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Date of Award


Degree Type

Dissertation (On-Campus Access Only)

Degree Name

Doctor of Psychology (PsyD)

Committee Chair

Jay Thomas

Second Advisor

Mark Nordlund

Third Advisor

Michel Hersen


The Crisis Stabilization Program (CSP) at Clackamas County Mental Health (CCMH) in Clackamas County, Oregon, is a hospital diversion program designed to help clients in acute psychiatric distress. Clients in CSP learn and practice stabilization skills with more frequent support and intervention than regular outpatient therapy. In order to optimize the utilization of CSP and outpatient services in general, and to prevent unnecessary psychiatric hospitalization, the current study investigated how clinicians within the CCMH system determine when to refer their clients, whether there is a significant problem with referral for inappropriate reasons, and whether there are cases when clinicians do not refer when CSP would be appropriate. A literature review highlighting the reasons clients are referred for crisis stabilization and describing the nature of hospital diversion programs in general is presented to provide a context for the current study. Participants in the study were clinicians selected from four outpatient programs at CCMH in which referrals currently are generated, and one outpatient program from which CSP receives no referrals. Results indicated that while there appear to be few problems related to referral to CSP for inappropriate reasons, the question of whether clinicians fail to make needed referrals requires more study. Implications of the study are discussed and recommendations rendered.