Suicide is the leading cause of death for young people in Colorado, and leaders at Children’s Hospital Colorado in Aurora are working to change that.
Becker’s caught up with Lisa Horowitz, PhD, a pediatric psychologist and director of suicide prevention and hospital-based services research at Children’s Hospital Colorado, and Sarah Brummett, manager of the Preventing Suicide Initiative for the Pediatric Mental Health Institute at Children’s Hospital Colorado, to discuss their mission of improving suicide prevention with a shared belief that such efforts must extend beyond the walls of healthcare.
Both leaders agree on the starting point: asking directly. Dr. Horowitz said young people are more forthcoming than many adults expect. “They will tell you if you ask them,” she said, emphasizing the importance of providers following through once the concern is voiced.
Ms. Brummett noted that language matters when asking the questions. The way they are framed can either support prevention efforts or signal discomfort on the part of the adult trying to reach the child, she said.
The Ask Suicide Screening Questions screening tool, which Dr. Horowitz helped design, is now used nationwide. But she cautioned that screenings are only a starting point. “Screening is a very rapid way to identify someone who needs further assessment,” she said.
Ms. Brummett agreed that systems cannot stop at screenings.
“There’s an early focus on screening and assessment because that’s step one in the care pathway,” she said. “So oftentimes that gets the focus, and sometimes to the detriment of the rest of the care pathway. … I think health systems have been encouraged to not stop there.”
Early implementation of the screening tool came with challenges, including procedures that lacked compassion for patients who disclosed suicidal thoughts.
“Any patient that said yes to any of the questions was put in a paper gown. Their phones were taken away. They were given a very costly one-to-one observer,” Dr. Horowitz said. “And frankly, that patient probably felt sorry they ever mentioned [it].”
The most persistent barrier is workforce capacity. Dr. Horowitz said systems should train limited staff in three key areas: using the 988 crisis line, creating safety plans and providing safety counseling.
Ms. Brummett said her team takes a similar approach, integrating suicide prevention into hospital workflows and training so it becomes a systemic practice rather than reliant on individuals.
While Children’s Hospital Colorado is advancing clinical practice, both leaders stressed that prevention must extend beyond healthcare.
“There is a role for everyone,” Ms. Brummett said, pointing to factors outside of healthcare that influence outcomes, such as someone’s community environment, and the importance of a complete prevention continuum.
Dr. Horowitz put it simply: “Every single one of us can make a difference. … I encourage everyone, especially adults who come in contact with young people, to reach out and say something.”
There are positive signs emerging as the approach has been implemented. For the first time, Colorado’s youth suicide rate is declining, according to Ms. Brummett. “It means what we’re doing here in the state is working.”
