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In March, an unprecedented collaboration between the American Academy of Pediatrics (AAP), American Foundation for Suicide Prevention (AFSP), and National Institute of Mental Health (NIMH) resulted in the development of the Blueprint for Youth Suicide Prevention. The blueprint comprises a consensus summary of expert recommendations, educational resources, and specific and practical strategies for pediatricians and other health care providers to support youth at risk for suicide in pediatric primary care settings. It is ambitious and far-reaching in scope and speaks to the growing understanding that suicide care pathways offer a clear ray of hope toward a shared “zero suicide” goal.
Following the declaration of a national emergency for child and adolescent mental health, the blueprint represents a resource to help us move forward during this national emergency. It offers practically focused suggestions at the clinic site and individual level, in addition to community and school levels, to tackle the deeply concerning and alarming increasing rate of emergency department visits by 30% in the last 2 pandemic years for youth suicide attempts. A reflexive visit for an emergency mental health evaluation in an emergency department after a disclosure of suicidal ideation isn’t always the next best step in a pathway to care, nor a sustainable community solution with the dearth of mental health and crisis resources nationally.
With this new tool, let’s proceed through a case of how one would approach a patient in the office setting with a concerning disclosure.
Case
Emily is a 12-year-old girl who presents for a routine well-check in your practice. Her mother shared with you before your examination that she has wondered if Emily may need more support. Since the pandemic, Emily had increasingly spent time using social media and watching television. When you meet with Emily on her own, she says, “I know that life is getting back to normal, and I am supposed to be excited for that, but now I have some anxiety about doing what I used to do. I’ve had some thoughts that it would be better to sleep forever and not wake up ...”
Case discussion
The blueprint recommends universal screening for suicide in all youths aged 12 and over. Not all children, like Emily, will be as open about their inner thoughts. The blueprint provides a link to the ASQ, which comprises questions to ascertain suicide risk and takes 20 seconds to complete with a patient. It is recommended as a first-line screening tool by the NIMH: Suicide Risk Screening Tool. This tool can guide one’s clinical thinking beyond the question of whether or not a child feels “suicidal” after a disclosure such as Emily’s. The blueprint also provides a tip sheet on how to frame these screenings to ensure their thoroughness and interpersonal effectiveness.
Case continued
You go through the ASQ with Emily and she revealed that she has had thoughts about suicide but not currently and without further plans. According to the ASQ, this screening falls into the category of a “non-acute positive screen (potential risk identified),” and now the patient requires a brief suicide safety assessment to determine if an emergency mental health evaluation is needed.
Case discussion
An initial screen (ASQ) should be followed by a Brief Suicide Safety Assessment (BSSA). Two common ones are the ASQ-BSSA (created by the same group that created the ASQ) or the C-SSRS (Columbia suicide severity rating scale).
The blueprint suggests adding this level of depth to one’s investigation in a pediatrics office for a divulged concern with suicidal ideation and following the algorithm to ensure safety.
The complete screening process is also described, in detail, in this instructional video: Suicide Risk Screening Training: How to Manage Patients at Risk for Suicide.
Case continued
Following the ASQ-BSSA, you determine that a referral to more immediate mental health resources would be most helpful and discuss your concerns with Emily and her family. You connect her via a “warm handoff” to a therapist in the office available from the newly adopted primary care mental health integration model. Emily completes further screening for anxiety and depressive disorders and begins a course of cognitive-behavioral therapy. You feel reassured that the therapist can connect with the consulting psychiatrist in the model who can offer a comprehensive psychiatric evaluation if needed. A referral to the emergency department to complete this screening has been avoided. You also plan for a “caring contact” from the office in a day to check in on Emily and her family and, before they go, provide them with crisis services and resources.
The blueprint represents a thoughtful means to know when emergency department visits are necessary and when other forms of support such as robust safety planning, a connection to other nonemergency services, and “caring contacts” from the office within 24-48 hours are actually of more benefit. “Caring contacts,” in particular, have been lauded as having a significant impact in modifying the course of a patient with suicidal ideation. Data show that differences such as follow-up phone calls by any staff member or even postcards from the clinic over 6-12 months can affect suicide risk.
Beyond outlining suicide care pathways, the blueprint also shares clinical algorithms from the National Network of Child Psychiatry Access Programs (NNCPAP). These algorithms help clinicians assess common issues in pediatrics and reserve referrals to psychiatry and escalations of care to the emergency department for certain high-risk circumstances.
The blueprint seeks to provide a “one-stop-shop” for accessible and usable resources in the clinic workflow for suicide prevention. It is inspiring to see our professional organizations pursuing practical and practice-based solutions to our children’s mental health crisis in unison.
Dr. Pawlowski is a child and adolescent consulting psychiatrist. She is a division chief at the University of Vermont Medical Center where she focuses on primary care mental health integration within primary care pediatrics, internal medicine, and family medicine. Email her at pdnews@mdedge.com.
In March, an unprecedented collaboration between the American Academy of Pediatrics (AAP), American Foundation for Suicide Prevention (AFSP), and National Institute of Mental Health (NIMH) resulted in the development of the Blueprint for Youth Suicide Prevention. The blueprint comprises a consensus summary of expert recommendations, educational resources, and specific and practical strategies for pediatricians and other health care providers to support youth at risk for suicide in pediatric primary care settings. It is ambitious and far-reaching in scope and speaks to the growing understanding that suicide care pathways offer a clear ray of hope toward a shared “zero suicide” goal.
Following the declaration of a national emergency for child and adolescent mental health, the blueprint represents a resource to help us move forward during this national emergency. It offers practically focused suggestions at the clinic site and individual level, in addition to community and school levels, to tackle the deeply concerning and alarming increasing rate of emergency department visits by 30% in the last 2 pandemic years for youth suicide attempts. A reflexive visit for an emergency mental health evaluation in an emergency department after a disclosure of suicidal ideation isn’t always the next best step in a pathway to care, nor a sustainable community solution with the dearth of mental health and crisis resources nationally.
With this new tool, let’s proceed through a case of how one would approach a patient in the office setting with a concerning disclosure.
Case
Emily is a 12-year-old girl who presents for a routine well-check in your practice. Her mother shared with you before your examination that she has wondered if Emily may need more support. Since the pandemic, Emily had increasingly spent time using social media and watching television. When you meet with Emily on her own, she says, “I know that life is getting back to normal, and I am supposed to be excited for that, but now I have some anxiety about doing what I used to do. I’ve had some thoughts that it would be better to sleep forever and not wake up ...”
Case discussion
The blueprint recommends universal screening for suicide in all youths aged 12 and over. Not all children, like Emily, will be as open about their inner thoughts. The blueprint provides a link to the ASQ, which comprises questions to ascertain suicide risk and takes 20 seconds to complete with a patient. It is recommended as a first-line screening tool by the NIMH: Suicide Risk Screening Tool. This tool can guide one’s clinical thinking beyond the question of whether or not a child feels “suicidal” after a disclosure such as Emily’s. The blueprint also provides a tip sheet on how to frame these screenings to ensure their thoroughness and interpersonal effectiveness.
Case continued
You go through the ASQ with Emily and she revealed that she has had thoughts about suicide but not currently and without further plans. According to the ASQ, this screening falls into the category of a “non-acute positive screen (potential risk identified),” and now the patient requires a brief suicide safety assessment to determine if an emergency mental health evaluation is needed.
Case discussion
An initial screen (ASQ) should be followed by a Brief Suicide Safety Assessment (BSSA). Two common ones are the ASQ-BSSA (created by the same group that created the ASQ) or the C-SSRS (Columbia suicide severity rating scale).
The blueprint suggests adding this level of depth to one’s investigation in a pediatrics office for a divulged concern with suicidal ideation and following the algorithm to ensure safety.
The complete screening process is also described, in detail, in this instructional video: Suicide Risk Screening Training: How to Manage Patients at Risk for Suicide.
Case continued
Following the ASQ-BSSA, you determine that a referral to more immediate mental health resources would be most helpful and discuss your concerns with Emily and her family. You connect her via a “warm handoff” to a therapist in the office available from the newly adopted primary care mental health integration model. Emily completes further screening for anxiety and depressive disorders and begins a course of cognitive-behavioral therapy. You feel reassured that the therapist can connect with the consulting psychiatrist in the model who can offer a comprehensive psychiatric evaluation if needed. A referral to the emergency department to complete this screening has been avoided. You also plan for a “caring contact” from the office in a day to check in on Emily and her family and, before they go, provide them with crisis services and resources.
The blueprint represents a thoughtful means to know when emergency department visits are necessary and when other forms of support such as robust safety planning, a connection to other nonemergency services, and “caring contacts” from the office within 24-48 hours are actually of more benefit. “Caring contacts,” in particular, have been lauded as having a significant impact in modifying the course of a patient with suicidal ideation. Data show that differences such as follow-up phone calls by any staff member or even postcards from the clinic over 6-12 months can affect suicide risk.
Beyond outlining suicide care pathways, the blueprint also shares clinical algorithms from the National Network of Child Psychiatry Access Programs (NNCPAP). These algorithms help clinicians assess common issues in pediatrics and reserve referrals to psychiatry and escalations of care to the emergency department for certain high-risk circumstances.
The blueprint seeks to provide a “one-stop-shop” for accessible and usable resources in the clinic workflow for suicide prevention. It is inspiring to see our professional organizations pursuing practical and practice-based solutions to our children’s mental health crisis in unison.
Dr. Pawlowski is a child and adolescent consulting psychiatrist. She is a division chief at the University of Vermont Medical Center where she focuses on primary care mental health integration within primary care pediatrics, internal medicine, and family medicine. Email her at pdnews@mdedge.com.
In March, an unprecedented collaboration between the American Academy of Pediatrics (AAP), American Foundation for Suicide Prevention (AFSP), and National Institute of Mental Health (NIMH) resulted in the development of the Blueprint for Youth Suicide Prevention. The blueprint comprises a consensus summary of expert recommendations, educational resources, and specific and practical strategies for pediatricians and other health care providers to support youth at risk for suicide in pediatric primary care settings. It is ambitious and far-reaching in scope and speaks to the growing understanding that suicide care pathways offer a clear ray of hope toward a shared “zero suicide” goal.
Following the declaration of a national emergency for child and adolescent mental health, the blueprint represents a resource to help us move forward during this national emergency. It offers practically focused suggestions at the clinic site and individual level, in addition to community and school levels, to tackle the deeply concerning and alarming increasing rate of emergency department visits by 30% in the last 2 pandemic years for youth suicide attempts. A reflexive visit for an emergency mental health evaluation in an emergency department after a disclosure of suicidal ideation isn’t always the next best step in a pathway to care, nor a sustainable community solution with the dearth of mental health and crisis resources nationally.
With this new tool, let’s proceed through a case of how one would approach a patient in the office setting with a concerning disclosure.
Case
Emily is a 12-year-old girl who presents for a routine well-check in your practice. Her mother shared with you before your examination that she has wondered if Emily may need more support. Since the pandemic, Emily had increasingly spent time using social media and watching television. When you meet with Emily on her own, she says, “I know that life is getting back to normal, and I am supposed to be excited for that, but now I have some anxiety about doing what I used to do. I’ve had some thoughts that it would be better to sleep forever and not wake up ...”
Case discussion
The blueprint recommends universal screening for suicide in all youths aged 12 and over. Not all children, like Emily, will be as open about their inner thoughts. The blueprint provides a link to the ASQ, which comprises questions to ascertain suicide risk and takes 20 seconds to complete with a patient. It is recommended as a first-line screening tool by the NIMH: Suicide Risk Screening Tool. This tool can guide one’s clinical thinking beyond the question of whether or not a child feels “suicidal” after a disclosure such as Emily’s. The blueprint also provides a tip sheet on how to frame these screenings to ensure their thoroughness and interpersonal effectiveness.
Case continued
You go through the ASQ with Emily and she revealed that she has had thoughts about suicide but not currently and without further plans. According to the ASQ, this screening falls into the category of a “non-acute positive screen (potential risk identified),” and now the patient requires a brief suicide safety assessment to determine if an emergency mental health evaluation is needed.
Case discussion
An initial screen (ASQ) should be followed by a Brief Suicide Safety Assessment (BSSA). Two common ones are the ASQ-BSSA (created by the same group that created the ASQ) or the C-SSRS (Columbia suicide severity rating scale).
The blueprint suggests adding this level of depth to one’s investigation in a pediatrics office for a divulged concern with suicidal ideation and following the algorithm to ensure safety.
The complete screening process is also described, in detail, in this instructional video: Suicide Risk Screening Training: How to Manage Patients at Risk for Suicide.
Case continued
Following the ASQ-BSSA, you determine that a referral to more immediate mental health resources would be most helpful and discuss your concerns with Emily and her family. You connect her via a “warm handoff” to a therapist in the office available from the newly adopted primary care mental health integration model. Emily completes further screening for anxiety and depressive disorders and begins a course of cognitive-behavioral therapy. You feel reassured that the therapist can connect with the consulting psychiatrist in the model who can offer a comprehensive psychiatric evaluation if needed. A referral to the emergency department to complete this screening has been avoided. You also plan for a “caring contact” from the office in a day to check in on Emily and her family and, before they go, provide them with crisis services and resources.
The blueprint represents a thoughtful means to know when emergency department visits are necessary and when other forms of support such as robust safety planning, a connection to other nonemergency services, and “caring contacts” from the office within 24-48 hours are actually of more benefit. “Caring contacts,” in particular, have been lauded as having a significant impact in modifying the course of a patient with suicidal ideation. Data show that differences such as follow-up phone calls by any staff member or even postcards from the clinic over 6-12 months can affect suicide risk.
Beyond outlining suicide care pathways, the blueprint also shares clinical algorithms from the National Network of Child Psychiatry Access Programs (NNCPAP). These algorithms help clinicians assess common issues in pediatrics and reserve referrals to psychiatry and escalations of care to the emergency department for certain high-risk circumstances.
The blueprint seeks to provide a “one-stop-shop” for accessible and usable resources in the clinic workflow for suicide prevention. It is inspiring to see our professional organizations pursuing practical and practice-based solutions to our children’s mental health crisis in unison.
Dr. Pawlowski is a child and adolescent consulting psychiatrist. She is a division chief at the University of Vermont Medical Center where she focuses on primary care mental health integration within primary care pediatrics, internal medicine, and family medicine. Email her at pdnews@mdedge.com.