Examining Family-Based Care for Suicidal Adolescents Psychiatrically Treated on a Youth Crisis Stabilization Unit versus a Traditional Inpatient Unit (Board#11)

Abstract : Research

Aims: Inpatient psychiatric treatment is often recommended for youth with suicidal ideation or behavior who are deemed to be in need of more intensive treatment than that offered in outpatient care. However, access to inpatient hospitalization has become increasingly limited and evidence-based therapeutic programming at the inpatient level of care varies.[1][2] Nationwide Children’s Hospital (NCH) has developed a novel treatment approach for suicidal crisis treatment known as the Youth Crisis Stabilization Unit (YCSU) which differs from a traditional adolescent psychiatric inpatient unit (Inpatient) in therapy focus, length of stay, milieu absence, and intensive family involvement. YCSU studies have demonstrated equivalent readmission rates or time to readmission when compared to Inpatient, and an average of a 5.8-day reduction in length of stay, thus increasing access and decreasing cost while providing similar levels of care.[3] All evidence-based treatments for suicidal youth involve including parents/caregivers in treatment, either through family sessions and/or individual sessions for the parents/caregivers.[4] Little is known, however, about the dose of family involvement that is most helpful at the inpatient level of care. Family intervention is considered to be a core component of the treatment on the YCSU and parents/caregivers typically participate in 30-90 minutes of family sessions per day.[5] Examining the amount of parent/caregiver involvement in treatment for patients admitted to the YCSU and APIU and clinical outcomes could provide valuable information for guiding treatment planning for youth admitted for suicidal ideation.

Proposal aims include to: 1) Describe the differential dose of family intervention received in YCSU and Inpatient; 2) Examine clinical outcomes (i.e., return to the Psychiatric Crisis Department/readmission) based on family intervention dose categories across the two units.


Methods: A retrospective chart review study was completed reviewing characteristics and clinical outcomes of adolescents admitted from the psychiatric crisis department to either YCSU or Inpatient for suicidal ideation or behavior. Information collected included demographic information, past psychiatric history, and characteristics of treatment, including minutes spent receiving intervention, during specific admission.


Results: The current study sample includes 20 participants, divided equally between YCSU and Inpatient. Purposive sampling (by gender and younger vs. older) was used during a 1-month period as original project goals were to understand referral pathways from the emergency department for youth presenting with suicidal ideation. Data collection is ongoing and has been extended beyond the original 1-month timeframe. In the first 20 participants, YCSU and Inpatient participants had similar past psychiatric history, including at least one psychiatric diagnosis and at least one psychiatric medication, number of previous suicide attempts/behaviors/preparatory behaviors, and length of previous therapy utilization; however, participants who were admitted to the Inpatient had more previous PCD presentations (1.8) vs YCSU (0.4; p=0.044). Length of stay varied between the two units, with average length of stay in YCSU as 4.43 days (SD=2.03) and in Inpatient as 8.83 days (SD = 4.67).When comparing YCSU to Inpatient, Inpatient participants received significantly less individual and family therapy per day compared to YCSU (Individual: 108.69 min/day for YCSU vs. 31.56 min/day for Inpatient, p=0.0001; Family 50.66 min/day for YCSU vs. 27.20 min/day for Inpatient, p=0.0099). Parent-only and other therapy lengths were similar between the two groups. Both groups had similar numbers of caregivers involved in therapies during admission. Clinical outcomes, with focus on family-based intervention dose, will be examined across the two programs when data collection is complete.


Conclusions: Family involvement in care for youth experiencing suicidal ideation and behaviors is critical. Inpatient care, whether traditional milieu-based multi-disciplinary approach or family-based therapy approach, includes parent and family sessions. More studies are needed to examine the optimal dose of such care at varying levels of care, as most studies of youth suicide-specific treatments have focused on outpatient care.