We report on 48 adolescents who were admitted consecutively for emergency hospitalization evaluation. These evaluations were specifically requested by members of the community (police, urgent care physicians, nurses, teachers, or family). The adolescents were aged 12 to 18 years, with a modal age of 16.5 years. Twenty-two males and 26 females were assessed in the study reported here. The adolescents were evaluated by master's-level clinical social workers, who were supervised over the telephone by a licensed independent social worker and a general psychiatrist. All adolescents who had taken overdoses were first treated medically in the urgent care facility. The mental health assessments were done in the urgent care facility at the request of the physician. In the facility, adolescents can be helped for up to 24 hours, if medically necessary. Semistructured interviews and mental status examinations were conducted for all individuals by the clinical social workers employed by the agency.
The interviews included a suicidal risk assessment tool that was developed by a hospital utilization management advisory workgroup for the Ohio Department of Mental Health (unpublished scale, ODMH, 1998). The suicidal risk assessment tool used 5-point Likert scales to rate suicidal plan, support, previous suicide attempts, stressors, reality testing, acceptance of help, disorganization of thought processes, and presence of medical problems. A homicidal risk assessment tool (unpublished scale, ODMH, 1998), provided as part of the department's recommended forensic assessment materials, was also completed. The homicidal risk assessment tool used 5-point Likert scales to rate verbal threats of violence, temper outbursts, availability of interventions, and history of arrests. Both ODMH instruments can be obtained by writing to ODMH, Office of the Medical Director, 30 East Broad Street, Columbus, Ohio 45215-3430.A Global Assessment of Function score was determined (4). The Brief Psychiatric Rating Scale also was completed (5). The Crisis Triage Rating Scale was then completed by the clinical social workers employed by the agency (6,7). This scale consists of three subscales—dangerousness, support system, and ability to cooperate—which have been empirically validated for use among adults and adolescents as a supplement to help with the decision about whether or not to hospitalize a psychiatric patient.After consulting with one of the general psychiatrists by telephone after the initial evaluation, the clinical social worker attempted a supportive, reality-based, present-focused therapeutic intervention at the time of the emergency assessment. In some cases the clinical social worker returned a second time to the urgent care facility to reevaluate the status of the adolescent within 24 hours. After this intervention the adolescent was either hospitalized psychiatrically or referred to one of several types of outpatient programs with immediate intensive case management.