The Use of Social Workers' Emergency Certificates and Factors Associated With Linkage to Services

Abstract

This research has the following specific aim: to measure outcomes of social work emergency certificates produced by a Mobile Crises Team to determine the effectiveness of these certificates at linking clients to services. Linkage to services is a programmatic goal and is achieved by ensuring clients receive adequate crisis and follow-up services as a result of emergency certificates. In doing so, risks of homicide, suicide, and grave disability are mitigated. The data come from 233 consecutive cases of emergency certificates employed by social workers to transport clients to the local emergency department for psychiatric evaluation and treatment. Data were gathered post-hoc by reviewing copies of each specific certificate and cross-referencing those certificates with an agency risk management report and an electronic data base that stores demographic data on all clients. Descriptive, bivariate, and multivariable analysis, such as cross tabulations and binary logistic regression, are used to analyze the data in this study. Outcomes include a linkage rate of 86%, with predictors of linkage including substance abuse, police involvement, health-related disorders, and suicidality. Data were then controlled to remove the effect of police-initiated referrals and referrals from rural locales. In both cases, suicide as justification for the referral was a negative predictor of linkage. Recommendations include improving follow-up on those with health-related disorders and responding to low rates of linkage for those with police involvement. Research recommendations include developing better definitions of suicide variable and better measurements of functional status, and using control groups and larger data sets.

Keywords:

• mobile crisis
• risk management
• crisis intervention teams
• emergency certificate
• program evaluation