Family-Based Crisis Intervention With Suicidal Adolescents: A Randomized Clinical Trial
Abstract
Objective In current practice, treatment as usual (TAU) for suicidal adolescents includes evaluation, with little or no intervention provided in the emergency department (ED), and disposition, usually to an inpatient psychiatry unit. The family-based crisis intervention (FBCI) is an emergency psychiatry intervention designed to sufficiently stabilize suicidal adolescents within a single ED visit so that they may return home safely with their families. The objective of this article is to report efficacy outcomes related to FBCI for suicidal adolescents and their families. Methods A total of 142 suicidal adolescents (age, 13-18 years) and their families presenting for psychiatric evaluation to a large pediatric ED were randomized to receive FBCI or TAU. Patients and caregivers completed self-report measures of suicidality, family empowerment, and satisfaction with care provided at pretest, posttest, and 3 follow-up time points over a 1-month period. Results Patients randomized to FBCI were significantly more likely to be discharged home with outpatient follow-up care compared with their TAU counterparts (P Conclusions Family-based crisis intervention is a model of care for suicidal adolescents that may be a viable alternative to traditional ED care that involves inpatient psychiatric hospitalization.
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Based on study-level results, adolescents who received family-based interventions had lower rates of re-presentation and were more likely to be linked to outpatient mental health services after discharge compared with adolescents who received treatment as usual.
“Based on study-level results, adolescents who received interventions that were family-based had lower rates of re-presentation44 and were more likely to be linked to outpatient mental health services after discharge35 compared with adolescents who received treatment as usual.”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents (2025) · cites this paper as [44]
Suicide-related behavior was designated as a primary outcome in 1 study and a secondary outcome in 2 studies.
“SRB was designated as a primary outcome in 1 study44 and a secondary outcome in 2 studies.35,38”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents (2025) · cites this paper as [44]
Re-presentation to acute care settings was designated as the primary outcome in zero studies and a secondary outcome in 2 studies.
“Re-presentation to acute care settings was designated as the primary outcome in zero studies and a secondary outcome in 2 studies.38,44”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents (2025) · cites this paper as [44]
Parent or family involvement may be an important modification because of the prominent role families have during this developmental stage and the apparent link between family functioning and adolescent SITB.
“For example, parent or family involvement may be an important modification44 because of the prominent role families have during this developmental stage and the apparent link between family functioning and adolescent SITB.52,53”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents (2025) · cites this paper as [44]
Only 3 studies had adequate-sized samples to compare treatment effects across groups; 2 of these used true randomization, and neither found significant between-group differences in suicide-related outcomes.
“Only 3 studies35,42,44 had adequate-sized samples to compare treatment effects across groups; 2 of these studies35,44 used true randomization, and neither found significant between-group differences in suicide-related outcomes.”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents (2025) · cites this paper as [44]
Cites
Merry, S. N., McDowell, H. H., Hetrick, S. E., Bir, J. J., & Muller, N. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003380.pub2 · Cited by 284 · cited 1× · see citing works
“Copyright © 2019 Wolters Kluwer H other depressive symptoms in the general child/adolescent population.(3,7,8,10,11) Increasingly, much of this research highlights the importance of including family in suicidal adolescent interventions.”
BackgroundTreatment of co-occurring substance abuse and suicidality among adolescents: A randomized trial.
Esposito-Smythers, C., Spirito, A., Kahler, C. W., Hunt, J., & Monti, P. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0026074 · Cited by 254 · cited 1× · see citing works
“Of those reflected in the literature, most take place in outpatient,(3,4) home,(5) or inpatient settings.(6) Evidence indicates that family processes are critical to adolescent suicidal interventions(3,7,8); however, access and delivery of treatment can be problematic.”
BackgroundAsarnow, J. R., Baraff, L. J., Berk, M., Grob, C. S., Devich-Navarro, M., Suddath, R., Piacentini, J. C., Rotheram-Borus, M. J., Cohen, D., & Tang, L. (2011) · Psychiatric Services · doi:10.1176/ps.62.11.pss6211_1303 · Cited by 251 · cited 6× · see citing works
“The authors20 developed the family-based crisis intervention (FBCI) based on their clinical observations of suicidal adolescents and their families in the ED.”
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What Works in Youth Suicide Prevention? A Systematic Review and Meta-Analysis
Robinson, J., Bailey, E., Witt, K., Stefanac, N., Milner, A., Currier, D., Pirkis, J., Condron, P., & Hetrick, S. (2018) · EClinicalMedicine · doi:10.1016/j.eclinm.2018.10.004 · Cited by 242 · see citing works
Suicide and Suicide Risk in Adolescents
Hua, L. L., Lee, J., Rahmandar, M. H., Sigel, E. J., COMMITTEE ON ADOLESCENCE, & COUNCIL ON INJURY, V. (2024) · Pediatrics · doi:10.1542/peds.2023-064800 · Cited by 205 · see citing works
Interventions for self-harm in children and adolescents
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Safety Planning Interventions for Suicide Prevention in Children and Adolescents
Albaum, C., Irwin, S. H., Muha, J., Schumacher, A., Clarissa, S., Finkelstein, Y., Bridge, J. A., & Korczak, D. J. (2025) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2025.1012 · Cited by 28 · see citing works
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- Authors
- Wharff, E. A., Ginnis, K. B., Ross, A. M., White, E. M., White, M. T., & Forbes, P. W.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Wharff, Elizabeth A.
- Ginnis, Katherine B.
- Ross, Abigail M.
- White, Erina M.
- White, Matthew T.
- Forbes, Peter W.
- Venue
- Pediatric Emergency Care
- Published
- 2019-03
- Volume
- 35
- Issue
- 3
- Pages
- 170-175
- ISSN
- 0749-5161 (ISSN-L)
- 1535-1815
- OpenAlex
- W2592501324
- Cited by
- 76
- References
- 5
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 9 · 2023: 13 · 2022: 3 · 2021: 13 · 2020: 5 · 2019: 3 · 2018: 3
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pediatric Emergency Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- adolescent suicide, suicidal adolescents, family empowerment, client satisfaction, outpatient follow-up, inpatient psychiatric hospitalization, suicide prevention
- MeSH terms
- Recidivism, Suicide Prevention, Adolescent, Adolescent Behavior, Crisis Intervention, Emergency Service, Hospital, Family, Female, Follow-Up Studies, Hospitalization, Humans, Male, Parent-Child Relations, Patient Discharge, Suicide, Patient Satisfaction
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