Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Services Interventions
Crisis Services
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.
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