Doernbecher Children’s Hospital is a participant of the 2023 cohort of 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
Doernbecher Children’s Hospital, part of Oregon Health and Science University (OHSU), provides a wide spectrum of pediatric healthcare through more than 100 inpatient beds and 21 outpatient specialty clinics across Oregon and Southwest Washington. It is home to one of only two pediatric emergency departments in the state, caring for children and youth experiencing both medical and psychiatric crises. The OHSU Division of Child and Adolescent Psychiatry provides outpatient and inpatient care, consultation, psychotherapy, and medication management. Its consult liaison team supports children and adolescents admitted through the emergency department or inpatient wards, making Doernbecher a critical resource for pediatric behavioral health across the region.
Implementation of Zero Suicide
Over the past several years, Doernbecher has seen a sharp increase in children and adolescents presenting in psychiatric crisis, including a dramatic rise in near-lethal suicide attempts requiring intensive care. To respond, Doernbecher’s Zero Suicide implementation team launched a biannual Zero Suicide Workforce Survey to identify staff concerns and training needs.
Survey results revealed a strong desire for expanded de-escalation training, standardized safety planning and lethal means counseling, and more evidence-based treatment training. In response, Doernbecher implemented the Stanley Brown Safety Plan model across the hospital, integrating it into the electronic health record so that safety plans can be pinned to patient charts and accessed by all staff. Safety plans are created by psychiatric social workers on the Child and Adolescent Psychiatry Consult Team, in collaboration with the child or adolescent and their parent/caregiver. The process emphasizes that the plan is “owned” by the patient themselves, ensuring it is meaningful and actionable.
More than 20 social workers from the emergency department and psychiatry team also completed SAFETY-A training (formerly called Family Intervention for Suicide Prevention, or FISP). SAFETY-A is an evidence-based brief intervention designed for use with suicidal youth in emergency departments. In addition, OHSU/Doernbecher approved a formalized de-escalation training program to be disseminated across the workforce.
The Zero Suicide work group also collaborated with colleagues in the Injury Prevention Program (IPP) and the IMPWR (Improving Mental Health and Promoting Wellness and Resilience) initiative to coordinate care and strengthen safety. Together, they conducted a hospital-wide safety and risk assessment, rating each inpatient unit and the emergency department. As a result, all units and stairwells were converted to key card access only, reducing the number of successful elopements among psychiatric patients.
More than 20 social workers from the emergency department and psychiatry team also completed Safety A training, an evidence-based program focused on equipping clinicians to intervene with youth presenting in psychiatric crisis. In addition, OHSU/Doernbecher approved a new formalized de-escalation training program that will be rolled out hospital-wide.
The Zero Suicide work group also collaborated with the Injury Prevention Program and the IMPWR (Improving Mental health and Promoting Wellness and Resilience) initiative to strengthen care coordination. Together, they conducted a comprehensive safety and risk assessment of the hospital building, rating each inpatient unit and the emergency department. As a result, all units and stairwells were converted to key card access only, reducing the number of successful elopements among psychiatric patients.
Key Outcomes
Alongside these practices and environmental changes, the Zero Suicide team evaluated existing programs to measure their effectiveness.
Firearm and Medication Safety Program
The Injury Prevention Program provides consultation for patients seen in the ED or inpatient units for mental health crises. These consults are a critical part of discharge safety planning, offering families tools such as medication lockboxes and safe firearm storage devices. However, baseline data revealed that only 26% of eligible patients (210 of 810) received an IPP consultation. Among those who did:
- 99% of families met with staff once the referral was placed.
- 86% accepted at least one safety product.
- 90% reported continued use of the product post-crisis.
- 98% said they felt their child was safer at home as a result.
This showed both the effectiveness of the intervention and the need to increase consultation orders so more families could benefit. Families expressed how impactful these interventions were during a difficult time:
- “The lockbox gave us peace of mind during a really hard time.”
- “Getting the medication lockbox helped me feel like I was doing something to keep my child safe.”
- “Wonderful program. I wish all families had access to these safety resources.”
- “Appreciate the resources. The Safety Educator/team member was respectful, straightforward, and knowledgeable.”
Lines for Follow-Up Care
Doernbecher also refers high-risk patients at discharge to Lines for Life, a community-based follow-up program. Referrals are placed by psychiatric social workers, and families can choose to opt in. The program provides four follow-up calls: the first three occur on consecutive days after discharge, and the fourth on day eight. These calls reinforce the patient’s safety plan and connect families with community resources. While Doernbecher has not yet gathered outcome data, national literature shows that caring contacts improve follow-up and safety for patients after hospitalization.
While outcome data is not yet available, families have shared that the program provides vital reassurance:
- “Knowing someone would check in (Lines for Life) gave me peace of mind after we left the hospital.”
- “Thank you for the work that you do at Doernbecher. Our family really appreciates the great care and resources we received.”
De-escalation and Safety Training
Monthly Mock Code Gray drills have been implemented to improve staff preparedness for managing combative or dangerous patients. Staff from all disciplines participate in these drills, practicing verbal de-escalation techniques and, when necessary, procedures for physical or chemical restraint in collaboration with security staff. These drills were developed in direct response to staff requests for more confidence and practice in managing crises.
Next Steps
Looking ahead, Doernbecher plans to expand its focus beyond hospital-based interventions by partnering with the Oregon Health Authority (OHA) to track statewide suicide attempts and deaths. This will help identify broader community trends and design programs that intervene earlier, before crises escalate to hospitalization.
Through collaborative safety planning, implementation of SAFETY-A, stronger environmental safety measures, firearm and medication safety interventions, and community-based follow-up care, Doernbecher Children’s Hospital has strengthened its ability to care for children and adolescents at risk of suicide. These efforts demonstrate a commitment to embedding Zero Suicide principles across clinical practice and to building a safer, more responsive system of care for youth and families across Oregon and Southwest Washington.