Suicide Risk Screening and Assessment in Pediatric Specialty Clinics

Purpose: The purpose of this work was to implement a standard process for pediatric suicide risk screening and assessment in the ambulatory care specialty and primary care clinics to appropriate resources across the organization.
Background/significance: A health care regulatory agency requires and a national suicide prevention organization recommends that all medical patients in all medical settings be screened for suicide risk. Suicide ranks as the second leading cause of death among young people ages 10-24 and is the leading cause of death among youth in Washington state. Few ambulatory care pediatric specialty organizations have implemented an organizational wide suicide risk screening tool.
Description: Suicide risk screening was initially implemented in the organization’s emergency department and inpatient units in 2019. For the implementation into ambulatory care specialty clinics and primary care clinic, a multidisciplinary team was formed with members from psychiatry, social work, medical and nursing leadership, operations, project management, informatics, analytics, and nursing education. The patient population eligible for suicide risk screening included patients aged 10 years and older who are developmentally able to answer a validated suicide risk screening tool. As a result of this team, a standardized screening pathway, electronic health record updates, training tools for staff and providers, and education to patients and families on this initiative were developed and communicated to stakeholders. Suicide risk screening began in a phased approach for in-person visits in 2021, adding new clinics every other week to a total of 27 specialty clinics, a primary care clinic, and 11 regional locations in Washington state. Screening occurred verbally to the patient during the rooming process of a clinic visit and has since transitioned to an electronic tablet for screening, with the responses loading directly into the patient’s medical record for review by the healthcare team.
Evaluation and outcomes: As of November 2022, over 70,000 suicide risk screenings have been completed on patients aged 10 and older who are developmentally able to answer the screening tool questions. An average of 10.3% of patients screen positive to the suicide risk screening tool. Of those patients screened from October 2021 to November 2022, 362 pediatric patients had a plan for self-harm and received intervention. In response to support the positive screenings, a dedicated team of social workers specific to follow up on positive suicide risk screening was added to conduct risk assessments and connect patients and families to appropriate resources across the organization. Also, with the transition to electronic screening from verbal screening, an increase in declination for suicide screening by patients/families has occurred. Evaluation of collecting patient responses via an electronic tablet versus verbal screening is occurring.
Conclusion: Suicide risk screening in medical settings is required by a healthcare regulatory agency and recommended by a national suicide prevention organization. In response to this need, a standardized approach for pediatric suicide risk screening and assessment was implemented across multiple ambulatory care clinic sites and specialties in a pediatric organization in Washington state. This is an important safety initiative for organizations to consider and identify patients at risk for suicide.