Youth Emergency Department Brief Suicide Safety Assessment Worksheet

PDF version

• Use after a patient (10-24 years) screens positive for suicide risk on the asQ
• Assessment guide for mental health clinicians, MDs, NPs, or PAs
• Prompts help determine disposition

What to do when a pediatric patient screens positive for suicide risk:

• Patient name:
• DOB:
• Interviewer name:
• Assessment date:

Praise the patient for discussing their thoughts

• “I’m here to follow up on your responses to the suicide risk screening questions. These can be hard things to talk about. Thank you for telling us. I need to ask you a few more questions.”

Assess the patient

• If possible, assess patient alone (depending on developmental consideration and parent willingness)
• Review the patient’s responses from the asQ

Frequency of suicidal thoughts

• Determine if and how often the patient is having suicidal thoughts. Ask the patient: “In the past few weeks, have you been thinking about killing yourself?” If yes, ask: “How often?” (once or twice a day, several times a day, a couple times a week, etc.) “When was the last time you had these thoughts?”
• “Are you having thoughts of killing yourself right now?” (If “yes,” patient requires an urgent/STAT mental health evaluation and cannot be left alone. A positive response indicates imminent risk.)
• Comments
  

Suicide Plan

• Assess if the patient has a suicide plan, regardless of how they responded to any other questions (ask about method and access to means). Ask the patient: “Do you have a plan to kill yourself? Please describe.” If no plan, ask: “If you were going to kill yourself, how would you do it?”
• Note: If the patient has a very detailed plan, this is more concerning than if they haven’t thought it through in great detail. If the plan is feasible (e.g., if they are planning to use pills and have access to pills), this is a reason for greater concern and removing or securing dangerous items (medications, guns, ropes, etc.).
• Comments
  

Past Behavior

• Evaluate past self-injury and history of suicide attempts (method, estimated date, intent). Ask the patient: “Have you ever tried to hurt yourself?” “Have you ever tried to kill yourself?” If yes, ask: “How? When? Why?” and assess intent: “Did you think [method] would kill you?” “Did you want to die?” Ask: “Did you receive medical/psychiatric treatment?”
• Note: Past suicidal behavior is the strongest risk factor for future attempts.
• Comments
  

Symptoms

• Depression: “In the past few weeks, have you felt so sad or depressed that it makes it hard to do the things you would like to do?”
• Anxiety: “In the past few weeks, have you felt so worried that it makes it hard to do the things you would like to do or that you feel constantly agitated/on-edge?”
• Impulsivity/Recklessness: “Do you often act without thinking?”
• Hopelessness: “In the past few weeks, have you felt hopeless, like things would never get better?”
• Isolation: “Have you been keeping yourself more than usual?”
• Irritability: “In the past few weeks, have you been feeling more irritable or grouchier than usual?”
• Substance and alcohol use: “In the past few weeks, have you used drugs or alcohol?” If yes, ask: “What? How much?”
• Other concerns: “Recently, have there been any concerning changes in how you are thinking or feeling?”
• Comments
  

Support and Safety

• Support network: “Is there a trusted person you can talk to? Who? Have you ever seen a therapist/counselor?” If yes, ask: “When and for what purpose?”
• Safety question: “Do you think you need help to keep yourself safe?” (A “no” response does not indicate that the patient is safe, but a “yes” is a reason to act immediately to ensure safety.)
• Reasons for living: “What are some of the reasons you would NOT kill yourself?”
• Comments
  

Interview patient and parent/guardian together

• *If patient is ≥ 18, ask patient’s permission for parents to join. Say to the parent: “After speaking with your child, I have some concerns about his/her safety. We are glad your child spoke up as this can be a difficult topic to talk about. We would now like to get your perspective.”
  • “Your child said (reference positive responses on the asQ). Is this something he/ she shared with you?”
  • “Does your child have a history of suicidal thoughts or behaviors that you’re aware of?” If yes, say: “Please explain.”
  • “Does your child seem:
  • Sad or depressed?”
  • Withdrawn?”
  • Anxious?”
  • Impulsive?”
  • Hopeless?”
  • Irritable?”
  • Reckless?”
• “Are you comfortable keeping your child safe at home?”
  • Yes
  • No
  • Comments
    
• “How will you secure or remove potentially dangerous items (guns, medications, ropes, etc.)?”
  • Comments
    
• At the end of the interview, ask the parent/guardian: “Is there anything you would like to tell me in private?”
  • Comments
    

Determine disposition

• After completing the assessment, choose the appropriate disposition.
• Emergency psychiatric evaluation: Patient is at imminent risk for suicide (current suicidal thoughts). Urgent/STAT page psychiatry; keep patient safe in ED
• Further evaluation of risk is necessary: Request full mental health/safety evaluation in the ED
• No further evaluation in the ED: Create safety plan for managing potential future suicidal thoughts and discuss securing or removing potentially dangerous items (medications, guns, ropes, etc.)
• Send home with mental health referrals, or
• No further intervention is necessary at this time
• Comments
  

Provide resources to all patients

• 24/7 National Suicide Prevention Lifeline: 1-800-273-TALK (8255), En Español: 1-888-628-9454
• 24/7 Crisis Text Line: Text “HOME” to 741-741