Pediatric Hospital Screening for Suicide Risk in Adolescents Referred for Maltreatment

Abstract Background Adolescents who have experienced the trauma of physical or sexual abuse are at increased risk for suicidal ideation and attempt, underscoring the importance of effective screening to detect and mitigate risk. Objective This quality improvement study aimed to develop, implement, and monitor a suicide risk screening protocol to improve consistency and efficacy in identifying and preventing suicidality among maltreated adolescents referred to a pediatric hospital for medical evaluation. Methods Mixed methods design using (1) retrospective patient chart review (N = 132) to examine case characteristics, rates of protocol adherence, and screening outcomes; and (2) clinician focus group interview (N = 7) to explore multilevel facilitators and barriers to protocol uptake. Results The frequency and uniformity of screening for suicide risk improved following execution of a standardized protocol administering a brief and valid instrument. The extent of clinician adherence to the protocol was promoted and inhibited by a range of personal and organizational factors. Acute risk for suicide was identified in one-third of the adolescents screened, and suicidal thoughts or behaviors were reported by more than one-quarter. Conclusion Findings demonstrate the utility of routine suicide risk screening with adolescents who have experienced maltreatment and are thus at elevated risk for suicide. The sequential process outlined for establishing an evidence-informed screening protocol offers a practical resource for pediatric healthcare providers concerned with prioritizing patient safety and well-being.