Alternative First Responder Models Can Help Youth in Crisis

Youth across the country are facing an urgent mental health crisis. Experts like the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association have declared this a national emergency, and research has shown an increased number of youth being hospitalized for mental and behavioral health needs.

When youth use emergency departments to address mental and behavioral health crises, this is a strong indication that community-based solutions are not accessible. Thus, experts such as the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association have called for action from state and local policymakers to increase the availability of a continuum of crisis and behavioral health services for young people, including school-based initiatives, primary care and telehealth options, culturally specific approaches, first response models, and community-based care.

Expanding mental and behavioral health resources for youth will not only increase access to care and decrease hospitalizations, it will also keep youth from experiencing the juvenile justice system as a result of their behavioral health needs. Research shows that youth with behavioral health needs are overrepresented in the juvenile justice system—70 percent of youth have a diagnosable mental health condition within the system. Many juvenile justice leaders have responded by calling for and integrating more mental health supports.

In response to this critical need, jurisdictions are trying new approaches to meet youth’s behavioral health needs in the community and simultaneously divert youth with behavioral health needs from the juvenile justice system. Diversion can include making community-based services more accessible to avoid juvenile court altogether. It can also involve conducting screening and assessments at intake, if a youth is referred to court or is detained, to see if a young person’s needs may be more appropriately addressed in a treatment context.

Some jurisdictions are going further by developing alternative first response options that center health care for youth in crisis. Examples include mobile crisis response teams, community assessment centers, credible messengers, and school-based initiatives.

The Importance of New Approaches

Establishing alternative first response options can create meaningful and long-term positive outcomes for safety and stability for youth and the community while addressing their behavioral health needs. For example, an evaluation of a youth mobile crisis model demonstrated a 25 percent reduction in subsequent emergency department visits.

States and counties stress that youth with behavioral health needs are a primary concern for their juvenile justice systems as they watch youth bounce between detention, hospitals, and the community without continuity of care. This leaves youth without consistent care, which can lead to further deterioration of their mental and behavioral health.

Further, across many juvenile justice systems, nonviolent offenses make up the vast majority of referrals to court. Developing alternative responder models and diversion policies can help keep youth in school and the community and out of the justice system for low-level offenses that are rooted in family conflict and behavioral health needs. These new approaches also directly respond to youth’s issues as health concerns rather than as public safety issues.

States Making Progress

Over the past few years, a number of states, counties, and school districts have developed new approaches to address youth’s behavioral health crises, such as statewide school-based mental health frameworks, youth mobile crisis responses, school-based conflict mediation with credible messengers, and others.

Examples of states that have implemented new alternative responder models and diversion efforts include the following:

• Colorado: The Community Assessment Program provides early intervention screening and connects youth to services. Anyone can make a referral, and the center will conduct the assessment in the community as well as short-term follow-up and case planning support.
• Connecticut: Mobile Crisis Intervention Services provides interventions for youth experiencing a crisis. Youth, family members, or professionals can call to dispatch a clinician for crisis support, and the clinician will meet youth anywhere in the community and continue to work with them for up to six weeks to develop a long-term care plan.
• Massachusetts: Mobile Crisis Intervention maintains a 24/7 hotline for children and families, conducts assessments, and coordinates care among a range of providers and community organizations. The School Mental Health Consortium provides comprehensive mental health services, supports, and responses to students.
• Nevada: Children’s Rural Mobile Crisis Response Team partners with detention centers, schools, and hospitals to provide telehealth crisis supports and aftercare.
• New Jersey: Mobile Response and Stabilization Services are for youth under 21 years old experiencing a crisis. Family members and professionals can request immediate stabilization services 24/7 from a clinician; up to eight weeks of follow-up are included.
• North Dakota: Recently passed legislation created the Children in Need of Services system that serves youth with unruly behaviors outside of juvenile court and required school-based diversion policies to divert youth from the justice system.
• Oklahoma: Youth Crisis Mobile Response supports community stabilization with youth up to 25 years old by providing crisis services and follow-up after the event via teams made up of peers and paraprofessionals with deep community ties.
• Wisconsin: The state’s School Mental Health Framework includes a range of components to build and sustain school mental health systems and support youth in schools with trained professionals.

To be most effective, these new approaches should be applied systemically via policy change. Otherwise, alternative responder models can become one-off programs that are only available to select youth, which often exacerbates inequities across race and ability. Also, as new approaches are designed, it is critical that they center and advance equity. One way to do this is to ensure that people whose experiences and backgrounds are similar to the young people being served inform the work and drive decision-making.