Youth in crisis need to be connected to comprehensive community-based mental health services. States can explore ways to streamline connection to these services through integrated, community-based crisis receiving and stabilization facilities.
Across the country, children and youth have dealt with many stressors: losing caregivers to COVID-19, homelessness, academic disruption, bullying, physical/emotional/verbal abuse, racial or gender discrimination and more. These factors can lead to a mental health crisis.
Trauma-Informed Care
A trauma informed approach recognizes the prevalence and impact of trauma and seeks to ensure environments, policies, practices and relationships are safe and welcoming for service recipients as well as staff. This focuses on an awareness of trauma, its relationship to mental health and substance use issues, and an understanding that current service systems may inadvertently retraumatize individuals.
The foundation for a trauma-informed environment is built upon five core values and principles: safety, trustworthiness, choice and empowerment. It is also based on an understanding that individual, societal and historical/cultural traumatic experiences are complex and interconnected.
Trauma results from an event or set of events that a person perceives as harmful, life threatening and/or distressing. It can impact a person’s physical, emotional, spiritual and social development. The HHSC Cross-Systems Trauma Informed Care initiative is committed to developing a trauma-informed culture and system of services in Texas. This includes a comprehensive, statewide approach to trauma informed care that is healing-centered and person-centered.
Safety Planning
Safety planning is a process where a teen and their therapist agree on a set of steps to help them cope with painful feelings when they are in danger of self-harm or suicide. This usually involves things they will do to calm down, distract themselves from destructive thoughts and ways they will reach out for support. It also includes limiting access to materials that could be used to harm themselves, such as locking up medications or making their home less accessible to dangerous items.
Ideally, the discussion around a safety plan is done with the person when they are not in crisis so that they can commit to following their plans. They may review their plan with their wellbeing team, a health professional or another significant support person. This process is designed to be flexible and individualized for the young person. A thoughtful approach to safety planning promotes acceptance and adherence in the long-term. It is important to understand that the specifics of an individual’s plan will be influenced by their culture, values and life experiences.
Support Systems
Having a strong support system is important for youth’s mental health and resilience. This system should include family, friends, mentors and peers. It should also include professionals that can provide treatment or guidance. Regular check-ins, active listening and empathy can help to strengthen these connections.
Crisis receiving and stabilization facilities offer an alternative to EDs by providing short-term triage in home-like settings. They can be more comprehensive than 23-hour observation units or the Living Room model, and may offer post-discharge planning and connection to intensive wraparound services.
States can seek input from children and families with lived experiences when designing these settings. For example, some state leaders have included family representation on their advisory councils for the State Interagency Advisory Council for Services and Supports to Children and Transition-Age Youth (SIAC). They can also work to reduce biases, discrimination and stigma. Lastly, they can improve community engagement through partnerships between law enforcement and behavioral health systems.
Community Engagement
Community engagement is the process of involving community members in activities that shape a community’s policies, services, and institutions. Community members offer unique perspectives, knowledge, and expertise that can greatly enrich planning and decision-making processes and lead to more practical, effective, and sustainable outcomes.
Successful community responder programs (teams of trained health professionals who act as first responders to crisis calls and social disturbances) will engage community members early and often. These programs will partner with local organizations like law enforcement, fire departments, EMS, 911 call centers and dispatchers, service providers, longtime neighborhood organization leaders, and others.
However, little is known about how community involvement can be effectively implemented and embedded in crisis response plans. This scoping review examined conceptual frameworks and global guideline documents on community engagement for crisis response using a realist-informed analysis [exploring context, mechanisms, and outcomes (CMO)]. A range of strategies to support effective community engagement were identified. These include the Active Community Engagement Continuum, which offers an incremental approach to increasing participatory practices, and the Collective Impact Framework, which emphasizes high-impact outcomes and requires sustained efforts over time.