Tanana Chiefs Conference - Coordinated Community Crisis Response Request Form

This form is NOT for individual patient crises-communities only

The TCC Crisis Response Committee will process this request within 24 hours. If submitted outside of business days, the request will be processed on the following business day. A staff member will reach out to follow up and coordinate a community crisis response.

If you are experiencing a mental health crisis and need immediate assistance, please reach out in one of the following ways:

TCC Behavioral Health
Call 907-459-3800
Available 24/7
Option 2 for After-Hours.

Alaska Careline
Call 1-877-266-4357 or
text 4help to 839863.
Available 24/7

Behavioral Health Crisis Line
Call or Text 988
Available 24/7

The 988 Suicide & Crisis Lifeline offers 24/7 call, text and chat access to trained crisis counselors who can help people experiencing suicidal, substance use, and/or mental health crisis, or any other kind of emotional distress. People can also call, text or chat 988 if they are worried about a loved one who may need crisis support.

Question Title

1. Please provide community requesting crisis response. (Required.)

Question Title

2. Is this a formal request from the tribe? (Required.)

Yes

Question Title

3. Who is the main point of contact for coordinating response? (Required.)

First and Last Name

Email Address

Phone Number

Question Title

4. When did crisis event occur?

Date / Time

Date

Question Title

5. Who is involved in the incident? Please provide their names and roles. (Required.)

Question Title

6. Please provide a summary of the incident. (Required.)

Question Title

7. What other organizations have been contacted? (Law enforcement, public safety, tribal courts, OCS,.etc.)

Question Title

8. Are immediate services needed? If yes, please specify. (Required.)

Question Title

9. What specific TCC service and/or technical assistance are being requested? (Required.)

Behavioral Health Services

Wellness and Prevention Services

Tribal Government and Justice

Other

Tanana Chiefs Conference - Coordinated Community Crisis Response Request Form

This form is NOT for individual patient crises-communities only

Question Title

* 1. Please provide community requesting crisis response. (Required.)

Question Title

* 2. Is this a formal request from the tribe? (Required.)

Question Title

* 3. Who is the main point of contact for coordinating response? (Required.)

Question Title

* 4. When did crisis event occur?

Question Title

* 5. Who is involved in the incident? Please provide their names and roles. (Required.)

Question Title

* 6. Please provide a summary of the incident. (Required.)

Question Title

* 7. What other organizations have been contacted? (Law enforcement, public safety, tribal courts, OCS,.etc.)

Question Title

* 8. Are immediate services needed? If yes, please specify. (Required.)

Question Title

* 9. What specific TCC service and/or technical assistance are being requested? (Required.)

1. Please provide community requesting crisis response. (Required.)

2. Is this a formal request from the tribe? (Required.)

3. Who is the main point of contact for coordinating response? (Required.)

4. When did crisis event occur?

5. Who is involved in the incident? Please provide their names and roles. (Required.)

6. Please provide a summary of the incident. (Required.)

7. What other organizations have been contacted? (Law enforcement, public safety, tribal courts, OCS,.etc.)

8. Are immediate services needed? If yes, please specify. (Required.)

9. What specific TCC service and/or technical assistance are being requested? (Required.)