Family-Based Crisis Intervention for suicidal adolescents in the Emergency Department: Results of an open trial

Background: Suicide is a significant public health problem. The emergency department (ED) often serves as a portal to the mental health system for the majority of suicidal adolescents. The prevailing model of care for psychiatric patients in the ED is evaluation and disposition, with little or no treatment provided at the time of the visit. Aims: This presentation describes results of an open trial of a family-based crisis intervention (FBCI) for suicidal adolescents and their families in a large, urban pediatric ED. FBCI is an intervention designed to sufficiently stabilize patients within a single ED visit so that they may return home safely with their families. Methods: Of the one hundred suicidal adolescents and their families in the pilot sample, sixty-seven patients met eligibility criteria for FBCI. Demographic and clinical characteristics and disposition outcomes from the pilot sample were compared to those obtained retrospectively from a matched comparison group (n=150). Statistical analyses compared group inpatient admission rates and disposition outcomes. Results: Patients in the pilot cohort were significantly less likely to be hospitalized than those in the comparison group (36% versus 55%, p<.001). Only two of the patients in the FBCI cohort were hospitalized immediately after receiving the intervention during their ED visit. Conclusions: FBCI with suicidal adolescents and their families during a single ED visit is feasible and safely limits the need for inpatient psychiatric hospitalization, thereby avoiding disruption of family, academic and social activities and increasing utilization of less intrusive and more cost-effective psychiatric treatment.