510 - Beyond Screening: A Qualitative Study Exploring Adolescent and Caregiver Perspectives of Emergency Department Responses to Identified Suicide Risk
Monday, April 28, 2025
7:00am – 9:15am HST
Publication Number: 510.3715
Rachel Cafferty, University of Colorado School of Medicine, Denver, CO, United States; Anastasia M. Klott, University of Colorado School of Medicine, Aurora, CO, United States; Ashley C. Dafoe, University of Colorado School of Medicine, Aurora, CO, United States; Chloe Glaros, University of Colorado School of Medicine, Aurora, CO, United States; Brooke Dorsey Holliman, University of Colorado School of Medicine, Aurora, CO, United States; Maya Haasz, University of Colorado School of Medicine, Aurora, CO, United States; Bruno J. Anthony, University of Colorado School of Medicine, Denver, CO, United States; Sean T. O'Leary, University of Colorado School of Medicine, Denver, CO, United States
Assistant Professor University of Colorado School of Medicine Denver, Colorado, United States
Background: Suicide is a leading preventable cause of death among adolescents in the US. As a safety net for adolescents who may underutilize primary care, the Emergency Department (ED) is considered an opportune setting for suicide prevention, including screening and response (i.e., risk assessment, brief interventions, and referral to treatment). The NIMH Suicide Risk Screening Pathway provides some ED guidance on using the Ask Suicide-Screening Questions (ASQ). However, ED response for patients with a non-acute positive screen (i.e., adolescents with elevated but non-imminent risk) is not standardized. Objective: To understand perspectives on the ED response when risk of suicide is identified, from adolescents with a non-acute positive ASQ and/or their caregivers. Design/Methods: Our institution performs universal suicide screening with the ASQ for all ED patients, ages 10 and older. We conducted semi-structured qualitative interviews with adolescents (ages 13-17 years old) who had a non-acute positive ASQ, and/or their caregivers. Eligible participants were approached in the ED to obtain informed consent and interviews were scheduled after ED discharge. Interviews occurred between October 2023 and June 2024. Interviews were audio-recorded, transcribed, and coded in ATLAS.ti using inductive and deductive coding strategies. The analytic team diagrammed the story from each transcript to augment the analysis (Figure 1). Content analysis was used to identify salient themes. Results: We completed 17 interviews (8 adolescent; 9 caregiver). Both adolescent and caregiver participants were majority female, heterosexual, White, non-Hispanic, and had been diagnosed with and/or received prior treatment for a mental health condition (Table 1). Three primary themes were identified characterizing the experiences of adolescents and/or their caregivers after suicide risk was identified in the ED: (1) ED responses are inconsistent and insufficient; (2) ED responses should be tailored, well-timed, and protect adolescent autonomy and privacy; (3) Resources and supports provided by the ED should help overcome existing barriers to accessing mental health care. Illustrative quotations by theme and subtheme are provided in Table 2.
Conclusion(s): Screening for suicide risk in the ED is an important component of prevention. In this study, participants highlighted the need to go beyond screening with a consistent, standardized ED response that promotes adolescent privacy, provides practical tools, and facilitates improved access to outpatient mental health services.
