Lessons Learned from Implementation of Suicide Risk Screening in Pediatric Primary Care Populations

Background:

Recent research indicates that about 45% of people who die by suicide have had contact with primary care providers within 1 month of suicide and about 75% people who die by suicide had contact with primary care providers within the year of suicide. Given the potential for screening to improve outcomes, primary care providers have enormous potential to prevent suicides and connect them to needed specialty care. Screening can be effective, but is an under-utilized prevention strategy. Primary care providers often lack the training and capacity to conduct these suicide risk screenings, due to discomfort, stigma, and lack of brief screening tools that have been validated in primary care settings.  Validation of suicide risk screening tools and guidelines for implementation can be effective ways to identify patients at risk and to link them to specialty care. This study builds on previous research conducted with the Ask Suicide-Screening Questions (ASQ), a 4-item rapid suicide risk screening instrument that has been validated in emergency and inpatient medical settings, with adolescent and young adults.  It has not yet been validated in primary care settings.  This presentation will describe the multisite study designed to validate a suicide risk screening instrument and guidelines for implementation to further increase the screening and identification of youth at risk for suicide in primary care settings.

 Methods:

As part of a larger instrument validation study, the current project examines the implementation planning phase of a brief suicide screening instrument in primary care using the PRECEDE-PROCEED implementation planning model.  This model underscores the importance of predisposing factors (e.g., knowledge, attitudes, beliefs, personal preferences, existing skills, and self-efficacy towards the desired behavior change), reinforcing factors (e.g., factors that reward or reinforce the desired behavior change, including social support, economic rewards, and changing social norms), and enabling factors (e.g., skills or physical factors such as availability and accessibility of resources, or services that facilitate achievement of motivation to change behavior).  

Results:

Lessons learned from implementation of a standardized suicide risk screening in the primary care clinic in a pediatric hospital will be described.  Specific strategies to address implementation barriers, including time, provider attitudes about and comfort with suicide risk screening, as well as other predisposing, reinforcing, and enabling factors, will be discussed. Specific protocol modifications that are unique to the primary care setting will be explored. 

Conclusions:

Screening for suicide risk can be an effective prevention strategy, but is underutilized in primary care clinics.  Implementation of a brief suicide risk screening protocol for adolescents presenting to primary care clinics is feasible, but uptake and sustainability of standardized practice requires much attention in the implementation phase.