Screening for Safety: Evidence-Based Tools to Prevent Suicide in Primary Care
April 2, 2018
From Kristin Dreves, MPH, CHES, Adolescent Health Project Manager, Oregon Pediatric Society
Two weeks ago, I lost someone I grew up with to suicide. As both an attempt and loss survivor, I am acutely aware of the desperation and hopelessness that leaves someone feeling like there’s no other way out and also the heartbreak and destruction that suicide leaves in its wake. Suicide death leaves no opportunities to say goodbye, no second chances to turn things around.
As one of the lucky ones, I know the power of second chances. When given the gift of time and professional help, I can attest that there is hope, there is light at the end of the tunnel, and there is a chance to thrive.
Over two million young people attempt suicide each year, with 90% of attempts among youth unknown to parents. With suicide the second leading cause of death for young people, youth suicide prevention is top priority.
To this aim, OPS provides adolescent mental health training for primary care teams. OPS Screening Tools and Referral Training (START) around ACEs/trauma informed care, substance abuse, depression, and suicide prevention are collectively designed to promote screening, assessment, and management of pediatric mental health issues by providers practicing trauma informed care.
We focus on primary care because:
35% of pediatric patients are seeing their primary care provider as their primary mental health care provider
23% of young people were seen by their primary care provider within one month prior to completing suicide and 62% were seen within the past year
In contrast, only 15% of young people were seen by a mental health provider within one month of suicide, 24% within the previous year, and 38% within their lifetime
In Fall 2017, OPS convened a panel of statewide experts to represent various perspectives and practices to inform best practice training for healthcare providers around youth suicide risk assessment, lethal means counseling, and safety planning.
If a positive screen occurs on the asQ Suicide Risk Screening Tool, a provider can follow-up with the asQ Brief Suicide Safety Assessment (BSSA), which is designed to take around 10-15 minutes to complete, depending on the situation. The BSSA includes methodology and scripts around talking to patients, talking to parents, lethal means restriction, safety planning, and determining next steps. The BSSA may be completed by a physician, physician’s assistant, nurse practitioner, or mental health practitioner.
The following outcomes are determined based on screening and assessment results:
Immediate referral to Emergency Department
Safety planning with urgent referral to mental health provider within 72 hours
Safety planning with non-urgent referral to mental health provider
No further intervention needed at this time
The asQ Toolkit available from the NIMH includes the asQ Information Sheet, asQ Screening Tool (in multiple languages), Brief Suicide Safety Assessment Guide, Nursing Script, Parent/Guardian Flier, Patient Resource List, and Educational Videos.
OPS START training also includes additional content around lethal means restriction, safety planning, office implementation, case scenarios, and community resources. Trainings are led by a pediatrician and child psychologist.
If you are a primary care provider and would like OPS to provide training for your clinic or school-based health center, please contact us at firstname.lastname@example.org.
OPS also invites anyone with an interest in adolescent health to join us for the OPS Adolescent Health Conference Saturday, April 28, 2018. asQ developer Lisa Horowitz, PhD, MPH of the NIMH will be the keynote speaker.
You don’t need to be a physician to make a difference. Suicide prevention necessitates cross-sector collaboration. We are all in this together. Whether you’re a health care provider, a politician, or a community member, you can do your part to offer support, policies, and resources that help keep people safe. Don’t give up on us.
Luoma JB, Martin CE, Pearson JL. Contact With Mental Health and Primary Care Providers Before Suicide: A Review of the Evidence. The American journal of psychiatry. 2002;159(6):909-916. doi:10.1176/appi.ajp.159.6.909.
National Institute of Mental Health, asQ Information Sheet.