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Implementing ‘Ask Suicide Screening Questions’ in a Pediatric Neurobehavioral Unit

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Alejo, Foluke
Date
2025-05
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DNP Project
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Problem and Purpose: Suicide ranks as the second leading cause of death among children and adolescents, with a 56% increase in suicide rates from 2007 to 2017 (Curtin, S., 2020), and 20% of youth reporting serious suicidal thoughts (Centers for Disease Control and Prevention, 2025). Neurodivergent individuals, including those with autism spectrum disorder (ASD), ADHD, and learning disabilities, face a significantly high suicide risk. Among 3,854 neurodivergent screenings, 6.8% were positive for suicide risk (Rybczynski et al., 2022). A study of 48,186 autistic individuals found 34.2% had suicidal ideation, 21.9% had suicide plans, and 24.3% attempted suicide (Newell et al., 2023). This elevated risk is often under-recognized. The "Ask Suicide Questions" (ASQ) tool has been validated for use in detecting suicide risk among neurodivergent patients aged eight years and older. The Pediatric Neurobehavior Unit, the project site, conducts suicide screening on patients 10 years and above during admission with parents. The Quality Improvement (QI) project incorporated a biweekly suicide screening and referral protocols within 30 minutes of a positive response for patients aged 8 and older throughout the duration of the admission in the Pediatric Neurobehavior Unit Method: Over a 15-week period, Registered Nurses (RNs) screened high-functioning patients (ages 8+) upon admission, and on the second and fourth Tuesdays of each month. Per order, the nurse referred any positive screening response to a psychiatrist (MD) within 30 minutes. Biweekly chart audits were conducted by the project lead, with all data stored in a HIPAA- compliant REDCap database. Results: The results indicate that biweekly ASQ screenings are effective in identifying neurodivergent patients with verbal capacity at risk for suicidality. Since implementation, 100% of screenings, (n-7), were documented in Electronic Health Record (EHR). Two patients screened positive and were referred per protocol for further psychiatric evaluation. Special cause was indicated. Conclusions: The findings indicate that conducting biweekly ASQ screenings improves the identification of suicide risk among neurodivergent patients. This approach supports timely interventions, potentially mitigating suicide rates within this vulnerable group. The age of screening was changed to 8 years and above, and the frequency of screening was increased to biweekly throughout the length of stay.

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