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Home My WebLink Aboutadult-preparedness-planning-trainingPRESENTED BY: GRECYA VIDA L ZAVALA, LMFT Adult Preparedness Plans: S U P P O R T I N G A L L A D U L T S Introduction I was born in Perú. I have a Peruvian passport that was issued to me on February 22 , 1995. My visa, better known as an I-94, has a stamp with my arrival date to the USA: October 22 , 1997. R-Visa, B1/B2 class. Expiration date: February 27 , 2005. One year before I graduated high school. nd nd th Today I am 38 years old, and I have not returned to my birth country. I earned multiple associate degrees, my undergraduate degree, and in 2020, my Master’s in Counseling Psychology with an emphasis in Community Mental Health. I completed my traineeship with the City of Berkeley (at Berkeley High School), worked in an incredible East Oakland elementary school while simultaneously working in a group private practice, and then began working with the SF Dept. of Public Health in primary care behavioral health. In 2024, I passed my clinical exam and became an LMFT. I hope I’ve made my ancestors proud. We gather on the unceded ancestral homeland of the Lisjan Ohlone people. We recognize that borders, colonization, and forced displacement are not new — they are the foundation upon which the current immigration system was built. Our work today exists within that history. Land Acknowledgement & Grounding Learning Objectives 1.Support adults in taking control: Help all adults (including those with psychosis, schizophrenia, complex mental health needs, and other realities) appoint caregivers and decision-makers using Power of Attorney, Advance Healthcare Directives, and verbal agreements, while respecting their autonomy and mental capacity. 2.Ask safely and document wisely: Know how to ask about immigration status, fears, and needs without judgment, and understand what to document and what to protect. 3.Meet adults where they are: Apply trauma-informed, harm reduction-centered approaches when working with all adults, including sex workers, people using drugs, neurodivergent, elderly, unhoused, and adults experiencing psychosis, schizophrenia, or other mental health conditions B Y T H E E N D O F T H I S T R A I N I N G , P A R T I C I P A N T S W I L L B E A B L E T O : Land Acknowledgement & Grounding Statement Why Adult Preparedness Plans Matter Legal Tools & How They Work BREAK How to Ask Safely & Document Wisely Supporting All Adults Facilitating Planning Conversations Resources & Closing Agenda Why Adult Preparedness Plans Matter - The Context I C E E N F O R C E M E N T H A S E S C A L A T E D S I G N I F I C A N T L Y I N 2 0 2 5 -2 0 2 6 W O R K P L A C E R A I D S , C O M M U N I T Y S W E E P S , T A R G E T E D E N F O R C E M E N T A R E H A P P E N I N G D E T E N T I O N A N D D E P O R T A T I O N A R E R E A L T H R E A T S B U T I T ’S N O T J U S T A B O U T I M M I G R A T I O N E N F O R C E M E N T ... Landlord doesn’t know you cant pay rent. Healthcare provider doesn’t know what you want or need Bank account is frozen Kids don’t know who to call Medications aren’t managed Pets aren’t cared for If experiencing psychosis/ schizophrenia, treatment is interrupted If using drugs, harm reduction supplies are inaccessible Why Adult Preparedness Plans Matter - The Context Landlord doesn’t know you cant pay rent. Healthcare provider doesn’t know what you want or need Bank account is frozen Kids don’t know who to call Medications aren’t managed Pets aren’t cared for If experiencing psychosis/ schizophrenia, treatment is interrupted If using drugs, harm reduction supplies are inaccessible If sex worker, safety strategies are compromised What is an Adult Preparedness Plan? A P P O I N T A C A R E G I V E R01 P R O T E C T A S S E T S02 03 04 A L L A D U L T S H A V E T H E R I G H T T O M A K E D E C I S I O N S A B O U T T H E I R O W N C A R E A N D P R O P E R T Y . O U R J O B I S T O S U P P O R T T H A T , N O T D I R E C T I T . A P E R S O N A L I Z E D D O C U M E N T T H A T A L L O W S A N A D U L T T O : D O C U M E N T W I S H E S O R G A N I Z E I N F O R M A T I O N 05 B U I L D C O M M U N I T Y ARE NOT ABOUT ARE ABOUT making decisions for the adult honoring the adult’s expertise assuming what they want respecting their values pathologizing their needs supporting self-determination limiting their autonomy building on their strengths judging their choices centering their voice criminalizing survival strategies meeting them where they are Adult Preparedness Plans .... Who needs a plan? U n d o c u m e n t e d & m i x e d -s t a t u s a d u l t s 01 S e x w o r k e r s02 P e o p l e u s i n g d r u g s03 N e u r o d i v e r g e n t a d u l t s04 A d u l t s w i t h p s y c h o s i s /s c h i z o p h r e n i a05 A d u l t s w i t h o t h e r m e n t a l h e a l t h c o n d i t i o n s06 E l d e r l y a d u l t s07 U n h o u s e d a d u l t s08 E V E R Y O N E The Three Legal Tools Covers: Financial & legal decisions Paying bills Managing bank accounts Handling investments Filing taxes Managing real estate P O W E R O F A T T O R N E Y (P O A ) Must be 18+ with mental capacity. Agent must be trusted Can be revoked anytime Takes effect immediately Called ‘durable’ if it survives incapacity Covers: Medical treatment decisions Hospital decisions End of life care Mental health decisions Psychiatric treatment Specific healthcare wishes A D V A N C E D H E A L T H C A R E D I R E C T I V E Must be 18+ with mental capacity. Agent should understand your values You can specify decisions & include instructions Takes effect only if you can’t decide Covers: Anything you want documented Values and priorities Who you trust & what matters to you How you want to be cared for V E R B A L A G R E E M E N T / L E T T E R O F I N T E N T Not a legal document But powerful – documents your wishes Can be a letter, recording, etc Useful if you don’t want formal processes Complements POA or Directive What happens to pets and/or belongings Mental health treatment preferences Harm reduction strategies Safety strategies The Three Legal Tools For Immigration Preparedness: Agent can pay rent/ mortgage Protects assets if detained P O W E R O F A T T O R N E Y (P O A ) Free to low cost Notarization is required A D V A N C E D H E A L T H C A R E D I R E C T I V E V E R B A L A G R E E M E N T / L E T T E R O F I N T E N T For Immigration Preparedness: Ensures healthcare managed if detained Allows agent to access medical records Protects from unwanted procedures Critical for complex healthcare needs Allows you to specify mental health treatment preferences Free to low cost Notarization is required For Immigration Preparedness: Documents wishes in your own words Easier to create Can be shared with trusted people Provides guidance even if not legally binding Can document mental health preferences in your language Can document harm-reduction strategies Can document safety strategies Free Write it yourself These tools DON’T... G i v e g u a r d i a n s h i p01 M a k e d e c i s i o n s w i t h o u t t h e i n d i v i d u a l ’s i n p u t02 P r o t e c t i m m i g r a t i o n s t a t u s03 C r e a t e a w i l l04 R e q u i r e f o l k s t o e x i t s e x w o r k , s t o p u s i n g d r u g s , o r c h a n g e m e n t a l h e a l t h s t a t u s05 O v e r r i d e f o l k s ’ a u t o n o m y (e v e n w i t h p s y c h o s i s /s c h i z o p h r e n i a )06 Mental Capacity I N D I V I D U A L U N D E R S T A N D S W H A T T H E Y ’R E S I G N I N G I N D I V I D U A L U N D E R S T A N D S T H E C O N S E Q U E N C E S I N D I V I D U A L C A N C O M M U N I C A T E T H E I R W I S H E S I N D I V I D U A L C A N M A K E D E C I S I O N S A B O U T T H E I R L I F E What it does NOT mean.. Individual has to be neurotypical 01 Individual has to be sober 02 Individual has to be housed 03 Individual has to be employed 04 Individual has to agree with others 05 Individual has to be ‘high functioning’ 06 Individual has to be free from psychosis/ schizophrenia 07 Individual has to be free from other mental health conditions 08 C a p a c i t y i s r e s p e c t e d .I f a n a d u l t h a s m e n t a l c a p a c i t y , t h e y g e t t o m a k e d e c i s i o n s a b o u t t h e i r o w n l i f e . I m p o r t a n t n o t e o n p s y c h o s i s a n d s c h i z o p h r e n i a : P e o p l e e x p e r i e n c i n g p s y c h o s i s o r s c h i z o p h r e n i a c a n h a v e m e n t a l c a p a c i t y . C a p a c i t y i s n o t d e t e r m i n e d b y d i a g n o s i s . I t 's d e t e r m i n e d b y w h e t h e r s o m e o n e c a n u n d e r s t a n d t h e d o c u m e n t a n d i t s c o n s e q u e n c e s . M a n y p e o p l e w i t h p s y c h o s i s o r s c h i z o p h r e n i a h a v e f u l l m e n t a l c a p a c i t y a n d s h o u l d b e s u p p o r t e d i n m a k i n g t h e i r o w n d e c i s i o n s . California Protections for Immigrants SB 54: The California Values Act Limits state and local law enforcement cooperation with ICE Prohibits police from detaining people solely based on ICE requests Protects immigrants from being turned over to ICE without a judicial warrant What this means Limitations Local police cannot hold an individual for ICE without a judicial warrant Does NOT prevent ICE from conducting their own enforcement Individual has the right to refuse consent to searches Does NOT prevent federal agents from entering someone’s home Individual has the right to remain silent Does NOT apply to certain serious crimes California Protections for Immigrants SB 81: Healthcare Privacy Protection Protects an individuals’ immigration status as confidential medical information Limits ICE enforcement activities at hospitals and clinics Requires healthcare providers to notify the individual if ICE is seeking the individuals’ information What this means Healthcare provider cannot share your immigration status with ICE without a warrant Medical information is protected ICE cannot conduct enforcement at hospitals without a judicial warrant Mental health treatment is protected Individuals can access healthcare without fear of deportation Substance use treatment is protected Know Your Rights: The Basics R i g h t t o r e m a i n s i l e n t .01 R i g h t t o r e f u s e t o c o n s e n t t o s e a r c h02 R i g h t t o a n a t t o r n e y03 R i g h t t o r e f u s e t o s i g n a n y t h i n g t h e i n d i v i d u a l d o e s n o t u n d e r s t a n d04 R i g h t t o a p h o n e c a l l i f d e t a i n e d05 R i g h t t o r e f u s e t o o p e n t h e d o o r w i t h o u t a j u d i c i a l w a r r a n t06 BREAK Having the Conversation Ask with purpose, not curiosity I'm asking because I want to help you protect your family if you're detained I'm asking because I want to understand your fears so I can help you plan I'm asking because I want to know who to contact if something happens I’m asking because there may be resources or legal supports we can connect you with—but it’s completely your choice what you want to share. Be transparent about your intentions. Avoid Leading with status questions before building rapport Documenting legal status unless clinically essential Assuming that lack of disclosure means lack of fear Don’t use fear-based messaging Don’t assume – ask what they already know Don’t overwhelm with information all at once Don’t center yourself – this is about them Approach with Trauma-Informed Care Recognize that asking about immigration, fears, or needs can trigger trauma The person may have experienced: Detention or deportation Family separation Violence or abuse Discrimination Loss of housing or employment Approach with: Gentleness Patience Respect for their pace Validation of their experience Safety & Confidentiality D o n 't s h a r e t h e p e r s o n 's i n f o r m a t i o n w i t h c o l l e a g u e s c a s u a l l y01 D o n 't d i s c u s s t h e i r s t a t u s i n h a l l w a y s , b r e a k r o o m s , o r g r o u p s e t t i n g s 02 D o n 't d o c u m e n t u n n e c e s s a r i l y03 D o n 't f l a g t h e i r c h a r t w i t h w a r n i n g s o r a l e r t s04 Do: Keep information in a secure place Share only with people who need to know Ask permission before sharing Respect the person’s wishes about who knows what. What NOT to Document Do Document Immigration status (undocumented or mixed status)Emotional impact (concern about family safety) Specific fears about ICE (afraid of ICE or deportation)Legal referrals (referred to X for legal planning) Detention history (detained by ICE; family deportation)Generalized language (prep for potential emergencies) Mental health diagnoses used against clients Clarification of confidentiality (discussed confidentiality with client) Substance use diagnoses used against clients Strengths & wishes Sex work status Preparedness plan completion (completed POA, etc) Specific harm reduction strategies Follow-up needs (help accessing services) Specific safety strategies (working in x areas)Client’s own words Affirming language What to Document & What to Protect The question is not 'What can I document?' The question is 'Will documenting this harm my client?' What to Ask What to Document Do you have a safe place to work?Client has safety contacts and communication strategies Are there areas where you work that feel safer than others?Client has identified trusted people who know about their work Do you have regular clients you trust?Client wants [trusted person] to manage their finances What’s your preferred way to communicate with clients?Client has specific communication preferences If something happened to you, who would you want to know about your work?Client is engaged in harm reduction and safety planning Do you want your sex work documented in your prep plan?Client wants their work-related contacts notified in case of emergency What would help you feel safer if you were detained or incapacitated? Supporting Sex Workers Specific Preparedness Needs Safety Contacts Who are the people who know about your work? Who can you trust to check on you? Who should be notified if you go missing? Areas Worked Where do you work? (general areas, not specific locatio Are there safe places to work? Are there places to avoid? Clientele Do you have regular clients? Do you have clients you trust? Should any clients be notified if something happens? Specific Preparedness Needs Communication How do clients contact you? What's your preferred communication method? Should your agent have access to your phone/messaging apps? Financial Protection Where do you keep your money? Who should manage your finances if you're incapacitated? Do you have a safe place to store cash? Legal Protection Do you have a lawyer who knows about your work? Do you want legal referrals? Should your agent know about your work? Healthcare Do you have a healthcare provider who knows about your work? Do you want your healthcare provider to know? What are your healthcare needs? How to Support Sex Workers in Planning A F F I R M T H E I R W O R K R E S P E C T T H E I R E X P E R T I S E C E N T E R T H E I R A G E N C Y P R O T E C T T H E I R P R I V A C Y C O N N E C T T O R E S O U R C E S V A L I D A T E T H E I R F E A R S S U P P O R T T H E I R C H O I C E S C H E C K I N R E G U L A R L Y Sex workers are experts on their own safety. Listen to them. Trust them. Support them. What to Ask What to Document Are you currently using any substances?Client is engaged in harm reduction and substance use treatment Are you in treatment? What kind of treatment?Client is taking [specific medication] for substance use disorder What medications are you taking for substance use or mental health?Client’s prescriber is [name/clinic] Do you have a prescriber or treatment provider?Client wants [trusted person] to manage their medications if incapacitated What harm reduction supplies do you use? (syringes, naloxone, fentanyl test strips, etc.)Client has identified harm reduction supplies & where to access them Where do you get your supplies?Client has support network for health & safety Do you have people who support your health and safety?Client wants their treatment provider notified in case of emergency If something happened to you, who would manage your medications and treatment? What would help you stay safe and healthy if you were incapacitated? Supporting People Using Drugs Specific Preparedness Needs Treatment & Medications Are you in treatment? What kind? What medications are you taking? Who is your prescriber? What happens if you miss doses? Should your agent have access to your treatment records? Harm Reduction Supplies What supplies do you use? (syringes, naloxone, fentanyl test strips, etc.) Where do you get your supplies? Who should have access to your supplies if you're incapacitated? Should your agent know where to find your supplies? Specific Preparedness Needs Overdose Prevention Do you have naloxone/Narcan? Who knows how to use it? Should your agent be trained? What's your overdose prevention plan? Healthcare Do you have a healthcare provider? Do they know about your substance use? What are your healthcare needs? Should your agent have access to your medical records? Specific Preparedness Needs Financial Protection Who should manage your finances if you're incapacitated? Do you have money for treatment or supplies? Should your agent have access to your accounts? Legal Protection Do you have a lawyer? Do you want legal referrals? Should your agent know about your substance use? Support Network Who supports your health and recovery? Who should be notified if something happens? Who can help manage your treatment if you're incapacitated? How to Support People Using Drugs A F F I R M H A R M R E D U C T I O N R E S P E C T T H E I R E X P E R T I S E C E N T E R T H E I R A G E N C Y P R O T E C T T H E I R P R I V A C Y C O N N E C T T O R E S O U R C E S V A L I D A T E T H E I R F E A R S S U P P O R T T H E I R C H O I C E S C H E C K I N R E G U L A R L Y Sex workers are experts on their own health. Listen to them. Trust them. Support them. What to Ask What to Document What helps you feel calm and grounded?Client is managing their mental health with support What helps you when you’re experiencing psychosis or hearing voices?Client is taking [specific medication] for mental health Are you taking medications? What are they?Client’s psychiatrist/provider is [name/clinic] What kind of treatment helps you?Client wants [trusted person] to manage their healthcare if incapacitated Who do you talk to when you’re struggling?Client has identified what helps them feel calm and grounded If something happened to you, who would you want to make healthcare decisions?Client has a support network for mental health and safety. What would help you stay safe & healthy if you were incapacitated Client wants their mental health provider notified in case of emergency Do you want your mental health treatment documented Client has capacity to make decisions about their own care Supporting People with Psychosis Specific Preparedness Needs Mental Health Treatment Are you in treatment? What kind? (medication, therapy, peer support, etc) What medications are you taking? Who is you psychiatrist/provider? What happens if you miss doses? Should your agent have access to your treatment records? What Helps You What helps you feel calm and grounded? What helps you when you’re experiencing psychosis or hearing voices? What activities or people help? What should your agent know about what helps you? Specific Preparedness Needs Crisis Planning What’s your crisis plan? Who should be contacted if you’re in crisis? What should your agent do if you’re experiencing psychosis? Do you want to be hospitalized if in crisis, or do you prefer other support? Healthcare Do you have a healthcare provider? Do they know about your mental health? What are your healthcare needs? Should your agent have access to your medical records? Specific Preparedness Needs Financial Protection Who should manage your finances if you're incapacitated? Do you have money for treatment or medications? Should your agent have access to your accounts? Legal Protection Do you have a lawyer? Do you want legal referrals? Should your agent know about your mental health? Support Network Who supports your mental health and recovery? Who should be notified if something happens? Who can help manage your treatment if you're incapacitated? How to Support People with Psychosis R E S P E C T T H E I R C A P A C I T Y R E S P E C T T H E I R E X P E R T I S E C E N T E R T H E I R A G E N C Y P R O T E C T T H E I R P R I V A C Y C O N N E C T T O R E S O U R C E S V A L I D A T E T H E I R F E A R S S U P P O R T T H E I R C H O I C E S C H E C K I N R E G U L A R L Y People with psychosis and schizophrenia have capacity. They deserve to make decisions about their own lives. Listen to them. Trust them. Support them. What to Ask What to Document How do you prefer to communicate? (verbal, written, visual, etc.)Client is neurodivergent and has specific communication needs Do you have any communication needs I should know about?Client prefers [communication method] for communication What helps you focus and understand information?Client needs [accommodation] to understand information Do you need extra time to process information?Client has identified strengths and skills Do you have sensory needs? (quiet space, low lighting, etc.)Client wants [trusted person] to support them if incapacitated What are your strengths?Client has support network If something happened to you, who would you want to make decisions?Client has capacity to make decisions about their own care What would help you feel safe and supported? Do you want your neurodivergence documented in your preparedness plan? Supporting Neurodivergent Adults Specific Preparedness Needs Communication Needs How do you prefer to communicate? Do you need written information? Do you need visual supports? Do you need extra time to process? Should your agent know your communication preferences? Sensory Needs Do you have sensory sensitivities? What helps you feel comfortable? What should your agent know about your sensory needs? Specific Preparedness Needs Support Needs What kind of support do you need? Who helps you? Should your agent have access to your support network? Healthcare Do you have a healthcare provider? Do they know you're neurodivergent? What are your healthcare needs? Should your agent have access to your medical records? Financial Protection Who should manage your finances if you're incapacitated? Do you have money for support or accommodations? Should your agent have access to your accounts? Specific Preparedness Needs Legal Protection Do you have a lawyer? Do you want legal referrals? Should your agent know about your neurodivergence? Support Network Who supports you? Who should be notified if something happens? Who can help if you're incapacitated? How to Support Neurodivergent Adults R E S P E C T T H E I R C O M M U N I C A T I O N N E E D S P R O V I D E A C C O M M O D A T I O N S R E S P E C T T H E I R E X P E R T I S E C E N T E R T H E I R A G E N C Y P R O T E C T T H E I R P R I V A C Y C O N N E C T T O R E S O U R C E S S U P P O R T T H E I R C H O I C E S C H E C K I N R E G U L A R L Y What to Ask What to Document Where do you sleep? (safe place, shelter, car, etc.)Client is experiencing housing insecurity Do you have a safe place to store belongings?Client has identified safe places to stay Are there places you feel safer than others?Client has support network for safety Do you have people who help keep you safe?Client wants [trusted person] to manage belongings if incapacitated What would help you feel safer?Client has identified important documents and where they are If something happened to you, who would you want to know?Client wants [trusted person] to be contacted in case of emergency Do you have important documents? Where are they? What would help you stay safe and healthy if you were incapacitated? Supporting Unhoused Adults Specific Preparedness Needs Safe Places to Stay Where do you sleep? Are there places you feel safer than others? Do you have access to shelters? Should your agent know where you stay? Belongings What belongings do you have? Where do you store them? Is there a safe place to store them? Who should manage your belongings if you're incapacitated? Specific Preparedness Needs Important Documents Do you have ID, birth certificate, or other documents? Where are they stored? Should your agent have access to them? Healthcare Do you have a healthcare provider? Do they know you're unhoused? What are your healthcare needs? Should your agent have access to your medical records? Specific Preparedness Needs Financial Protection Do you have money or resources? Who should manage them if you're incapacitated? Should your agent have access? Legal Protection Do you have a lawyer? Do you want legal referrals? Should your agent know about your housing status? Support Network Who helps you? Who should be notified if something happens? Who can help if you're incapacitated? How to Support Unhoused Adults R E S P E C T T H E I R S U R V I V A L S T R A T E G I E S R E S P E C T T H E I R E X P E R T I S E C E N T E R T H E I R A G E N C Y P R O T E C T T H E I R P R I V A C Y C O N N E C T T O R E S O U R C E S V A L I D A T E T H E I R S I T U A T I O N S U P P O R T T H E I R C H O I C E S P R O V I D E P R A C T I C A L S U P P O R T What to Ask What to Document What matters most to you?Client has identified what matters most to them What are your cultural or spiritual wishes?Client has cultural/spiritual wishes Are you experiencing any changes in your health or memory?Client wants [trusted person] to make healthcare decisions Do you have family or people who support you?Client has identified family/support network If something happened to you, who would you want to make decisions?Client has capacity to make decisions about their own care What kind of healthcare do you want?Client has completed Advance Healthcare Directive What would help you feel safe and supported?Client wants [trusted person] to be contacted in case of emergency Do you want your wishes documented in your preparedness plan? Supporting Elderly Adults Specific Preparedness Needs Healthcare Wishes What kind of healthcare do you want? Do you want life-sustaining treatment? What are your end-of-life wishes? Should your agent have access to your medical records? Cultural & Spiritual Wishes What are your cultural or spiritual beliefs? What rituals or practices are important to you? Should your agent know about these? Specific Preparedness Needs Family & Support Who is your family? Who supports you? Should they be notified if something happens? Financial & Legal Do you have assets or property? Who should manage them if you're incapacitated? Do you have a will? Should your agent have access to your accounts? Specific Preparedness Needs Healthcare Do you have a healthcare provider? What are your healthcare needs? Should your agent have access to your medical records? Living Situation Where do you live? Do you want to stay there? What support do you need? Support Network Who helps you? Who should be notified if something happens? Who can help if you're incapacitated? How to Support Elderly Adults R E S P E C T T H E I R W I S D O M R E S P E C T T H E I R A U T O N O M Y C E N T E R T H E I R A G E N C Y R E S P E C T T H E I R C U L T U R E C O N N E C T T O R E S O U R C E S V A L I D A T E T H E I R E X P E R I E N C E S U P P O R T T H E I R C H O I C E S C H E C K I N R E G U L A R L Y Facilitate Planning Conversations B U I L D T R U S T — P r i v a t e s p a c e , c l e a r p u r p o s e , c o n f i d e n t i a l i t y e x p l a i n e d01 A S S E S S R E A D I N E S S — "A r e y o u r e a d y t o t a l k a b o u t t h i s ?" R e s p e c t i f t h e y s a y n o02 L I S T E N M O R E T H A N Y O U T A L K — A s k o p e n -e n d e d q u e s t i o n s . L e t t h e m l e a d03 D O C U M E N T T H E I R W O R D S — U s e q u o t e s . C a p t u r e t h e i r v o i c e , n o t y o u r i n t e r p r e t a t i o n 04 F O L L O W U P — C h e c k i n . U p d a t e a s n e e d e d . K e e p t h e m i n c o n t r o l05