Crisis Team Research Articles

Brief psychodynamic psychotherapy for adolescents and their families in crisis: a pilot study

ABSTRACT The global rise in adolescent self-harm and suicidal behaviours has intensified the demand for mental health services in the UK. This has further strained already underfunded and understaffed resources, resulting in longer waiting times and increased emergency department visits among teenagers. To address the overwhelming need for effective community-based emergency support, a brief psychodynamic crisis therapeutic intervention was developed within a CAMHS adolescent crisis team, inspired by child psychotherapist Ruth Schmidt Neven’s work on time-limited psychotherapy with adolescents and their families. This 12-session intervention offers both individual therapy for the adolescent and sessions for their parents, along with regular family reviews. Two psychotherapists work closely together on each case – one with the young person, the other with the parents. The brief model views crises as opportunities for deeper understanding, moving beyond diagnostic and symptom-centred approaches, as well as standard risk management and safety-planning strategies, and underlines the centrality of parent involvement in adolescent crisis work. This paper outlines the intervention’s theoretical foundation, guiding principles, and practical design, and presents preliminary findings from a pilot study of 22 cases, run over two and a half years. Early results suggest broad potential for this psychodynamic crisis approach in various adolescent crises, and merit further investigation.

Review article: Scoping review of interventions that reduce mechanical restraint in the emergency department.

Mechanical restraints are known to be associated with many undesirable outcomes in clinical settings. Our objective was to examine the current literature to explore possible interventions that would reduce the use of mechanical restraints in the ED. In this scoping review, we searched online databases Embase, MEDLINE and Cochrane CENTRAL for any studies published between the databases from 1 January 2007 to 19 September 2023. Studies were included if interventions were hospital- or staff-focused and reported measured outcomes before and after the introduction of the intervention. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Cohort Studies. The search strategy yielded 1937 studies across the three databases, of which 13 studies were extracted and included in the review. Interventions were categorised into four groups: provision of staff training, addition of a de-escalation team, creation of a dedicated unit and introduction of an agitation scale only. Most of the studies saw reduction in restraint rates or time in restraints. Only the two studies that used an agitation scale as a stand-alone intervention saw no significant reduction. Only one study had low risk of bias, whereas the remainder had high risk. Evidence supports further exploration of interventions that include: designing an agitation guideline; training staff in assessment, attitudinal and de-escalation skills; addition of a crisis team; and environmental changes in the form of adding a dedicated clinical space. Although these strategies may reduce mechanical restraint in the ED setting, further high-quality studies are needed before definitive conclusions may be drawn.

Sports Identification in Situational Problem-Solving: A Framework for Understanding Fans’ Communicative Behaviors in Sports Crises

Sports have been enjoyed by people worldwide as an essential part of life. Inevitably, sports-related issues have also permeated into the industry. Specifically, scholars have called for more attention to fan-enacted crisis communication in sports. Based on the situational theory of problem-solving, this project incorporates sports identification, modified engagement in and disengagement from online communication, and self-mocking to examine fans’ online communicative behaviors regarding the National Football League (NFL) concussion issue and the Chinese men’s national soccer team crisis. The findings reveal that sports identification was a significant indicator that influenced fans’ perceptions of the issue. In addition, fans motivated to solve the problem were more likely to engage in online communication rather than disengage from it. Moreover, referent criterion and self-mocking were comparatively unique to the other factors in that they were sensitive to the case and the fans’ cultural background. Theoretical contributions, practical implications, and recommendations for future research are enclosed.

“They made me feel like I mattered”: a qualitative study of how mobile crisis teams can support people experiencing homelessness

BackgroundMobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services.MethodsWe conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent’s self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model.ResultsNearly all respondents preferred the MCT model over traditional first responders, highlighting the team’s person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation.ConclusionsIn this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT’s effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.

EMS Paramedics and Law Enforcement Officers' Experiences with Joint-Response Efforts on Suspected Opioid Overdose Calls: A Qualitative Study.

In the United States, the opioid crisis remains a nationwide public health emergency. Narcan laws have increased medical collaboration between emergency medical services (EMS) paramedics and law enforcement officers (LEOs), yet research on joint opioid-response efforts with these first responders remains underexplored. Using a phenomenological approach, this study explores EMS paramedics and LEOs' experiences with joint-response efforts on suspected opioid overdose calls amidst the ongoing opioid crisis. Researchers conducted semi-structured interviews with 14 first responders (n = 8 EMS paramedics; n = 6 LEOs) from a large Central Florida emergency services district covering urban, suburban, and rural areas. Four major themes emerged: (1) facilitators to joint-response efforts; (2) barriers to joint-response efforts; (3) concerns for patient co-occurring behavioral health conditions; and (4) perceived solutions. Overall, participants described mutual respect, reliance, and communication as key facilitators, while barriers included conflicting on-scene priorities and differences in Narcan protocols. Concerns for co-occurring behavioral health (i.e., addiction and mental health) conditions among overdose patients included difficulties in assessing mental health and the availability of wraparound services, yet these concerns remained secondary to medical treatment during an opioid-related emergency. Key solutions included enhanced Narcan training for LEOs and increased availability of behavioral health services for long-term patient care. This research contributes to existing literature on opioid overdose response by specifically examining joint-response efforts between EMS paramedics and LEOs. These findings may be applicable to other partnering agencies such as mental health crisis teams and should be explored across behavioral health collaborations.

Crisis management in community pharmacies during a pandemic

BackgroundAlthough the COVID-19 pandemic required community pharmacies to implement several adaptation strategies to ensure medicines' and services’ availability, related empirical research based on crisis management theory is lacking. ObjectiveThis study sought to holistically depict crisis management in Finnish community pharmacies and explore whether (1) pre-existing crisis plans, (2) crisis teams, (3) shared decision-making or (4) collaboration and communication with external stakeholders can protect staff resilience, pharmacy owners' resilience, organisational cohesion (‘team spirit’) and pharmacies' resources or finances during the pandemic. MethodsA cross-sectional survey was developed based on the crisis management process model and sent to Finnish community pharmacy owners (n = 602) during the pandemic's second wave in October–November 2020. Descriptive statistics were calculated, and logistic regression analysis was performed to explore effects of crisis management efforts. Open-field responses were analysed qualitatively using deductive content analysis. ResultsIn total, 221 (36.7 %) pharmacy owners participated in the study. Pharmacies responded to the pandemic with increased order volumes and new suppliers, home deliveries and remote consultations, hand sanitiser production and additional customer counselling concerning the COVID-19. Shared decision-making with pharmacy colleagues (p = 0.025) and collaboration with peers or stakeholders in the supply chain (p = 0.015) protected pharmacy owners' resilience during the pandemic. Additionally, shared decision-making protected pharmacies' finances (p = 0.040). Crisis teams or collaboration with social and healthcare operators did not provide advantage to pharmacies. However, pre-existing pandemic plans associated with reduction of pharmacies’ resources (p = 0.006). ConclusionsCommunity pharmacies responded to the COVID-19 pandemic with several measures to ensure the continuity of pharmaceutical services and care and the availability of medicines, disinfectants and personal protective equipment. Developing shared decision-making in pharmacies and active collaboration with peers and supply-chain stakeholders could improve pharmacies' finances and their owners’ resilience in future crises.

Quick Response Crisis Communication Strategies Insights from Public Relations PT. KAI DAOP 2 Bandung's Train Accident Response

A crisis that occurs in a company has the potential to damage the company's reputation. However, if the crisis can be handled properly, then the crisis will not harm the company. The purpose of this research is to find out the crisis communication steps and efforts made by the Public Relations of Daop 2 Bandung in dealing with the crisis situation caused by the train accident. Researchers use a descriptive analysis approach because it is considered capable of describing something clearly and each part can be studied one by one, so that the facts of a case can be revealed transparently. Data collection techniques in the form of interviews, in this study the data source consists of primary data and secondary data. Primary data was obtained from interviews with Mr. Ayep Hanapi as Public Relations Manager of PT KAI Daop 2 Bandung. The results showed that PT KAI Public Relations has made several efforts to maintain the company's image, namely: First, pre-crisis PT KAI applies the zero accident principle by increasing employee competence and discipline as well as maintaining facilities and infrastructure. Second, PT KAI's crisis team collaborates with stakeholders, provides solutions, is responsive in serving the media by preparing accurate data and fact information. Third, post-crisis to improve the image by providing compensation to employees and accident victims and conducting evaluations to improve train safety and security in the future.

In Search of a Modus Operandi for Evaluation: Developing a Mixed-Methods Approach for Crisis Team Exercises

AbstractIn recent years, there has been an increase in critical situations such as crisis and disasters in Germany. Due to the country's low-crisis history and the predominance of blue-light organizations like the police and fire departments in managing disasters, these circumstances affect other organizations, such as public administrations, that have had less contact with crisis management, sometimes unexpectedly. This is illustrated by examples such as the refugee situation in 2015/2016 and the COVID-19 pandemic. One way to prepare is through exercises in crisis management and, more specifically, staff work. The demand for these therefore also seems to be increasing in administrations. This article presents an evaluation approach for such exercises based on an example of a staff exercise in Germany. It describes the developed evaluation approach, discusses some exemplary results in relation to the topic of communication and the potential of a partially standardized evaluation. Finally, the article discusses the extent to which a multi-method approach to exercise evaluation, which works with a standard framework but also leaves scope for individual adaptation, contains practical and scientific added values.

Mobile Crisis Teams' Implementation in the Context of new Medicaid Funding Opportunities: Results from a National Survey.

This cross-sectional survey study describes characteristics of mobile crisis teams (MCTs) in the United States. Mobile crisis teams (MCTs) are increasingly recognized as essential responders to help those experiencing mental health crises get urgent and appropriate care. Recent enhanced federal funding is designed to promote adoption of MCTs, but little is known about their current structure and function and whether teams meet new Medicaid rules governing their utilization. Survey participants (N = 554) are a convenience sample of MCT representatives recruited through professional organizations, listservs, and individual email contacts from October 2021 - May 2022. Respondents most frequently identified themselves as MCT program director/manager (N = 237, 43%). 63% (N = 246) of respondents reported billing insurance for services provided (including Medicaid), while 25% (N = 98) rely on state or county general funds only. Nearly all respondents (N = 390, 98%) reported including behavioral health clinicians on their teams, and 71% (N = 281) reported operating on a 24/7 basis, both of which are required by Medicaid's enhanced reimbursement. Just over half of respondents (N = 191, 52%) reported being staffed with 11 or more FTE staff members, our estimated number required for adequate 2-person coverage on a 24/7 basis. MCTs are a popular policy initiative to reduce reliance on law enforcement to handle mental health emergencies, and enhanced federal funding is likely to expand their utilization. Federal rule makers have a role in establishing guidelines for best practices in staffing, billing, and outcomes tracking, and can help ensure that stable financing is available to improve stability in service delivery.

Enhancing cognitive motivation: an evaluation model for emergency preparedness exercises

Purpose Evaluating emergency preparedness exercises is crucial for assessing enhanced knowledge, facilitating learning and implementing knowledge in organizations. The cognitive process of motivation for action is a precursor for action, coping behavior and individual learning. This study aims to focus on how guided evaluation of emergency preparedness exercises can enhance cognitive motivation and influence the mental readiness of exercise participants. Design/methodology/approach This is a conceptual paper with a model approach design. The main conceptual contribution is suggesting a model for guided evaluation in emergency preparedness exercises. We present a theoretical background for understanding the increase in motivation based on social cognitive learning theory. In particular, this study discusses how different evaluation steps contribute to enhanced motivation and learning for exercise participants. Findings Increased motivation and enhanced personal performance standards could be achieved through using processes that lead to self-efficacy in guided exercise evaluation. Specifically, sources of enhanced motivation, such as repeated coping experiences, self-regulation processes, mastery motivation and performance motivation, would proliferate the readiness of individual crisis managers and teams. Practical implications This article suggests an evaluation model for use in emergency preparedness exercises. This approach combines bottom-up and top-down processes for debriefing, reflection and feedback, both individually and in teams. This approach aims to enhance exercise participants’ motivation and utilize exercise evaluation for organizational learning. Originality/value The conceptual discussion leads to developing implications for evaluation practice, suggesting how to structure evaluation and why. This study is novel for its explanation of how to use evaluation in the learning process.

Chatting: Family Carers' Perspectives on Receiving Support from Dementia Crisis Teams.

Family caregivers are vital to enabling people with dementia to live longer in their own homes. For these caregivers, chatting with clinicians-being listened to empathetically and receiving reassurance-can be seen as not incidental but important to supporting them. This paper considers and identifies the significance of this relational work for family carers by re-examining data originally collected to document caregivers' perspectives on quality in crisis response teams. This reveals that chatting, for family caregivers, comprises three related features: (i) that family caregivers by responding to a person's changing and sometimes challenging needs and behaviors inhabit a precarious equilibrium; (ii) that caregivers greatly appreciate 'chatting' with visiting clinicians; and (iii) that while caregivers appreciate these chats, they can be highly critical of the institutionalized character of a crisis response team's involvement with them.

Differences in treatment trajectory following brief paediatric inpatient admissions for children and young people with eating disorders.

Little is known about factors associated with treatment trajectory following brief paediatric admissions for children and young people (CYP) admitted for medical complications of their eating disorder (ED). This project aimed to identify possible factors and ways to improve the usefulness of paediatric admissions. Retrospective NHS data was analysed to explore differences between paediatric admissions followed by community-based care or inpatient psychiatric care. Twelve parents were interviewed to seek feedback about paediatric admissions. Patients who received subsequent inpatient psychiatric care were unwell for longer, had longer paediatric admissions and more crisis team input, were more likely to have had previous admissions, and had higher parent-reported anxiety and depression. However, the groups did not significantly differ in ED severity. The interviews identified recommendations for improving paediatric admissions, which included improving understanding of EDs, enhancing communication channels, and providing psychological support to parents. Factors linked with illness severity (but not illness severity itself) appear to be associated with the difference between CYP either returning to community-based care or requiring more intensive psychiatric input. These factors may help clinicians understand who requires subsequent inpatient care, allowing clinicians to target more intensive support earlier and facilitate smoother transitions between services.

Research, analytics and intelligence in issues and crises

AbstractToday, corporate crises inherently pose a threat to brand reputation. Multiple stakeholders, online influence and the interconnectedness of reputation with major social issues raise the stakes for crisis teams. The level of complexity has perhaps never been so great, and with it, the need for data‐driven decision‐making. In practice, research, analytics, and intelligence experts are full members of corporate risk and crisis teams from planning, to response, to evaluation. These professionals develop the insights to fuel smart, timely decision‐making by surfacing insights to ameliorate crises. Additionally, they are responsible for measuring and evaluating progress and performance improving the brand's readiness for future issues. Insights, intelligence and performance measures drive conclusions necessary to determine what, if any, brand damage has occurred, how to fix it, and how to prepare better for the next time.

Design of a homelessness-focused suicide prevention program

IntroductionThis project proposes a program for the promotion of mental health and prevention of suicidal behavior among individuals experiencing homelessness, with the aim of reducing suicidal ideation and suicide mortality within this vulnerable population.ObjectivesThe project aims to implement an evidence-based program to reduce suicidal ideation and suicide mortality among homeless individuals. This will be achieved through two phases: a review of scientific literature and the development of the program in collaboration with experts and homeless individuals.MethodsThe first phase of the project involved a review of scientific literature to identify the most effective content and programs for improving mental health and preventing suicide. These findings were adapted for application in the program and for dissemination to professionals who will directly engage with individuals experiencing homelessness. In the second phase, the program content was designed in collaboration with experts and validated through the input of educational professionals. Additionally, individuals experiencing homelessness actively participated in the creation of materials and the definition of the approach to be utilized. Subsequently, a four-hour training was provided to professionals working in specialized homeless shelters to guide groups of individuals experiencing homelessness.ResultsThe program consists of the following components:-Training and Awareness: Workshops and campaigns to reduce the stigma surrounding suicide.-Early Detection and Risk Assessment: Staff training in recognizing suicide indicators and risk assessment protocols.-Psychological and Social Interventions: Crisis teams, individual and group therapy.-Access to Services: Mobile mental health clinics and collaborations with healthcare professionals.-Ongoing Support and Monitoring: Temporary housing programs and support groups.ConclusionsThe proposed program seeks to mitigate the risk of suicide among individuals experiencing homelessness through a comprehensive approach. The collaboration of experts and homeless individuals ensures that the solutions are appropriate and effective. The implementation of this program has the potential to make a significant difference in promoting mental health and preventing suicide within this vulnerable population.Disclosure of InterestNone Declared

Change in risk status of psychiatric patients admitted to Crisis and Home Treatment Team: an evaluation in the UK

IntroductionThe Crisis and Home Treatment Teams (CRHT) in psychiatry manages patients with risk to self and others in the community. The number of patents under CRHT who attempt or die of suicide is high in the UK (Hunt et al BJPsych Bull. 2016;40:172-4). The CRHT is an option to help support patients in managing their risk using various interventions and also aim to prevent admission to acute psychiatric wards where possible.ObjectivesWe intended to study the change in risk to self and others and the factors associated with it during the intervention from a CRHT taking care of adult patients in the West Midlands region of England.MethodsThe study was conducted as a service evaluation of patients admitted under the CRHT. Data was collected from the case records, for 100 patients for whom details were available. Risk to self and others were checked, along with overall risk as red (highest risk), amber (intermediate risk) and green (low risk). Demographic and clinical information was collected and the data quality was checked.ResultsThere were 46 male and 54 female patients in the study, with mean age of 40.4 ± 12.4 and 40.2 ± 12.8 Years respectively (not significant). They were comparable in number of diagnoses (mean 1.2 each) and number of days (22.2 ± 13.1 v 20.2 ± 17.8) in CRHT respectively. There was no significant association of risk with gender (56.3% females and 44.2% of males), being on benefits or type of accommodation the service users live at. Similarly, there was no significant difference of risk of self-harm based on ethnicity; it was noted that 61.2% of patients of British White ethnicity had a risk of self on admission compared to 41.7% Black and ethnic minority patients. On admission, 89% of patients were categorised as red, amber 8% and 1% green; which changed to 18%, 2% and 77% respectively (missing data was not included, so percentages do not add up to 100%). The risk to self was present in 46% on admission and 18% on discharge (p<0.005); and in 14% this risk continued without change. The risk to others on admission was recorded in 12% which was at 1% on the point of discharge (p<0.05). Eight people had both risk to self and others. In 15 patients the risk continued to remain in red category, while in two patients it changed from amber to red.ConclusionsThe risk levels for patients admitted under the CRHT improved. The majority with overall high risk changed to majority presenting as low risk on discharge. The percentage of patients portraying a risk to self and others also decreased from admission to discharge. Although there was considerable decrease in risk, a proportion of patients did not have any change, or even an increase in their risk, which highlights need for additional risk management strategy for these patients in CRHT.Disclosure of InterestNone Declared

State Policies Associated with Availability of Mobile Crisis Teams.

Mobile crisis teams are comprised of multidisciplinary mental health professionals that respond to mental health crisis calls in community settings. This study identified counties with mobile crisis teams and examined state policies associated with mobile crisis teams. Descriptive statistics and geographic information system software were used to quantify and map counties with mobile crisis teams in the United States. Relationships between state policies and mobile crisis teams were examined using an adjusted logistic regression model, controlling for county characteristics and accounting for clustering by state. Approximately 40% (n = 1,245) of all counties in the US have at least one mobile crisis team. Counties in states with legislation in place to fund the 988 Suicide and Crisis Lifeline were more likely to have a mobile crisis team (Adjusted Odds Ratio (AOR): 2.0; Confidence Interval (CI): 1.23-3.26), whereas counties in states with 1115 waivers restricting Medicaid benefits were less likely to have a mobile crisis team (AOR: 0.43; CI: 0.21-0.86). Additionally, counties with the largest population were more likely to have a mobile crisis team (AOR: 2.20; CI:1.43-3.38) than counties with the smallest population. Having a mobile crisis teams was positively associated with legislation to fund 988. Legislation that encourages expansion of existing crisis care services, specifically funding aimed at mobile crisis teams, may help increase availability of services for people who are experiencing a mental health crisis in the community.

RREACT: A mobile multidisciplinary response to overdose.

Opioid overdose is a leading cause of death in the United States, and engaging with patients following overdose to provide harm reduction and recovery resources can prove difficult. Quick response models use mobile, multidisciplinary teams to establish a time-sensitive connection between individuals who overdosed and harm reduction and recovery resources that improve outcomes. These quick response models are consistent with the broader field of mobile-integrated health programs that are growing in number and acceptability, though the literature base is sparse and programs vary. We describe the 5-year reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework of the Rapid Response Emergency Addiction and Crisis Team (RREACT), a fire/emergency medical services-led, multidisciplinary (firefighter/paramedic, law enforcement officer, social worker) mobile outreach team. RREACT provides harm reduction, linkage/transportation to care and wrap-around services to individuals following a nonfatal opioid overdose that resulted in an emergency response in Columbus, Franklin County, Ohio, United States. Between 2018 and 2022, RREACT made 22,157 outreach attempts to 11,739 unique patients. RREACT recorded 3,194 direct patient contacts during this time, resulting in 1,200 linkages to care: 799 direct transports to opioid use disorder treatment and 401 warm handoffs to community treatment agencies. Furthermore, RREACT's staffing increased from 4 full-time equivalent staff in 2018 to 15.5 in 2022 and was supported by the surrounding community through 287 community outreach events and the development of an alumni program. These preliminary results further support the deployment of multidisciplinary mobile outreach teams to increase access to harm reduction and recovery resources following opioid overdose.

Community-based organizations at the front lines of the COVID-19 pandemic: Strategies for building equitable COVID-19 vaccine uptake and distribution.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the disproportionate negative health outcomes faced by racial and ethnic minority communities as a result of various factors that affect health equity. In response to the COVID-19 pandemic and the overwhelming disparities within communities, public health agencies have aimed to establish partnerships with community-based organizations (CBOs) to distribute information about COVID-19 to populations expressing vaccine hesitancy, recognizing that they are necessary partners in ensuring and maintaining equitable distribution of resources. In line with the National Foundation for the Centers for Disease Control and Prevention (CDC Foundation)'s Health Equity Strategy, the CDC Foundation's Response, Crisis and Preparedness Unit (RCPU) team is responsible for managing the portfolio of more than 110 grants to CBOs across 14 grant opportunities by private and federal funding that supports the COVID-19 response. The goal is to promote activities, including support for sharing of accurate, culturally appropriate vaccine information to address concerns and the development and strengthening of strategic partnerships to support effective community outreach and vaccination. Most, if not all of the CBOs use similar techniques to address equitable vaccine uptake and distribution by partnering or becoming vaccine providers via mobile or pop-up clinics, engaging community health workers, door-to-door canvasing, conducting listening sessions, providing incentives, and hosting community events and communications campaigns. As of June 23, 2022, the funded CBOs have collectively reached over 14.8 million individuals with COVID-19 safety and vaccine education messaging, administered 288,197 COVID-19 vaccinations within their communities, and partnered with 416 public health jurisdictions and 853 community organizations. Two case studies are provided to share specifics on strategies and activities done toward providing equitable information and vaccine distribution. This rapid and flexible grant management process al-lowed CBOs to focus on the areas of greatest need in their community and select strategies that would be well-received by community members.

HHS approves New Mexico's community‐based care expansion

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services, has approved a proposal from New Mexico for community‐based mobile crisis intervention teams to provide Medicaid crisis services, a cms.gov news release stated. The Feb. 6 announcement is the latest in HHS' ongoing efforts to support President Biden's whole‐of‐government strategy to transform mental health services for all Americans — a key part of the President's Unity Agenda, the news release stated. New Mexico is the 15th state to expand access to community‐based mental health and substance use crisis care through President Biden's American Rescue Plan. With this approval, the state will be able to provide Medicaid services through mobile crisis teams by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days a year. This work builds on HHS' broader work to expand dramatically the full continuum of mental health crisis services, including through the nationwide launch of the 988 Suicide & Crisis Lifeline and expansion of Certified Community Behavioral Health Clinics under the Bipartisan Safer Communities Act, providing crisis services 24 hours a day, 7 days a week, regardless of a person's ability to pay.

Association between continuity of care and attendance of post-discharge follow-up after psychiatric emergency presentation

The number of accident and emergency (A&E) hospital attendances by young people aged 18 or under with a recorded diagnosis of a psychiatric condition more than tripled between 2010 and 2022. After discharge from the hospital, attendance at follow-up appointments in the community is critical to ensure the safety of young people and optimise the use of clinical resources. A retrospective cohort study was conducted to evaluate the association between follow-up attendance and the continuity of clinicians and clinical teams, using electronic clinical record data from East London NHS Foundation Trust (ELFT), between April 2019 and March 2022. Multi-level mixed effects logistic regression was performed to model the follow-up attendance odds based on whether the same or different clinician and clinical team offered the initial A&E and the community follow-up appointment or whether a crisis team was involved. 3134 A&E presentations by 2368 young people were identified within the study period. Following these presentations, 2091 follow-up appointments in the community were offered. The attendance rate increased by more than three times if the follow-up appointment was offered by the same clinician who saw the young person in A&E (odds ratio (OR) = 3.66; 95% CI 1.65–8.13). Whether the same clinical team provided the community follow-up appointment, or whether a crisis team was involved before discharge made no difference to the likelihood of follow-up attendance. The findings support the importance of the continuity of clinicians in the care of young people in crisis.