250 - Looking Over My Shoulder: A Qualitative Study Exploring Adolescent and Caregiver Perspectives of Electronic Suicide Screening in the Emergency Department

Publication Number: 250.5725

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

Background: Electronic screening is utilized for sensitive topics in adolescent health including human trafficking, sexual health, and postpartum depression. Electronic suicide screening has been implemented within a few pediatric Emergency Departments (EDs). Our prior work demonstrated that electronic suicide screening in the ED, using the Ask Suicide-Screening Questions (ASQ), is fast, easy, and promotes patient privacy. However, youth with a positive ASQ had increased privacy/confidentiality concerns, compared to youth with a negative ASQ.

Objective: To understand perspectives on privacy, confidentiality, and honesty when completing electronic suicide screening in the ED, from adolescents with a non-acute positive ASQ and/or their caregivers.

Design/Methods: During routine medical encounters at an academic pediatric ED, adolescents completed electronic suicide screening (ASQ) via an institutionally provided iPad or personal cellular phone after scanning a QR reader. We conducted semi-structured qualitative interviews with adolescents (ages 13-17 years old) who had a non-acute positive ASQ (i.e., positive screen without imminent risk) and/or their caregivers. Eligible participants were consented in the ED. Interviews were scheduled after ED discharge and occurred between October 2023 and June 2024. Interviews were audio-recorded, transcribed, and coded in ATLAS.ti. Coded data were queried, summarized, and iteratively discussed in team meetings to develop themes.

Results: Of 41 eligible adolescents and caregivers, 34 consented and 17 (8 adolescent; 9 caregiver) completed interviews (Figure 1). Participant characteristics are provided in Table 1. Five primary themes were identified: (1) ED suicide screening is considered important and beneficial; (2) electronic screening promotes adolescent autonomy; (3) electronic screening improves privacy; (4) confidentiality concerns about data security and information sharing may limit adolescent honesty; (5) enhancing communication before screening may quell existing concerns. Illustrative quotations by theme and subtheme are provided in Table 2.

Conclusion(s): In this study, participants highlighted adolescent autonomy and improved privacy (i.e., an inability to ‘look over one’s shoulder’) as benefits of electronic ASQ screening in the ED. Some adolescents raised concerns about data security and information sharing with electronic screening. Future work evaluating implementation barriers and facilitators, including best practices for communication about data sharing and security in healthcare settings, is needed.

Figure 1. Flow diagram of participant eligibility, recruitment, and interviews completed
Figure 1_Looking Over My Shoulder_Flow Diagram.pdf

Table 1. Self-reported characteristics of study participants
Table 1_Looking Over My Shoulder_Participant Characteristics.pdf

Table 2. Illustrative Quotations by Theme and Subtheme
Table 2_Looking Over My Shoulder_Themes and Quotes.pdf