Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Crisis services are used in emergency situations either to furnish immediate and sufficient care or to serve as a transition to longer term care within the mental health system. These services are extremely important because many youth enter the mental health service system at a point of crisis. Crisis services include three basic components: (1) evaluation and assessment, (2) crisis intervention and stabilization, and (3) followup planning. The goals of crisis services include intervening immediately, providing brief and intensive treatment, involving families in treatment, linking clients and families with other community support services, and averting visits to the emergency department or hospitalization by stabilizing the crisis situation in the most normal setting for the adolescent. Crisis services include telephone hotlines, crisis group homes, walk-in crisis intervention services, runaway shelters, mobile crisis teams, and therapeutic foster homes when used for short-term crisis placements.
Crisis programs are small in order to facilitate close relationships among the staff, child, and family. Crisis staff are required to have skills and experience in the areas of assessment, emergency treatment, and family support. Short-term services are provided, with the staff meeting more frequently with the client at the outset of the crisis. A typical treatment plan consists of 10 sessions over a period of 4 to 6 weeks. Crisis services usually are available 24 hours a day, 7 days a week (Goldman, 1988).
Research on crisis services consists exclusively of uncontrolled studies. Kutash and Rivera (1996) reviewed 12 studies with pre-post designs. Positive behavioral and adjustment outcomes for youth presenting to crisis programs and emergency departments across the country were reported in all of the studies. Most programs also demonstrated the capacity to prevent institutionalization.
The most recent studies examine three different models: a mobile crisis team, short-term residential services, and intensive in-home service. The first study examined the Youth Emergency Services (YES) program in New York. This program included a mobile crisis team that sent clinicians directly to the scene of the crisis. The data showed that YES prevented emergency department visits and out-of-home placements (Shulman & Athey, 1993).
A second crisis program, in Suffolk County, New York, involved short-term residential services. In a study of 100 children served by the program over a 2-year period, more than 80 percent were discharged in less than 15 days. Most were diverted from inpatient hospitalization, and inpatient admissions to the state children’s psychiatric center for Suffolk County were reduced by 20 percent after the program was established (Schweitzer & Dubey, 1994).
In the third study, records were analyzed from a large sample of youth (nearly 700) presenting to the Home Based Crisis Intervention (HBCI) program in New York over a 4-year period. Youth received short-term, intensive, in-home emergency services. After an average service episode of 36 days, 95 percent of the youth were referred to, or enrolled in, other services (Boothroyd et al., 1995). The HBCI program was established at eight locations across the State of New York. Overall, programs with more access to community resources reported shorter average lengths of services.
Although crisis and emergency services represent a promising intervention, the research done so far only includes uncontrolled studies, limiting the conclusions that can be drawn. Kutash and Rivera (1996) recommend additional effectiveness research using controlled study designs and comparing differences between the various types of crisis services. Finally, there remains a need for investigation of cost-effectiveness as well as an exploration of the integration of crisis services into systems of care.