“In the past few weeks, have you wished you were dead?
This blunt question is part of a screening given to all patients age 11 and up in the Emergency Department at Children’s Wisconsin. The screening helps identify kids who are at risk for suicide so they can get the support they need. It’s just one part of Children’s Wisconsin’s commitment to addressing the mental and behavioral health crisis facing kids today.
The question may sound harsh, but the realities of teen suicide are even more so. A 2017 Wisconsin high school survey showed that in the past year, 31.5 percent of students felt sad or depressed, 17.2 percent had suicidal thoughts and 8 percent attempted suicide.
“By identifying adolescents with suicidal thoughts, we can offer resources to be sure kids have the care they need and, ultimately, to prevent a suicide,” said Amy Drendel, DO, medical director of the Emergency Department at Children’s Wisconsin. “It’s important to do it in the emergency setting, since we see kids here who don’t always have good primary care resources.”
While staff in Children’s Wisconsin’s Emergency Department have long asked patients about suicidal tendencies verbally, since October 2018 the team has taken a different approach. While parents are completing electronic registration forms, kids age 11 and up are given an iPad on which they answer the five questions that make up the Ask Suicide-Screening Questions (ASQ) screening, an evidence-based tool used in medical settings around the country.
“Studies have shown patients answer self-administered questionnaires more honestly than verbal questions, so by asking kids to respond on the iPad we are more likely to find out what they are truly experiencing,” said Michelle Pickett, MD, physician leader for the suicide screening project in Children’s Wisconsin’s Emergency Department. The results have confirmed that thinking –– since October 2018, more than 6,000 patients have been screened and more than 900 have screened positive (answered “yes” to at least one suicide question).
When a child screens positive, the team immediately goes into action. The first step is for the doctor to talk to the child and their parents. Then if more evaluation or resources are needed, a Children’s Wisconsin social worker, available 24/7, consults with the child and family. Together, they determine the next steps for the best care of the child. “Sometimes, families are aware of the issue and our role is to confirm that they are getting good care,” said Dr. Drendel. “But many times, parents are surprised and it’s our job to help get the child and family connected with the services they need.”
As with any new approach, some parents are hesitant at first. “That may be due to the stigma around talking about mental and behavioral health,” said Dr. Drendel. “Historically, doctors have been much more comfortable talking about kids’ medical needs –– their mental health needs can be harder to providers to address.”
Many teens don’t share their struggles with family members, feeling they will be a burden.
But most parents, once they understand what their kids are feeling, are grateful. One mom, who thought her daughter was doing okay with recent family changes, appreciated understanding what her child was feeling and learning about resources available to her. Another child, a teen boy who was in the Emergency Department for an injury, screened positive and was hospitalized as he was actively planning a suicide.
“That child obviously had needs way beyond the original reason he came to the Emergency Department,” said Dr. Drendel. “The screening may have saved his life.”
Nationwide, 90 percent of kids who visit an emergency department go to a general facility that provides the majority of care to adults. “The beauty of our pediatric-focused Emergency Department is that we only see kids, so we focus our efforts on always doing what’s best for them,” said Dr. Drendel. That’s one reason Children’s Wisconsin has implemented the ASQ screening.
A coordinated, multidisciplinary team, including nursing, medical and social work staff, patient experience and information technology staff, worked together to make the screening part of standard care in Children’s Wisconsin's Emergency Department.
“This screening offers families one more way for kids with mental health struggles to be identified and to get the help they need,” said Dr. Drendel.
Emergency department suicide screening is just one way that Children’s Wisconsin is caring for kids’ mental and behavioral health. Our primary care offices are using a depression screening tool to catch early signs of depression and anxiety before kids reach the crisis level. And a team is developing other screening tools so that every child –– in every Children’s Wisconsin clinic –– will soon have their mental health “vital signs” checked as a normal part of their visit.
“Ultimately, our goal is to support every child, at every stage, so that we help kids stay mentally and physically healthy, and prevent crisis,” said Amy Herbst, vice president of Mental and Behavioral Health at Children’s Wisconsin. “In the meantime we must meet kids and families where they are, and that includes this important intervention work in our Emergency Department.”
Youth suicide risk factors include: bullying; family history of mental health concerns; drug or alcohol abuse; concerns about sexual orientation; personal stressors such as a break up, major move/relocation, or parental separation; and domestic abuse.
If your child is having active suicidal thoughts or has made a suicide attempt, call 9-1-1 or bring them to the emergency department.