Implementation and outcomes of a brief crisis intervention for adolescents with borderline personality features: a pre-post observational study

TL;DR

A brief crisis intervention called Gold Card SA was tested for adolescents with borderline personality features, showing reduced emergency visits and improved mental health outcomes.

Contribution

This study evaluates the implementation and outcomes of a new brief crisis intervention model for adolescents with borderline personality features in real-world mental health settings.

Findings

Emergency department visits dropped by 90% in the 6 months after the intervention.

Adolescents showed significant reductions in perceived burdensomeness and psychosocial dysfunction.

Older adolescents (16–17 years) also reported reduced borderline symptoms and lower self-harm likelihood.

Abstract

Suicide is one of the leading causes of death among young people. Borderline personality features have been identified as a risk factor for suicide-related behaviour among adolescents. Targeted brief interventions may facilitate early identification and intervention.

A single-group pre-post observational study design examined implementation of a brief crisis intervention (Gold Card SA) for adolescents aged 12–17 years-of-age, delivered in outpatient hospital and community mental health settings. The intervention offered up to three weekly psychologically focussed sessions to explore goals and values, provide psychoeducation and develop a collaborative care plan. A fourth session was offered to the adolescent’s nominated support person. We examined patient-reported outcome measures collected at the first and final appointment and service outcomes (e.g., acute mental-health service utilisation comparing the 6-months pre- and postintervention). We also considered our findings in light of early implication indicators such as acceptability, appropriateness, fidelity, penetration and sustainability.

One-hundred and fifty-five adolescents consented for their outcomes to be evaluated (12–15-year-olds n = 46; 16–17-year-olds n = 109). Borderline features were high among adolescents attending their initial Gold Card SA appointment. The incidence of emergency department presentations in the 6-months postintervention was 90% lower relative to the 6-months beforehand (95% CI [0.05, 0.18]; p < .001). Adolescents who completed the intervention demonstrated a significant reduction in perceived burdensomeness (12–15 years, dav = 0.31, p = .001; 16–17 years old, dav = 0.51, p < .001) and psychosocial dysfunction (12–15 years, dav = 0.31, p = .006; 16–17 years old, dav = 0.31, p = .01). Adolescents aged 16–17 years also reported significant reduction in borderline symptom severity (dav = 0.89, p < .001) and the likelihood of engaging in deliberate self-harm (Exp (B) = 0.86, p = .03) pre- and postintervention.

A brief intervention model such as Gold Card SA, embedded within a public mental health setting, may support adolescents and their families during crisis. Screening for borderline personality features at this time may facilitate early intervention whereby at-risk adolescents are offered additional intervention via a broader stepped model of care.

Not applicable.

The online version contains supplementary material available at 10.1186/s12888-026-07871-y.

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