Conclusion
Despite the rising rates of suicide in children and youth, there are critical opportunities to identify and respond to this risk in health and behavioral health settings, and across children and youth-serving systems. While not unique to prevention efforts for children and youth, it is important to attend to the social determinants of health and familial impact that both contribute to and mitigate risk. Implementing the Zero Suicide framework when working with children and youth requires collaboration between multiple systems and effectively engaging families and other caring adults.
The Promise of Zero Suicide
Emergency departments, outpatient mental health specialty and pediatric primary care physicians constitute the most prevalent settings in which youth are seen prior to death1. Emergency department visits secondary to suicidal ideation and behavior have increased dramatically in recent years. Combined with shortages in child psychiatry and outpatient mental health care for youth, as well as limited inpatient psychiatric programs, extensive boarding in emergency departments has become commonplace in many areas of the country. The need for more effective approaches to address suicide risk in these health settings is clear.
Emergency departments, mental health care systems, and pediatric primary care are also settings amenable to practice change consistent with the Zero Suicide framework. Understanding that effective youth suicide prevention necessitates a comprehensive approach that bridges health systems, schools, and communities further lends support to the application of Zero Suicide with these populations.
Numerous children and youth-serving systems across the country have effectively adopted the Zero Suicide framework, developing exemplar care pathways specifically for use with pediatric populations that incorporate the use of validated tools, best practices, and the necessary integration with the support systems crucial for effective suicide prevention with youth. Driving innovation in health technology, pediatric health systems have also demonstrated the capacity for electronic health records to advance Zero Suicide implementation with fidelity, seamlessly capturing the data necessary for the continuous quality improvement philosophy of the framework. While the systems transformation needed for effective youth suicide can present challenges, comprehensive approaches to preventing youth suicide are imperative to saving lives.
As the nature of suicide behavior and risk evolves, a variety of effective interventions may be needed to fit the developmental needs of the youth and family. Cognitive development, learning style, and emotional intelligence vary greatly across youth, families, and the broader developmental trajectory of childhood. Research into suicide-specific psychosocial interventions is also demonstrating important nuances in efficacy across outcomes. For example, some treatments have a more robust impact on suicide attempt behaviors, while others more strongly influence ideation. Additional factors to consider when exploring treatment options for youth include the efficacy of engaging the family and contextual system, promotion of resilience and protective factors, and reduction of risk factors at individual, family, and community levels.
While there is undoubtedly great need for further research, Zero Suicide offers a flexible and promising approach to reducing suicide in children and youth. The ability to engage youth and bridge gaps between support systems, schools, health care systems, and community providers is a critical feature of any promising approach to prevention. By addressing suicide-specific care from a comprehensive framework, Zero Suicide is well-suited to bridge the many systems and contextual factors needed to effectively address the complex challenge of youth suicide.
Preventing Youth Suicide Collaborative
The Zero Suicide Institute would like to thank the Cardinal Health Foundation and the Children’s Hospital Association for their ongoing support of the Preventing Youth Suicide Collaborative. The following hospitals are members of the collaborative:
2020 Pilot
- Akron Children’s Hospital
- Ann & Robert H. Lurie Children's Hospital of Chicago
- Arkansas Children's Hospital
- Children’s Hospital of Philadelphia
- Cincinnati Children’s Hospital Medical Center
- Dayton Children’s Hospital
- Nationwide Children’s Hospital
- ProMedica Russell J. Ebeid Children’s Hospital
- UH Rainbow Babies & Children’s Hospital
2022-2024
- Atrium Health Levine Children's
- Children's Health of Orange County
- Children’s Memorial Hermann Hospital
- Children's Mercy Kansas City
- Children’s Nebraska
- Connecticut Children's
- C.S. Mott Children's Hospital, Michigan Medicine
- Le Bonheur Children’s Hospital
- Nicklaus Children's Hospital
- Pediatric Mental Health Institute, Children's Hospital Colorado
- Phoenix Children's Hospital
- Saint Louis Children's Hospital
- Seattle Children's Hospital
- UCSF Benioff Children's Hospitals
- Valley Children's Healthcare
- Yale New Haven Children's Hospital
2023-2025
- Advent Health for Children
- Advocate Healthcare
- Boston Children's Hospital
- Children's Minnesota
- Children's Wisconsin
- Cohen Children's Medical Center a Division of Long Island Jewish Medical Center
- Doernbecher Children's Hospital
- Mary Bridge Children's Hospital
- Medical University of South Carolina
- Monroe Carell Jr. Children's Hospital at Vanderbilt
- Pennsylvania State University—Penn State Children's Hospital
- Primary Children's Hospital
- Stanford Children's Health / LPCH Stanford
- Wolfson Children's Hospital
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Ahmedani, B.K., Simon, G.E., Stewart, C., Beck, A., Waitzfelder, B.E., Rossom, R., Lynch, F., Owen-Smith, A., Hunkeler, E.M., Whiteside, U., Operskalski, B.H., Coffey, M.J., and Solberg, L.I. (2014). Health care contacts in the year before suicide death. Journal of General Internal Medicine, 29(6), 870-7. doi: 10.1007/s11606-014-2767-3.