Examining the Efficacy of the Family Based Crisis Intervention for Suicidal Adolescents in the Emergency Department: Results of a Randomized Clinical Trial

Background and Purpose:  Suicide is a significant public health problem, recently ranked as the 3^rdleading cause of death in adolescents in the US.  The Emergency Department (ED) often serves as a portal to the mental health system for suicidal adolescents. The usual practice for suicidal adolescents in emergency psychiatry is evaluation, with little or no in-ED treatment; and disposition, usually to an inpatient psychiatry unit. Unfortunately, often there are not enough inpatient psychiatric beds throughout the system of care for all of the suicidal adolescents who need them, resulting in patients who must “board” in the ED while awaiting appropriate care. In response to this systemic crisis, the investigators developed the Family Based Crisis Intervention (FBCI) for suicidal adolescents and their families.   Developed exclusively by social workers, FBCI is a single-session intervention that is designed to sufficiently stabilize patients within a single ED visit by reducing suicidality and increasing individual tools and familial supports, so that they may return home safely with their families. Previous open and pilot trials of FBCI demonstrated feasibility and safety of the intervention; with significant differences in hospitalization rates among a cohort of FBCI patients compared to a retrospectively matched comparison group (36% versus 55%, p<.001).  The objectives of this presentation are to report on efficacy outcomes for a randomized clinical trial of FBCI. 

Methods:   A total of N=100 suicidal adolescents (ages 13-18) and their families presenting for a psychiatric evaluation to a large pediatric ED were randomized to be treated with FBCI or treatment as usual (TAU).  Patients and their caregivers completed demographic and validated self-report measures of suicidality, family communication, and family empowerment, which were collected at pretest, posttest, and 3 follow up time points over a one month period. Data on disposition, psychiatric diagnoses and ED recidivism rates were collected through retrospective chart review. All statistical analyses were completed using Stata 12.

Results: Of the 100 patients recruited, 76% were female.  The sample was 62% white, 20% mixed, 8% Latino, 7% Black, and 3% Asian, and average age of the adolescent participant was 15.4 years.  Results of initial logistic regression reveal that, at posttest, patients receiving FBCI condition were significantly more likely to be discharged home with outpatient follow-up care compared to their TAU counterparts (p<0.05) when controlling for age, race, gender, and insurance type.  Longitudinal outcomes related to psychiatric symptoms (including suicidality), family communication, family empowerment, and ED recidivism will also be reported. No completed suicides were reported during the study period by any study participant.

Conclusions and Implications:  A focus on evidence-based suicide prevention initiatives is critical to enhancing the long-term health and well being of adolescents.  There is an increasing reliance on the development and translation of evidence-based practices for many conditions in the ED, although the main focus has been on medical interventions.  FBCI may be a viable alternative to usual care provided by psychiatry, and would reflect the treatment model already used for medical patients in the ED.