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When a suicidal teenager comes to an emergency department (ED), the usual care model is to evaluate them and admit them for inpatient psychiatric treatment. The wait for a psychiatric bed can take hours, even days. While waiting, the child receives no psychiatric treatment, but instead is sometimes "boarded"—kept in the ED under supervision—a practice that can increase distress for the child and family while taking ED beds out of circulation for other acutely ill patients.
"Generally speaking, there is no history of providing psychiatric treatment in the ED," says Elizabeth Wharff, PhD, MSW, LICSW, director of Children's Emergency Psychiatry Service, who has piloted an alternative to boarding: a new model for ED-based treatment called family-based crisis intervention (FBCI).
Carried out in the ED by a trained psychiatric clinician, FBCI—which on average takes only 90 minutes—reduces suicidality in the adolescent and helps families learn how to talk to and support their teenager during a crisis, while reinforcing for teens that they can count on their parents and feel safe going home. The intervention stems from two observations: that child-family communication breakdowns are often the trigger for suicidal thoughts or feelings, and that working with families during a crisis can help teens move out of a suicidal mentality.
During their pilot study, Dr. Wharff's team was able to send home many more teens triaged for admission by using FBCI. "When we compared these patients to a matched sample of similar patients, we saw that the psychiatric hospitalization rate declined from 55 to 36 percent," she says. They hope to establish FBCI as a new standard for emergency psychiatric treatment with a randomized clinical trial.
"We have yet to find a similar program anywhere else in the country," Dr. Wharff notes. "We see evidence of interest in the literature, but to the best of our knowledge Children's is the only place actually offering it."
More information:
on.chbos.org/pv0212psych
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