(PS5-C60) Characterizing Clinician Confidence Working with High-risk Individuals in Crisis Settings

Background: Community crisis services (i.e., mobile clinicians who deploy to individuals in need to de-escalate acute crises) are cost-effective, minimally restrictive alternatives to hospitalization for clients experiencing behavioral health crises. However, we know little about the implementation supports clinicians in these settings may need to optimize care. To begin to address this gap, we surveyed crisis clinicians about their confidence working with various high-risk clinical presentations and examined predictors of greater confidence.

Methods: We surveyed 42 Philadelphia-based mobile crisis clinicians (74% female; age M = 39.4 years, SD = 11; 40.5% White, 16.7% Black, 7.1% Asian, 7.1% Hispanic/Latinx) about their confidence in identifying and assessing risk and intervening with individuals experiencing: suicidal ideation (SI), SI with a plan or intent to act, suicidal behavior (SB), non-suicidal self-injury, homicidal ideation, extreme physical aggression, acute psychotic episode, and drug/alcohol use. Clinicians rated their confidence with all populations using an established 7-point scale (1 = not at all confident, 7 = very confident). Clinicians also reported on clinical and demographic characteristics.

Results:  Clinicians’ overall confidence in identifying/assessing risk varied; average confidence scores ranged from 4.93-6.07 across high-risk presentations. Clinicians reported the highest confidence in their ability to assess risk of SI (M = 6.07, SD = 0.77, range = 5-7) and lowest confidence in their ability to assess risk associated with drug/alcohol use (M = 4.93, SD = 1.09, range = 2-7). Overall confidence for intervention was lower than identification/assessment of risk, with average confidence scores ranging from 4.69-5.93. Clinicians again reported the highest confidence in their ability to intervene for SI (M = 5.93, SD = 0.73, range = 5-7) and lowest in their ability to intervene with drug/alcohol use (M = 4.69, SD = 1.14, range = 2-6). To explore variability in clinician confidence ratings, we examined whether clinician experience and primary clinical population were associated with higher confidence. A series of t-tests demonstrated that clinicians with more experience working with SI/SB tended to report higher confidence delivering interventions to high-risk clients than those with less experience (ps < .05). Compared to clinicians who worked mainly with adults, those who worked primarily with youth reported higher confidence in both assessing risk and intervening with all high-risk clinical presentations (ps < .05), except psychosis and drug/alcohol use.

Conclusions: Clinicians reported the lowest confidence related to assessing and intervening with clients using mobile crisis services because of drug or alcohol use, suggesting that implementation supports might be most needed in this area. Clinicians with less SI/SB experience and those who work primarily with adults may particularly benefit from additional supports to bolster their confidence working with high-risk populations.