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

In emergency departments (EDs) nationwide, increasing numbers of youths in psychiatric crisis are "boarding," or awaiting psychiatric care in a nonpsychiatric setting. Community stabilization programs may reduce the prevalence of boarding while supporting behavioral health. This study aimed to evaluate ED and inpatient (IP) psychiatric recidivism of youths receiving Crisis and Transition Services (CATS), a community-based program providing in-home behavioral health crisis services.

This retrospective matched cohort study used 2012-2020 medical claims data and linked program-collected data to compare CATS participants with nonparticipants (2018-2020). In total, 533 youths receiving CATS were matched to a control group (N=1,066) on initial ED visit date, reason for visit, age, and sex. Outcomes included time until first insurance claim for psychiatric or suicide attempt recidivism to an ED, IP admission, or both. Cox proportional hazard models were used to estimate the association between the outcomes of interest and CATS participation or nonparticipation up to 1 year following hospital (ED or IP) discharge.

CATS participation was significantly associated with reduced psychiatric recidivism to an ED, IP, or both, compared with nonparticipation, with significantly lower IP return admissions for suicide attempt.

Some boarding youths may be safely discharged to intensive community-based behavioral health crisis programs. Although return visits to EDs for suicide attempt did not differ between groups, youths in CATS had significantly lower hazards of IP admissions for suicide attempt. Comparable programs may reduce boarding without adding risk. Future studies should examine which individuals would benefit most from community-based treatment as well as key program components associated with outcomes.