From TEDMED 2020: Screening teens for suicide with Dr. Cheryl King

Cheryl A. King, PhD, clinical psychologist and professor in the department of psychiatry at Michigan Medicine, the academic health system at the University of Michigan, Ann Arbor, joined Nick Andrews at TEDMED2020.

Dr. King spoke with Nick (@Nick_Andrews_) at @TEDMed about a suicide risk screen for teens that is based on computerized algorithm.

Take-home points

• Dr. King is a longtime researcher in teen suicide, and her current project is creating a personalized adaptive suicide risk screen for teens called CASSY (Computerized Adaptive Screen for Suicidal Youth).
• In an adaptive algorithm, subsequent questions will change based on the previous answer. The aim is to create a profile of risk factors and warning signs to generate a risk level that will guide the type of mental health interventions required in the ED and beyond.
• CASSY also is being developed as a universal screen for those who might come to the ED without a mental health history. Many teens who die by suicide do not have previous contact with mental health professionals.
• More research is being done to create and validate treatment interventions for at-risk teens so the risk levels generated in the ED can be met with evidence-based interventions for preventing suicide.
• With the scarce mental health resources in some areas, Dr. King and associates have created an intervention that trains youth-nominated adults from within families to intervene in times of crisis.

Summary

• The CASSY is based on computerized algorithms from data collected by the Pediatric Emergency Care Applied Research Network (PECARN). Within this network, thousands of teens in mental health crisis, after suicide attempt or not, have completed a suicide risk survey aimed at modeling specific warning signs and risk factors for predicting suicide attempts in the next 3 months. In an adaptive algorithm, subsequent questions will change based on the previous answer.
• The risk factors for teen suicide are well established, but teens who attempt are a heterogeneous group. The key to predicting an imminent risk of suicide depends on developing profiles of risk based on how the risk factors and warning signs group together. The result of the CASSY is a level of risk. Individual institutions can set their risk levels.
• CASSY is being developed as a universal screen for those who might come to the ED without a mental health history. Many teens who die by suicide do not have previous contact with mental health professionals. The goal is for CASSY to be integrated into a medical system's EHR in order to make it easier to use on a broad population.
• The most common intervention in an ED for suicide risk is creating a safety plan that involves identifying warnings signs for decompensated mood, brainstorming coping skills, and delineating emergency contacts and a plan of action for suicidal emergency.
• Dr. King and associates developed the Youth-Nominated Support Team intervention, which harnesses the strength of the adults in the family to bolster treatment as usual. The teens nominate "caring adults" who they want to support them after hospitalization, and the adults are provided psychoeducation and training to more effectively support the teens.
• Dr. King is also working on a National Institute of Mental Health–supported study to identify the 24-hour warning signs for suicide attempts. Dr. King thinks there is more work to be done combining the screening tools with interventions in the ED and beyond.

References

King CA. J Am Acad Child Adolesc Psychiatry. 2019 Oct;58(10):S305.

King CA et al. J Clin Psychol Med Settings. 2017 Mar;24(1):8-20.

King CA et al. JAMA Psychiatry. 2019 Feb 6;76(5):492-8.

King CA et al. J Am Acad Child Adolesc Psychiatry. 2019 Dec 9. doi: 10.1016/j.jaac.2019.10.015.

ASQ toolkit for suicide screening: https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/index.shtml

Show notes by Jacqueline Posada, MD, who is associate producer of the Psychcast and consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Dr. Posada has no conflicts of interest.

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