For many children and teens a mental health crisis will occur at least once in their lives. They may lose a loved one to suicide or be victims of violence and other traumas.
Many states have created youth crisis stabilization programs that can offer more individualized care than hospital emergency departments.
Home-based Crisis Intervention Programs
This program provides intensive home-based family therapy for children/youth and their families experiencing serious emotional and behavioral difficulties. The HBCI interventionist works with the youth and family up to 8 hours a week. The program is intended to prevent out-of-home placement (psychiatric hospitalization, emergency department visits or residential treatment) and improve family functioning.
The service is provided by the Nassau County Office of Mental Health. This program is free of charge to eligible families. Referrals may be made by a hospital’s psychiatric emergency room, inpatient or out-patient mental health clinics, community agencies or mobile crisis teams.
The LINK program provides short-term intensive home-based case management services to help prevent psychiatric hospitalization. The case managers work with youth and their families to address current crisis issues, identify risk factors and provide education about available services and supports. The case managers are available 24/7 and respond to referrals within twenty-four hours. This service is available to Suffolk County residents ages 5-18 who are at risk of out-of-home placement.
Intensive Outpatient Treatment
Aimed at people with a mental health or substance abuse problem who do not require detox, IOP programs are ideal for individuals who have access to a stable home environment and support system. They are often a step-down from residential treatment and allow patients to maintain daily responsibilities while receiving a higher level of care than basic outpatient services can provide.
A teen’s IOP program should be personalized to meet their specific needs and situation. It should also focus on group therapy and meetings, which can help them build a network of peer support. This can help reduce the embarrassment that many young people feel when it comes to disclosing their problem and need for treatment to friends and family.
Intensive outpatient treatment is less expensive than residential treatment. This is because IOP programs only last a few hours each day and patients are permitted to return to their homes at night. In contrast, residential treatment involves living in the treatment facility and requires around-the-clock supervision.
Observation Units
With rates of mental health crisis rising, many states are implementing a wide variety of systems and services to ensure that young people have access to comprehensive community-based care. Observation units are a critical component of these efforts.
These are facilities where individuals who come to the crisis program with acute symptoms can be monitored and assessed to determine what level of care they need. Often referred to as “23-hour observation units,” Living Room Model programs, or walk-in crisis respite centers, these facilities combine hospital-level safety standards (eg, anti-ligature design) with home-like environments that are staffed by peer support specialists and social workers. Lengths of stay range from a few hours to days or weeks.
These settings can be free-standing or affiliated with/attached to a psychiatric hospital or ED. In some cases, these youth crisis services are provided under a capitation model that reimburses the crisis service provider on a per-member basis based on the state’s established rates at the time of service delivery.
Community Support
Youth in crisis often experience multiple, interrelated risk factors that contribute to their behavioral health challenges. For example, some lack healthy parental guidance and monitoring. Others live in chaotic neighborhoods with unsafe access to guns and drugs. They may attend disorganized schools with ineffective instruction and a skewed curriculum, and have few, if any, prosocial peer groups.
Providing alternative first response options for children and youth who are experiencing mental health crises can create meaningful, long-term positive outcomes in safety and stability for both the youth and community. These include mobile crisis intervention programs and community stabilization models.
To make these solutions work, a community needs to support the efforts of families and youth by establishing a robust continuum of care, supporting family-to-family support, and providing flexible services and supports. Moreover, community members must continue to reduce biases, discrimination and stigma.