# 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.

## Key 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.