Medical Student Washington University in St. Louis School of Medicine Saint Louis, Missouri, United States
Background: Given suicide is the second leading cause of death in youth, the American Academy of Pediatrics (AAP) recommends universal suicide screening for patients age 12 and up. Race, sexual orientation and gender identity are noted as factors that may heighten suicide risk. Studies also indicate that youth in foster care are at higher risk. The SPOT youth center provides sexual and reproductive health and social services with a focus on serving Black, Indigenous, People of Color (BIPOC) and lesbian, gay, bisexual, transgender, queer (LGBTQ) youth. Within the SPOT is the COACH program, a medical home for adolescents in foster care offering trauma-informed primary care with integrated behavioral health. In 2022, universal suicide screening was implemented at the SPOT. Objective: This study compared screening and follow-up outcomes between foster care youth and non-foster care youth after implementation of the Ask Suicide Screening Questions (ASQ) instrument. Design/Methods: Screening results of the ASQ between 5/25/22-3/22/23 are reported by foster care status (n=356). Once youth in foster care establish care through COACH, they remain “COACH youth” regardless of custody status. A positive response to any of the 4 ASQ items indicates risk for suicide (ASQ+). All youth met with case management on the day of screening for risk assessment, safety planning, referrals and resources. Variations in ASQ+ responses were compared. Therapy and psychiatry follow-up rates within 3 months were compared between COACH/ASQ+ (n=11), non-COACH/ASQ+ (n=23), and COACH/ASQ- (n=27). Results: Screened youth ages 13-26 consisted of 11% foster care youth, 72% Black youth, 7% gender diverse; 26% identified as LGBTQ. Overall 9.6% of youth screened positive for suicide risk. COACH youth were more likely to screen positive (28%) and report previous attempts. COACH/ASQ+ had similar rates of therapy with non-COACH/ASQ+ youth, but higher rates of psychiatry visits (45% vs 13%). Among COACH youth, ASQ+ had higher rates of therapy and psychiatry (provided at the SPOT) follow-up.
Conclusion(s): Community health and social service centers for diverse youth are key sites for suicide screening. This study is the first to report on therapy and outpatient psychiatric follow-up after suicide risk screening in a foster care medical home. The COACH program appears effective in timely mental healthcare coordination, and youth in foster care deserve special focus given high rates of positive suicide screens. Non-foster care youth at the SPOT may also benefit from integrated behavioral health. Slide1.jpeg
