41 - Pediatric Emergency Departments’ Suicide Prevention Preparedness: Surveys and Interviews with Leaders

Poster Number: 41
Publication Number: 41.406

Cadence F. Bowden, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Diana Worsley, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Jeremy Esposito, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Gretchen Cutler, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States; Stephanie Doupnik, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Children increasingly present to emergency departments in mental health crisis, including suicidal ideation and attempt. Pediatric Emergency Departments (PEDs) have an opportunity to reduce risk of suicide death by implementing evidence-based suicide prevention practices.

Objective: To assess PEDs’ current state of implementing suicide prevention evidence-based practices and climate for change to improve care for youth at risk of suicide.

Design/Methods: We conducted an electronic, national, cross-sectional survey of PED directors and follow-up, in-depth telephone interviews with a subset of survey participants. The survey included a questionnaire about use of suicide prevention practices and subscales from the Organizational Readiness for Change Assessment. The interview guide was developed using existing implementation science and mental health best-practice frameworks. We analyzed descriptive survey statistics, and we analyzed qualitative data using rapid content analysis.

Results: Directors at 64 PEDs participated in the survey (response rate 47%) and 21 were subsequently interviewed. 64% of PEDs had a mental health specialist available 24/7; 80% reported practicing mental health disposition planning; and 41% reported practicing psychiatric medication management. PEDs reported a positive culture towards suicide prevention (mean 3.89, SD: 0.68) and high readiness for change (m: 4.07; SD: 0.67); however, tools for evaluation and quality measurement of PEDs’ mental health services were lacking (m: 3.24; SD: 0.98). Access to financial, staffing, training and facilities resources varied (Figure 1). Interviews revealed varying strategies for implementing suicide prevention practices and confirmed that standardization, evaluation, and quality improvement initiatives were absent at most institutions, often hindering the ability to improve care for youth at risk of suicide. PED directors reported high interest in improving care, acknowledging the current mental health crisis may serve as a catalyst for change.Conclusion(s): PED directors reported a positive climate and culture of change to improve suicide prevention practices in PEDs; however, PEDs lack resources and evaluation tools to support improvements in care. Future research, policy, and reimbursement reform to improve PED mental health resource availability and quality infrastructure are likely to help PEDs implement high-quality suicide prevention services for children.
Figure 1: Organizational Readiness for Change and Availability of Resources to Improve Suicide Prevention among Pediatric Emergency Departments