Crisis Stabilization Research Articles

Characterizing Crisis Services Offered by Certified Community Behavioral Health Clinics: Results From a National Survey.

The authors aimed to examine how certified community behavioral health clinics (CCBHCs) fulfill crisis service requirements and whether clinics added crisis services after becoming a CCBHC. National survey data on CCBHC crisis services were paired with data on clinic features and the demographic and socioeconomic characteristics of the counties within a CCBHC service area. The dependent variables were whether CCBHCs provided the three categories of CCBHC crisis services (i.e., crisis call lines, mobile crisis response, and crisis stabilization) directly or through another organization and whether these services were added after becoming a CCBHC. Descriptive statistics and multivariable logistic regression analyses were performed with data about clinics and the counties they served. In total, 449 CCBHCs were surveyed in the summer of 2022, with a response rate of 56%. The final sample comprised 247 clinics. The number of CCBHC employees per 1,000 people within a CCBHC service area was significantly and positively associated with clinics providing some crisis services directly (mobile crisis response: adjusted OR [AOR]=1.46, 95% CI=1.08-1.98; crisis stabilization services: AOR=1.60, 95% CI=1.17-2.19). Compared with clinics that did not receive a CCBHC Medicaid bundled payment, clinics that received this payment had higher odds of adding mobile crisis response (AOR=2.52, 95% CI=1.28-4.97) and crisis stabilization services (AOR=3.19, 95% CI=1.51-6.72) after becoming a CCBHC. CCBHC initiatives, particularly CCBHC Medicaid bundled payments, may provide opportunities to increase the availability of behavioral health crisis services, but the sufficiency of this increase for meeting crisis care needs remains unknown.

Availability of behavioral health crisis care and associated changes in emergency department utilization.

To determine whether availability of behavioral health crisis care services is associated with changes in emergency department (ED) utilization. We used longitudinal panel data (2016-2021) on ED utilization from the Healthcare Cost and Utilization Project's State ED Databases and a novel dataset on crisis care services compiled using information from the Substance Abuse and Mental Health Services Administration's National Directories of Mental Health Treatment Facilities. A total of 1002 unique zip codes from Arizona, Florida, Kentucky, Maryland, and Wisconsin were included in our analyses. To estimate the effect of crisis care availability on ED utilization, we used a linear regression model with zip code and year fixed effects and standard errors accounting for clustering at the zip code-level. ED utilization related to mental, behavioral, and neurodevelopmental (MBD) disorders served as our primary outcome. We also examined pregnancy-related ED utilization as a nonequivalent dependent variable to assess residual bias in effect estimates. We extracted data on crisis care services offered by mental health treatment facilities (n = 14,726 facility-years) from the National Directories. MBD-related ED utilization was assessed by applying the Clinical Classification Software Refined from the Healthcare Cost and Utilization Project to the primary ICD-10-CM diagnosis code on each ED encounter (n = 101,360,483). All data were aggregated to the zip code-level (n = 6012 zip-years). The overall rate of MBD-related ED visits between 2016 and 2021 was 1610 annual visits per 100,000 population. Walk-in crisis stabilization services were associated with reduced MBD-related ED utilization (coefficient = -0.028, p = 0.009), but were not significantly associated with changes in pregnancy-related ED utilization. Walk-in crisis stabilization services were associated with reductions in MBD-related ED utilization. Decision-makers looking to reduce MBD-related ED utilization should consider increasing access to this promising alternative model.

The UT Health Living Room: Expanding the Psychiatric Crisis Continuum of Care.

Traditional forms of psychiatric crisis treatment increasingly are being buttressed by services along the Psychiatric Crisis Continuum of Care, such as short-term crisis stabilization services and peer crisis services. The UT Health Living Room (LR) is an outpatient crisis counseling service that adds three promising elements to the Continuum: (1) it integrates outpatient treatment plans into crisis counseling, (2) provides care in a space and with staff who are familiar to patients, and (3) provides training in evidence-based crisis intervention. We examined two-year LR feasibility and outcome data. Mixed-method analyses used longitudinal clinic data and patient self-report measures. Results provide initial support for the feasibility, cost effectiveness and clinical effectiveness of the LR. Limitations include non-blinded ratings, limited experimental control, and simple cost-effectiveness methodology. The UT Living Room is feasible and offers novel elements to help patients in community clinics address emotional crises.

Arkansas crisis stabilization unit guests: Baseline characteristics from a longitudinal cohort study.

Crisis Stabilization Units (CSUs) are short-term residential facilities that provide care to people experiencing mental health crises, seeking to reduce reliance on local emergency departments and avoid unnecessary jail detention. Despite these intentions, there is little foundational literature to support research on CSU efficacy and a dearth of research on the sociodemographic characteristics and specific needs of CSU patients. Here, we recruited and surveyed 208 participants admitted to one of two focal Arkansas CSUs on their sociodemographic characteristics, justice-involvement, mental health, substance use, and health care utilization. Results revealed that participants were mostly unemployed (68.16%), low-income (72.34%), and experiencing insecure housing (33.33%). They reported extensive justice-involvement (85.57%), high rates of clinically significant mental illness symptom severity (77.00% for anxious symptoms; 78.33% for depressive symptoms; 79.40% for traumatic stress symptoms), and recent substance use (73.34%). Recent engagement with other medical services was common, though more participants reported visiting an emergency department (42.23%) than did receiving outpatient medical care (26.73%). While research on CSU patient outcomes is needed, our results indicate that CSUs have the potential to be an essential part of the health care continuum by serving a population with multiple, intersecting needs and addressing a deficit in community-based crisis care. Continued investigation of community-based crisis intervention services is critical to bridging the gap between vital behavioral health resources and the populations in need of them. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access

There have been notable increases in pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement in psychiatric treatment programs. We aimed to evaluate the outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis. Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement. Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October-December 2021 and one year later (October-December 2022). Inclusion criteria were patients ≤17 years who presented with mental health-related emergencies during the study period. Exclusion criteria were patients ≥18 years and/or patients with >100 days of admission awaiting long-term placement. Primary outcome was mean length of boarding (LOB). Secondary outcome was mean length of stay (LOS) at the hospital's acute psychiatry units. One year after full intervention implementation (October-December 2022), mean LOB decreased by 53% (4.3 vs 9.1 days, P < 0.0001) for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to October-December 2021. Additionally, mean LOS at all the 24-hour acute psychiatry treatment programs was reduced by 27% (20.0 vs 14.6 days, P= 0.0002), and more patients were able to access such programs (265/54.2% vs 221/41.9%, P < 0.0001). Across both years, youth with aggressive behaviors had 193% longer LOB (2.93± 1.15, 95% CI [2.23, 3.87]) than those without aggression, and youth with previous psychiatric admissions had 88% longer LOB than those without (1.88± 1.11, 95% CI [1.54, 2.30]). The current study shows decreased LOB and improved access for youth requiring acute psychiatric treatment after comprehensive interventions and highlights challenges with placement for youth with aggressive behaviors. We recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.

Management of youth with suicidal ideation: Challenges and best practices for emergency departments.

Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self-harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self-harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home- and community-based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on-site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community- and home-based services, pediatric-receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.

A Statewide Evaluation of the Implementation of Evidence-Based Suicide Prevention Guidelines in Juvenile Detention Centers.

This study aimed to explore suicide prevention in juvenile detention centers by conducting a case study of one state. Qualitative data from semistructured interviews were synthesized from 10 juvenile detention centers. Analytical techniques included thematic and content analysis and the integration of quantitative information and qualitative themes to illustrate key differences in suicide prevention practices and center characteristics among facilities with varying frequencies of crisis stabilization calls and critical incidents. Although the use of many suicide prevention practices was reported across the sample, the quality with which those practices were implemented was highly variable. The analysis suggests that facilities with higher-quality implementation of suicide prevention practices may have had leaders who acknowledged that their facility plays a role in suicide prevention. Moreover, preliminary evidence suggests that the quality of suicide prevention implementation may be associated with the number of crisis stabilization calls and critical incidents (i.e., variables related to suicidality) a facility experiences. Clear conceptualization of a juvenile detention center's role in suicide prevention may lead to better outcomes in suicide prevention implementation. High-quality implementation may reduce suicidality exhibited by youths in juvenile detention and save lives.

School-Based Tele-Behavioral Health: A Scoping Review of the Literature.

Telehealth utilization exploded during the COVID-19 pandemic, including within school-based health programs. School-based tele-behavioral health can help programs overcome barriers of access to care, but the current state and effectiveness of such programs are unknown. A scoping literature review was conducted. Studies were included if they described in-school behavioral health services delivered via telehealth for children ages 5 to 18. From the included studies, population, location, setting, intervention, telehealth modality, clinician type, and outcomes assessed were extracted. Eighteen studies met inclusion criteria. All described psychotherapy or medication management delivered by psychologists (n = 7) and/or psychiatrists (n = 11). Treatment included psychotherapy (N = 8), psychiatric consultation (N = 7), medication management (N = 4), crisis stabilization (N = 1), and caregiver education (N = 1). Eight studies provide qualitative or quantitative outcomes, with 4 examining clinical effectiveness. Despite limited findings in the literature, school-based tele-behavioral health is feasible, effective, and acceptable for delivery of behavioral health care to children and adolescents.

Remodeling Broken Systems: Addressing the National Emergency in Child and Adolescent Mental Health.

A national emergency in child and adolescent mental health was declared in the United States in 2021 in the wake of the COVID-19 pandemic. This Open Forum discusses potential solutions to better support child and adolescent mental health by improving or expanding school-based mental health services, child psychiatry access programs, virtual mental health services, and new models of care (e.g., integrated youth services hubs and crisis stabilization units). The success of such programs is dependent on stable funding, strong leadership and accountability, robust and well-trained workforces, systems integration, and attention to health equity.

Methods of stabilization of the banking sector in the crisis of the COVID-19 pandemic

The COVID-19 pandemic broke out unexpectedly for everyone. Due to the accelerated pace of the introduction of restrictions on the movement of the population and the complication of the processes of making various kinds of transactions, all sectors of the economy were unable to accumulate their resources in time to stabilize the situation, which led to the destruction of the usual standards of organizations and the outbreak of a crisis in the economy. The article examines the main problems faced by the banking sector during the COVID-19 pandemic crisis and describes the main methods of crisis stabilization used by credit institutions. Despite the three-year period of time that has passed since the beginning of the pandemic, this topic does not lose its relevance due to the serious consequences for the economy, which continue to affect all its spheres to this day.

Study protocol paper for the multi-site feasibility evaluation of mobile and technology-assisted aftercare services for crisis stabilization units

BackgroundLaw enforcement frequently responds to substance abuse and mental health crises. Crisis stabilization units (CSUs) operate as a public-receiving facility to provide short-term stabilization services for individuals experiencing these crises and offer law enforcement an important alternative to arrest. However, there is limited understanding about how and when law enforcement decides to use CSUs. There is also the challenge of retaining individuals in treatment after CSU stabilization to prevent future crises and persistent engagement with police. This study will respond to these gaps by exploring CSU procedures and examining the feasibility and acceptability of a technology-assisted mobile aftercare intervention designed for individuals brought to a CSU by law enforcement.MethodsThis study will consist of three aims. Aim 1 will include qualitative interviews with law enforcement and CSU-affiliated mental health staff (n=80) regarding CSU utilization and collaboration logistics between the groups. Findings from Aim 1 will be synthesized for the development of an implementation guide of our intervention, mobile, and technology-assisted aftercare, designed for individuals brought to a CSU by law enforcement, during Aim 2. During Aim 2, intervention services will be pilot-tested for 6 months through a small sample (n=24), randomized control trial (RCT). Control participants will receive standard services available for individuals discharging from a CSU. Treatment participants will receive the mobile aftercare intervention. Qualitative and quantitative data will be collected at 2 weeks, 3 months, and 6 months post-recruitment for all study participants. Aims 1 and 2 will inform the design of a multi-site RCT to compare CSUs with and without mobile and technology-assisted aftercare (Aim 3).DiscussionThe study will offer decision making and procedural insight into law enforcement use of CSUs as an alternative to jail and provide opportunities to inform that process. This research will provide outcome trends for those who go through standard CSU services compared to those who receive mobile and technology-assisted aftercare services. The current study will inform a larger RCT efficacy study of CSUs with and without technology-assisted aftercare services.Trial registrationThis study was registered on ClinicalTrials.gov (reference #NCT04899934) on May 25, 2021.

Pilot Study: Assessing Personal and Clinical Impacts from a Recovery-Centric Intervention in Inpatient Psychiatry Using Mixed Methods

Objective: The conventional model of biomedical mental healthcare focused on diagnosis, crisis stabilization, and pharmaceutical treatment might be enriched with recovery-oriented programming and improve the overall inpatient experience. This study aimed to assess the impacts of a person-centered intervention on patient-reported recovery measures and clinical progression over time. Methods: Eighteen patients from a tertiary-level regional unit enrolled in the pilot program over an eight-month intervention period. Clinical and proxy recovery data was collected and compared before and after the intervention in a combination of within group and between group assessments using unit clinical performance as a control. Results: Contrary to expectation, intervention participants reported a decline in four of five proxy recovery scores from the pretest to the post-test and concurrent deterioration in routine clinical monitoring scores. Research cohort scores declined in three of six domains with a statistically significant change in one category while unit clinical scores declined in five of six domains with statistically significant changes in three categories. A comparison of mean coefficients indicated more favourable outcomes for research participants in five clinical domains. Conclusions: Concurrent declines in recovery-focused and clinical measures suggest a risk of inpatient regression over time in hospital. The findings support the need for innovative approaches to inpatient service delivery including recovery-focused interventions which might improve clinical progression. The results also indicate the need for rigorous program evaluation which can be facilitated by leveraging existing clinical assessment tools and in considering patient perspectives in determining the effectiveness of interventions.

Providing crisis care in a pandemic: a virtual based crisis stabilization unit.

Winnipeg, Canada operates a 16-bed subacute unit, the Crisis Stabilization Unit (CSU), for voluntary patients in crisis not requiring hospital admission. The virtual CSU (vCSU) launched in March 2020 as an adjunct to the in-person CSU during the COVID-19 pandemic, providing the same resources virtually, allowing patients to remain at home. Program data were collected for vCSU admissions between April 1, 2020 and April 7, 2021 (n = 266) to examine patient characteristics and discharge outcomes. Data were retrieved from the electronic patient record (EPR) for both in-person and vCSU admissions during the same period for comparison (n = 712). vCSU admissions (n = 191) were summarized by patient demographics, clinical factors/outcomes, and compared on the same measures to in-person CSU admissions (n = 521) using binary logistic regression. 30.1% of patients admitted to the vCSU received initial mental health assessment virtually (phone/videoconference), therefore receiving all care at home. Clinical symptoms at assessment included depression/anxiety (39.0%), psychosis/mania (2.7%), suicidal behaviour/self-harm (27.4%), psychosocial event/stressor (19.8%). Average stay was 4.9 days. Compared to the in-person CSU, vCSU referrals were associated with the absence of psychosis [odds ratio (OR).40, 95% confidence interval (CI).18-0.89] and no prior 1-year contact with referral site (OR.43, 95% CI.28-0.64). Those living farther away from the referral site were more likely to receive a vCSU referral. The vCSU model is feasible for a diverse group of patients experiencing mental health crises. Future work is needed to better determine who the model is right for and examine longer term outcomes.

The perils of boarding: A call to achieve parity in the delivery of acute psychiatric services for children with COVID-19.

Boarding across pediatric healthcare systems is on the rise during the pandemic. Children with positive COVID-19 test results awaiting psychiatric placements in the emergency department or medical unit settings are at increased risk for decompensation with unmet psychiatric needs during a time of crisis marked by vulnerability. There is scant literature unveiling best practices on delivery of care for these patients to achieve acute crisis stabilization. Recent studies have uncovered substantial increases in mental health disorders among children during the pandemic compared to previous incidence and prevalence rates prior to the pandemic. From the published literature, two healthcare systems have initiated long-term planning, development, and implementation of biodome psychiatric units for patients with COVID-19 in need of acute crisis stabilization services. We sampled 100 acute inpatient child and adolescent psychiatric programs to discern their post-COVID positive clearance policies for admission. Findings were mixed among days of quarantine required, symptomology, covid-designated spaces vs. self-isolated rooms for psychiatric treatment, number of COVID negative retests, and additional considerations. We also review a range of considerations and recommendations for clinical practice and the health system in achieving parity in mental health care for these patients which in turn could contribute towards mitigating the rising global mental health crisis. Furthermore, increasing access to acute psychiatric services for these patients will also contribute towards the larger goal of the World Health Organization, Sustainable Developmental Goals of the United Nations, and Healthy People 2030 in increasing accessibility, quality and equity of mental health care for individuals on both global and national frontiers.

National preparedness for 988—the new mental health emergency hotline in the United States

988, a national mental health emergency hotline number, went live throughout the United States in July 2022. 988 connects callers to the 988 Crisis & Suicide Lifeline, previously known as the National Suicide Prevention Lifeline. The transition to the three-digit number aimed to respond to a growing national mental health crisis and to expand access to crisis care. We examined preparedness throughout the U.S. for the transition to 988. In February and March 2022, we administered a national survey of state, regional, and county behavioral health program directors. Respondents (n = 180) represented jurisdictional coverage of 120 million Americans. We found that communities throughout the U.S. appeared ill-prepared for rollout of 988. Fewer than half of respondents reported their jurisdictions were ‘somewhat’ or ‘very’ prepared for 988 in terms of financing (29%), staffing (41%), infrastructure (41%), or service coordination (47%). Counties with higher representation of Hispanic/Latinx individuals were less likely to report being prepared for 988 in terms of staffing (OR: 0.62, 95 %CI: 0.45, 0.86) and infrastructure (OR: 0.68, 95 %CI: 0.48, 0.98). In terms of existing services, sixty percent of respondents reported a shortage of crisis beds and fewer than half reported availability of short-term crisis stabilization programs in their jurisdictions. Our study highlights components of local, regional, and state behavioral health systems in the U.S. that require greater investments to support 988 and mental health crisis care.

A Qualitative Investigation of Preparedness for the Launch of 988: Implications for the Continuum of Emergency Mental Health Care

On July 16, 2022, the 988 mental health crisis hotline launched nationwide. In addition to preparing for an increase in call volume, many jurisdictions used the launch of 988 as an opportunity to examine their full continuum of emergency mental health care. Our goal was to understand the characteristics of jurisdictions’ existing continuums of care, identify factors that distinguished jurisdictions that were more- versus less-prepared for 988, and explore perceived strengths and limitations of the planning process. We conducted 15 qualitative interviews with state and local mental health program directors representing 10 states based on their preparedness for the 988 rollout. Interviews focused on 988 call centers, mobile crisis response, and crisis stabilization, as well as strengths and limitations of the 988 planning process. Data were analyzed using rapid qualitative analysis, an approach designed to draw insights on evolving processes and extract actionable findings. Interviewees from jurisdictions that reported that they were more-prepared for the launch of 988 tended to have local 988 call centers and already had local access to mobile crisis teams and crisis stabilization units. Interviewees across jurisdictions described challenges to offering a robust continuum of crisis services, including workforce shortages and geographic constraints. Though jurisdictions acknowledged the importance of integrating peer support staff and serving diverse populations, many perceived room for growth in these areas. Though 988 has launched, efforts to bolster the existing continuum will continue and hinge on efforts to expand the behavioral health workforce, engage diverse partners, and collect relevant data.

Improving Adult and Youth Crisis Stabilization and Community Reentry Program (DOJ)

Federal Grants & ContractsVolume 47, Issue 6 p. 5-5 Grants Alerts Improving Adult and Youth Crisis Stabilization and Community Reentry Program (DOJ) First published: 14 February 2023 https://doi.org/10.1002/fgc.32867Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume47, Issue616 February 2023Pages 5-5 RelatedInformation

Peer Support Specialists Can Play Important Role in Patients’ Lives

Peer Support Specialists Can Play Important Role in Patients’ Lives

Fulfilling the Goals of 988 Through Crisis Stabilization Care.

Recent implementation of the nationwide 988 Suicide and Crisis Lifeline has expanded telephone-based mental health crisis services and created a unified framework for crisis care in the United States. However, the infrastructure for the final step of the crisis continuum-an appropriate mental health service for persons in crisis to receive the care they need-is fragmented, unevenly distributed, underfunded, and understudied. Given the few options for individuals in crisis, most often inpatient psychiatric hospitals are the default option. In this Open Forum, the authors describe the scope of the problem and propose how clinicians, policy makers, and researchers can improve the availability of evidence-based disposition options for individuals in crisis.

After 988’s Launch, Experts Emphasize More Work Needed

After 988’s Launch, Experts Emphasize More Work Needed