A 2-year $115,000 Preventing Youth Suicide award grant from Cardinal Health Foundation and Children’s Hospital Association (CHA) was awarded to Jennifer Marshall, MPH, RN, Strategic Planning, Jennifer Regan, RN, BSN, CPN, Developmental and Behavioral Health, Kathryn Worland, MSW, LCSW, LSCSW, Social Work, and Angela Guzman, MSW, MA, LMSW, Developmental and Behavioral Health (the PReventing yOuTh suicidE or PROTECT team) with the support of hospital leaders and the National Patient Safety Goal 15 (suicide screening) committee.

The grant project, “Children's Mercy Suicide Prevention: Current Practice, Collaborative Initiatives, Continued Improvement,” will be conducted through the Zero Suicide initiative guidelines, guided through collaboration, and building on a broad foundation of suicide screening and assessment work that began at Children’s Mercy in 2014.  The basis of this programmatic grant is the pursuit of collaborative learning as part of a nationwide cohort of hospitals participating in the Zero Suicide initiative.

Through this initiative, to continue progressing suicide prevention at Children’s Mercy, the team will work to create standardization in suicide screening, assessment tools, and processes across settings utilizing sustainable methods. Among the initial steps are identifying inconsistencies throughout the spectrum of established suicide prevention processes from screening to caring contact. Additional steps will be related to efficiency of documentation and location in the EHR, and consistent suicide education and staff support.

Additional information about these steps:

1. Spread the implementation of “Non-Demand Caring Contact” (outreach calls following a mental health assessment). Caring contact is made with the intent to assess wellbeing, safety plan adherence and connection to mental health resources.
   
   
2. Create customized educational materials related to risk stratification.  Risk stratification is determined through completion of a mental health assessment, determining the patient’s status as related to their intention including means and plan to die by suicide, designating high, medium, or low risk. This designation through stratification determines the appropriate level of intervention.
   
   
   1. For those determined to be at high risk, immediate one-to-one support is provided, and psychiatric hospitalization is sought through Social Work support.
      
      
   2. Patients identified as medium risk express suicidal ideation with intent to die by suicide and can maintain safety with additional behavioral health supports in the home and community. Supports would include developing and following a safety plan including safe storage, involving the caregiver, and establishing intensive behavioral health services. This level of risk poses challenges, heavily relying on clinical judgment specifically in determining the ability of the patient to remain safe in the home, complicated by difficulties with accessing community behavioral health supports and services.
      
      
   3. Low risk may indicate that a patient has expressed suicidal ideation, however this ideation may not be current and is without active intent; and therefore requires a safety plan and safe storage, caregiver awareness, and continuing with established mental health treatment.

Further staff education and support will be developed around risk stratification, specifically to the challenges faced with the medium risk clinical pathway.    

3. Reconcile differences in the documentation of risk stratification and safety planning between clinical groups and create a home for safety plans in the EHR that is used by all groups, is modifiable, and is easily located so that all appropriate care teams can find them in an efficient manner.

Once these elements have been addressed, other elements within the Zero Suicide and CHA collaborative will be implemented – more to come!

“An important aspect of this grant is the collaborative learning opportunity provided with other participating hospitals. Our participation in this collaborative is a clear reflection of Children’s Mercy’s commitment to suicide prevention work for youth, in alignment with this national initiative, Zero Suicide,” Angela said.

For additional information on Zero Suicide, please visit their website.