exit criteria back to Plan A.

Attach the current Letter of Intent (or a one-page summary), current medication list with allergies, signed HIPAA releases for relevant providers, the BSP if one exists, and the case manager’s contact information. Keep the attachments current. Stale attachments are sometimes worse than no attachments because they create the illusion of being prepared without actually being prepared.

Practice on paper, not just in the head.

Once the three plans are drafted, walk through Plan B and Plan C on paper as if they were activating. Read the trigger out loud. Read the first call. Identify what would happen next. Where does the gap show up? The trial run usually reveals two or three gaps the family had not noticed: a phone number that turns out to be a wrong number when dialed, an intake form the provider needs that the family has not pre-completed, a HIPAA release that has not been updated since the adult’s eighteenth birthday. Fix the gaps. Re-run the trial.

Do not actually activate the plans for practice. Activation has real costs: bed-night charges, intake processing, staff time. Paper practice is sufficient. Even paper practice is more practice than most families have ever done.

Documenting urgency for systems.

Some plan activations require documentation to systems beyond the immediate provider. Medicaid agencies may need to reauthorize service hours. The state waiver office may need to be notified of placement changes. The HCBS waiver case manager will need to update the person-centered plan. Document these system-side notifications as part of the activation script for each plan. The system catch-up is the part that gets dropped during a crisis and then generates an overpayment notice three months later.

For Plan C specifically, the documentation of urgency to the state waiver office is important. A documented crisis activation often moves the family from a “future need” category to an “urgent” or “in-crisis” category on any pending waiver waitlist. This is the moment when the risk-log work from the waitlist post pays off.

What other states make easier.

Several states fund dedicated emergency respite networks specifically for adults with developmental disabilities (Pennsylvania, Ohio, Wisconsin). Several states publish crisis stabilization protocols and mobile crisis team contacts publicly (Massachusetts, Oregon, Vermont). The 988 Suicide and Crisis Lifeline, federally funded, includes mobile crisis dispatch in a growing number of regions with developmental disabilities trained responders. Michigan funds Community Mental Health regional crisis teams of varying quality, with mobile crisis dispatch available in most regions through the PIHP system but with less consistent autism-specific response capacity than some peer states. Other states made different choices about crisis infrastructure. Michigan didn’t, fully.

Your assignment this week.

One evening. Three pages. Plan A, Plan B, Plan C. Specific names, numbers, addresses. Sign and date. Share with the case manager and the named successor caregivers. Set the annual review on the calendar with the Letter of Intent update. Re-verify Plan B and Plan C contacts every six months. The night Plan A fails is not the night to start drafting Plan B. Other states have built more of the infrastructure that backs up Plan B and Plan C. Michigan didn’t, fully. Now we know what we are fighting. Together.