How to Prepare your Clinic or Health System for a Suicide Prevention Program

Get Support from Leadership

One of the main steps in building a successful suicide prevention program is to get support from senior leaders of the organization. The following components can help build a foundation of support:

Identify champions who represent multiple disciplines and diverse backgrounds to move the program forward
Involve all healthcare staff (physicians, nurses, medical assistants/technicians, social workers, behavioral health professionals, front-desk workers, environmental services staff, etc) in the suicide prevention program
Secure sustained buy-in from senior leadership is crucial for a plan’s longevity. Any changes in senior leadership or champions should be accompanied with transition plans so suicide prevention programs do not falter or discontinue because of staff departures
Involve youth, parents/caregivers, or families early in the process for feedback, particularly those with lived experience of suicide

Assign Roles

Staff from different disciplines can take on various roles in suicide prevention initiatives. These roles may vary between settings. Health systems can assign roles based on available staff and resources:

Nurses and medical assistants/technicians can be trained to administer screening tools during initial nursing assessments or at triage
Physicians, nurse practitioners, physician assistants, social workers, and other mental health clinicians can be trained to administer brief suicide safety assessments (see Clinical Pathways)
Office staff can be trained in support roles, such as handing out screening forms and telling parents/caregivers that they will communicate questions to the clinical staff

Collaborative or integrated care models present a promising method to connect medical patients with mental health resources. These models may:

Ease referral processes for patients at risk for suicide
Ensure that participating clinicians are competent in suicide prevention practices (eg, providing evidence-based care, appropriately managing patients at risk for suicide)
These models have also been demonstrated to reduce suicidal ideation
For more information on collaborative or integrated care models, visit:

Connect with Mental and Behavioral Health Providers in your Community

When planning to integrate a suicide prevention protocol in your clinic, it is critical to first identify mental and behavioral health providers in your community, build connections with those providers, and identify alternate strategies for communities that have a lack of mental health resources. See Two Critical Steps Before You Begin for full details.

Build a Suicide Prevention Program that Best Serves your Community of Patients

Individual communities experience and discuss mental health, distress, and suicide in different ways. Terms used to talk about death or suicide may vary by population and culture, and beliefs or stigmas about mental health may impact delivery of patient care.

Partnerships with community members are critical to building effective suicide prevention programs:

Engage community/tribal leaders, youth, and parents/caregivers from the beginning, to identify needs and desires for suicide prevention and mental health services among your patient population
Youth and families with lived experience of suicide are especially important collaborators to engage in the design of programs. Learn more about safely engaging people with lived experience here
Partner with community/tribal members, faith leaders, and school leaders in the implementation of your suicide prevention program, as care navigators, clinic staff, or peer educators

Health systems can build an inclusive and welcoming care environment for their patient community:

Use inclusive language in office signage, forms, and clinical interactions
Ask patients about their names and pronouns and avoid gendered language in clinical discussions
Display signs or printed materials in the language(s) spoken by the patient population
Ensure that posters and photographs in the office reflect a diverse range of families and patients
Display posters or signs conveying that patients and families deserve to feel welcome and respected
Seek feedback from patients and families about the physical environment of the clinic
Ensure clinic documents are professionally translated into the languages spoken by your patient population
Utilize an interpreter during clinical visits with patients who speak a language other than your own. Ensure that family members of the patient are not asked to serve as interpreters
In telehealth visits, utilize interpreters and assistive technology to promote accessibility for all families

Assess and Address Barriers

Barriers can be overcome, but they are also real issues that need to be addressed by each institution. Understanding common barriers to suicide prevention protocols can help health systems overcome potential roadblocks. Barriers can be addressed through staff training and by adapting the evidence-based clinical pathway below to meet the individual needs of your practice.

Common Implementation Barriers and Strategies to Overcome* Them

Limited time/resources and competing priorities in a busy health system

Consider strategies to efficiently integrate a suicide prevention protocol into your standard workflow: How can your Electronic Health Record (EHR) system facilitate screening? How can other members of the care team support safety planning or referrals?
Utilize a standardized care pathway, as described above. This pathway is designed as a straightforward workflow to ease decision making and care processes

Limited access to mental and behavioral health providers in the community

Make a list of available pediatric mental health providers and connect with them to assess affordability and determine capacity for new patients
In areas with limited mental health support, consider alternative options, such as telehealth or school-based mental health resources
Consider consulting with a Pediatric Mental Health Care Access Program (PMHCA) to obtain timely training and support in addressing mental and behavioral health concerns in primary care settings
Build relationships with local schools, community organizations, juvenile justice centers, and child welfare organizations to support wrap-around care services for youth

Language or cultural barriers

Identify mental and behavioral health supports in the community that are culturally and linguistically appropriate for your patient population; if these resources do not exist in the community, consider telehealth services, community/school-based services, or consulting with a Pediatric Mental Health Care Access Program (PHMCA)
Utilize multiple languages, translation and interpreter services, and assistive technology to increase access to care for all patients and families
Be aware of cultural factors, historical trauma, systemic racism, and other factors that may impact a patient’s or family’s experience with mental health and the medical system
Utilize trauma-informed care principles when working with patients and families
Understand that existing, validated suicide screening and risk assessment tools may not have been developed and tested with diverse populations—this is a limitation of the field, and research is needed to build culturally appropriate screening/assessment tools. In the meantime, use existing, validated screening tools with patients in your practice

Families facing logistical challenges in making/accessing mental health appointments

Consider employing care-navigators to partner with families to support them in making appointments and facilitating access to those referrals
Consider a multi-disciplinary team-based care approach, when possible, to provide care coordination or social work support to families accessing care

Stigma around mental health symptoms

Talk with clinicians, health system administrators, families, and other community members about the essential role that mental health plays in overall child health and development. Challenge the false dichotomy between mental and physical health
Use careful language when talking about suicide, to avoid inadvertently blaming the patient or family for suicidal ideation or behaviors

Clinician discomfort in talking about mental health

Review this Blueprint and other resources about youth suicide prevention
Utilize a clinical pathway for suicide risk screening, brief suicide safety assessment/risk assessment, and management
Ask patients about their mental health – practice talking about mental health as a standard part of all visits with patients and families
Practice asking directly about suicide risk – use the mirror, and rehearse how you will ask, and what you will do if you hear a positive response
Understand that you do not need to be an expert in mental health to advance suicide prevention: you just need to ask the right questions and refer high-risk patients to a mental health professional for specialized care
Know that you do not have to do this work alone—develop a workflow that engages other members of the clinical team
Take time to check in with your own mental health, especially in times of stress

Concerns around billing/payment for mental health services

Zero Suicide provides resources on financing suicide prevention care in clinical settings
Consult AAP coding resources to support billing for pediatric visits that address:
(For other topic areas, visit AAP’s repository of coding fact sheets)

*Many of the barriers listed in this table result from systemic factors that impact disparities in access and delivery of health care across the US. Meaningfully addressing these barriers requires large-scale changes to systems and resources.

In the meantime, pediatric health clinicians can ensure they are aware of these barriers and use the strategies outlined above to address them as well as possible during the clinical visit. More information on these strategies can be found in the sections above.

Train the Staff

All staff should be involved in suicide prevention training. Training can build skills, confidence, and self-efficacy in staff and can help staff communicate compassionately and more effectively with parents, caregivers, and families.

Interactive training strategies, such as role-plays, standardized patients, or peer feedback on skills and techniques may help staff understand and integrate this content into practice.

Training programs should address the following topics:

Epidemiology of suicide among youth and young adults
Addressing common myths and stigma related to suicide
Specific training in how to use the screening and assessment tools that will be used by your health system (see Screening and Assessment tools)
Knowing what to say and do (and what not to say or do) when a patient reports suicidal thoughts or behaviors
Trauma-informed care
Safety planning
Lethal Means Safety Counseling
Understanding the impact of a suicide loss on child/youth mental health
Understanding the impact of a suicide loss on healthcare professionals
Billing procedures (including CPT codes and payments)
Working with interpreters
Confidentiality practices and limits for adolescent healthcare
Rare emergencies, such as patients at imminent risk for suicide
Regulatory procedures (The Joint Commission, insurance, state requirements)
Maintenance of Certification and quality improvement strategies for implementation
Health equity and cultural considerations for care provision
Understanding and addressing personal and systemic biases that impact care delivery

To promote a program’s longevity, training should be repeated regularly for all staff, and updated as new information becomes available. During leadership transitions or when onboarding new employees, suicide education and prevention training should be incorporated into the training process for smooth transitions.

Experts are available to train your health system staff in person, online, or via recorded trainings:

Last Updated

02/22/2023

Source

American Academy of Pediatrics