274 - Integrating Suicide Prevention into Pediatric Primary Care: Building Systems to Identify and Support Youth at Risk

Publication Number: 3263.274

Tracey Keane, American Academy of Pediatrics, Itasca, IL, United States; Kristen Kaseeska, American Academy of Pediatrics, Itasca, IL, United States; Beth Frank, American Academy of Pediatrics, Itasca, IL, United States

Background: Suicide is a leading cause of death among youth aged 10–24. The majority who die by suicide have contact with a medical professional within 3 months of killing themselves, positioning pediatric primary care as a critical setting for early identification and intervention. Training, infrastructure, and integrated systems are needed to address youth suicide risk effectively.

Objective: To develop an evidence-based training and learning collaborative framework from the American Academy of Pediatrics (AAP) that supports pediatric providers in implementing a suicide prevention clinical pathway into routine primary care.

Design/Methods: A formative qualitative study was conducted with pediatricians, mental and behavioral health professionals, and clinical staff to understand knowledge about youth suicide and determine facilitators and barriers to implementation of suicide prevention clinical pathways into pediatric primary care. IRB approval was obtained. Participants were recruited from AAP membership and through targeted outreach. Fraudulent participation affected data collection and recruitment was adjusted to mitigate impact on overall findings. Data were transcribed, two coders independently applied a structured coding framework, and thematic analysis was used to identify relevant themes.

Results: Thirteen participants (62% pediatrician, 85% female, 31% private practice, 16 years mean clinical experience) participated. A majority (n=9, 69%) self-reported a medium to high working knowledge of youth suicide and prevention. Common implementation barriers included workflow burden, limited referral, and clinician discomfort. Facilitators included leadership buy-in, clinician autonomy, and an established champion to lead efforts. These practices had been refining their suicide prevention workflow for an average of 10 years. Among pediatric providers we interviewed, majority had integrated a suicide prevention clinical pathway. Factors supporting their sustainability included leveraging available resources, instituting a bottom-up approach, and integrating efforts within broader mental health supports and processes. Additional considerations include investing in clinician empowerment and strengthening pediatric-patient-parent relationships.

Conclusion(s): Participants in a qualitative research study reported an understanding of youth suicide and prevention. Additional support is needed to facilitate long-term, sustainable implementation of a suicide prevention workflow into pediatric primary care settings.

Funding: The Pew Charitable Trusts