It's easy to quantify the number of suicide screenings performed at Children’s Wisconsin: 27,000 since July 2023, resulting in more than 400 social work consults.
What’s harder to quantify is the gratitude parents and patients feel.
“The feedback from patients and families are the things that keep me going,” said Jenny Walczak, PsyD, clinical director of mental and behavioral health at Children’s Wisconsin. “Not screening patients kept me up at night, and these positive stories keep me going.”
Walczak cited a patient who thanked the staff for prompting her to address her mental health and parents who say positive suicide screenings opened a dialogue within their families.
The 27,000 screenings were the result of Walczak and director of ambulatory clinical practice Tera Bartelt’s journey to implement a universal suicide screening process across the health system.
“This is a way to reduce the stigma around mental health,” Walczak said. “This is just how we take care of kids now.”
Planning and implementation
In 2021, Children’s Wisconsin piloted screenings in multiple specialty clinics using the patient health questionnaire-9 (PHQ-9). After the conclusion of the pilot and reflecting on lessons learned, the team decided to transition to the Ask Suicide-Screening Questions (ASQ) tool to align with their inpatient team and emergency department. Patients who score in the non-acute positive range on the ASQ are additionally screened using the Columbia Suicide Severity Rating Scale to help triage their level of risk. Those with moderate or high-risk positive screenings meet with a social worker.
Children 10 and older are screened every 30 days within the health system. If a patient received a PHQ-9 screening during a primary care visit or an ASQ during an emergency visit, they would not receive one at a specialty care visit within the same 30-day time frame.
Best Practice Advisories (BPA) were added to the hospital’s electronic health record that outlined next steps for medical assistants. BPA appears if a child has not had a screening within 30 days and allows medical assistants to know if a patient has had a positive screening within the last six months.
“We wanted to make it as easy for staff as possible to know what the next steps were,” Bartelt said. “We prepared the team for when a child comes in and what the potential next steps are within the process.”
Training and building confidence
During implementation, the team noted anticipatory anxiety, time commitment concerns, and what ifs among managers and frontline staff.
“We worked with our ambulatory managers to empower them and give them the needed tools and materials,” Walczak said. “We shared workflow information and said, ‘We are here to support you, social workers are here to support you, and we will pivot if we need to.’ We just wanted to empower those managers.”
One of the lessons Walczak and Bartelt learned during the pilot was that they could not expect staff to start screenings without comprehensive training. A refreshed education approach included regular meetings with department leadership and frontline staff and learning materials, including process maps and scripting.
Staff felt a lot of anxiety about giving suicide screenings, so Walczak and Bartelt built confidence among teams through “Life Savers,” weekly meetings, and Lunch and Learns. “Life Savers” offered office hours to talk through mitigation strategies with department leaders. Lunch and Learns were offered and social workers were invited to connect with clinics during the process.
“We learned some of the clinics did not know they had an assigned social worker, so establishing those relationships was really beneficial,” Bartelt said.
Looking forward
As the team plans for what is ahead, they hope to incorporate more technology into their process, analyze their data, and make progress on quality improvement initiatives such as staff re-education and family resources available on their website.
Walczak and Bartelt's presentation was part of the educational session, “Optimizing Mental Health Screenings,” at Children's Hospital Association’s 2024 Transforming Quality Conference.
