By: Steven Rogers, MD, MS

It is an alarming statistic – suicide is the second leading cause of death from ages 10 to 34. At Connecticut Children’s, we understand and embrace the role we can play in reducing death by suicide for our young patients. We now screen all children ages 10 and older who visit our Emergency Department for suicide risk, regardless of the treatment they are seeking.

Developing the Universal Screening

In 2019, the Joint Commission, the national accreditation body for hospitals, announced a need for providers to screen patients for suicide risk and that inspired us to explore what we could do at Connecticut Children’s. Providers, nurses and our quality improvement team worked together to develop and implement a universal suicide screening program in our Emergency Department, where we typically care for more than 60,000 patients each year.

In developing the program, we considered a number of potential concerns: Are children too young to ask about such a sensitive topic? Would parents embrace it? Do we have the resources needed to help children who screen at moderate- or high-risk?

We established the age of 10 as the youngest age for our screening since that is that age in which the risk for suicide starts to escalate. We identified a validated screener that includes direct questions that patients would be asked, such as “In the past few weeks, have you wished that you were dead?” and “Have you ever tried to kill yourself?”

We provided training for our nurses, who would be responsible for administering the initial screen, as well as for our providers, who would be responsible for administering a secondary suicide assessment tool to confirm the initial screen and determine a child’s level of risk.

We identified resources to refer low- and moderate-risk patients to, who are typically not in immediate danger and are discharged home. We also developed a plan to help those children who screen at high-risk and need inpatient or immediate outpatient intervention. We are fortunate to have access to a Behavioral Health Transitions Clinic in our Emergency Department, which is a novel clinic where higher-risk patients can connect with a psychiatrist, a social worker and a care coordinator within days of arriving at the hospital for help. The clinic provides care they would typically wait weeks or even months to receive if it did not exist.

Success of the Universal Screening

Simply put, the screening has surpassed all expectations. In just the first year, we screened well over 16,000 children and more than 2,600 of them screened positive for suicide risk. We are proud to have achieved over a 90% compliance rate from our nursing staff, which is unheard of in busy emergency departments. Of those who are screened, we are seeing about 16% screen positive including about 5% (779) who visit the Emergency Department for medical-only chief complaints, as opposed to a behavioral health chief complaint. These 779 children may never have been identified as having suicide risk but now can connect to the resources they need.

Parents have been overwhelmingly receptive to the suicide screening. We have had just a few decline to have their children participate. Many end up thanking us for opening a new channel of communication, especially those whose children screen positive.

One of the most powerful stories to come out of our suicide screening involved an 11-year-old girl. After she screened positive for suicide risk, her shocked mother turned to her daughter and asked, “Why didn’t you tell me about this?” Her daughter replied, “Because you never asked.” She then turned to her provider and said that she had been thinking about suicide for a long time now but didn’t know who to talk to.

Aside from preventing suicide, normalizing the conversation about suicide is among our top goals. Talking about suicide does not cause it or contribute to the risk. Instead, it is likely to be protective and relieving for a child to know that it’s okay to talk about it and to seek help.

Next Steps

Going forward, we hope to expand our universal suicide screening program to all clinical departments at Connecticut Children’s. In addition, we hope to expand it to community-based primary care providers as well. Eventually, we hope to see such programs available statewide and across the country.

Suicide should not be a secret. It is 100% preventable yet it remains the second leading cause of death for children as young as 10 years old.

We have already made a difference with our universal suicide screening program and will continue to do so. By opening the lines of communication, as well as making resources and treatments available to those who need them, we are making our patients healthier and safer.

Steven C. Rogers, MD, is an attending physician and medical director of emergency behavioral health services for Connecticut Children’s. Dr. Rogers is also an associate professor at the UConn School of Medicine and a research scientist for Connecticut Children’s Injury Prevention Center, which is a program of Connecticut Children’s Office for Community Child Health.

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