Boston Children’s Hospital is a participant in the Preventing Youth Suicide Collaborative; a national initiative of leading children’s hospitals committed to advancing the implementation of the Zero Suicide framework. This important work is made possible through the generous support of the Cardinal Health Foundation, in partnership with the Children’s Hospital Association.
Organization Profile
Boston Children’s Hospital (BCH) is the largest pediatric hospital in New England, with 485 licensed beds, more than 40 clinical departments, and 269 specialized programs. It is also home to the largest pediatric research enterprise in the world. The Department of Psychiatry provides acute psychiatric treatment, including 40 licensed psychiatric beds, consultation services to inpatient medical and surgical floors, emergency mental health care, and outpatient services. BCH integrates behavioral health clinicians into pediatric primary and specialty medical and surgical care throughout the enterprise, reflecting a long-standing institutional priority of collaborative mental health care.
Implementation of Zero Suicide
The pandemic brought a sharp rise in pediatric mental health crises, making suicide risk management a top institutional priority. In 2020, BCH launched a system-wide quality improvement initiative aligned with the Zero Suicide framework and Joint Commission National Patient Safety Goals. The hospital introduced a standardized suicide screening, assessment, and management protocol that incorporates:
- Ask Suicide-Screening Questions (ASQ)
- Columbia Suicide Severity Rating Scale (C-SSRS)
- Suicide Assessment Five-step Evaluation and Triage (SAFE-T)
- Stanley-Brown Safety Planning Intervention
Over 600 behavioral health clinicians have been trained in the protocol, with more than 90% compliance across acute psychiatric services. In 2023, BCH joined the national Zero Suicide Collaborative with 38 other children’s hospitals, participating in Community of Practice webinars and the annual Academy to accelerate learning and culture change.
Key Outcomes
1. Reduction of Suicidality for Adolescents in Inpatient Psychiatry
A retrospective two-year study (Sept 2021 – Sept 2023) of 218 adolescents (ages 12–17) admitted to inpatient psychiatry demonstrated significant improvement:
One of the highest lifetime rates of suicide attempts reported in an adolescent sample
54% reduction in suicidal ideation from admission to discharge
These findings underscore the effectiveness of standardized suicide care protocols.
(Full study available here <hyperlink https://doi.org/10.1176/appi.prcp.20240127 > in Psychiatric Research and Clinical Practice.)
2. Improved Lethal Means Counseling in the Emergency Department
After joining the national collaborative, BCH enhanced lethal means counseling by:
- Providing clinician training
- Embedding new documentation tools into the EHR (Epic)
A six-month quality improvement project showed a 66% increase in documented lethal means counseling for patients presenting with mental health crises who were discharged from the ED.
3. Expansion of Suicide Risk Protocols in Primary Care
Recognizing that many youth who attempt suicide are seen in primary care prior to their attempt, BCH extended Zero Suicide protocols into its three primary care sites serving over 27,000 patients. Efforts included:
- Standardizing suicide screening, assessment, and management processes
- Training behavioral health clinicians and building infrastructure for monitoring
- Coordinating protocol migration during BCH’s transition to a new Epic EHR
Results: Protocol utilization and C-SSRS screenings increased from 46% to 73% over 12 months.
Next Steps
BCH is committed to expanding and deepening its Zero Suicide efforts. Priorities include:
- Extending suicide risk protocols to specialty medical and surgical programs
- Expanding evidence-based suicide-specific treatments such as Collaborative Assessment and Management of Suicidality (CAMS), with 20 clinicians trained to date
- Strengthening the transition phase of care, prioritizing support post-discharge
- Tracking long-term outcomes for patients following psychiatric hospitalization, and monitoring treatment results for high-risk patients across ambulatory programs
Conclusion
Boston Children’s Hospital has embedded Zero Suicide practices across psychiatry, emergency, inpatient medical, and primary care settings. With demonstrated reductions in suicidality, improved lethal means counseling, and expanded suicide screening in primary care, BCH continues to lead in advancing pediatric suicide prevention. Through training, protocols, and culture change, the hospital is transforming care for children and families at risk of suicide.