by Dominique Yarritu, LMFT

Although a Master's Degree in Counseling Psychology and Social Work require the completion of a class in crisis management, dealing with a full blown crisis as an associate can be daunting. As I have discovered through my work as a clinician with the Uplift Family Services Crisis Continuum of Service, it can be equally intimidating for professionals (school psychologists, counselors, and staff, doctors, psychotherapists, police officers) and parents.

There are evident crises when youth are visibly dysregulated, out of control, in extreme pain, unable to return to baseline, or in a state of grave disability, and at a risk for themselves and others. In these latter cases, the decision to write a 5150 hold is unequivocal. (For minors, a hold is technically a 5585, but everyone uses the “5150” language). However, the severity of a crisis can be difficult to assess when the youth has not mastered the vocabulary to express accurately what they are experiencing; or when a teenager describes their intent to self-harm or harm others with a dismissive or matter-of-fact demeanor. Many questions may surface such as how to evaluate the intensity of the youth’s symptoms, how to best intervene to help them de-escalate, and how to provide them and their families with the best support—in the moment, and in the days and months to come. This process can be compounded by concern for the youth’s mental health and the urgency to comply with the legal obligations to report danger to self and others.

In all these circumstances, the Crisis Continuum at Uplift Family Services can help. More than a crisis assessment service to the community, the Continuum is a three-fold process known as the Continuum of Crisis Service, which includes the Child and Adolescent Crisis Program (CACP), the Crisis Stabilization Unit (CSU) and the Community Transition Services (CTS) program. These three services “work together to help children recover from traumatic experiences in a safe and caring environment” (Uplift, 2017). Full-time and on-call clinicians (associate and licensed psychotherapists and social workers) are available around the clock on the Mobile Crisis Team to provide “intervention to children and teens . . . who are in acute psychological crisis” (Uplift, 2017). So how does it all work?

When someone calls the crisis line (a professional, a parent, a police officer, or sometimes a youth), they are connected via a call center to a clinician who runs through a comprehensive list of questions to understand the presentation, symptomology, safety concerns, and other pertinent items about the current event. For low risk situations, the crisis clinician can provide emotional support to the youth and caller and offer resources and consultation. However, if the clinician determines that the case presents a high risk to the safety of the youth and others, they initiate an in-person crisis intervention to evaluate these safety concerns. The crisis clinician may also consult with the mobile crisis team to consider how to best support the youth. On-site interventions are provided on school campus, at home, at hospitals, at the CSU if the family feels safe driving the youth to us, or anywhere the youth is located.

All the clinicians have been certified by Santa Clara County to write psychiatric holds. The response time varies depending on the location of the youth and the average duration of an intervention lasts two to four hours. Once on site, the team of clinicians meets with the youth, the professional who requested the intervention (if relevant), and the parents. Clinicians use this time with the youth to de-escalate the immediate crisis, evaluate the risk factors, identify coping skills and support systems, and decide how to best ensure safety. The on-site clinicians confer with each other first, and then with an Uplift consultant, to make a joint decision on the best outcome for the youth. The intervention can lead to safety planning in collaboration with the youth and the caregivers or to write a 5150 hold. In a situation where safety planning alone is indicated, the team offers referrals for ongoing support of the youth and the family. If the youth has Medi-cal coverage, they can be referred to Uplift services. Otherwise, referrals can be given if the youth’s family has private insurance. On the other hand, if the youth is put on a 5150 hold, the team organizes transport and transfer to the CSU at the Campbell campus for further psychiatric evaluation. It is important to note that if the youth needs to be medically cleared (the youth has physically hurt themselves), they must be transported to a hospital in the county before being admitted to the CSU.

The Crisis Stabilization Unit (CSU) is an around-the-clock service with nurses, clinicians, family specialists, and a psychiatrist on staff. If needed, this service is the second phase of the intervention and “is available for children and teens on a psychiatric hold who receive short-term emergency assessment and stabilization instead of going [directly] to the hospital” (Uplift, 2017). This second assessment is more in depth. It is performed by another clinician, a nurse, and a psychiatrist and includes a period of stabilization of a maximum length of less than 24 hours. After the visit with the psychiatrist, the team decides whether the youth needs to be on a longer hospitalization to ensure immediate safety or whether they can safely return home. Throughout their time at the CSU, the youth is fed, supervised, and provided crisis stabilization services. The team contacts, meets, and supports the parents during the second phase of the process. Similarly, if the youth has mental health services already in place, the CSU team communicates with these providers to gather additional information, work collaboratively to support the youth, and coordinate the next steps. If the youth has returned to baseline and shows no immediate risk of self-harm, suicide, or harm to others, the team meets with the youth and caregivers together to develop a viable safety plan for the youth to be released into the care of their parents or caregivers.

The last phase of the continuum of care consists in referrals to the Community Transition Services program that provides “skill development, parenting support, behavior analysis, access to ongoing community-based mental health services” (Uplift, 2017). However, only youth who benefit from full scope Medi-cal coverage are eligible for this service. Once they are enrolled in the CTS program, the youth and family work with the CTS team to develop a treatment plan to address any ongoing safety or behavioral concerns. This support consists of a “weekly child and family team meeting [to] ensure the appropriate services are being provided to the child or teen” (Uplift, 2017). This last phase of crisis intervention and support lasts up to 90 days. If ongoing therapeutic support is needed, the family is linked with the appropriate care.

I hope that this brief overview of the Uplift Crisis Continuum will provide clarification on the process of crisis intervention for children and teens. For consultations, requests for assessment, referrals, and interventions, contact (408) 379-9085 any time of the day, any day of the year.

Continuum of crisis care. (2017). Uplift Family Services. Retrieved from www.upliftfs.org

Dominique Yarritu is a newly licensed marriage and family therapist who focuses her practice on adults and couples using a psychodynamic and Jungian approach. She is a doctoral candidate at Pacifica Graduate Institute in Depth Psychology with an emphasis in Somatic Studies and is currently training in somatic experiencing. She is affiliated with Uplift Family Services where she works on-call at the Mobile Crisis Unit, assessing children and teenagers in crisis, and sees clients at Family Matters Counseling Services. She can be reached at dyarritu@familymatters.expert.