The central goal of this study is to determine whether an intensive family- and home-based treatment (i.e., Crisis Family Preservation) is a more effective and less costly strategy than psychiatric hospitalization for addressing the mental health emergencies of adolescents with SED. Thus, this study directly addresses the widely held concern that children's mental health services have overrelied on expensive and restrictive inpatient treatments. Furthermore, the proposed study builds directly on the accomplishments of CASSP supported research and the Public-Academic Liaison initiative on formulating mental health policy and services in the state of South Carolina. Specifically, this study includes a 2 (treatment condition; Crisis Family Preservation vs. hospitalization for crisis stabilization) x 5 (time of assessment: within 24 hours of referral, post hospitalization, post family preservation, and 6- and 12-month follow-ups) design, with random assignment of yoked subjects to treatment conditions. Participants will include 252 12- to 17-year-old adolescents with SED referred to the project by the Crisis Stabilization program of the Charleston-Dorchester Community Mental Health Center. Youths will be presenting severe mental health problems such as homicidal intent, suicidal intent, serious affective disorder, or psychosis. A comprehensive multimethod, multisource evaluation will address the following questions: 1. """"""""To what extent does Crisis Family Preservation services prevent hospitalization and reduce the symptoms precipitating the crisis?"""""""" 2. """"""""Over the long-term (i.e., 12 months), to what extent does Crisis Family Preservation maintain reductions in identified symptoms; ameliorate the family, peer, and community problems associated with such symptoms; and prevent subsequent institutional placement?"""""""" 3. """"""""What factors moderate or mediate therapeutic outcome?"""""""" 4. """"""""What are the comparative financial costs of the treatment conditions?""""""""
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