Youth Suicide Prevention
Pediatric Health Clinicians & Other Adults Who Work with Youth Can Make a Difference
Explore resources and information to help decrease pediatric suicide and effectively work with families and communities on this rising issue.
Stats
Risk & Protective Factors
Warning Signs
Screening & Assessment Tools
Blueprint for PreventionWhy Suicide Screenings, Assessments, & Referrals Matter
34%
of youths >14 years had contact with a healthcare provider in the week before their death.
38%
of adolescents had contact with a healthcare system within the 4 weeks before their death.
49%
of youth had visited an emergency department (ED) within the year before their death.
80%
of adolescents visited a healthcare provider within the year before their death.
It is safe to ask youth if they are thinking about suicide!
According to the AAP, it is a common myth that asking will “put the idea into their heads.”
Illinois Children & Teens Are At Risk
Suicide rates are increasing, especially among children aged 10 to 14 years old
In Illinois, 8.4% of high school students attempted suicide
Illinois Youth Risk Behavior Survey (YRBS), 2021
Risk and Protective Factors for Suicide in Young Children & Teens
Suicide Risk Factors
Suicide is generally caused by multiple factors or events. Some of these factors are individual or due to relationships and others are due to community or societal factors. Risk factors include:
Suicide Protective Factors
Just like with suicide risk factors, protective factors are due to individual, relationship, community, or societal factors. Suicide protective factors include:
Know The Warning Signs & Save a Life
Common warning signs for increased risk of suicide & suicide ideation include:
- Talk about killing oneself
- Talk about feeling like a burden
- Talk about feeling hopeless
- Talk about having no reason to live
- Talk about feeling trapped
- Talk about unbearable pain
- Changes in mood
- Increased anger or rage
- Depression
- Anxiety
- Agitation
- Increased substance use
- Withdrawal from activities
- Isolating from family and friends
- Sleeping too much or too little
- Giving away possessions
- Making suicide plans
- Trying to gain access to lethal means
Screening Tools & Resources for Pediatric Health Clinicians
Identifying Warning Factors & Engaging in Prevention
Suicide screenings and assessments can make an incredible impact on the mental health trajectory of our youth. 34% of youths 14+ had contact with a healthcare provider in the week before their death, while 38% of adolescents had contact within 4 weeks. Explore these screening and assessment resources and tools to more readily address suicidal ideation in children and adolescents.
Screening Tools for Clinicians
Use these assessment tools after a patient has a positive screening. Some tools have trainings available online (see ASQ BSSA and C-SSRS). See NIMH ASQ toolkit for more details on administering the brief suicide safety assessment.
- Important Note: If a patient has a positive screen and shows they are at imminent risk for suicide, they do NOT need a brief suicide safety assessment. They need an EMERGENT Full Mental Health and Safety Evaluation. The brief suicide safety assessment is a triage tool for patients who screen positive (non-acute/non-imminent) to determine the next steps.
Ask Suicide Screening Questions (ASQ) Toolkit
A free resource for use in medical settings that can help clinicians successfully identify individuals at risk for suicide. The toolkit includes youth and adult versions as some materials account for developmental considerations.
Assess for Safety and Suicide Risk Flowchart
Illinois – Assessment for Safety and Suicide Risk and how Illinois Doc Assist can support clinicians
Columbia Suicide Severity Rating Scale (C-SSRS) – Triage Version
The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), supports suicide risk screening through a series of simple, plain-language questions that anyone can ask. The answers help users identify whether someone is at risk for suicide, determine the severity and immediacy of that risk, and gauge the level of support that the person needs.
Patient Health Questionnaire – 9 Adolescent Version (PHQ-9A)
Downloadable PDF of the PHQ-9 Modified for Teens
Patient-health-questionnaire.pdf (apa.org) (PHQ9)
Downloadable PDF of the PHQ-9 Depression Screening Modified for Teens
Patient Safety Screener – 3 (PSS-3)
Downloadable PDF of the PSS-3 Patient Safety Screener for teens.
Suicide Behavior Questionnaire-Revised (SBQ-R)*
The present study examined the reliability and validity of a brief self-report measure of past suicidal behavior, the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Both the single SBQ-R Item 1 and SBQ-R total scores are recommended for use in clinical and nonclinical settings.
Suicide Assessment Five-Step Evaluation and Triage (SAFE-T)
This resource gives a brief overview on conducting a suicide assessment using a five-step evaluation and triage plan. The five-step plan involves identifying risk factors and protective factors, conducting a suicide inquiry, determining risk level and interventions, and documenting a treatment plan.
The SSHADESS Screening: A Strength-Based Psychosocial Assessment
This guide provides an overview of the SSHADESS screening tool which offers a standard flow to the adolescent psychosocial interview that is rooted in a strength-based approach but also explores emotional wellbeing and adolescent risk factors
Screening Guidance & Resources for Clinicians
Use these support tools to better interpret screenings and create referral and treatment plans to limit risk.
AAP Clinical Report: Suicide and Suicide Risk in Adolescents
This clinical report is an update to the previous American Academy of Pediatrics clinical report, “Suicide and Suicide Attempts in Adolescents,” and includes resources on suicidal behavior, suicide, suicide risk assessment, mental health, and suicide precautions.
Algorithm Integration of Mental Health Care Into Pediatric Practice
Algorithm from the AAP for clinicians on how to address mental health concerns in pediatrics
Brief Interventions for Suicidal Youths in Medical Settings
Journal article published in Pediatrics which consolidates available literature on suicide risk screening and intervention in outpatient medical settings
BSSA Outpatient Youth ASQ NIMH Toolkit
This 2 page toolkit outlines what to do when a pediatric patient screens positive for suicide risk
BSSA Worksheet Outpatient Youth ASQ NIMH
This 4-page worksheet accompanies the above toolkit by the same name. The worksheet prompts clinicians and gives space to respond and consider aspects of assessment, patient interview, safety plan, and disposition determination.
Illinois Children’s Behavioral Health Transformation Initiative 2024
Progress report from January 2024 on the IL Children’s Behavioral Health Transformation Initiative
Nurse Script Outpatient Youth ASQ NIMH Toolkit
This flyer provides a 1 page list of example scripts for nurses to use in the outpatient setting when screening youths and young people for suicide risk
Suicide risk in adolescents: Updated report guides pediatricians through screening, intervention
This updated report is designed to guide pediatricians through screening and intervention best practices.
Suicide Risk Screening Tools for Pediatric Patients
This journal article published in Pediatrics identifies and reviews the accuracy of suicide risk screening tools for pediatric patients in nonpsychiatric medical settings
Suicide Risk Screening Tools for Pediatric Patients
This journal article published in Pediatrics identifies and reviews the accuracy of suicide risk screening tools for pediatric patients in nonpsychiatric medical settings
Youth Suicide Prevention: Strategies for Clinical Settings (full PDF version)
This Blueprint is designed to outline clinical and community strategies and partnership opportunities that pediatric health clinicians can use to better identify and support youth at risk for suicide.
Resources for Patient Outreach
Use these materials in your clinics, exam rooms, and waiting areas to help parents, guardians, and children better understand screening and treatment.
Mental Health Screenings Poster
This poster for adolescent and young adult patients outlines details about mental health screenings including information about who, when, where, and why screenings are taking place and what will be asked during the screenings
Parent flyer Outpatient Youth ASQ NIMH Toolkit
This flyer for parents/guardians provides a short overview about what parents/guardians can expect during a visit where their child is screened for suicidality
Use your social platforms for Suicide Prevention Week! We encourage all health care providers who work with children and teens to share social media graphics that include important facts, statistics, and what to do if children and teens are experiencing thoughts of suicide. Together, we can help spread awareness and protect our youth.
After Assessment - Determining Next Steps:
- If your patient is at imminent risk, provide an Emergent Mental Health Evaluation and provide support using guidance from:
Caring for Patients and Imminent Risk of Suicide - If your patient is not at imminent risk, provide further evaluation and support using guidance from:
Caring for Patients Who Need Further Medical Mental Health Evaluation - If your patient is at low risk, provide resources and a mental health referral using guidance from:
Caring for Patients at Low Risk of Suicide
What to Do When Community Resources are Lacking:
- Consider telehealth services
- School-based behavioral health services
- Follow-up appointments with the pediatrician until mental health services can be arranged
- Safety planning and lethal means safety counseling
- Pediatric health clinicians can consider working with Pediatric Mental Health Care Access Programs (PMHCA) also called Child Psychiatry Access Programs (CPAP). These are collaborative programs that provide training and support to primary care providers related to addressing mental health conditions in practice.
- In Illinois, this program is Illinois DocAssist
Patient Referral & Follow Up Resources for Clinicians
Leveraging Existing Resources & Supports to Improve Outcomes
Help your patients and their families find the tailored mental health support they need by sharing these mental health resources, referrals, and crisis lines.
Mental health resource list for services and resources in IL.
IDHS: Mental Health (state.il.us)
Mental health resource list for services and resources in IL
Children’s Behavioral Health | HFS (illinois.gov)
HFS (illinois.gov) – Mental health resource list for services and resources for school based health centers in IL
Building a System of Care for Children with Complex Behavioral Health Needs Pathways to Success Home
Pathways to Success is a program for Medicaid enrolled children under the age of 21 in Illinois who have complex behavioral health needs and could benefit from additional support. The program provides access to an evidence-informed model of intensive care coordination and additional home and community-based services.
Family Support Program (FSP) | HFS (illinois.gov)
The Family Support Program (FSP), formerly known as the Individual Care Grant program, provides access to intensive mental health services and supports to youth with a severe emotional disturbance
Call. Text. Chat. (988lifeline.org)
Got Transition: Six Core Elements of Health Care Transition
The Six Core Elements define the basic components of a structured transition process and include customizable sample tools for each core element
Additional Resources for Suicide Screening, Assessment, & Referrals
Resources for Parents, Caregivers, & Families
Guidance on Warning Signs, Intervention, & Suicide Prevention
Get help connecting with the children and teens you care for with these resources designed to help families discuss the difficult topic of suicide openly. Learn the warning signs, get immediate crisis support, and help limit your child’s risk of suicide.
Crisis Lifeline & Immediate Suicide Help
Contact a helpline if you or a loved one is experiencing mental health-related distress. They are confidential, free, and always open (24/7/365).
- Suicide and Crisis Lifeline – call or text 988
- National Suicide Prevention Lifeline: 800-273-TALK
- Crisis Text Line – text TALK or HOME to 741741
- National Suicide Prevention Lifeline: 800-273-TALK
- Safe2Help Illinois: 844-4-SAFE-IL; Text SAFE2 (72332)
- Illinois CARES: 800-345-9049
- Trans Lifeline: 877-564-8860
- The Trevor Project: 866-488-7386;
The American Academy of Pediatrics Blueprint for Youth Suicide Prevention
The AAP has put together a Blueprint for Youth Suicide Prevention, which is designed to support pediatric health clinicians in advancing equitable youth suicide prevention strategies in all settings where youth live, learn, work, and spend time. It was created following the 2021 AAP and American Academy of Child and Adolescent Psychiatrists and Children’s Hospital Association's joint declaration of a national emergency in child and adolescent mental health.
The Blueprint includes: Strategies for Clinical Settings for Youth Suicide Prevention as well as information about addressing disparities and systemic inequities in youth suicide and mental health.
Universal Suicide Risk Screening
Helps Support Equity in Suicide Prevention Efforts!
Source: NIMH ASQ Toolkit