Identifying Barriers to Equitable Implementation of Emergency Department Pediatric Universal Suicide Screenings

Youth continue to present to Emergency Departments (EDs) with suicidal thoughts and behaviors at alarmingly high rates, and racially and ethnically minoritized youth are particularly impacted by this growing crisis. Universal screening for suicidal thoughts and behaviors of all youth who present to the ED regardless of their presenting concern is increasingly important in order to address suicide among traditionally underserved populations. However, implementation of universal suicide screening in pediatric EDs has been difficult to successfully accomplish. Lurie Children’s Hospital, a major children’s hospital and Central DuPage Hospital, a general community hospital have implemented the Ask Suicide Questionnaire (ASQ) in Emergency Departments for all youth ages 10 and up, However, rates of eligible youth being screened remain around 50%, which is similar to national trends. The existing literature on barriers to implementing ED screening is limited and racially and ethnically minoritized youth are underrepresented in these studies. No known studies to date have examined differences between youth who received screening versus those who did not receive screening, and this represents an important gap in the literature in better understanding ways to provide equitable suicide screening. With input from a Community Advisory Board, the objective of the current study is to utilize a multi-methods approach informed by the Health Equity Implementation Framework to examine barriers and facilitators to the equitable implementation of universal suicide screening across two unique hospital sites. Aim 1 will utilize an electronic medical record review of approximately 35,000 unique ED encounters to assess clinical (presenting concern, mental health history), demographic (race, ethnicity, preferred language, insurance status) and system (ED census, staff caring for patient) differences between youth who did receive a suicide screen and those who did not receive screening. We hypothesize that clinical and demographic differences in screening patterns will emerge that reflect potential inequities in care delivery. Aim 2 seeks to further triangulate quantitative findings by conducting in-depth interviews with purposively sampled stakeholders (N = 30) including patients, caregivers, frontline ED staff and hospital-level administrators to better understand preferences for screening and barriers and facilitators to suicide screening implementation. The proposed study aligns with the American Foundation for Suicide Prevention funding priority related to underrepresented and diverse communities and will provide the foundation for developing interventions aimed at equitable implementation of suicide screening across both pediatric specialty and general community hospitals, filling a critical gap in the literature and addressing an urgent need for enhanced screening and identification of suicidal youth.