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Implementing Universal Suicide Risk Screening in a Pediatric Hospital

      Background

      Health care providers are in a prime position to identify teens at risk for suicide, yet many do not. The research team developed and implemented a hospitalwide program to identify teens at elevated risk for suicide and connect them with services.

      Methods

      Screening was implemented at both locations of a pediatric hospital, including two emergency departments, three urgent care clinics, and ambulatory clinics. Patients aged 12 years and older presenting for care were screened for suicide risk using the Ask Suicide-Screening Questions (ASQ) in most settings, while the Columbia–Suicide Severity Rating Scale (C-SSRS) was used in mental health areas. A social worker responded to positive screens to complete a more thorough assessment and determine next steps. Social workers also completed outreach to patients in the weeks following a positive screen. Implementation began with pilot locations and expanded after refinements were made. Stakeholders provided screening recommendations, and education was provided prior to implementation. The cost of implementation was calculated based on the time screening required from nursing and social work.

      Results

      Review of the program focused on implementation fidelity, quality improvement, and trends among screening results. During the first year of screening, 138,598 screens were completed, and 6.8% of screens were positive for elevated risk. The annualized cost of the program was estimated to be $887,708.65 for personnel directly involved in screening and following up on positive screens.

      Conclusion

      Early involvement of stakeholders and hospital leaders and a robust response plan were essential to successful implementation of this suicide-screening program.
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      References

        • Ivey-Stephenson A.Z.
        • et al.
        Suicidal ideation and behaviors among high school students—Youth Risk Behavior Survey, United States, 2019.
        MMWR Suppl. 2020 Aug 21; 69: 47-55
        • Curtin S.C.
        • Heron M.
        Curtin SC, Heron M. Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017.
        . 2019; 10: 2000-2017
      1. Centers for Disease Control and Prevention, National Vital Statistics System, National Center for Health Statistics. 10 Leading Causes of Death by Age Group, United States— 2018. Accessed May 13, 2021. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_by_age_group_2018_1100w850h.jpg.

      2. The Joint Commission. Suicide Prevention. Accessed May 13, 2021. https://www.jointcommission.org/resources/patient-safety-topics/suicide-prevention/.

        • LeFevre M.L.
        U.S. Preventive Services Task Force. Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2014 May 20; 160: 719-726
        • Fowler K.A.
        • et al.
        Childhood firearm injuries in the United States.
        Pediatrics. 2017; 140e20163486
        • McKean A.J.S.
        • et al.
        Rethinking lethality in youth suicide attempts: first suicide attempt outcomes in youth ages 10 to 24.
        J Am Acad Child Adolesc Psychiatry. 2018; 57: 786-791
        • Ahmedani B.K.
        • et al.
        Health care contacts in the year before suicide death.
        J Gen Intern Med. 2014; 29: 870-877
        • Frankenfield D.L.
        • et al.
        Adolescent patients—healthy or hurting? Missed opportunities to screen for suicide risk in the primary care setting.
        Arch Pediatr Adolesc Med. 2000; 154: 162-168
        • Roaten K.
        • et al.
        Development and implementation of a universal risk screening program in a safety-net hospital.
        Jt Comm J Qual Patient Saf. 2018; 44: 4-11
        • Brahmbhatt K.
        • et al.
        Suicide risk screening in pediatric hospitals: clinical pathways to address a global health crisis.
        Psychosomatics. 2019; 60: 1-9
        • Ogrinc G.
        • et al.
        SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process.
        BMJ Qual Saf. 2016; 25: 986-992
        • Bradley-Ewing A.
        • et al.
        Parent and adolescent thoughts about suicide risk screening in pediatric outpatient settings.
        Arch Suicide Res. Epub. 2020 Dec 28;
        • Dazzi T.
        • et al.
        Does asking about suicide and related behaviors induce suicidal ideation? What is the evidence?.
        Psychol Med. 2014; 44: 3361-3363
        • Loeb D.F.
        • et al.
        Primary care physician perceptions on caring for complex patients with medical and mental illness.
        J Gen Intern Med. 2012; 27: 945-952
        • Gilbert A.L.
        • Rickert V.I.
        • Aalsma M.C.
        Clinical conversations about health: the impact of confidentiality in preventive adolescent care.
        J Adolesc Health. 2014; 55: 672-677
        • Gipson P.
        • et al.
        Columbia–Suicide Severity Rating Scale: predictive validity with adolescent psychiatric emergency patients.
        Pediatr Emerg Care. 2015; 31: 88-94
        • Horowitz L.M.
        • et al.
        Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department.
        Arch Pediatr Adolesc Med. 2012; 166: 1170-1176
        • Diamond G.
        • et al.
        Development, validation, and utility of internet-based behavioral health screen for adolescents.
        Pediatrics. 2010; 126: e163-e170
        • Boudreaux E.D.
        • et al.
        The Patient Safety Screener: validation of a brief suicide risk screener for emergency department settings.
        Arch Suicide Res. 2015; 19: 151-160
        • Folse V.N.
        • Hahn R.L.
        Suicide risk screening in an emergency department: engaging staff nurses in continued testing of a brief instrument.
        Clin Nurs Res. 2009; 18: 253-271
        • Osman A.
        • et al.
        The Suicidal Behaviors Questionnaire–Revised (SBQ-R): validation with clinical and nonclinical samples.
        Assessment. 2001; 8: 443-454
        • Olfson M.
        • et al.
        Suicidal ideation in primary care.
        J Gen Intern Med. 1996; 11: 447-453
        • Patel A.
        • et al.
        Universal adolescent suicide screening in a pediatric urgent care center.
        Arch Suicide Res. 2018; 22: 118-127
        • Bostic J.Q.
        Summer is the best time for Treatment of Resistant Depression In Adolescents (TORDIA): the importance of school in medication trials.
        J Am Acad Child Adolesc Psychiatry. 2011; 50: 1095-1097
        • Curtin S.C.
        State suicide rates among adolescents and young adults aged 10–24: United States, 2000–2018.
        Natl Vital Stat Rep. 2020 Sep 11; 69: 1-10
        https://stacks.cdc.gov/view/cdc/93667
        Date accessed: May 13, 2021
        • Inman D.D.
        Identifying the risk of suicide among adolescents admitted to a children's hospital using the Ask Suicide-Screening Questions.
        J Child Adolesc Psychiatr Nurs. 2019; 32: 68-72
        • Choi H.J.
        • et al.
        Establishing the role of honest broker: bridging the gap between protecting personal health data and clinical research efficiency.
        PeerJ. 2015 Dec 17; 3: e1506