Implementing Suicide Risk Screening in a Pediatric Primary Care Setting: From Research to Practice
Open accessAbstract
Objective: To describe the methodological development and feasibility of real-world implementation of suicide risk screening into a pediatric primary care setting. Methods: A suicide risk screening quality improvement project (QIP) was implemented by medical leadership from a suburban-based pediatric (ages 12 to 25 years) primary care practice in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. A pilot phase to acclimate office staff to screening procedures preceded data collection. A convenience sample of 271 pediatric medical outpatients was screened for suicide risk. Patients, their parents, and medical staff reported their experiences and opinions of the screening procedures. Results: Thirty-one (11.4%) patients screened positive for suicide risk, with one patient endorsing imminent suicide risk (3% of positive screens; 0.4% of total sample). Over half of the patients who screened positive reported a past suicide attempt. Most patients, parents, and medical staff supported the implementation of suicide risk screening procedures into standard care. A mental health clinical pathway for suicide risk screening in outpatient settings was developed to provide outpatient medical settings with guidance for screening. Conclusions: Screening for suicide risk in pediatric primary care is feasible and acceptable to patients, their families, and medical staff. A clinical pathway used as guidance for pediatric healthcare providers to implement screening programs can aid with efficiently detecting and managing patients who are at risk for suicide.
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Previous studies describing opinions for screening show that most pediatric patients and parents/guardians support screening for suicide risk in healthcare settings.
“Moreover, previous studies describing opinions for screening show that most pediatric patients and parents/ guardians support screening for suicide risk in healthcare settings.”
From Suicide in young people: screening, risk assessment, and intervention (2023) · cites this paper as [95]
Disposition based on screening alone can fail to respond appropriately to real suicide risk and result in inefficient use of resources.
“Once a patient screens positive for suicide risk, a follow-up assessment is a critical best practice, as disposition based on screening alone can fail to respond appropriately to real suicide risk and result in inefficient use of resources.”
From Suicide in young people: screening, risk assessment, and intervention (2023) · cites this paper as [95]
The outpatient clinical pathway for screening was developed by the AACAP PaCC workgroup to assist hospitals, EDs, and inpatient units implementing suicide risk screening, with subsequent versions for outpatient primary and specialty care modified by NIMH.
“The outpatient clinical pathway was developed by the Pathways in Clinical Care (PaCC) workgroup from within the Physically 111 Child committee of the AACAP to assist hospitals and EDS, and inpatient medical/surgical units implementing suicide risk screening to pediatric patients,98 with subsequent versions developed for outpatient primary and specialty care modified by NIMH.99”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [98]
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Additional file 1 of Implementation strategies in suicide prevention: a scoping review
Chen, J. I., Roth, B., Dobscha, S. K., & Lowery, J. C. (2024) · Figshare · doi:10.6084/m9.figshare.26685633
Additional file 2 of Implementation strategies in suicide prevention: a scoping review
Chen, J. I., Roth, B., Dobscha, S. K., & Lowery, J. C. (2024) · Figshare · doi:10.6084/m9.figshare.26685636
O’Reilly, L. M., Meadors, D., Marriott, B. R., Hulvershorn, L. A., & Aalsma, M. C. (2025) · BMC Family Practice · doi:10.1186/s12875-025-03102-7
The Role of Nursing Policy in Standardizing Suicide Risk Screening Across Healthcare Settings
Ling, A., Kim, D. H., & Garcia, G. (2026) · Issues in Mental Health Nursing · doi:10.1080/01612840.2026.2632767 · Cited by 1 · see citing works
Jensen, P. S., Green, C. M., Galanter, C. A., & Amsel, L. (2026) · Academic Pediatrics · doi:10.1016/j.acap.2026.103312
Sarfika, R., Kustanti, C. Y., Saifudin, I. M. M. Y., Efendi, F., & Abdullah, K. L. (2026) · International Journal of Behavioral Development · doi:10.1177/01650254261430618 · Cited by 1 · see citing works
Danzo, S., Abler, A., Hoang, A. N., Comtois, K. A., Hartzler, A. L., Richardson, L. P., & McCauley, E. (2026) · PLOS mental health. · doi:10.1371/journal.pmen.0000607
Suicide Risk Among Youth Who Choose “No Response” on Emergency Department Suicide Risk Screenings
Boyd, S. D., King, C. A., Brent, D. A., Casper, T. C., Bridge, J. A., Webb, M., Hatkevich, C. E., Hengehold, T., & Grupp‐Phelan, J. (2026) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.70102
Self-citationStreicher, B. E., Cooley, J. L., Sims, J. G., Marvin, C., Rojas, D., Wakefield, S. M., & Mitchell, S. M. (2026) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2026.2718212
Kobayashi, I., Fernandes, S. N., Stein, C. R., & Lois, B. H. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.09.003
Beyond Risk Identification: Adherence to a Pediatric Suicide Prevention Pathway in Primary Care
Huttle, A., Rajan, M., Kelly, N. E., Jimenez, L., & Green, C. M. (2026) · Academic Pediatrics · doi:10.1016/j.acap.2026.103469
Pestaner, M. C., Reich, J. C., Mechling, B., Altergott, H., & Tyndall, D. E. (2026) · Journal of School Health · doi:10.1111/josh.70257
- Authors
- Horowitz, L. M., Bridge, J. A., Tipton, M. V., Abernathy, T., Mournet, A. M., Snyder, D. J., Lanzillo, E. C., Powell, D., Schoenbaum, M., Brahmbhatt, K., & Pao, M.
- Affiliations
- National Institutes of Health (US)
- Abigail Wexner Research Institute (US)
- National Institute of Mental Health (US)
- University of California, San Francisco (US)
- Corresponding author
- Horowitz, Lisa M.
- ORCID
- Venue
- Academic Pediatrics
- Publisher
- Elsevier BV
- Published
- 2022-03
- Volume
- 22
- Issue
- 2
- Pages
- 217-226
- ISSN
- 1876-2859 (ISSN-L)
- PMC
- PMC8908796
- OpenAlex
- W4214948380
- Semantic Scholar
- a24ddcfc3f11b4340ee5914a39e4153e8d96f7ad
- Cited by
- 64
- References
- 29
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 20 · 2023: 11 · 2022: 3
- FWCI
- 12.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Academic Pediatrics (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 MH999999)
- National Institute of Mental Health (ZIAMH002922)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
- Keywords
- suicide risk screening, pediatric primary care, adolescents and young adults, implementation feasibility, suicide prevention, quality improvement, care pathways, suicide attempts, medical staff attitudes
- MeSH terms
- Suicide Prevention, Adolescent, Adult, Child, Disease Susceptibility, Humans, Mass Screening, Outpatients, Primary Health Care, Young Adult, Quality Improvement
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