Early Childhood Mental Health Provider Perspectives on Treating and Understanding Young Children with Suicidal Thoughts and Behavior

Background and Purpose: Suicidal thoughts and behaviors (STB) among young children is the strongest predictor of school age and adolescent suicidality, emphasizing the need for continued research to examine STB in young children (EC STB) (Martin et al., 2016; Whalen, et al., 2015). Efforts to increase understanding of EC STB are ongoing but significant gaps remain. Among those gaps is the absence of examining provider understanding of EC STB. Early childhood mental health (ECMH) providers assess and treat EC STB amid a landscape of limited clinical guidance and training. An examination of their understanding of EC STB can offer valuable insights about how they how they assess and treat these children, amid the complex early childhood developmental stage. This study uses focus group methodology to fill gaps in current knowledge, in pursuit of these research questions: 1) How do ECMH providers understand EC STB and the role of the caregiver? 2) How do ECMH providers approach assessment and treatment of EC STB? 3) What are ECMH provider responses EC STB?

Methods: ECMH providers were invited to participate in a focus group. Recruitment targeted adults who fit the following criteria: master’s level education or above; providers serving children birth to 7 years; at least 1 year practice experience; treatment with at least 3 young children with STB. Semi-structured focus group discussions were facilitated online and lasted approximately 90 minutes. Transcripts were reviewed by the lead author who defined themes and developed preliminary codes. The second author independently read and coded two focus group transcripts using identified themes. Preliminary codes were collaboratively reviewed and refined by the researchers, and a codebook was developed.

Results: Themes identified were grounded in three areas related to EC STB: provider meaning making, provider experiences, and provider treatment. There were several subthemes under the umbrella of provider meaning making of EC STB, including STB as: a mechanism for communication; a reflection of a child’s environmental context, including trauma exposure and child-caregiver relationships; and anchored in a child’s developmentally based understanding of death. Subthemes under treatment of EC STB were provider commitment to taking children’s STB seriously, their efforts to assess risk and develop safety plans with children and caregivers. Finally, the prominent subthemes under provider responses to EC STB were provider compassion, concern and urgency, as well as reflections by providers on their personal exposure to suicide.

Conclusions and Implications: ECMH providers assess and treat young children and their caregivers amid a context of societal minimization of young children’s voices and experiences, and without specialized clinical guidance to support effective responses to EC STB. This study highlights the perspectives of ECMH providers, whose experiences assessing and treating EC STB offer valuable contributions. Their understanding of EC STB as a mechanism for communication, insights into the range of caregiver responses and the role of the child-caregiver relationship in EC STB, their approach to treatment, and the impacts of working with this population offer novel insights to inform future research and clinical practice.