Family-based Crisis Intervention With Suicidal Adolescents in the Emergency Department: A Randomized Clinical Trial
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Boston Children's Hospital
- Enrollment
- 143
- Locations
- 1
- Primary Endpoint
- Disposition at discharge from the ED (psychiatric hospitalization or other)
Study Overview
Brief Summary
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. This study is a randomized clinical trial of FBCI v. TAU in an urban Emergency Department.
Detailed Description
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.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Participant)
Eligibility Criteria
- Ages
- 13 Years to 18 Years (Child, Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
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.
Arms & Interventions
Family-Based Crisis Intervention
The Family-Based Crisis Intervention (FBCI) is a single-session intervention that takes place in the Emergency Department. Adolescents randomized to the experimental condition received a standard psychiatric evaluation followed by the experimental intervention. FBCI was administered by licensed psychiatric social workers who were trained in the intervention. The research clinician provided FBCI to the suicidal adolescent and his/her parent(s)/guardian(s) in a 60-90 minute session in which she helped the adolescent and family develop a joint crisis narrative of the problem and taught them cognitive-behavioral skill-building, therapeutic readiness, psycho-education about depression, and safety planning.
Intervention: Family-Based Crisis Intervention (Behavioral)
Treatment As Usual
Treatment as usual included an emergency psychiatry evaluation (standard care).
Outcomes
Primary Outcomes
Disposition at discharge from the ED (psychiatric hospitalization or other)
Time Frame: one day, one week, and one month
The primary outcome measure is disposition (psychiatric hospitalization vs. less restrictive level of care) after receiving the FBCI intervention or TAU. Psychiatric hospitalization was reassessed at 1 day, 1 week and 1 month intervals after randomization.
Secondary Outcomes
- Client Satisfaction Questionnaire (CSQ-8)(one day)
- Family Empowerment Scale (FES)(one month)
Investigators
Elizabeth Wharff
Clinical Researcher
Boston Children's Hospital