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How can clinicians support both youth and their families in managing and recovering from crisis?
America is experiencing a youth mental health crisis. In 2021, 44% of high school students reported that they had experienced persistent feelings of sadness or hopelessness in the past year.1 In 2019, about 1 in 5 students seriously considered suicide.2 At Connections Health Solutions, the leading innovator in immediate-access behavioral health crisis care, we have treated the youth population and supported their families for more than 8 years. We often see and treat youth who have suicidal ideation aggressive behavior, or who are struggling with substance use, among other mental health and behavioral concerns.
What is often forgotten, or not even mentioned, is the fact that when a youth is in crisis, there is not 1, but 2 crises occurring: the crisis the youth is experiencing, and the crisis that their family members or caregivers are also experiencing in attempting to manage the situation.
Supporting 2 Crises Through a Crisis Care Continuum
To address both crises, engaging the youth and their family can help determine the cause of cause the crisis and what skills and supports the family needs. It can also help encourage safety, health, and functionality within the home. Communication struggles within the family, unhealthy coping skills, a lack of structure and organization, and strained relationships among family members can all influence a youth’s ability to manage and seek support.
To see and address both crises, it is critical to take the time to interview both the youth and their family/caregiver(s) so the clinical team can begin to identify ways that treatment can support both parties. Creating a space for caregivers to feel safe and listened to, without judgment, supports trust development and rapport, which is essential for identifying resources that will help with recovery and healing. Meeting with the family/youth and treatment team, creating safety plans, holding family therapy sessions, and submitting referrals for step-down care are all ways that a crisis center can support the family as a whole.
Set the Tone for Treatment With a Great First Impression
To create a positive experience for youth and their family/caregiver(s), a crisis care facility should be a welcoming, family-friendly space rather than a space that feels too institutional.
It is also important for staff to offer personalized care. When the crisis worker conducts a psychosocial assessment, they should pay close attention to non-verbal communication. Often, youth should be interviewed separately to ensure their safety and an accurate assessment of the acuity. The crisis worker and the behavioral health medical provider (BHMP) should engage in a clinical discussion to determine recommendations for treatment, which will be reviewed with the family/caregiver(s).
It is not just the lobby where special considerations for the youth population need to be met. Interview rooms should have more of an outpatient feel to them to ensure more comfort for youth and their families. At the Connections Health Solutions youth facility, superhero themes, fun paint colors, crayons or toys, and soft seating are a few of the “special touches” we have added to our lobby and treatment rooms.
If a more secure, monitored atmosphere for treatment is appropriate for the youth, they should be admitted to an observation unit. If the assessment determines that a higher level of care is not needed, staff should help the youth and their family by providing specific and individualized resources, setting up appointments with outpatient providers, and influencing the long-term treatment and recovery plan. Regardless of the level of care required to stabilize, the goal should remain the same: to support the youth in crisis and to set both the youth and their family up for long-term recovery and success.
Provide Treatment and Stabilization in a Comfortable, Caring Environment
If the youth meets admission criteria, treatment should occur in a dedicated youth observation unit. A higher level of care decision can be difficult for both the family/caregiver(s) and the youth, so staff should be present throughout the intake process to support the family/caregiver(s) and ensure they know that a team member is there to care for their child, that their child is safe, and that admission to the observation unit allows for more intensive treatment and stabilization to occur.
Considerations regarding design can help create a comfortable observation unit that promotes both treatment and recovery. At Connections, the youth unit is painted with calming colors and includes small divider walls that promote a sense of privacy for the youth, while still allowing staff complete line of sight. To help with routine and consistency, create daily schedules so the youth know when to expect visits from family/caregiver(s), when they will meet with providers, when mealtimes or movie times occur, and more. A youth-trained BHMP should meet with the youth daily to conduct psychiatric evaluations and make level-of-care determinations.
Create a Successful Discharge Plan
An effective discharge process is crucial to a successful crisis care facility when it comes to both youth and adults. Clinical staff should be expertly trained in collecting and gathering information from parents, outpatient treatment teams, and potential resources to start the discharge planning process from the minute a youth meets admission criteria. A multidisciplinary team should work together to present multiple options for a safe discharge, supporting the BHMP in determining the disposition.
Collaboration and partnership with the family/caregiver(s) can positively impact the effectiveness and implementation of the discharge plan. Youth and their families should leave a facility with clear next steps for maintaining safety, individualized resources, and post-crisis follow-up appointments at an outpatient clinic of their choosing. For youth who will move on to an inpatient setting, great care should be taken to ensure a smooth transfer of care for both the youth and their family.
At Connections Health Solutions, we have seen how observation, timely treatment, and support for the whole family can help bring a youth out of crisis and put them on a successful path. Our average length of stay on the youth observation unit is about 1 day, with nearly 50% of youth returning home after 24 hours of care. Considerations made for the treatment environment, the staff, and the milieu can all promote successful resolution of the crisis, while taking into account the unique needs of the youth population.
Engaging the family/caregiver(s) through active and non-judgmental listening can increase an organization’s ability to create a safe and smooth discharge process, with individualized services to support the whole family in recovery from the crisis.
Ms Andre serves as the vice president of clinical integration and innovation at Connections Health Solutions. She brings more than 17 years of experience in the behavioral health field, specializing in psychiatric crisis care, at-risk youth, evidenced-based family therapy, and substance use disorder treatment. Currently, Ms Andre monitors clinical key performance indicators and ensures clinical quality and fidelity to the Connections mission and clinical models. Additionally, she supports Connections as a clinical subject matter expert through participation in program and new market development.
1. New CDC data illuminate youth mental health threats during the COVID-19 pandemic. US Centers for Disease Control and Prevention. News release. March 31, 2022. Accessed October 20, 2022. https://www.cdc.gov/media/releases/2022/p0331-youth-mental-health-covid-19.html
2. Youth behavior risk survey: data summary & trends report 2009-2019. US Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Adolescent and School Health. Accessed October 20, 2022. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508.pdf