New SAMHSA Guidelines Will Benefit Youth in Crisis

Youth in the United States have a growing need for multisystem behavioral healthcare. Unfortunately, they are often subject to unnecessary hospital visits, lengthy stays in inpatient facilities, or other out-of-home placements to receive care. Often, communities do not have enough resources to treat youth with behavioral health needs. Instead, they may be disproportionately disciplined by their school or require justice system involvement, simply because there were no treatment alternatives. Both educational systems and law enforcement typically do not have the funding or resources to train staff or officers on how to understand and respond to youth with complex behavioral health needs. Officers may also lack options to divert youth to treatment rather than entering them into the legal system. Our youth need—and deserve—better care.

Recently, the Substance Abuse and Mental Health Services Administration (SAMHSA) published the new National Guidelines for Child and Youth Behavioral Health Crisis Care. These guidelines offer a framework of best practices for youth crisis response programs. I have spent over a decade watching these care practices improve outcomes for the youth population and their families. If utilized, these guidelines will help children and families successfully resolve the full scope of the crisis. It should always be the goal to empower the families and caregivers with support and tools to maintain stability, rather than creating a reliance on formal service providers.

High Standards of Care

The guidelines from SAMHSA are aligned with the philosophy that the least restrictive level of care should be used to provide the most effective behavioral health treatment. Implementation of the guidelines will also make it easier for youth and families to access crisis services, ensuring that the youth will be assessed for the most appropriate level of care.

SAMHSA strongly encourages youth crisis systems to keep young people in their homes as often as possible, rather than recommending out-of-home placements. With family or caregiver empowerment and evidence-based, family-centered treatments, this is truly possible. The guidelines also encourage youth crisis systems to provide developmentally appropriate services that treat patients according to their developmental level, involve peer support providers when planning, implementing, and evaluating services, and provide equity-driven services to meet the needs of all youth and their families.

The 3 components in SAMHSA’s model for crisis services that help children and families include:

• Someone to talk to (crisis call centers available 24/7/365)
• Someone to respond (mobile response teams that provide immediate support)
• A safe place to be (crisis receiving and stabilization services for youth and families).

Family Engagement is Crucial for Success

After many years serving the youth population in Arizona, first as a multisystemic therapist and supervisor, and then entering clinical crisis leadership as the former director of social services and current vice president of clinical integration and innovation for Connections Health Solutions, I have seen how vital crisis services for youth are in a community. The crisis system in Arizona, where Connections operates 2 large crisis response centers, has been using a service model that meets the new SAMHSA standards for years.

Effective crisis stabilization treatment for youth should only refer to the lowest level of care necessary. For youth who have struggled in the home or in educational settings prior to presenting for crisis services, family and treatment teams may seek out-of-home treatments as a first option in an attempt to “fix” the youth’s presenting crisis behaviors before discharging the youth to the family. It is critical that, as clinicians and treatment providers, we consider the message that this sends to the youth that we serve. Using a higher level of care is often not necessary for stabilization. Additionally, care providers may be unable to achieve sustainable change when treating youth in a controlled environment without the family’s active involvement and participation in learning new skills.

A youth behavioral health system is more likely to achieve long-term, positive outcomes in the home when crisis systems prioritize finding ways to establish robust safety plans and parent or caregiver engagement strategies. It is critical that social services frequently review and investigate potential resources to ensure quality and individualized treatment planning. These support the youth’s ability to be discharged home to their family post-crisis or, in cases of higher need, after the use of a post-crisis brief intervention program (BIP).

In Arizona, BIP programs can be used as a short-term placement option. Such programs provide families and treatment teams time (generally about 3 days) to ensure that appropriate services are in place, and that hands-on support is established prior to the youth returning home. With the help of the BIP and treatment team, families can work out a more detailed safety plan prior to the youth returning home.  

Empower Caregivers to Engage the Family

Based on the success seen with youth crisis treatment and stabilization programs in Arizona, the best strategy is one that empowers families and caregivers. Youth crisis centers should:

• Coordinate care and develop individualized safety plans by collaborating with caregivers, establish ongoing outpatient services for the youth and family, and help families understand the spectrum of behavioral health services, including the benefits of using lowest level of care to create sustainable change within the home. 
• Educate family members and caregivers on triggers, coping skills, how to identify warning signs, and how to monitor technology and social media. 
• Identify natural and formal supports to promote ongoing treatment, strengthen family relationships, and assist in a crisis as part of safety planning. 
• Invest in tools and tactics to promote and enhance communication that: establishes the family as a source of support to the youth, empowers families to be advocates for the youth’s needs, and enables the family to confidently work with providers and schools to share what works for them. 

Setting Youth Crisis Care Centers up for Success

The new SAMHSA youth crisis care standards offer a long-awaited model for best practices that can be used by facilities to reach this vulnerable population in high need throughout the country. SAMHSA’s advocacy of providing the least restrictive level of care and keeping youth in the home is an important and powerful foundation for youth crisis care that will enable families to access services promoting sustainable change within the home and family system rather than looking to inpatient or residential treatment to “fix” a youth’s behavioral health separate from the home environment.

Experience in Arizona has indicated that the youth crisis system will need facilities to actively engage families collaboratively as partners to be successful in consistently providing the least restrictive care to youth in crisis. 

SAMHSA’s guidelines will surely provide many valuable opportunities for best practices to evolve with time and experience as the youth crisis care continuum expands to meet the needs of so many diverse families in need. 

Leigh-Anne Andre, LCSW, is vice president, clinical integration and innovation for Connections Health Solutions.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.