Evolution of Pediatric Suicide Screening in the Ambulatory Care Setting: Maximizing Technology

The identification of suicide risk in pediatric patients is a growing concern in ambulatory care. According to the CDC in 2022, suicide was the second leading cause of death for ages 10-14. At Yale New Haven Children’s Hospital Pediatric Specialty Centers (PSC), comprising of seven sites across Connecticut, our goal was to develop a standardized screening process to identify adolescents at risk.
Over the past 5 years in PSC, 70k children aged 12 years or older have been screened for depression utilizing the patient health questionnaire (PHQ). We have made many changes to optimize the workflow. Previously reliant on paper and verbal assessments, the screening process evolved to integrate confidential iPad technology, allowing adolescents to self-report sensitive information with greater privacy. Our iPad initiative was introduced in May 2024. This technological innovation has transformed the screening process, enabling earlier identification and intervention for at-risk adolescents.
With each change, a collaborative interdisciplinary team including clinical nurse leaders, educators, social workers, and IT specialists conducted a thorough review of the screening process. While the PHQ-9 tool effectively screened for depression, it was determined that a more comprehensive evaluation was necessary for assessing suicide risk. As a result, the Columbia Suicide Severity Rating Scale (CSSRS) was integrated into the workflow. Nurses were trained to administer the CSSRS, and an algorithm was developed to guide care planning for patients identified as at risk.
Adolescents flagged through the screening process undergo a complete suicide risk assessment by a licensed SW, who recommends further evaluation, treatment, or psychiatric admission. Telehealth technology was implemented to address SW resource limitations ensuring that patients identified at risk, regardless of their clinic location, receive timely, comprehensive risk assessments. Telehealth capabilities provide equitable access to mental health care across all pediatric ambulatory care specialty sites, ensuring a standardized approach to care.
The iPad technology significantly enhances patient safety by increasing reliability while maintaining confidentiality. Integrating self-administered screenings allows adolescents to self-report sensitive information with greater privacy. This initiative exemplifies how leveraging technology in clinical settings can improve outcomes for at-risk youth. Implementing the iPad questionnaire resulted in 236% increase in positive screenings and a 343% rise to question nine of the PHQ-9, indicating improved patient reliability. Identifying patients earlier enables us to provide immediate intervention such as additional resources, referral to the crisis hotline or a psychiatric evaluation.
This effort has empowered pediatric ambulatory care nurses to play a critical role in identifying and escalating care for at-risk patients. With improved reliability of PHQ-9 screening process and seamless integration of technology, nurses are now equipped to coordinate timely interventions and facilitate access to treatment. The integration of validated tools, technology, and training ensures early identification ultimately aiming to save lives and provide mental health resources. This collaborative approach ensures that adolescents in the ambulatory care setting receive the care they need while maintaining patient confidentiality and standardizing the quality of care across sites. The process not only enhances patient safety but also strengthens the role of ambulatory care nurses in providing holistic, patient-centered care.