Wasserman Gail A, Elkington Katherine S, Robson Gail, Taxman Faye
Department of Psychiatry, College of Physicians and Surgeons Columbia University, New York, USA.
Columbia University and New York State Psychiatric Institute, 40 Haven Avenue, Kolb Annex Rm 273, New York, NY, 10032, USA.
Health Justice. 2021 Nov 29;9(1):36. doi: 10.1186/s40352-021-00164-4.
Justice-involved youth have high rates of suicidal behavior and co-morbid psychiatric disorders, yet low rates of service use. Implementation efforts aimed at supporting cross-agency linkage protocols may be useful components of interventions promoting behavioral healthcare service access for youths on probation. The purpose of this study was to develop clear referral Pathways for three suicide risk classifications of youth, across 10 counties in a single state through a community-academic partnership in New York state, a strategic planning process between county Probation departments and community Behavioral Health.
We sought to clarify service destinations for youth in three classes of risk for suicidal behavior: Class I (Crisis, Imminent Risk); Class II (Crisis, Non-Imminent Risk); and Class III (Non-Crisis but in Need of Service). Prior to Pathway Meetings, there was a low degree of agreement between Probation and Behavioral Health leadership for the appropriate service destination for youths in crisis, whether at imminent risk (Class I: 57.8% overlap) or at lower than imminent risk (Class II: 45.6% overlap). Options for referral destinations for Classes I and II decreased significantly (indicating greater overlap) as a result of Pathway Meetings [(Class I: from 2.5 to 1.1 (t = 3.28, p < 0.01); Class II: from 2.8 to 1.3 (t = 4.025, p < 0.003)]. Pathway Meetings allowed Behavioral Health and Juvenile Justice systems to make joint decisions regarding referral pathways, resulting in innovative solutions, such as the use of mobile crisis.
The community-academic partnership served to bring internal (Juvenile Justice) and external (Behavioral Health) contexts together to successfully generate agreed upon Pathways to care for youths demonstrating risk for suicidal behavior. Bridging Behavioral Health and Juvenile Justice systems together to agree to referral Pathways for each risk class can increase appropriate service use.
ClinicalTrials.gov , NCT03586895 . Registered 21 June 2018, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=Edit&listmode=Edit&uid=U0003B7I&ts=4&sid=S00080NN&cx=-n4kinh.
涉及司法事务的青少年自杀行为和共病精神障碍发生率较高，但服务利用率较低。旨在支持跨机构联系协议的实施工作可能是促进缓刑青少年获得行为医疗服务的干预措施的有用组成部分。本研究的目的是通过纽约州的社区 - 学术伙伴关系，即县缓刑部门与社区行为健康之间的战略规划过程，为该州10个县的三类自杀风险青少年制定明确的转诊途径。
我们试图明确三类自杀行为风险青少年的服务去向：第一类（危机，紧迫风险）；第二类（危机，非紧迫风险）；第三类（非危机但需要服务）。在转诊途径会议之前，缓刑部门和行为健康部门领导对于处于危机中的青少年（无论是处于紧迫风险（第一类：重叠率57.8%）还是低于紧迫风险（第二类：重叠率45.6%））的适当服务去向的意见一致性较低。由于转诊途径会议，第一类和第二类的转诊目的地选项显著减少（表明重叠度更高）[（第一类：从2.5降至1.1（t = 3.28，p < 0.01）；第二类：从2.8降至1.3（t = 4.025，p < 0.003）]。转诊途径会议使行为健康系统和青少年司法系统能够就转诊途径做出联合决策，从而产生了创新解决方案，例如使用移动危机干预服务。
社区 - 学术伙伴关系有助于将内部（青少年司法）和外部（行为健康）环境结合起来，成功生成商定的途径，以照顾有自杀行为风险的青少年。将行为健康系统和青少年司法系统联系起来，就每个风险类别商定转诊途径，可以增加适当服务的使用。
ClinicalTrials.gov，NCT03586895。于2018年6月21日注册，https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=Edit&listmode=Edit&uid=U0003B7I&ts=4&sid=S00080NN&cx=-n4kinh。
