Skip to main content

Family-Based Crisis Intervention in the Emergency Department: A New Model of Care

Journal of Child and Family Studies volume 24, pages 172–179 (2015)Cite this article

Abstract

Adolescent suicide is on the rise and treatment resources are scarce. Adolescents with suicidal behavior often are evaluated in the Emergency Department (ED), where the default treatment recommendation traditionally has been admission to an inpatient psychiatric unit. Emergency Medicine increasingly provides intervention in the ED with the goal of stabilization and discharge, avoiding unnecessary inpatient stays that are expensive and utilize limited resources. Family-Based Crisis Intervention (FBCI) is a manualized psychiatric intervention that is used to optimize care for suicidal adolescents and their families in the ED. This paper presents the framework of FBCI and includes a case to demonstrate the essential parts of the treatment.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  • Aguilera, D. C., & Messick, J. M. (1990). Crisis intervention: Theory and methodology. St. Louis, MO: Mosby.

    Google Scholar 

  • American College of Emergency Physicians. (ACEP). (2008). ACEP Psychiatric and substance abuse survey 2008 Retrieved June 2, 2008, from http://www.acep.org/uploadedFiles/ACEP/Advocacy/federal_issues/PsychiatricBoardingSummary.pdf.

  • Asarnow, J. R., Baraff, L., Berk, M., Grob, C., Devich-Navarro, M., Suddath, R., et al. (2011). An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment. Psychiatric Services, 62(11), 1303–1309.

    PubMed Central  PubMed  Article  Google Scholar 

  • Bernstein, S. L., Aronsky, D., Duseja, R., Epstein, S., Handel, D., Hwang, U., et al. (2009). The effect of emergency department crowding on clinically oriented outcomes. Academic Emergency Medicine, 16(1), 1–10.

    PubMed  Article  Google Scholar 

  • Brooker, C., Ricketts, T., Bennett, S., & Lemme, F. (2007). Admission decisions following contact with an emergency mental health assessment and intervention service. Journal of Clinical Nursing, 16(7), 1313–1322. doi:10.1111/j.1365-2702.2007.01302.x.

    PubMed  Article  Google Scholar 

  • Bruffaerts, R., Sabbe, M., & Demyttenaere, K. (2008). Emergency psychiatry in the 21st century: Critical issues for the future. European Journal of Emergency Medicine, 15(5), 276–278.

    PubMed  Article  Google Scholar 

  • Burns, D. (1999). The feeling good handbook. New York, NY: Penguin Group.

    Google Scholar 

  • Camilli, V., & Martin, J. (2005). Emergency department nurses’ attitudes toward suspected intoxicated and psychiatric patients. Topics in Emergency Medicine, 27, 313–331.

    Google Scholar 

  • Center for Disease Control. (2007). Web-based Injury Statistics Query and Reporting System (WISQARS™). Atlanta, GA: US Department of Health and Human Services.

    Google Scholar 

  • Center for Disease Control. (2008). Suicide trends among youths and young adults aged 10–24 years—United States, 1990—2004. Morbidity and Mortality Weekly Report (MMWR), 56(35), 905–908.

    Google Scholar 

  • Center for Disease Control and Prevention. (1998). Youth risk behavior surveillance-United States, 1997. Morbidity and Mortality Weekly Report (MMWR), 43(6), 1–18.

    Google Scholar 

  • Center for Disease Control and Prevention. (2007). Youth risk behavior surveillance—United States, 2007. Morbidity and Mortality Weekly Report (MMWR), 57, SS-4.

    Google Scholar 

  • Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and preventive interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42(4), 386–405.

    PubMed  Article  Google Scholar 

  • Greenfield, B., Larson, C., Hechtman, L., Rousseau, C., & Platt, R. (2002). A rapid-response outpatient model for reducing hospitalization rates among suicidal adolescents. Psychiatric Services, 53(12), 1574–1579.

    PubMed  Article  Google Scholar 

  • Hellzen, O., & Lilja, L. (2008). Former patient’s experiences of psychiatric care: A qualitative investigation. International Journal of Mental Health Nursing, 17(4), 279–286.

    PubMed  Article  Google Scholar 

  • Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C., Sheidow, A. J., Ward, D. M., Randall, J., et al. (2003). One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis. Journal of the American Academy of Child and Adolescent Psychiatry, 42(5), 543–551.

    PubMed  Article  Google Scholar 

  • Henggeler, S. W., Rowland, M. D., Randall, J., Ward, D. M., Pickrel, S. G., Cunningham, P. B., et al. (1999). Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 38(11), 1331–1339.

    PubMed  Article  Google Scholar 

  • Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: Causes, effects, and solutions. Annals of Emergency Medicine, 52(2), 126–136. doi:10.1016/j.annemergmed.2008.03.014.

    PubMed  Article  Google Scholar 

  • Hoot, N. R., Epstein, S. K., Allen, T. L., Jones, S. S., Baumlin, K. M., Chawla, N., et al. (2009a). Forecasting emergency department crowding: an external, multicenter evaluation. Ann Emerg Med, 54(4), 514–522 e519. doi: 10.1016/j.annemergmed.2009.06.006.

    Google Scholar 

  • Hoot, N. R., Leblanc, L. J., Jones, I., Levin, S. R., Zhou, C., Gadd, C. S., et al. (2009b). Forecasting emergency department crowding: A prospective, real-time evaluation. Journal of the American Medical Informatics Association, 16(3), 338–345. doi:10.1197/jamia.M2772.

    PubMed Central  PubMed  Article  Google Scholar 

  • Huey, S. J, Jr, Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C. A., Cunningham, P. B., Pickrel, S. G., et al. (2004). Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. Journal of the American Academy of Child and Adolescent Psychiatry, 43(2), 183–190.

    PubMed  Article  Google Scholar 

  • Iyer, S., Reeves, S., Varadarajan, K., & Alessandrini, E. (2011). The acute care model: A new framework for quality care in emergency medicine. Clinical Pediatric Emergency Medicine, 12(2), 91–101. doi:10.1016/j.cpem.2011.04.002.

    Article  Google Scholar 

  • Klein, J. B., Jacobs, R. H., & Reinecke, M. A. (2007). Cognitive-behavioral therapy for adolescent depression: A meta-analytic investigation of changes in effect-size estimates. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1403–1413. doi:10.1097/chi.0b013e3180592aaa.

    PubMed Central  PubMed  Article  Google Scholar 

  • Lewis, L. M. (2007). No-harm contracts: A review of what we know. Suicide and Life-Threatening Behavior, 37(1), 50–57.

    PubMed  Article  Google Scholar 

  • Mansbach, J. M., Wharff, E., Austin, S. B., Ginnis, K., & Woods, E. R. (2003). Which psychiatric patients board on the medical service? Pediatrics, 111(6 Pt 1), e693–e698.

    PubMed  Article  Google Scholar 

  • McCarthy, M. L., Zeger, S. L., Ding, R., Aronsky, D., Hoot, N. R., & Kelen, G. D. (2008). The challenge of predicting demand for emergency department services. Academic Emergency Medicine, 15(4), 337–346. doi:10.1111/j.1553-2712.2008.00083.x.

    PubMed  Article  Google Scholar 

  • McIntosh, J. L. (2010). USA suicide 2007: Official final data. Washington, DC: American Association of Suicidology.

    Google Scholar 

  • Nicks, B. A., & Manthey, D. M. (2012). The impact of psychiatric patient boarding in emergency departments. Emergency Medicine International, 2012, 360308. doi:10.1155/2012/360308.

    PubMed Central  PubMed  Article  Google Scholar 

  • Office of Disease Prevention and Health Promotion. (2000). Healthy people 2010. Rockville, MD: US Department of Health and Human Services.

    Google Scholar 

  • Parad, H. J. (1965). Preventive casework: Problems and implications. In H. J. Parad (Ed.), Crisis intervention: Selected readings. New York, NY: Family Service Association of America.

    Google Scholar 

  • Rabin, E., Kocher, K., McClelland, M., Pines, J., Hwang, U., Rathlev, N., et al. (2012). Solutions to emergency department ‘boarding’and crowding are underused and may need to be legislated. Health Affairs, 31(8), 1757–1766.

    PubMed  Article  Google Scholar 

  • Rotheram-Borus, M. J., Piacentini, J., Cantwell, C., Belin, T. R., & Song, J. (2000). The 18-month impact of an emergency room intervention for adolescent female suicide attempters. Journal of Consulting and Clinical Psychology, 68(6), 1081–1093.

    PubMed  Article  Google Scholar 

  • Rotheram-Borus, M. J., Piacentini, J., Van Rossem, R., Graae, F., Cantwell, C., Castro-Blanco, D., et al. (1996). Enhancing treatment adherence with a specialized emergency room program for adolescent suicide attempters. Journal of the American Academy of Child and Adolescent Psychiatry, 35(5), 654–663.

    PubMed  Article  Google Scholar 

  • Spirito, A., Esposito-Smythers, C., Wolff, J., & Uhl, K. (2011). Cognitive-behavioral therapy for adolescent depression and suicidality. Child & Adolescent Psychiatric Clinics of North America, 20(2), 191–204. doi:10.1016/j.chc.2011.01.012.

    Article  Google Scholar 

  • Staggs, L., Peek, M., Southard, G., Gracely, E., Baxendale, S., Cross, K. P., et al. (2012). Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems. Journal of Medical Economics, 15(4), 704–711.

    PubMed  Article  Google Scholar 

  • Stewart, C., Spicer, M., & Babl, F. E. (2006). Caring for adolescents with mental health problems: Challenges in the emergency department. Journal of Paediatrics and Child Health, 42(11), 726–730.

    PubMed  Article  Google Scholar 

  • The Joint Commission. (2009). National Patient Safety Goals Hospital Program.

  • Wharff, E., Ginnis, K., & Ross, A. (2012). Family-based crisis intervention with suicidal adolescents in the emergency room: A pilot study. Social Work, 57(2), 133–143.

    PubMed  Article  Google Scholar 

  • Wharff, E. A., Ginnis, K. B., Ross, A. M., & Blood, E. A. (2011). Predictors of psychiatric boarding in the pediatric emergency department: Implications for emergency care. Pediatric Emergency Care, 27(6), 483–489. doi:10.1097/PEC.0b013e31821d8571.

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA, 02115, USA

    Katherine B. Ginnis, Erina M. White, Abigail M. Ross & Elizabeth A. Wharff

Authors
  1. Katherine B. Ginnis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erina M. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abigail M. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth A. Wharff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine B. Ginnis.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ginnis, K.B., White, E.M., Ross, A.M. et al. Family-Based Crisis Intervention in the Emergency Department: A New Model of Care. J Child Fam Stud 24, 172–179 (2015). https://doi.org/10.1007/s10826-013-9823-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-013-9823-1

Keywords

  • Suicide
  • Adolescent
  • Crisis intervention
  • Family therapy
  • Evidence-based practice