Evaluation of the efficacy of a brief mental health crisis intervention for adolescents

The research project aims to evaluate the effectiveness of a Brief Crisis Intervention for Adolescents who present to the Monash Health Early in Life Mental Health Service (ELMHS) with recent suicidal behaviour/plan or deliberate self-harm (within the past 2 weeks). This intervention is offered to young people and their parents/carers as part of routine mental health care by mental health clinicians within the ELMHS Intake, Assessment, Consultation and brief Treatment (iACT) team at the ELMHS Dandenong site - Community Services Building. All mental health clinicians within the iACT Team are health practitioners who have training and experience in assessment and treatment of mental health conditions in children, adolescents and youth, including mental health crisis presentations. These clinicians include certified psychologists, social workers, occupational therapists, medical practitioners, and consultant psychiatrists who are at a Grade 2 category of employment or higher. Young people (aged 12 to 18 years) and their parents/carers who agree to participate in the Brief Crisis Intervention for Adolescents as part of the young person’s routine care, will also be invited to participate in this research study. The primary treatment goals of the intervention are: To reduce reoccurrence of suicidal/self-harm behaviour and to increase coping with stressors that can trigger suicidal crises. The iACT brief crisis intervention is provided over a total of 4-5 sessions, with sessions ideally administered on a weekly basis. This intervention consists of initial, middle and end phases of acute treatment. Each session commences with a risk assessment and broad review, so that revisions may be made to the crisis plan as required. Sessions will generally be allocated in the following order: 1. Assessment Session (90-120 mins) 2. Initial Treatment phase (1-2 sessions – 60-90 mins) 3. Middle Treatment Phase (2-3 sessions – 60 mins) 4. End Treatment Phase (1 session – 60 mins) Each phase consists of the following core tasks: 1. Initial Treatment Phase – Psychoeducation, safety planning and shared narrative/case formulation 2. Middle Treatment Phase – Selective individual skill building modules and family intervention modules. 3. End Treatment Phase – Relapse prevention The iACT brief crisis intervention is a semi-structured treatment. Thus, individual and family modules are collaboratively chosen by the individual, family and clinician at the end of the initial treatment phase. Selection of the modules is based on relevance to the individual formulation and predicted effectiveness regarding risk reduction. Individual skill building treatment modules from the middle phase of treatment can include: self monitoring skills; emotional regulation skills; problem solving skills (around identified stressors); mobilising social supports; behavioural activation; communication skills; thought-based strategies and goal setting skills. Family treatment modules include: enhancing parental emotional reflection skills; strengthening family relationships; and family communication skills. The relapse prevention focus of the final stage of treatment involves: reviewing the crisis event; reviewing the crisis event with skills learned through current treatment; reviewing future high-risk scenarios and engaging in planning around how these may be most effectively managed; debriefing around the therapy experience and engaging in planning around recommended follow up supports. Family involvement in all aspects of the young person's treatment can be flexibly planned. Therefore, parents may join the young person for parts of their treatment sessions or participate in entire sessions with the young person at the clinician’s discretion. Additional family phone ‘check ins’ (5-15 minutes per/week) may be offered at clinician’s discretion. These will not be considered as treatment sessions. Treatment Fidelity/Adherence Measures: Mental Health Clinicians providing this brief crisis intervention to young people and their carers, as part of the young person's routine mental health care, will have had orientation to the 'Treatment Fidelity ­Guiding Document'. This guideline aims to define the minimum therapeutic tasks that should be covered in each treatment stage and selected treatment module to support consistency of the intervention. This aims to ensure that the treatment is implemented as planned and that each component is delivered in a comparable manner to all participants Clinicians who are providing this routine brief crisis intervention package to young people who have consented to participate in the current research evaluation project will complete a Treatment Fidelity Session Checklist at end of each session that helps document therapeutic tasks covered each session. Clinicians will also be required to have several of their client’s full series of therapy sessions audio recorded, where a research investigator will rate these recorded sessions in relation to treatment adherence. A random selection method will be utilised for selecting clinician’s clients within the study to request consent for this audio-taping process. The number of sessions recorded will equate to 15-20% of the total number of treatment sessions delivered to all participants group. This recording process is voluntary. If a participant does not want their treatment sessions to be recorded, they do not have to be.