Pediatric Health Care Teams Can Help Prevent Youth Suicide

After losing a young patient to suicide in early 2023, Dr. Edward Salzberg, a pediatrician at Roswell Pediatrics Center in Georgia, found himself looking for solutions.

“I had a teenager who died by suicide within 30 minutes of leaving their wellness visit,” Salzberg recalled. “After that, I thought to myself, ‘How can we do better?’ Until it happens to you, until you have a really close encounter, you may not know what to do.”

Suicide is the second-leading cause of death for young people ages 10 to 24. In 2021, the suicide rate for ages 20 to 24 was 19.4 deaths per 100,000, and the rate for 10- to 14-year-olds was 2.9 deaths per 100,000. In 2021, more than 7,000 young people died by suicide, accounting for 15% of all suicides in the United States that year. Between 2000 and 2021, suicide rates for this entire age group increased 52%, with 9% of high school students in 2021 reporting that they had attempted suicide in the past 12 months.

Creating effective resources

As the rate of youth experiencing suicide risk continues to increase, evidence-based strategies can help support pediatricians in identifying, assessing, and connecting at-risk young people to appropriate suicide care. In response to these trends, the American Foundation for Suicide Prevention (AFSP) and the American Academy of Pediatrics (AAP) began a partnership in 2021 to support pediatric providers in advancing equitable youth suicide prevention in all settings where those in this age group live, learn, work, and spend time.

AAP and AFSP’s Suicide Prevention Project ECHO (Extension for Community Healthcare Outcomes) program engages pediatricians, other pediatric health providers, and community members to integrate recommendations from the partnership’s Blueprint for Youth Suicide Prevention. That resource provides evidence-based strategies and tools to identify and support youth at risk for suicide in clinical and community settings.

Project ECHO uses a telementoring model that promotes knowledge-sharing and learning through virtual lectures, de-identified patient case studies, and real-time problem solving to teach providers to implement best practices for suicide prevention. A team of seven faculty members with expertise in pediatric suicide prevention, family medicine, public health research and practice, and effective clinical care pathways for suicide prevention facilitates the process. Participants then work with faculty and each other to measure clinical outcomes to help foster change.

Early last year, Salzberg participated in the first cohort for this program as a provider. “[The program] was enlightening. I wasn’t aware there were standard screenings that could be used,” he said. “I didn’t realize there we so many resources available.”

This cohort launched in January 2023 with support from AFSP, The Pew Charitable Trusts, and CVS Aetna. By December, more than 40 pediatric providers from urban, suburban, and rural communities across 17 primary care practices in 11 states had adopted universal suicide screening for all patients, regardless of the reason for their visit. Since then, this program has continued to engage and educate hundreds of providers and community members across more than 40 states.

“There was definitely a sense of community—an instant connection with people,” Salzberg said. “They asked, ‘How are you doing?’, and I honestly hadn’t even thought about it—how I was doing after losing a patient. The resources for providers who lose a patient were also so helpful.”

Other participants shared Salzberg’s sentiments in post-program surveys, highlighting the relevance and applicability of the content to what they are experiencing in their practices. Another provider remarked on the impact and benefits of the “actual concrete suggestions as to how to implement suicide prevention in primary care,” such as how to conduct a safety assessment and identify next steps for care for a patient who has screened positive for suicide risk.

A continued impact

AAP-AFSP surveys found that 85% of participants in the initial cohort reported afterward that they had increased their knowledge about suicide prevention (including risk factors and warning signs for suicide); 77% reported increased confidence in their ability to apply the information presented; and nearly all (93%) said they were committed to implementing the skills learned in practice.

In the months since, Salzberg has continued to apply those skills. He has worked to train staff on best practices in suicide prevention and treatment and provide suicide care resources to families.

“We’re at the beginning stages of implementing, and there are three projects: We’re creating a list of reliable resources for patients and families, we’re training our staff on how to screen patients for suicide risk, and we’re looking into how we can incorporate these processes into our daily visits. We can’t create a perfect system right away, but we can try,” Salzberg said.

Models such as Project ECHO that bring partners together are key to implementing and scaling evidence-based mental health care. Just as health care providers are trained to respond to physical health problems, they have a key role to play in identifying and helping treat pediatric patients’ mental health needs.

“We’re always prepared for the asthma attack or seizure or a kid who isn’t breathing,” Salzberg said. “Now we have a mechanism for assessing suicide risk and feel more confident managing these critical encounters.”

Seven more Suicide Prevention Project ECHO cohorts are planned this year, including groups focused on school-based health centers and emergency departments, to ensure that more providers in these and other settings have the support they need to better address the growing risk of youth suicide.

Kristen Mizzi Angelone directs The Pew Charitable Trusts’ suicide risk reduction project, Corbin J. Standley is director of impact communication and continuous improvement at AFSP, and Jessica Leffelman is a program manager for Project ECHO suicide prevention initiatives at AAP.

To learn more about Project ECHO and upcoming opportunities to participate, contact [email protected].

Learn more about the Blueprint for Youth Suicide Prevention at aap.org/suicideprevention.

A version of this piece also was published on the American Foundation for Suicide Prevention website on April 22.