National Guidelines for Child and Youth Behavioral Health Crisis Care: SAMHSA's Response

In the previous installment of this series, we discussed the context that led to the SAMHSA National Guidelines for Behavioral Health Crisis Care, which highlight the needs for crisis care serving diverse populations. These new behavioral health care guidelines align with SAMHSA’s earlier publication, National Guidelines for Behavioral Health Crisis Care- Best Practice Toolkit, by encouraging youth crisis services to adopt certain principles.    

Key Principles for Youth Crisis Services

• Address recovery needs
• Use trauma-informed care
• Assure a significant role for peers
• Adopt zero suicide/suicide safer care
• Assure safety and security for staff and people in crisis
• Build crisis response partnerships with law enforcement and other first responders

Unlike adults, children and most youth do not live independently. They live with families. So, any child or youth crisis must also involve the families of those in crisis. SAMHSA recognized this in the new guidelines by including families as a focus along with children and youth. For simplicity, we will refer to this group collectively as “youth” for the rest of this paper.

SAMHSA's Three-Level Model for Youth Crisis Services

• Avoid out-of-home placements
• Provide developmentally appropriate services
• Integrate family and youth peer support services
• Provide services that are culturally and linguistically appropriate

As in adult crisis services, SAMHSA proposed a three-level model for youth crisis services that spans different levels of intervention. The first is Someone To Talk To, meaning the use of developmentally appropriate call centers available to respond to crisis calls from youth. The second refers to mobile crisis teams - Someone To Respond. These teams are used to go to where the person in crisis is and provide services and interventions there. The third and most intensive level is Safe Place To Be, which includes both home-based services and developmentally appropriate, trauma-informed, institution-based care. This level is meant to be as short as possible with the goal of returning the young person to their home and family.

Importance of Coordination Between Organizations

Youth services of all kinds rarely involve only one organization, and coordination between all the organizations providing services is critical. Various combinations of behavioral health providers, schools, child welfare, juvenile justice and pediatric and primary care medical providers are frequently working with the same young person. The three-level model above clearly suggests a system of care approach that allows close cooperation and communication between different agencies caring for the same young person. This is particularly true for youth crisis services.

Addressing Unique Populations in Youth Crisis Services

While youth crisis services are different than crisis services for adults, there is wide variance even within the general category of “youth.” There are unique populations and unique settings that need special attention. These can be age based (infants and children), gender based (LGBTQI+), geographic (rural and homeless), ethnic (tribal, immigrant, refugee) or developmental. Identifying and responding to these populations can be challenging for providers especially since these issues may not be captured in relevant documentation, may not be part of their medical record and are then inaccessible, or may not have been considered part of the presenting problem and therefore not a focus of care.

Conclusion

Addressing the recommendations in SAMHSA’s guidelines for youth is a step towards crisis care that better serves children in need. Even though the standards are relatively new, human services organizations have already instituted a broad range of youth crisis services that align with SAMHSA’s vision.