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Cited by 9Psychiatric care and mental health servicesChild and Adolescent Psychosocial and Emotional DevelopmentEmergency and Acute Care Studies

Bridging the gap between the emergency department and outpatient care: feasibility of a short-term psychiatric crisis intervention for children and adolescents

Open access
Dekel, Idit, Hertz-Palmor, Nimrod, Dorman-Ilan, Shirel, Reich-Dvori, Mor, Gothelf, Doron, Pessach, Itai M.·2023·European Child & Adolescent Psychiatry
DOI 10.1007/s00787-021-01896-2PMC PMC8547560
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Abstract

Child and adolescent mental health systems are facing limited resources of available psychosocial interventions, often leading to long waiting lists for acceptance to treatment. We describe the feasibility of a short-term (8–10 sessions) psychological crisis intervention (CI) protocol for children and adolescents aged 8–17 years (n = 30, mean ± standard deviation 12.9 ± 2.4 years) who were referred to an outpatient mental health clinic due to suicidal ideation, aggression, severe anxiety, or extreme family conflict. The participants were assessed before and after the CI, and at a 3–6-months follow-up visit. The psychiatric assessments included clinical evaluation by a senior psychiatrist, and the completion of self-report questionnaires by both the participants and their parents. Following the establishment of the CI unit, the waiting lists for urgent cases were reduced from a median of 84 days in the two preceding years to 23 days in the following 3 years (H[2] = 18.5, p < 0.0001) for patients of the CI unit. A 1-year psychiatric follow-up after the end of the CI revealed that 72% did not require additional psychotherapy. The overall clinical evaluation measures (clinical evaluation, parents-report and child report) improved and had been preserved at the 3–6-months follow-up. Our results demonstrate the feasibility of a short-term CI protocol for expediting admission to treatment for urgent psychiatric cases. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Integrity signals

Registry

Crossref · 10.1007/s00787-021-01896-2

Cites

33 of 33 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

9 of 17 cited sources checked · 5 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Research in children and adolescents supports early crisis intervention models that prevent escalation of mental health issues through community-based approaches.

    “In recent years, accumulating research in children and adolescents support the utilization of models of intervention during crisis that are implemented early and prevent the escalation of mental health issues through community-based approaches [23].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [23] Vusio F, Thompson A, Birchwood M, Clarke L (2020) Experiences and satisfaction of children, young people and their parents with alternative mental health models to inpatient settings: a systematic review. Eur Child Adolesc Psychiatry 29:1621–1633 source
  • Premisecitation

    Psychiatric emergencies, including suicidal behaviors, presenting to pediatric emergency departments have increased in Israel.

    “Similar to the world trend, a rise in psychiatric emergencies, such as suicidal behaviors, presenting to pediatric EDs, is well documented in Israel [8].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Haruvi Catalan L, Levis Frenk M, Adini Spigelman E, Engelberg Y, Barzilay S, Mufson L, Apter A, Benaroya Milshtein N, Fennig S, Klomek AB (2020) Ultra-Brief Crisis IPT-A based intervention for suicidal children and adolescents (IPT-A-SCI) pilot study results. Front Psychiatry 11:553422 source

      The Introduction reports an increase in suicidal-behavior presentations to the pediatric emergency room at Schneider Children’s Medical Center in Israel. It does not document a rise in psychiatric emergencies generally across Israeli pediatric emergency departments, so the citing sentence is broader than the evidence in our copy. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Findingown data

    The improvements reported by parents were maintained at follow-up.

    “Improvement was preserved at follow-up (Table 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    The groups differed significantly in waiting-list time (H[2] = 18.5, p < 0.0001, η2 = 0.19).

    “Group differences were significant (H[2] = 18.5, p < 0.0001, η2 = 0.19).”
    Quote in the paperSubstantial claim
  • Findingown data

    The self-reported improvements were not maintained at follow-up.

    “Improvement in those traits was not preserved at follow-up (Table 2).”
    Quote in the paperSubstantial claim
  • May combine two claims. 23
  • Classified as probably not a substantial claim. 11

  • May combine two claims.

    Premisecitation

    Most recently published brief interventions target specific psychiatric emergencies such as suicidality or trauma exposure, and others focus only on youth in acute crisis and not younger children.

    “However, most of the recently published brief interventions are aimed at specific psychiatric emergencies, such as suicidality [8, 24] and trauma exposure [25, 26]. Others focus exclusively on youth in acute crisis and are not for younger children [27].”
    Quote in the paperSubstantial claim5 of 5 sources checked
    • cites [8] Haruvi Catalan L, Levis Frenk M, Adini Spigelman E, Engelberg Y, Barzilay S, Mufson L, Apter A, Benaroya Milshtein N, Fennig S, Klomek AB (2020) Ultra-Brief Crisis IPT-A based intervention for suicidal children and adolescents (IPT-A-SCI) pilot study results. Front Psychiatry 11:553422 source
    • cites [24] Morken IS, Dahlgren A, Lunde I, Toven S (2019) The effects of interventions preventing self-harm and suicide in children and adolescents: an overview of systematic reviews. F1000Res 8:890 source
    • cites [25] Coldiron ME, Llosa AE, Roederer T, Casas G, Moro MR (2013) Brief mental health interventions in conflict and emergency settings: an overview of four Medecins Sans Frontieres—France programs. Confl Health 7:23 source

      This source is cited for the second sentence, about interventions exclusively for youth in acute crisis and not younger children. Its Program overview (Table 1; page not provided) instead describes four programs serving adults as well as children; the Gaza and Nablus age distributions include younger children. The first sentence, about suicidality and trauma-focused interventions, cites other sources. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [26] Berkowitz SJ, Stover CS, Marans SR (2011) The Child and Family Traumatic Stress Intervention: secondary prevention for youth at risk of developing PTSD. J Child Psychol Psychiatry 52:676–685 source
    • cites [27] Henggeler SW, Rowland MD, Halliday-Boykins C, Sheidow AJ, Ward DM, Randall J, Pickrel SG, Cunningham PB, Edwards J (2003) One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis. J Am Acad Child Adolesc Psychiatry 42:543–551 source

      Sample and Recruitment reports that participants were 10–17 years old and had been approved for emergency psychiatric hospitalization, supporting the description of the study population. It does not establish that MST is unsuitable for children under 10. Treatment Implementation also reports an average treatment duration of 127 days, so describing this intervention as brief is not clearly supported. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Unmeasured characteristics may have influenced participants' willingness to comply with the treatment protocol, potentially biasing the results.

    “In addition, it is possible that unmeasured characteristics affected individuals' willingness to comply with the treatment/experimental protocol, thereby biasing our results [31].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] McGowan HM, Nix RL, Murphy SA, Bierman KL, Conduct Problems Prevention Research G (2010) Investigating the impact of selection bias in dose-response analyses of preventive interventions. Prev Sci 11:239–251 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Emergency department visits for psychiatric illness have increased globally in recent years.

    “In recent years, the number of emergency department (ED) visits for psychiatric illness has been rising worldwide [1, 3, 4].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [1] Carubia B, Becker A, Levine BH (2016) Child psychiatric emergencies: updates on trends, clinical care, and practice challenges. Curr Psychiatry Rep 18:41 source
    • cites [3] Mapelli E, Black T, Doan Q (2015) Trends in pediatric emergency department utilization for mental health-related visits. J Pediatr 167:905–910 source
    • cites [4] Kalb LG, Stapp EK, Ballard ED, Holingue C, Keefer A, Riley A (2019) Trends in psychiatric emergency department visits among youth and young adults in the US. Pediatrics 143(4) source

      The Abstract and Discussion report that psychiatric ED visits increased among people aged 6–24 in the United States between 2011 and 2015. They do not establish a worldwide rise or a rise across all age groups; the provided passages do not specify page numbers. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Participants' self-reports showed significant decreases in depressive symptoms (CDI 22.5 to 18.2, p = 0.042) and anxiety symptoms (STAI-C 44.0 to 40.8, p = 0.024) from pre- to post-crisis intervention.

    “The participants’ self-reports showed a significant decrease in depressive and anxiety symptoms between pre- and post-CI (CDI: pre = 22.5, post = 18.2, p = 0.042; STAI-C: pre-CI = 44.0, post-CI = 40.8, p = 0.024).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among the 30 analyzed patients, 6 (20.0%) were already on psychopharmacological treatment before referral, and 14 additional patients (46.7%) were prescribed psychiatric medications during the crisis intervention.

    “Of the 30 patients that were included in the analysis, 6 (20.0%) were on psychopharmacological treatment prior to their referral to the unit, while 14 (46.7%) additional patients were prescribed psychiatric medications during the CI treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Post-hoc comparisons showed that crisis intervention patients had significantly shorter waiting-list times than patients treated before the unit was established (U = 854, p < 0.001) and than patients who declined crisis intervention (U = 586.5, p = 0.005).

    “Post-hoc comparisons using Mann–Whitney test (corrected for multiple comparisons with FDR correction [21]) revealed that the time on waiting list among CI patients was significantly shorter compared with the waiting list time of patients treated prior to the unit's establishment (during 2014–2015) (U = 854, p < 0.001) as well as the waiting list time of patients who declined CI treatment (U = 586.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B Methodol 57:289–300 source

  • May combine two claims.

    Findingreasoning

    The increase in psychiatric emergency presentations overloaded the authors' psychiatric outpatient clinic, producing an average overall wait of about six months and about four months for urgent emergency department referrals.

    “This increase has led to an overload of the psychiatric outpatient clinic at our hospital, with an average of a 6 months wait time to treatment overall, and about 4 months for urgent cases referred from the ED.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Seventeen patients completed the follow-up assessments.

    “Seventeen patients completed follow-up assessments (Fig. 1).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Twenty-three patients (43%) were referred directly from the emergency department.

    “Twenty-three were referred directly from the ED (43%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Parental reports showed significant decreases in depressive symptoms (CDI 22.2 to 16.8, p < 0.0001) and state anxiety (STAI-S 48.6 to 40.0, p = 0.001), with no change in trait anxiety.

    “The parental reports showed a significant decrease in the participants’ depressive symptoms (CDI; pre-CI = 22.2, post-CI = 16.8; p < 0.0001) and state anxiety (STAI-S; pre-CI = 48.6, post-CI = 40.0; p = 0.001), with no change in trait anxiety symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After the crisis intervention unit was established (2016-2019), the median waiting time was 23 days for patients treated by the unit and 52 days for patients who declined crisis intervention.

    “This time was significantly shortened after the CI unit was establishment (2016–2019) with a median of 23 days for patients that were treated by the unit, and 52 days for patients who declined CI treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    At the authors' tertiary pediatric hospital in Israel, annual psychiatric emergency presentations to the emergency department increased and reached about 350 cases per year.

    “At the Edmond and Lily Safra Children's Hospital-Sheba Medical Center-Tel Hashomer, a tertiary pediatric hospital in Israel, the annual number of psychiatric emergencies presenting to the ED increased in recent years and now stands at about 350 cases annually.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Clinician-rated CGI-S scores improved significantly from pre- to post-intervention (4.9 to 3.5, p < 0.0001), as did CGAS scores (41.2 to 52.3, p < 0.0001).

    “There was a significant improvement between pre- and post-interventions in CGI-S (pre-CI = 4.9, post-CI = 3.5; p < 0.0001) and CGAS (pre-CI = 41.2, post-CI = 52.3; p < 0.0001) scores.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At the one-year post-intervention follow-up, 2 patients (3.8%) required admission to a closed psychiatric ward, 2 (3.8%) were referred to a psychiatric daycare service, and 38 (72%) did not require additional psychotherapy.

    “At the 1-year post-intervention follow-up, two patients (3.8%) required admission to a closed psychiatric ward, two (3.8%) were referred to a psychiatric daycare service, and 38 (72%) did not require any additional psychotherapy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The final analytic sample comprised 30 patients who completed baseline and endpoint assessments, with a mean age of 13.1 years (SD 2.4) and 20 girls (66.7%).

    “The final analytic sample included 30 patients (mean age ± standard deviation = 13.1 ± 2.4, 20 girls [66.7%]) who completed baseline and endpoint assessments (Table 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    All patients adhered to their medications through the end of the intervention, and 4 patients (20.0%) discontinued pharmacotherapy during the first six months after the treatment endpoint.

    “All patients adhered to their medications until the end of the intervention, and 4 (20.0%) discontinued pharmacotherapy during the first 6 months following the treatment endpoint”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The study findings demonstrate that the novel psychiatric crisis intervention model for children and adolescents is feasible and useful.

    “The findings of this study demonstrate the feasibility and utility of a novel psychiatric CI model for children and adolescents.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Youths with common psychiatric crises are referred urgently to emergency departments or psychiatric clinics and typically face very long waiting lists for intervention.

    “Part of this rise includes youths with common psychiatric crises, such as suicidal ideation, aggression, severe anxiety, or extreme family conflict, that are referred urgently to emergency departments (ED) or to psychiatric clinics, where they are invariably confronted by very long waiting-lists for intervention [5].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Aviram U (2010) Promises and pitfalls on the road to a mental health reform in Israel. Isr J Psychiatry Relat Sci 47:171–183 (discussion 183–194)

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Patients who completed the treatment protocol may have been more motivated and adhered more closely to the recommended treatment.

    “For example, patients who completed the treatment protocol may have been more motivated participants, who adhered more closely to the recommended treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study was conducted at a single center, had a small sample size, and lacked a control group.

    “This study has several imitations: first, this is a single center study with a small sample size; lacking a control group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The intervention combined principles from established treatment protocols and substantially reduced waiting-list time for acute cases.

    “Our intervention integrated principles from well-established treatment protocols, and dramatically reduced the waitlist time for treatment of acute cases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    The authors' model is unique in addressing a variety of common emergencies in children and adolescents without excluding complicated cases with psychiatric comorbidities.

    “To the best of our knowledge our model is unique as it addresses a variety of common emergencies in children and adolescents and does not exclude complicated cases with psychiatric comorbidities.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Family disorganization may affect dropout, as children or parents unable to attend sessions regularly were more likely to drop out, creating survivorship bias.

    “Family disorganization may also be an artifact that affects dropout from treatment; children or parents who were not able to attend the treatment sessions on a regular basis were more likely to drop out, therefore, creating a survivorship bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The authors compared baseline characteristics between participants with complete and missing data to check that survivorship bias did not affect the results.

    “compared baseline differences between participants with full and missing data to assure that our results were not affected by survivorship bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Not all cases referred for initial evaluation were well documented, and incomplete data prevented inclusion of all crisis intervention unit patients in the final sample.

    “Furthermore, not all cases referred to an initial evaluation were well documented and not all cases that had been treated in the CI unit were included in the final sample due to incomplete data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The authors conclude that the novel intervention for pediatric psychiatric emergencies is feasible and safe and that its implementation significantly shortened waiting-list times.

    “In conclusion, we describe a novel intervention for psychiatric emergencies of children and adolescents. We demonstrate this intervention to be feasible and safe and that its implementation significantly shortened waitlist times.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Child and adolescent mental health systems have limited psychosocial intervention resources, which often leads to long waiting lists for treatment.

    “One of the main challenges faced by child and adolescent mental health systems is the limited resources of available psycho-social interventions [1, 2].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Carubia B, Becker A, Levine BH (2016) Child psychiatric emergencies: updates on trends, clinical care, and practice challenges. Curr Psychiatry Rep 18:41 source
    • cites [2] Sheppard R, Deane FP, Ciarrochi J (2018) Unmet need for professional mental health care among adolescents with high psychological distress. Aust N Z J Psychiatry 52:59–67 source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    To the authors' knowledge, this is the first model to provide short-term intervention for diverse common psychiatric emergencies in a child and adolescent psychiatric outpatient clinic.

    “To the best of our knowledge, this is the first model that offers short-term intervention for diverse common psychiatric emergencies in the setting of a child and adolescent psychiatric outpatient clinic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The observation that 72% of children needed no further psychotherapy one year after the intervention suggests the intervention is beneficial and likely to fit well within a stepped-care model in routine practice.

    “The finding that 72% of children did not require further psychotherapy 1 year following the intervention, suggests that it is a beneficial strategy that is likely to work well within a ‘stepped care’ model in routine practice.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis accounted for interpersonal variance and missing data by treating participants as random factors.

    “We controlled for interpersonal variance and missing data by modelling the participants as random factors”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The post-intervention treatment need data came from electronic medical records for all 53 patients who completed the crisis intervention, including those who did not complete the research questionnaires.

    “These data were collected from the electronic medical records of all patients that completed the CI intervention, including those that did not complete the research questionnaires (N = 53).”
    Quote in the paperSubstantial claim
31 of 31

  • The paper relies on this without support.

    Community-based services for youth in mental health crisis are scarce.

    “However, community-based services are scarce.”

  • The paper relies on this without support.

    The majority of outpatient psychiatric services are overloaded.

    “The majority of these services are provided in outpatient clinic settings that are overloaded.”

  • The authors state this as an assumption.

    Immediate professional help increases motivation for treatment and hope for change in families in acute crisis.

    “We believe that when a family which is struggling with their child’s acute crisis is offered immediate professional help, the motivation for treatment and the hope for change are high.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract says outcome was preserved, but self-report follow-up says it was not

    Minor

    The abstract states the overall clinical evaluation measures improved and were preserved at follow-up. But the self-report results section says the improvement in those traits was not preserved at follow-up, which directly conflicts if the abstract is summarizing the same outcomes broadly.

  • Abstract age and sample size differ from Results

    Minor

    The abstract reports 30 participants with a mean age of 12.9 ± 2.4 years, while the Results section reports 30 participants with a mean age of 13.1 ± 2.4. The sample size matches, but the mean age is inconsistent between sections.

  • Mean age differs for the same 30-patient sample

    Minor

    The abstract gives a mean age of 12.9 years for 30 participants, while Results gives 13.1 years for the 30-patient analytic sample. Both report the same standard deviation.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Kendall PCHK (2006) Cognitive-behavioral therapy for anxious children: therapist manual. Workbook Publishing, Ardmore

Cited by

Sorted by citations

Related

Authors
Dekel, I., Hertz-Palmor, N., Dorman-Ilan, S., Reich-Dvori, M., Gothelf, D., & Pessach, I. M.
Affiliations
  • Tel Aviv University (IL)
  • Sheba Medical Center (IL)
Corresponding author
Dekel, Idit
ORCID
Venue
European Child & Adolescent Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2021-10-26
Volume
32
Issue
4
Pages
631-637
ISSN
  • 1018-8827 (ISSN-L)
  • 1435-165X
DOI
10.1007/s00787-021-01896-2
PMC
PMC8547560
OpenAlex
W3208337283
Cited by
9
References
32
Citations by year
2026: 3 · 2025: 3 · 2024: 2 · 2023: 1
FWCI
0.51
Type
journal article
Language
en
Open access
Licence
Locations
  • European Child & Adolescent Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • united states - israel binational science foundation (2017369)
  • foundation dora (2017369)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
psychiatric crisis intervention, child and adolescent mental health, emergency department, outpatient care, waiting lists, suicidal ideation, aggression, anxiety, family conflict, brief psychotherapy, treatment admissions, feasibility
MeSH terms
Adolescent, Ambulatory Care, Child, Crisis Intervention, Emergency Service, Hospital, Feasibility Studies, Humans, Psychotherapy

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Claims read under definition version 3 (extract-v3) on 2026-09-28.

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