When emergency department (ED) visits for youth suicidality rose at Seattle Children’s from about 2,000 in 2015 to nearly 3,500 in just three years, it became clear they needed a new approach to properly care for this influx of behavioral health patients.
“We found it unacceptable that a family could call us, and we wouldn’t be able to see their child for an evaluation for three, six or even twelve months—we didn't feel good about that,” says Molly Adrian, Ph.D., clinical child psychologist at Seattle Children’s, and associate professor at University of Washington. “Having a just-in-time model was really important to align with our values.”
The result was the creation of a Crisis Care Clinic (CCC) at Seattle Children’s. Launched in 2018, the CCC was funded by a private donor family who had trouble accessing timely, effective care following their daughter’s suicidal crisis. The outpatient center works to provide quick access to evidence-based treatment; most patients have their first session with the CCC care team within a few days of their referral from the ED or a community-based behavioral health caregiver.
Central to the clinic’s approach is the Collaborative Assessment & Management of Suicidality (CAMS) care framework. Developed by David Jobes, Ph.D., ABPP, director of The Catholic University of America Suicide Prevention Lab in Washington, D.C., CAMS focuses on four primary components:
- Philosophy. A multi-disciplinary, collaborative effort in treating suicide patients with empathy, nonjudgment and honesty.
- Assessment. The patient completes a Suicide Status Form (SSF) at every CCC session; the form includes ratings indicating their current feelings and lists of reasons they want to live or die.
- Treatment. At each session, the clinic team updates the patient’s individualized care plan focused on their self-defined drivers of suicide.
- Disposition. Following four weekly meetings, the clinic’s care team determines any further care needs—typically this involves a home maintenance plan administered by the patient and their parents.
Parental role is pivotal
Not only has the CCC program filled a major need in the behavioral health care continuum at Seattle Children’s but it has also been effective in improving patient outcomes. Adrian and her team have seen a significant decrease in self-reported suicide risk ratings in patients who’ve completed the program, and the patient’s caregivers are very happy with the care. Satisfaction ratings average 3.8 out of 4.0, and 98% say they’d recommend the CCC approach.
A big driver of both metrics is the crucial role parents and caregivers play in the process. A dedicated clinician works directly with parents at each CCC session to help them better understand the causes behind the suicidal crisis and equips them with the tools to help their child more effectively. Additionally, the program includes care navigators to assist parents in managing the complex system of behavioral health care providers and community resources.
“It's really critical because we're asking parents to do an extraordinarily difficult thing,” Adrian says. “We need to provide them with skills and structure for how to maintain safety and stability; the only fair way to do that is through integrated support and treatment.”