Association of Outpatient Crisis Services with Emergency Department Revisits in Suicidal Youth

Background and Objective: Pediatric emergency department (ED) visits for suicidal ideation and behavior have increased substantially, highlighting the need for scalable outpatient interventions that reduce recurrent ED use. We tested whether referral to outpatient crisis services was associated with fewer mental health-related ED revisits, hypothesizing that referred youth would have lower revisit rates than those receiving usual community care. Methods: We conducted a quasi-experimental study of 3,125 youth presenting with suicidal ideation or behavior to a large academic childrens health system between October 1, 2023, and August 31, 2025. Youth were referred to outpatient crisis services or community treatment (usual care) based on slot availability and clinician discretion. Propensity score modeling balanced demographic, clinical, and prior treatment characteristics between groups. Results: Among 3,125 qualifying index ED visits, 763 (24.4%) youth were referred to crisis services and 461 (14.8%) received ≥1 crisis visit within 30 days. In intent-to-treat analyses, referral was associated with fewer mental health-related ED revisits at 90 days (adjusted incidence rate ratio [aIRR], 0.67; 95% CI, 0.56-0.81) and 180 days (aIRR, 0.68; 95% CI, 0.59-0.80). Associations were strongest among youth requiring short-term hospitalization (aIRR, 0.46; 95% CI, 0.36-0.58) and those with moderate-to-high suicide risk (aIRR, 0.49; 95% CI, 0.39-0.61). Findings were consistent in as-treated analyses. Conclusion: Outpatient crisis services were associated with substantially fewer mental health-related ED revisits among suicidal youth, with the largest reductions among youth with greater clinical acuity.