Parkland expands universal suicide screening to kids age 10 and up
Innovative program for adults, youth first of its kind in nation
Suicide among children in the U.S. is on the rise. According to the Centers for Disease Control and Prevention (CDC), suicide is the second leading cause of death for adolescents and is a growing threat, occurring more frequently than ever before in children 13 and under. The CDC reports that from 1999 through 2015, more than 1,300 children ages 5 to 12 took their own lives and for the first time, suicide rates exceeded those for homicide and motor vehicle crashes as a cause of death in 2014 for kids between the ages of 10 and 14. In 2015, more than 7,000 children ages 10 to 12 attempted suicide.
Predicting and preventing suicide attempts is crucial – and possible, say experts at Parkland Health & Hospital System, a nationally-recognized innovator in the effort. In 2015, Parkland became the first health system in the nation to administer a universal suicide screening program to identify persons at risk and help save lives through early intervention. The program was designed to screen not only adults but also youth, ages 12 to 17, regardless of their reason for seeking care. Since initiating the program, more than 2 million suicide risk screenings have been completed.
Now, Parkland has expanded the screenings to include patients age 10 and older in the Emergency Department, Urgent Care Center, inpatient units and Community Oriented Primary Care (COPC) health centers. Parkland expects to complete more than 11,000 screenings for children ages 10 to 12 annually.
“Research shows that today’s youth are exposed to more stresses and pressures than ever before. According to the National Alliance on Mental Health, one in five kids experiences a mental health condition, but only 20 percent receive services. We think this is an opportunity to both identify early risk factors and open the conversation for pediatric patients and their caregivers about mental health issues,” said Celeste Johnson, DNP, APRN, PMH CNS, Parkland’s Vice President of Behavioral Health.
“We recognize that we have the opportunity to identify children and young adults coming to Parkland for other health services who may also need mental health services. By asking a few questions of every patient, regardless of why they come in for medical care, we can determine if there are reasons for concern and take steps to help,” said Kimberly Roaten, PhD, Director of Quality for Safety, Education and Implementation, Department of Psychiatry at Parkland and Associate Professor of Psychiatry at UT Southwestern Medical Center.
Dr. Roaten said studies show that suicide screening does not lead to increased distress or create suicidal thoughts. Instead, children in distress and their caregivers are more likely to feel relieved and grateful that someone has expressed concern. In fact, many kids and their caregivers believe that suicide risk screening is an important part of general healthcare.
Parkland uses the clinical practice screener version of the Columbia Suicide Severity Rating Scale (C-SSRS) with adults 18 and over and the ASQ (Ask Suicide-Screening Questions) with 10- to17-year-olds, both validated screening tools.
The Parkland Algorithm for Suicide Screening (PASS) stratifies patients into three suicide risk categories based on their answers to the screening questions: no risk identified, moderate risk identified and high risk identified. Those at high risk are immediately placed under one-to-one supervision, suicide precautions are implemented and an evaluation by a behavioral health clinician is initiated. Patients at moderate risk are automatically referred to a provider with competency in suicide risk assessment and usually are seen during the same visit. If a patient chooses not to speak with a psychiatric social worker during the visit, they receive a follow-up phone call to provide additional support and resources.
All patients who screen positive receive information about outpatient mental health resources, including crisis hotlines. The process is the same for children ages 10-12, except that parents or guardians are involved in the conversation about safety.
Lisa Horowitz, PhD, MPH, a clinical psychologist at the National Institutes of Health who specializes in suicide prevention and detection, developed the pediatric suicide screening instrument (ASQ) used nationally. According to Horowitz, “There’s a myth that younger children do not kill themselves, but it’s not true. The suicide rate is rising fastest in younger children.”
“When I first started practicing pediatrics, depression or suicide in a patient as young as 10 was never a clinical consideration. But now, we must be vigilant about suicide for every patient this age who comes to our clinics,” said Cesar Termulo, MD, senior lead staff physician at Parkland’s Hatcher Station Health Center.
And because younger children act impulsively, early detection and prevention through screening is critical.
“They are old enough to understand death, but too young to have developed necessary coping strategies,” Horowitz stated. “Nurses or physicians may be the only adult in that young child’s life who will ask them directly about suicide and respond with getting them help. It sends the message, ‘I care, I’m not afraid to ask about difficult things, I’m going to help you.’ I applaud Parkland for being a trailblazer in providing routinized screening for suicide risk in younger kids.”
For more information on Parkland services, please visit www.parklandhospital.com
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