OUTCOMES OF 3 CHILDREN'S PSYCHIATRIC EMERGENCY PROGRAMS

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Little is known about the comparative outcomes or costs associated with different programs of emergency care for children in psychiatric crisis and their families. A popular model of infamily care, used in mental health settings in 14 states, is based on the Homebuilders program developed for a child welfare population. This model (called Home-Based Crisis Intervention in New York State) has not been evaluated to determine its outcomes when used for treatment of children in psychiatric crisis. The specific aims of this project arc to establish two new in-family emergency programs, enhanced Home-Based Crisis Intervention (HBCI+) and Crisis Case Management (CCM) in The Bronx, NY and to compare the outcomes of these programs with those of HBCI when all 3 programs exist in the same urban community. Additionally we will determine which children and families experience the best outcomes with which model. HBCI links clients to services and teaches parenting and communication skills, HBCI+ is culturally competent and enhanced with respite, a parent advocate, and flexible service dollars, and CCM uses case management and respite. The research uses a positive controlled randomized study design with repeated measures, randomly assigning children 5-18 years presenting to 2 emergency services to one of the 3 treatment conditions. Data collection occurs on enrollment, at 6 weeks or discharge, and at 6 months. The. evaluation examines provider behavior (i.e., services provided), child outcomes (e.g., functioning), family outcomes (e.g., adaptability and cohesion, parenting self-efficacy), system outcomes (e.g. costs, admissions to restrictive settings), and provider outcomes (e.g., job tenure and satisfaction). An important collaborator is the Hispanic Research Center at Fordham University whose role will be to ensure cultural competence of HBCI+, modify or develop instrumentation appropriate for the largely minority population, translate consent forms and other materials into Spanish,and collect follow-up data on children and families. The study will provide data urgently needed for policy development regarding establishment of effective psychiatric emergency services for children and families.