Family-based Crisis Intervention with Suicidal Adolescents in the Emergency Room: A Pilot Study

Abstract

The prevailing model of care for psychiatric patients in the emergency room (ER) is evaluation and disposition, with little or no treatment provided. This article describes the results of a pilot study of a family-based crisis intervention (FBCI) for suicidal adolescents and their families in a large, urban pediatric ER. FBCI is an intervention designed to sufficiently stabilize patients within a single ER visit so that they can return home safely with their families. Of the 100 suicidal adolescents and their families in the sample, 67 met eligibility criteria for FBCI. Demographic and clinical characteristics and disposition outcomes from the sample were compared with those obtained retrospectively from a matched comparison group (N = 150). Statistical analyses compared group inpatient admission rates and disposition outcomes. Patients in the pilot cohort were significantly less likely to be hospitalized than were those in the comparison group (36 percent versus 55 percent). Only two of the patients in the FBCI cohort were hospitalized immediately after receiving the intervention during their ER visit. FBCI with suicidal adolescents and their families during a single ER visit is feasible and safely limits the need for inpatient psychiatric hospitalization, thereby avoiding disruption of family, academic, and social activities and increasing use of less intrusive and more cost-effective psychiatric treatment.

Engaging families in the management of adolescent self-harm

“…The emergency setting single session family interventions include the Trial of Therapeutic Assessment in London (TOTAL),13 Family Intervention for Suicide Prevention (FISP)14 and a family-based crisis intervention (FBCI)15 (table 1). The TOTAL trial compared the impact of therapeutic assessment (TA) based on cognitive analytic therapy with assessment as usual in adolescents presenting to the emergency department with self-harm 13.…”

Many Replications Do Not Causal Inferences Make

“…However, its effectiveness was ignored because neither association was significant. Recent reviews have concluded that no replicated individual treatment has proven to be effective for suicidal youth (e.g., Corcoran, Dattalo, Crowley, Brown, & Grindle, 2011;Hawton, Saunders, & O'Connor, 2012;Ougrin, Tranah, Leigh, Taylor, & Asarnow, 2012;Spirito & Esposito-Smythers, 2006), but several treatments that incorporate families are showing success (Diamond et al, 2010;Huey et al, 2004;Pineda & Dadds, 2013;Wharff, Ginnis, & Ross, 2012). The potential effectiveness of family-oriented treatments could have been recognized much earlier if the correlational bias against corrective actions had been corrected for (Larzelere et al, 2004).…”

The Role of Parents in Safety Planning Interventions with Suicidal Adolescents

“…Brief interventions with safety planning components that actively involve parents have demonstrated the ability to improve clinical outcomes, and in some cases reduce suicide-related outcomes, among suicidal adolescents (Anastasia, Humphries-Wadsworth, Pepper & Pearson, 2015;Asarnow, Berk, Hughes & Anderson, 2015;Diamond et al, 2010;Harrington et al, 1998;RotheramBorus et al, 2000;Pineda & Dadds, 2013;Stanley & Brown, 2012;Wharff, Ginnis & Ross, 2012). For instance, specific to suiciderelated outcomes, Asarnow et al (2015) found that a brief cognitivebehavioral family intervention administered in the ED demonstrated significant reductions in reattempt rates and suicidal behavior, relative to an enhanced treatment as usual which included provider education.…”

“…Focusing on the role of parents in maintaining the safety of their suicidal adolescent upon discharge from acute care settings is therefore critical. Safety planning procedures with suicidal adolescents are enhanced by in-depth conversations between mental health providers, adolescents, and their parents (Wharff, Ginnis & Ross, 2012). Attention to the involvement of parents in the safety planning process has the potential to enhance family connection and communication and provide essential support to adolescents in acute suicidal distress.…”