Youth Emergency Department and Inpatient Psychiatric Recidivism After Treatment in a Community-Based Crisis Program

Area of Science:

• Psychiatry
• Public Health
• Health Services Research

Background:

• Emergency departments (EDs) face increasing numbers of youth in psychiatric crisis, known as "boarding."
• Community stabilization programs offer a potential solution to reduce boarding and support youth behavioral health.

Purpose of the Study:

• To evaluate the impact of Crisis and Transition Services (CATS), an in-home community-based program, on psychiatric recidivism in youth.
• To compare emergency department (ED) and inpatient (IP) psychiatric recidivism rates between youth receiving CATS and a matched control group.

Main Methods:

• A retrospective matched cohort study utilizing medical claims and program data from 2012-2020.
• 533 CATS participants were matched to 1,066 nonparticipants based on initial ED visit, age, and sex.
• Cox proportional hazard models analyzed psychiatric or suicide attempt recidivism to EDs or IPs within 1 year post-discharge.

Main Results:

• CATS participation was significantly associated with reduced psychiatric recidivism to EDs and IPs.
• Significantly fewer inpatient return admissions for suicide attempts were observed in the CATS group compared to controls.
• No significant difference in ED return visits for suicide attempts was found between groups.

Conclusions:

• Intensive community-based behavioral health crisis programs, like CATS, can potentially reduce ED boarding for youth.
• These programs may decrease inpatient admissions for suicide attempts without increasing risks associated with ED recidivism.
• Further research is needed to identify optimal candidates and key program components for community-based crisis interventions.