Abstract
Abstract.Background: Suicide risk following youth psychiatric hospitalization is of significant concern. This study evaluated Linking Individuals Needing Care (LINC), a theory-driven, comprehensive care coordination approach for youth discharged from crisis services. Aims: To pilot LINC's potential effectiveness in increasing service utilization and decreasing suicide risk. Method: Participants were 460 youth patients who received LINC for approximately 90 days following discharge from crisis services. Service utilization, depressive symptoms, and suicide-related variables were measured at baseline and 30, 60, and 90 days after baseline. Results: Patients significantly increased the use of various beneficial, least restrictive services (individual therapy, medication management, and non-mental health supports) over the 90-day intervention. Significant decreases were observed in depressive symptoms, suicide ideation, and engagement in suicide-related behaviors. Limitations: Absence of a comparison group and nonparticipating families limit causal conclusions and generalizability. Conclusions: LINC may be a promising new approach following inpatient hospitalization that can engage and retain youth in services, likely resulting in improved treatment outcomes. This approach was designed emphasizing patient engagement, suicide risk assessment and management, safety planning, community networking, referral/linkage monitoring, coping and motivational strategies, and linguistic/culturally responsive practices to meet service and support needs of high-risk suicidal youth.
References
2020). Medically treated self-injury among children and adolescents: Repeated attempts and service use over 1 year. Psychiatric Services, 71(5), 447–455. 10.1176/appi.ps.201900152
(2007). Improving access to care in America: Individual and contextual indicators. In R. M. AndersenT. H. RiceG. F. Kominsji (Eds.), Changing the U.S. health care system: Key issues in health services policy and management (pp. 3–31). Jossey-Bass.
(2017). Promoting treatment engagement with specific populations: Depression. In W. O'DonohueL. JameC. Snipes (Eds.), Practical strategies and tools to promote treatment engagement (pp. 151–170). Springer.
(2019). Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalization. BMJ Open, 9(3), e023883. https://10.1136/bmjopen-2018-023883
(2019). Death rates due to suicide and homicide among persons aged 10–24: United States, 2000–2017. NCHS Data Brief (352), 1–8.
(2015). Longitudinal trajectories of suicidal ideation and subsequent suicide attempts among adolescent inpatients. Journal of Clinical Child and Adolescent Psychology, 44(1), 181–193. http://10.1080/15374416.2013.836454
(2020). Association of timely outpatient mental health services for youths after psychiatric hospitalization with risk of death by suicide. JAMA Network Open, 3(8), e2012887. http://10.1001/jamanetworkopen.2020.12887
(2016). A strengths-based case management service for people with serious mental illness in Israel: A randomized control trial. Psychiatric Research, 241, 182–189. 10.1016/j.psychres.2016.04.106
(2017). Cancer care coordination: A systematic review and meta-analysis of over 30 years of empirical studies. Annals of Behavioral Medicine, 51(4), 532–546. 10.1007/s12160-017-9876-2
(2019). Effect of a motivational interviewing-based intervention on initiation of mental health treatment and mental health after an emergency department visit among suicidal adolescents: A randomized clinical trial. JAMA Network Open, 2(12), e1917941. 10.1001/jamanetworkopen.2019.17941
(2015). Florida youth suicide prevention project. Substance Abuse and Mental Health Service Administration.
(2018). Care monitoring form [Unpublished LINC care monitoring form]. University of Central Florida and University of South Florida.
(2015). Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: A review of the literature. Clinical Psychology Review, 40, 28–39. 10.1016/j.cpr.2015.05.006
(2010). Post-discharge services and psychiatric rehospitalization among children and youth. Administration and Policy in Mental Health and Mental Health Services Research, 37(5), 433–445. 10.1007/s10488-009-0263-6
(2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: The evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26(1), 50–65. 10.1016/j.cpr.2005.09.001
(2018). Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy. Psychotherapy, 55(4), 341–355. 10.1037/pst0000176
(1995). A prospective study of adolescent suicidal behavior following hospitalization. Suicide and Life-Threatening Behavior, 25(3), 327–338. 10.1111/j.1943-278X.1995.tb00955.x
(2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. 10.1046/j.1525-1497.2001.016009606.x
(2007). Closing the quality gap: A critical analysis of quality improvement strategies – Care coordination. Agency for Healthcare Research and Quality.
(2002). Motivational interviewing: Preparing people to change (2nd ed.). Guilford Press.
(2020). Repeating a suicide attempt during adolescence: Risk and protective factors 12 months after hospitalization. European Child and Adolescent Psychiatry, 29, 1729–1740. 10.1007/s00787-020-01491-x
(2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatric Services, 52(6), 828–833. 10.1176/appi.ps.52.6.828
(2018). Hospitalization for suicide ideation or attempt: 2008–2015. Pediatrics, 141(6), 1–10. 10.1542/peds.2017-2426
(2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. The American Journal of Psychiatry, 168(12), 1266–1277. 10.1176/appi.ajp.2011.10111704
(2010). Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics, 126(6), 1117–1123. 10.1542/peds.2010-0852
(1997). Validating quality indicators: Quality as relationship between structure, process, and outcome. Evaluation Review, 21(3), 292–309. 10.1177/0193841X9702100302
(2020). Depressed mood prior to death: Implications for precipitating factors of youth suicide. Crisis, 41(6), 445–452. 10.1027/0227-5910/a000660
(2013). Mental health follow-up among adolescents with suicidal behaviors after emergency department discharge. Archives of Suicide Research, 17(4), 323–334. 10.1080/13811118.2013.801807
(2017). Stata statistical software: Release 15. StataCorp LLC.
. (2014). Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: A systematic review and meta-analysis. Canadian Medical Association Journal, 186(15), E568–E578. 10.1503/cmaj.140289
(2016). Coping card usage can further reduce suicide reattempt in suicide attempter case management within 3-month intervention. Suicide Life Threat Behav, 46(1), 106–120. 10.1111/sltb.12177
(2018). Trajectories of suicidal ideation among adolescents following psychiatric hospitalization. Journal of Abnormal Psychology, 46(2), 355–363. 10.1007/s10802-017-0293-6
(