Identifying Risk in Teens: Prevention is Possible

By Dr. Shayla Sullivant

The impact of teen suicide—the second leading cause of death in teens—hit close to home for those of us at Children’s Mercy Kansas City in November 2014 when two local high school athletes died by suicide. In the aftermath, we wanted to find a way to identify at-risk athletes, so our Sports Medicine Department started administering suicide screenings for all of our teen patients.

This initiative began with Kevin Latz, MD, Chief of Sports Medicine, Angie Vanderpool, APRN, MSN, RN, ONC, CPNP, Nurse Practitioner, members of the Sports Medicine Department’s leadership team and their entire staff. We had been moving forward with screening in other parts of the hospital, trying to find the most efficient and effective way to identify those at risk, so Sports Medicine seemed like a logical and necessary expansion.

We started out using the Columbia Suicide Severity Rating Scale (C-SSRS). It asks three basic questions about thoughts, plans and actions regarding suicide to identify a patient’s lifetime history of suicidal thoughts. We then completed a research study using the Ask Suicide Screening Questionnaire. The ASQ focuses on the patient’s thoughts over the past couple of weeks, as well as his or her history of suicide attempts. We have since changed to the ASQ as we want to focus on current symptoms.

This video, produced by Children's Mercy, explains the suicide screening process that has been adopted by our Sports Medicine Department. 

To ensure the screenings went as smoothly as possible, we had to make some changes to our standard procedures. For example, we knew the teens weren’t likely to open up to us in front of their parents, so we would need to screen them in private. To accomplish this, our staff nurses and athletic trainers changed their workflow and saw patients alone at the beginning of their visit to complete the screen.

We also had to educate our staff on how to ask about suicide and address questions from parents. We presented staff with data on why we were doing the screenings and that asking patients about suicide was safe. Role playing got them more comfortable with what to say and how to handle unexpected situations.

Finally, we assigned a “champion” to the sports medicine clinic, Jen Farrell, MSN, MBA, RN, Orthopedic Clinic Charge Nurse, who fielded any questions that arose in the screening process. She helps link the sports medicine staff to the suicide prevention group at Children’s Mercy.

Since we started the screenings, roughly two percent of teens in Sports Medicine surveyed have expressed suicidal thoughts. When a patient is identified as at-risk, we have a social worker evaluate the individual to further to determine what kind of action is needed.

The care after the visit is critically important. We know that most patients we identify are not acutely suicidal, and most do not require inpatient admission for suicidal thoughts. They do, however, benefit from follow-up, which can include referral to a mental health care provider or primary care physician. Our social workers contact the patient’s family weekly to ensure they are not running into barriers with seeking care.

Overall, our suicide screening process has been well-accepted by patients, families, and staff. While we initially worried that parents would be uncomfortable with the questionnaires, we have had few families express concern—most thank us for addressing this important issue.

At Children's Mercy we have a large group tackling the issue of suicide prevention and how we can improve identification of young people at risk. Moving forward our goal is to expand so we can do even more to help our patients who may be at risk.

Learn more about the services offered through Children’s Mercy’s Sports Medicine Center.