Screen youth and young adults for suicide risk and refer identified individuals for further evaluation and intervention.
Screening and referral is appropriate for youth in any setting but may be particularly warranted for those in subgroups known to be at higher risk for suicide. These include: incarcerated youth, youth with history of juvenile justice and/or protective service involvement; American Indians; white males; depressed youth; substance abusers; high-striving, perfectionist youth; potential dropouts; runaways; gay and lesbian youth; victims of assault and/or abuse; and pregnant teens.38
Screening can identify which youth need assessment and care.
RATIONALE AND EFFICACY
Screening can identify youth with symptoms of depression, suicidal ideation, and behavior, thus providing a means to determine which of them are in need of further assessment and care.
Screening using a three step process that reduces the number of false positives has been shown to be efficient and cost effective when used with both individual youth and large populations.39
Screening programs can be characterized as focused or broad. Focused screening would select youth known to be at increased risk who present in settings such as juvenile corrections, foster care, alcohol and drug treatment, mental health, youth shelters, and family planning programs. Broad screening programs screen every youth in a population.
One focused approach is to screen high risk youth in settings where they appear for protective services, detention, or health care. Screening can be accomplished by trained paraprofessionals at service delivery sites administered by state and local agencies and community-based organizations.
Suicide-risk screening instruments are still in the developmental stage, with evaluation a priority research area. Some promising screening instruments that have been used include: Suicide Ideation Questionnaire; Evaluation of Imminent Danger of Suicide; Emergency First Aid; Measure of Adolescent Potential for Suicide; Columbia Teen Screen; and the National Institute of Mental Health Diagnostic Interview Schedule for Children.40, 41, 42, 43, 44, 45
Settings in which screening should occur include:juvenile corrections centers, homeless shelters, crisis centers, family planning clinics, mental health centers, alternative schools, recreation centers, homeless shelters, crisis centers, employee assistance offices, and alcohol and drug treatment programs.
Periodic screening of high-risk youth should be conducted, since an individual?s risk for suicide may change over time.
SAMPLE IMPLEMENTATION ACTIVITIES
- Assess current efforts and gaps in screening youth and young adults for suicide risk in school and community settings.
- Identify screening approach,either focused or broad.
- Identify environments where high-risk groups appear and where screening should occur.
- Identify screening instrument.
- Train staff to administer screening process.
- Ensure that clinicians are available to assess and treat referred youth.
- Conduct screening and document implementation processes.
- Refer youth at high risk to clinicians for further assessment and intervention.
- Assist youth at imminent danger of attempting suicide with immediate crisis intervention.
Alcohol, Drug Abuse and Mental Health Administration. Report of the Secretary?s Task Force on Youth Suicide. 1989. Publication No. ADM 89-1621 US Government Printing Office. Washington, DC. 39
39 Shaffer D, Craft L. Methods of Adolescent Suicide Prevention. J Clin Psychiatry. 1999; 60(suppl2):70-74. 40
Reynolds W. Suicide Ideation Questionnaire: A Professional Manual. 1988. Psychological Assessment Resources, Inc. Odessa, Florida. 41
Bradley J, Rotheram-Borus M. Evaluation of Imminent Danger for Suicide: A Training Manual. 1990. National Resource Center for Youth Services. Tulsa, Oklahoma. 42
Ramsay R, Tanney B, Tierney R, ang W. Suicide intervention handbook. Living Works Education Inc. 1994. Calgary, AB, Canada. 43
Eggert L, Thompson E, Herting J. A measure of adolescent potential for suicide (MAPS): Development and preliminary findings. Suicide & Life-threatening Behavior. 1994; 24:359-381. 44
Shaffer D, Wilcox H, Lucas C, et al.T he development of screening instrument for teens at risk for suicide. Poster presented at the 1996 meeting of the Academy of Child and Adolescent Psychiatry. 1996. New York, NY. 45
Shaffer D, Fisher P, Lucas C, et al. NIMH diagnostic interview schedule for children,version IV (NIMH DISC-IV). J Am Acad Child Adolesc Psychiatry. In Press.Back to Top