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How to incorporate suicide prevention strategies in a busy practice

August 30, 2021












Editor's note:For more coverage of the 2021 AAP National Conference & Exhibition, visit

The statistic is alarming: More than one-quarter of deaths among 10- to 24-year-olds are from suicide, according to the Centers for Disease Control and Prevention.

Furthermore, most young people who die by suicide have visited a health care professional within months and sometimes within weeks of their death, said Alex R. Kemper, M.D., M.P.H., M.S., FAAP.

“This fact is a clear call to action for all of us,” said Dr. Kemper, division chief of primary care pediatrics at Nationwide Children's Hospital in Columbus, Ohio.

Yet, pediatricians may be unsure of whether they are equipped to answer that call.

Dr. Kemper is inviting pediatricians to view a session he is presenting with pediatric psychologist Lisa Horowitz, Ph.D., M.P.H., on how busy clinicians can screen adolescents for suicide risk and provide follow-up care to those with a positive screen. Titled “Pediatricians as Partners in Suicide Prevention: A Call to Action,” the session will be livestreamed from 4-5 p.m. CDT Sunday. It also will be recorded for attendees to view later.

“The central lesson is that without directly asking about suicide, most kids won’t talk about it,” he said. “Doing this can be one of the most powerful things that pediatric practices can do.”

Dr. Horowitz, a researcher and clinician at the National Institute of Mental Health, has led the development of the Ask Suicide-Screening Questions (ASQ), which she calls “a simple but highly accurate tool for providers in busy clinical practices.”

“Sometimes we hear clinicians say that they do not want to screen for suicide risk because so many will screen positive,” Dr. Horowitz said. “We understand the hesitancy given the constraints of a busy practice. However, this concern really underscores why we must have a standard, feasible approach to screening and treatment.”

She and Dr. Kemper will provide well-tested approaches pediatricians can use to efficiently identify and provide care to patients at risk for suicide. They will discuss the importance of using a well-validated screening instrument and having evidence-based pathways and clear office policies for evaluation and referral.

“Although many teens will screen positive for increased suicide risk, there are steps that can be done in the practice to ensure safety and treat the underlying issues,” said Dr. Kemper, a member of the AAP Section on Epidemiology, Public Health and Evidence.

Dr. Horowitz noted that some patients are more likely to have increased suicide risk that is not detected and are less likely to receive necessary mental health services, including those who are Black, indigenous or people of color; LGBTQ youths; families in the welfare system; those in rural areas; and those who do not speak English as their primary language.

“We need to have plans to address the care of the youth who are most vulnerable and often most underserved,” she said. “Consistent screening with clear follow-up plans can be an important strategy to address these disparities.” 

If you or someone you know is in crisis or considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 or the Crisis Text Line by texting HOME to 741741.

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