Children and teens in crisis need a safe place to stay. They also need access to support services that address their mental health needs.
The mental health of adolescents and youth in crisis has been trending worse for more than a decade. This trend worsened during the COVID-19 pandemic.
Crisis Receiving and Stabilization Facilities
For times when a youth is experiencing a mental health or substance use crisis that requires more than a call to the 24-hour crisis line but less than a visit to a hospital emergency room, many states have established a system of crisis receiving and stabilization facilities. These services can provide short-term stabilization, including psychiatric evaluation and monitoring, crisis counseling and support groups, community resource navigation and linkage to needed ongoing treatment supports.
These facilities can be free-standing, like 23-hour observation units or living rooms, or they can be a specialized high-intensity program such as an EmPATH (emergency psychiatry assessment treatment and healing) unit directly affiliated with a hospital emergency department. Unlike traditional EDs, these facilities are designed to provide safe, secure settings and a higher level of acuity for individuals who are suicidal, chemically dependent, intoxicated, or acutely agitated.
States are incorporating family and youth lived experience in the design of these facilities. For example, some states have established advisory boards for these facilities that include members with lived experience. Others are experimenting with ways to incorporate this input into systemwide planning processes.
Intensive Care Coordination
A key component of a comprehensive crisis system is intensive care coordination services to help youth and their families navigate the complex child-serving systems and connect them with needed resources. These services can be delivered in a variety of settings, including community support homes, residential treatment facilities and in the family’s home.
Intensive care coordination services (also known as High Fidelity Wraparound) bring together a team of professionals, the family/caregiver and other people important to the family to create an Individualized Care Plan (ICP). The team assesses the child’s strengths and needs, helps the family locate, access and coordinate services, identifies goals and supports for the child/youth, monitors progress toward these goals, and makes changes in the ICP as needed.
These services are provided through a managed care model for youth enrolled in full scope Medi-Cal and may be available to children/youth with behavioral health diagnoses. This type of care is an alternative to involuntary psychiatric hospitalization or residential treatment facility placement.
Post-Discharge Planning
Creating a plan of action for after discharge is vital to the success of a patient. A well-thought-out plan, followed by appropriate support services, can significantly decrease the risk of readmission.
Having an effective discharge planning point person who can answer questions and address issues after the hospital stay is essential. This can be a nurse, social worker, or other hospital representative. The point person should be able to provide the name of someone to contact for care questions and medication needs, as well as a phone number that can be reached 24 hours a day.
Studies show that a dedicated post-discharge bridging service including case management and therapeutic supports can reduce emergency department mental health (EDMH) presentations and hospital readmissions. However, little research has been conducted on how to effectively integrate this service into the community. Providing regular judgment free communication and updates to parents and school guidance counselors is also important. This can help establish consistency and promote healthy family environments.
Supporting the Whole Family
Many families in crisis are working hard to stay out of poverty and build toward the lives they dream of. They need access to the resources that can help them reach their goals and avoid homelessness, domestic violence and child neglect.
People in crisis feel frightened and often have low self-esteem. They may be reluctant to seek assistance or claim they are not in need. Involving the whole family, especially youth, in the development and delivery of services allows their voices to be heard, which is critical for improving outcomes and building trust.
Family-driven strategies enable children and youth to achieve their goals, which can make it more likely that adults will receive services. The Family-Led Strategy helps them navigate the system and provides support for their caregivers, which can increase opportunities to reach long-term stability and well-being. The Family-Led approach also enables services to be tailored and culturally relevant for the families that need them.