The Effectiveness of a Child and Adolescent Mobile Crisis Team In Preventing Psychiatric Hospitalizations

Background and Purpose: First responders to youth experiencing behavioral or emotional crises are likely to be police or mobile crisis teams with expertise intervening with adults. Without a youth-focused mobile crisis team (YMCT), a youth in crisis may be inaccurately assessed, the crisis might escalate, and restraint, incarceration, or hospitalization results. The present study examines the impact of one YMCT serving youth in three counties in large northeastern state. The multidisciplinary team has crisis and child and family services experience, and uses family-focused and strengths-based approaches consistent with System of Care principles. Given heightened awareness of the need for evidence-based information to guide policy and practice for children and adolescents with mental health problems, the present study was conducted to evaluate two questions: first, how effective are the YMCT services in preventing hospitalizations, and second is YMCT a cost-effective service relative to either police or adult mobile crisis responses? Methods: Data on hospitalization, and time and effort devoted to all phases of the intervention were extracted from YMCT case files of a random sample of 100 youth who received a mobile visit in 2009. YMCT service costs came from administrative and personnel data. Police and adult crisis team data came from a range of secondary sources, including quarterly reports on referral sources and dispositions for youth who presented to area crisis evaluation centers and emergency rooms, and publically available salary data. Cost estimates focus on the direct costs associated with treatment provision (i.e., excluded fixed program costs), and were calculated for the two possible outcomes (hospitalized or not). The incremental cost-effectiveness ratio (ICER), or the difference in costs divided by the difference in effects, indicates the marginal cost of achieving one less inpatient hospitalization with a YMCT intervention relative to the two other crisis responders. A low or negative ICER is interpreted as YMCT being more cost-effective. Results: Youth served by the YMCT have serious behavior and emotional problems. One quarter (24.2%) had previous inpatient admissions and 7.1% had previous recent ER visits. Three-quarters (73.7%) had multiple Axis I diagnoses, about half had an Axis III diagnosis (30% of these had asthma). The hospitalization rate was 15.2% and 26.2% for YMCT and other responders, respectively. The incremental cost effectiveness estimates per hospitalization prevented was approximately $9,000. To evaluate the estimate's sensitivity, modifications to service costs (i.e., time spent on the scene) and hospitalization probability (i.e., equal probability regardless of responder) were tested. Only when police or adult mobile crisis had a lower probability of hospitalization did the ICER value lead to concluding that YMCT is not cost effective. Conclusions and Implications: The YMCT yields clinical and economic benefits beyond those achieved when either police or adult mobile crisis teams are used. Communities considering launching a YMCT may find this information useful in persuading funders about the value of such an investment. If a specialty YMCT is not feasible, other crisis responders may be important targets for outreach and training to respond to youth more effectively.