Family-based Crisis Intervention With Suicidal Adolescents in the ED

In current practice, treatment as usual (TAU) for suicidal adolescents includes evaluation, with little or no intervention provided in the Emergency Department (ED), and disposition, usually to an inpatient psychiatry unit. The Family Based Crisis Intervention (FBCI) is an emergency psychiatry intervention designed to sufficiently stabilize suicidal adolescents within a single ED visit so that they may return home safely with their families. The intervention works intensively with both the adolescent and the family, so that the caregiver has the knowledge and skills to help the adolescent after discharge.

In this study, suicidal adolescents (ages 13-18) and their families presenting for psychiatric evaluation to a large pediatric ED were randomized to receive FBCI or treatment as usual (TAU). Patients and caregivers completed self-report measures of suicidality, family empowerment, and satisfaction with care provided at pre-test, post-test, and 3 follow up time-points over a one-month period. Clinicians contacted the adolescent and caregiver at these timepoints to administer the questionnaires and assure safety planning was being carried out.

Inclusion criteria

• adolescent presenting to the ED with suicidality
• presence of a consenting parent or legal guardian with whom the adolescent resided.

Exclusion criteria

• either adolescent or parent/guardian lacked fluency in English;
• adolescent was not medically stable, including intoxication;
• adolescent demonstrated cognitive limitations prohibiting completion of research instruments;
• adolescent presented with active psychosis;
• adolescent required physical or medication restraint in the ED.