23-Hour Youth Crisis Center

Adolescents and young adults ages 10 to 24 are experiencing increased behavioral health challenges, including depression, anxiety, self-harm, suicidality, and overdose risk.ii At the same time, behavioral health systems face workforce shortages and limited capacity for community-based care, resulting in increased reliance on emergency departments and inpatient hospitalization.iii These high-acuity settings are often not the most appropriate or supportive environments for youth experiencing moderate-intensity behavioral health crises.iv

SAMHSA’s National Guidelines for Child and Youth Behavioral Health Crisis Care emphasize the importance of a comprehensive crisis care continuum that includes a safe place for help, such as a Crisis Observation and Stabilization Services (COSS) where clients can stay up to 23 hours and 59 minutes.v A 23-hour COSS operates 24/7/365 and provides short-term stabilization, assessment, and connection to ongoing care for individuals whose acuity does not require hospitalization.

Despite evidence that these services reduce unnecessary hospitalization and improve outcomes, Jefferson County currently lacks a youth-focused 23-hour COSS that provides care to children, adolescents, and young adults (ages 0-24). This project sought to address that gap by engaging youth, caregivers, and professionals in planning a youth-centered 23-hour COSS for Louisville.

This project was guided by community-based participatory research, implementation science, and rapid qualitative analysis. Two primary strategies were used. First, the research team conducted a rapid Community Health Needs Assessment between February and December 2025, completing 66 interviews with youth (6), caregivers (7), and professionals (53) across Louisville’s crisis care continuum. Interviews explored behavioral health experiences, gaps in crisis services, appropriate utilization of a youth 23-hour COSS, service and design needs, post-crisis connections, and evaluation priorities. 

Second, the research team convened participatory planning groups to translate findings into actionable recommendations. The Youth Advisory Council and Young Adult Advisory Board provided lived-experience perspectives on services, design, and education. A multidisciplinary professional workgroup met to define client profiles, services and operations, post-crisis pathways, data metrics, and phased implementation strategies. Data were analyzed thematically and organized around core planning domains critical to 23-hour COSS development. 

• The youth 23-hour COSS is needed in Louisville.
• The youth 23-hour COSS should provide services for a wide range of behavioral health crises.
• The acuity of client’s crisis informs 23-hour COSS design, operations, and utilization.
• A low-barrier, moderate intensity youth 23-hour COSS is the best evidence-based model to get started.
• The youth 23-hour COSS should provide time-limited stabilization and connections to continued care.
• The youth 23-hour COSS should have interdisciplinary staff and align with client needs.
• The youth 23-hour COSS access should be available via walk-ins, first-responder drop-offs, and referrals.
• Strong partnerships must be formed and sustained to ensure timely and appropriate transitions to ongoing care.
• The youth 23-Hour COSS’s success is multifaceted.
• Evaluation is needed to monitor implementation and outcomes, and to inform growth.
• Innovations in data-sharing practices are needed to enhance continuity of care for clients.
• Transportation barriers must be overcome to enhance access.
• A centralized and accessible location can enhance utilization.
• The youth 23-hour COSS should cultivate a home-like, age-appropriate environment.
• A multi-agency collaboration is key to long-term success and sustainability.
• Widespread awareness and education campaigns are vital for youth 23-hour COSS utilization.
• Education campaigns should utilize trusted messengers and be coordinated across community partners.

This project identified a critical gap in Louisville’s youth behavioral health crisis care continuum and strong community support for developing a youth-centered 23-hour COSS. Through engagement with youth, caregivers, and professionals, the project produced a shared vision for a moderate-intensity, community-based crisis center available 24/7/365 and regardless of insurance, that prioritizes safety, stabilization, dignity, and connection to ongoing care. The findings provide a clear, community-informed foundation for phased implementation and a report card that allows community partners to monitor and evaluate implementation. The phased plan is available in the full report and presents key building design, operations, personnel, services, collaborations, data sharing/monitoring, and outcomes for the youth 23-hour COSS that should be in place when a youth 23-hour COSS opens, with additional features being added to the space over time. To request a copy of the executive summary or full report, please contact the authors using the contact information below. 

ii Keyes, K.M., Gary, D., O’Malley, P.M. et al. (2019). Recent increases in depressive symptoms among US adolescents: trends from 1991 to 2018. Soc Psychiatry Psychiatric Epidemiol, 54. https://pubmed.ncbi.nlm.nih.gov/30929042/  
iii Hoge M.A., Vanderploeg, J., Paris, M. Jr., Lang, J.M., & Olezeski, C. (2022). Emergency department use by children and youth with mental health conditions: a health equity agenda. Community Ment Health J., 58, 7. https://pubmed.ncbi.nlm.nih.gov/35038073/  
iv Substance Abuse and Mental Health Services Administration. (2025). National Guidelines for Child and Youth Behavioral Health Crisis Care. SAMHSA. https://www.samhsa.gov/mental-health/national-behavioral-health-crisis-…;
v Substance Abuse and Mental Health Services Administration (2025). Model Definitions for Behavioral Health Emergency, Crisis, and Crisis-Related Services. HHS Publication No. PEP24-01-037: Substance Abuse and Mental Health Services Administration.