Innovative and Collaborative Suicide Risk Screening in Ambulatory Care Pediatrics

There is a national mental health crisis that has been accelerated by the COVID-19 pandemic. According to the CDC, in 2020 suicide was the 2nd leading cause of death for ages 10-14. In 2018-2019, in adolescents aged 12-17 years old, 8.8% seriously considered attempting suicide, 15.7% made a suicide plan, 8.9% attempted suicide, and 2.5% made a suicide attempt requiring medical treatment. The pediatric specialty centers (PSC) have optimized the screening process and evaluation of at-risk youth in the ambulatory care setting, prompting early intervention and potentially preventing significant injury or death by suicide.
The PSC consists of six ambulatory care sites throughout Connecticut. Three years ago, the PSCs began screening children aged 12 and older for depression and suicidal ideation. Worsened by the pandemic, there has been a stark increase in the number of children identified as at-risk for suicide who have required further assessment by a medical professional. A complete suicide assessment is completed by a social worker to determine the need for further evaluation, treatment, or psychiatric admission to an accredited mental health facility. Currently, not all PSC sites have a social worker present onsite and clinical nurses at these locations have requested more support and resources. A collaborative team of nursing staff, leaders, educators, social workers, and IT specialists has worked to develop a streamlined screening process to identify and assess children at-risk.
The first step involved a process change and training of clinical nurses to administer the Columbia-Suicide Severity Rating Scale (CSSR-S) screening tool. From July to October 2022, nurses used the CSSR-S tool to identify 29 pediatric patients who were screened as either low, moderate, or high risk for suicide. Of the 29 patients, 14 patients (nearly 50%) screened as moderate or high risk for suicide; eight were assessed by an onsite social worker and discharged home with a safety plan in place. The remaining six patients were cared for at locations without an onsite social worker. For five of these patients, nurses contacted the on-call social worker to receive guidance by phone. The five patients were discharged home with instructions and a list of crisis resources in the event the patient’s situation were to change or warrant further intervention. One patient, however, was transported via ambulance to the emergency room, received a psychiatric evaluation, and was then discharged home. This reinforced the importance and need for access to a social worker at all PSC sites.
The dedicated interdisciplinary team worked collaboratively to implement an innovative new telehealth process for locations without onsite social workers. Through a video visit conducted on a tablet device, social workers now provide a live telehealth mental health assessment for patients screened as moderate or high suicide for suicide, providing the same level of care across all six PSC sites. Since the rollout of telehealth assessments on November 7, 2022, ambulatory care nurses now feel empowered to screen children, coordinate assessments, and manage the care of this most vulnerable pediatric patient population.