Strengthening Families Through Crisis Management: High-Risk Children and Familial Support

Introduction

A crisis is characterized by an overwhelming event or critical incident that results in psychological imbalance and behavioral, physiological, or physical symptoms that affect a person's coping strategies (Kalafat et al., 2007). A crisis “is perceived as overwhelming despite the use of traditional problem-solving and coping strategies” (DiTomasso & Martin as cited in Kavan et al., 2006, p. 1159). Factors such as parental stress, poverty, and substance abuse place children and youth at risk of imminent harm (Child Welfare Information Gateway, 2019; Psychologenie, 2007). Children and adolescents who experience victimization such as physical, emotional, or sexual abuse, exploitation, neglect, and bullying may experience negative long-term psychological, physical, and behavioral consequences (Child Welfare Information Gateway, 2019). The long-term sequelae of abuse can contribute to psychological symptoms of trauma, depression, anxiety, impairment in cognitive functioning, and the lack of ability to form healthy attachments. Risk factors that increase the likelihood of experiencing a crisis include having a prior history of self-harm behaviors, passive or active suicidality, or family history of suicidality, depression, or other psychiatric illnesses, alcohol/substance use, behavioral problems, access to weapons or lethal methods, a history of bullying and cyberbullying, and passive or active homicidal behaviors (O’Riordan et al., 2023; Sadock, 2005).

Suicide is the second leading cause of death in children aged 10-14 (Center for Disease Control and Prevention, 2023). In 10 years (2008-2018), suicide attempts and deaths doubled among 13- and 14-year-olds (Young, 2023). An estimated 15% of all suicides occur among youth and young adults ages 10-24 years. Trends of suicidal behaviors in high school students in the United States between 1991 and 2017 found that one in five adolescents have thoughts of suicide (Lindsey et al., 2019). According to Lindsey and colleagues, students with a suicide plan are at risk of suicide completion. Suicide attempts and injuries were higher among Black adolescents. According to these authors, Black adolescents exhibited a significant increase in suicidal injuries compared to American non-Hispanic Asian, American Indian/Alaska Native adolescents. Compared to adolescent boys, girls showed a decrease in suicide attempts across all other races and ethnicities.

Suicide attempts are considered a psychiatric emergency, which is defined as something that poses a significant threat to the individual or others and whose symptoms require immediate medical attention. Yearly, millions of people visit the emergency department for psychiatric emergencies. Cushing et al. (2023) reported that between 2015-2020, emergency room visits for psychiatric issues in children’s hospitals increased by 8% annually, and revisits increased by about 6% annually. Emergency rooms are commonly used as primary sources of emergency support for children and families who are experiencing a life-threatening situation resulting from psychiatric emergencies. Emergency departments in U.S. hospitals for children and adolescents ages 17 and under continue to be a significant resource for pediatric emergencies (Radhakrishnan & et al, 2022). The CDC (2022) estimates that emergency room visits for self-harm are higher among youth and young adults than middle-aged adults. Thus, it is critical that medical personnel and clinicians are trained in crisis intervention and the treatment of children and adolescents. Medical personnel and clinicians serve an important function in parental education and initial support that can help parents navigate through crisis situations and better support their children and adolescents.