How to support youth in crisis with behavioral health services
How can clinicians help young people and their families manage and recover from a crisis?
America is experiencing a mental health crisis among young people. In 2021, 44% of high school students reported experiencing 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 crisis care, we have been treating the youth population and supporting their families for over 8 years. We often see and treat young people who are having suicidal ideation, aggressive behavior, or struggling with substance use, among other mental health and behavioral issues.
What is often overlooked, if not mentioned, is that when a young person is in crisis, there is not 1, but 2 crises that occur: the crisis that the young person is going through and the crisis that family members or caregivers are also going through trying to manage the situation.
Support 2 crises through a continuum of crisis care
To cope with both crises, involving young people and their families can help determine the cause of the crisis and the skills and support the family needs. It can also help encourage safety, health and functionality within the home. Communication difficulties within the family, unhealthy coping skills, a lack of structure and organization, and strained relationships between family members can all influence a young person’s ability to manage and seek support.
To see and treat both crises, it is essential to take the time to interview both the young person and their family/caregiver(s) so that the clinical team can begin to identify ways in which treatment can support the two parts. Creating a space where caregivers feel safe and heard, without judgment, promotes the development of trust and relationships, which is essential for identifying resources that will aid in recovery and healing. Meeting with the family/youth and treatment team, creating safety plans, conducting family therapy sessions, and submitting referrals for escalation care are all ways a crisis center can support the family. in general.
Set the tone for treatment with a great first impression
To create a positive experience for young people and their family/caregiver(s), a crisis care facility should be a welcoming and family-friendly space rather than one that feels too institutional.
It is also important that staff provide personalized care. When the emergency response worker performs a psychosocial assessment, special attention should be paid to non-verbal communication. Often, young people need to be interviewed separately to ensure their safety and an accurate assessment of acuity. The crisis response worker and behavioral health medical provider (BHMP) should engage in a clinical discussion to determine treatment recommendations, which will be reviewed with the family/caregivers.
It is not just the lobby where special considerations for the youth population must be met. Interview rooms should have a more ambulatory feel to provide more comfort for youth and their families. At the Connections Health Solutions Youth Facility, superhero themes, fun paint colors, crayons or toys, and plush seating are some of the “special touches” we’ve added to our lobby and to our treatment rooms.
If a more secure and supervised atmosphere for treatment is appropriate for the young person, they should be admitted to an observation unit. If the assessment determines that a higher level of care is not needed, staff should support the young person and their family by providing specific, individualized resources, scheduling appointments with outpatient care providers, and influencing 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 prepare the youth and their family for long-term recovery and success.
Provide treatment and stabilization in a comfortable and caring environment
If the young person meets the admission criteria, the treatment must take place in an observation unit dedicated to young people. A decision about a higher level of care can be difficult for both the family/caregiver(s) and the young person. Staff should therefore be present throughout the admission process to support the family/caregiver(s) and ensure that they know a member of the team is there. care for their child, that the child is safe and that admission to the observation unit allows for more intensive treatment and stabilization.
Design considerations can help create a comfortable viewing unit that supports both treatment and recovery. At Connections, the youth unit is painted in soothing colors and includes small dividing walls that promote a sense of privacy for youth, while allowing staff a full line of sight. To help with routine and consistency, create daily schedules so young people know when to expect family/caregiver visits, when they will meet providers, when meal or movie times will be, and more. A youth-trained BHMP should meet with the youth daily to conduct psychiatric assessments and determine level of care.
Create a successful discharge plan
An effective discharge process is critical to the success of a crisis care facility, for both youth and adults. Clinical staff should be expertly trained in gathering and collecting information from parents, outpatient treatment teams and potential resources to start the discharge planning process as soon as a young person meets the criteria for discharge. ‘admission. A multidisciplinary team should work together to present several options for a safe exit, supporting the BHMP in determining the disposition.
Collaboration and partnership with family/caregivers can have a positive impact on the effectiveness and implementation of the discharge plan. Youth and their families should leave a facility with clear next steps to maintain safety, individualized resources, and post-crisis follow-up appointments at an outpatient clinic of their choice. For young people who will go to hospital, care must be taken to ensure a smooth transfer of care for both the young person and his family.
At Connections Health Solutions, we’ve seen how observation, prompt treatment, and support from the whole family can help lift a young person out of crisis and put them on the path to success. Our average length of stay in the Youth Observation Unit is approximately 1 day, with nearly 50% of youth returning home after 24 hours of care. Considerations for the treatment environment, staff, and setting can all support successful crisis resolution, while taking into account the unique needs of the youth population.
Engaging family/caregivers through active, non-judgmental listening can increase an organization’s ability to create a safe and smooth exit process, with individualized services to help the whole family recover from the crisis.
Mrs Andrew serves as Vice President of Clinical Integration and Innovation at Connections Health Solutions. She brings over 17 years of behavioral health experience, specializing in psychiatric crisis care, at-risk youth, evidence-based family therapy, and substance use disorder treatment. Currently, Ms. Andre monitors key clinical performance indicators and ensures clinical quality and adherence to Connections’ mission and clinical models. Additionally, she supports Connections as a clinical subject matter expert by participating in program and new market development.
1. New CDC data sheds light on threats to youth mental health during the COVID-19 pandemic. US Centers for Disease Control and Prevention. Press release. March 31, 2022. Accessed October 20, 2022. https://www.cdc.gov/media/releases/2022/p0331-youth-mental-health-covid-19.html
2. Youth Behavioral Risk Survey: Data Summary and Trends Report 2009-2019. US Centers for Disease Control and Prevention National Center for the Prevention of HIV/AIDS, Viral Hepatitis, STDs and Tuberculosis, Division of Adolescent and School Health. Accessed October 20, 2022. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508.pdf