410 - The Feasibility of Youth Suicide Risk Screening in an Indian Health Service Emergency Department

Among young people aged 10-24, American Indian/Alaska Native (AI/AN) youth have the highest rate of suicide of any racial subgroup. Screening for suicide risk in medical settings can identify youth at risk, especially in emergency departments (ED), where high risk youth present for healthcare. There is limited research on the feasibility or implementation processes of suicide risk screening within health systems specifically serving AI/AN youth.

Objective:

To describe a pilot quality improvement project to determine the feasibility of implementing suicide risk screening in an Indian Health Service (IHS) ED.

Design/Methods:

In November 2019, suicide risk screening using the Ask Suicide-Screening Questions (ASQ) was implemented at an IHS ED serving a rural community. To account for cultural differences in describing suicidal ideation, a modified version of the ASQ was utilized; “dead” was replaced with “not alive” and “killing yourself” was replaced with “ending your life” where applicable. All patients medically able to answer questions were screened. Descriptive statistics were calculated to examine the number of completed patient screens and number of youth (aged 8-24) identified as “at risk” for suicide. Implementation processes and challenges were documented.

Results:

In approximately 7500 patient encounters between November 2019 and February 2021, 59.4% of patients between age 8 and 24 years were screened for suicide risk (54.9% female; 99.7% AI/AN; M[SD] age = 17.0[4.65] years). 6.7% of pediatric medical patients screened positive for suicide risk; of the positive screens, 37.5% reported current thoughts of suicide. Examining rates among preteens (youth aged 8-12), 2.6% were at risk for suicide; of those positive screens, 45.8% had current thoughts of suicide. Preparation, training, and embedding tools into an electronic health records system were critical parts of the implementation process. *Please note that exact numerical values were omitted to protect the confidentiality of the AI/AN population in which this study was conducted.

Conclusion(s):

Findings from this QIP indicate that screening AI/AN youth for suicide risk in the ED is important because rates are high, screening is feasible and, with iterative QI processes, can be conducted in a way that will not overburden already busy IHS healthcare systems. Notably, a large portion of youth, including preteens, who screened positive reported acute thoughts of suicide, further emphasizing the importance of detection through universal screening in medical settings, especially for high risk populations.