Suicide is a major public health crisis, and healthcare settings play a crucial role in prevention. Identifying individuals at risk is the first step, and suicide risk evaluation tools are essential for healthcare professionals. The Ask Suicide-Screening Questions (ASQ) toolkit, developed and validated by the National Institute of Mental Health (NIMH), offers a practical and efficient solution for screening patients of all ages in various medical settings.
Understanding the ASQ: A Brief Suicide Screening Tool
The ASQ tool is a set of four concise questions designed for rapid suicide risk screening. It takes approximately 20 seconds to administer, making it highly feasible for busy healthcare environments like emergency departments, inpatient units, and outpatient clinics. This brief suicide evaluation tool helps identify individuals who may require further assessment and intervention to ensure their safety.
Clinical pathway for youth suicide risk screening using the ASQ tool in healthcare settings.
The Importance of Suicide Risk Screening in Healthcare
Suicide is a leading cause of death, especially among young people. Statistics from the Centers for Disease Control and Prevention (CDC) highlight the severity of the issue, with tens of thousands of lives lost each year in the United States alone. Alarmingly, many individuals who die by suicide have visited a healthcare provider in the months leading up to their death. This underscores a critical opportunity for healthcare providers to intervene through effective suicide risk evaluation and prevention strategies.
Recognizing this opportunity, The Joint Commission, a leading healthcare accreditation organization, recommends universal suicide risk screening for all medical patients across all healthcare settings. Using validated suicide screening tools like the ASQ is crucial for accurately identifying at-risk individuals and connecting them with necessary mental health resources.
The ASQ Toolkit: Development and Validation
The NIMH spearheaded multisite studies to develop and validate the ASQ as an effective suicide evaluation tool. Initially focused on youth in medical settings starting in 2008, research expanded to include adults in 2014. The ASQ’s validity has been rigorously tested and proven across diverse patient populations and healthcare environments.
Studies have demonstrated the ASQ’s effectiveness in identifying individuals at risk. For instance, an NIMH study found that a positive response to just one of the four ASQ questions accurately identified 97% of at-risk youth aged 10 to 21. Subsequent research has confirmed its validity for adult medical patients as well, solidifying the ASQ as a reliable suicide risk screening tool for all ages.
Implementing the ASQ Toolkit in Your Healthcare Setting
The ASQ toolkit is designed to facilitate the seamless integration of suicide risk evaluation into various medical settings. It is a free resource offering materials for emergency departments, inpatient medical/surgical units, and outpatient primary care and specialty clinics. The toolkit addresses a major barrier to screening – managing patients who screen positive – by providing clinical pathways and resources for appropriate follow-up.
The toolkit includes versions tailored for both youth and adults, acknowledging developmental differences. It is available in multiple languages and is free to use. For youth screening, it is recommended to conduct the ASQ without parents or guardians present, if possible, to encourage open and honest responses from young patients.
What Happens After a Positive ASQ Screen?
A positive screen on the ASQ indicates potential suicide risk and necessitates a brief suicide safety assessment (BSSA). This BSSA should be conducted by a trained clinician to determine the next steps, which may include a more comprehensive mental health evaluation or outpatient mental health care. Regardless of the subsequent disposition, all patients screening positive should be provided with a patient resource list to ensure access to support and help.
Accessing the ASQ Toolkit and Resources
The ASQ toolkit and related materials are readily accessible online from the NIMH. These resources include:
- ASQ Tool: The four screening questions themselves.
- Toolkit Summary: A concise overview of the ASQ toolkit and its implementation.
- Combined PHQ-A/ASQ tool: Integrating depression screening with suicide risk screening.
- Clinical Pathways: Setting-specific pathways for emergency departments, inpatient, and outpatient settings for both youth and adults, including pathways for telehealth during COVID-19.
These resources provide healthcare professionals with the necessary tools to effectively implement suicide risk evaluation using the ASQ in their practice.
Suicide Prevention is Everyone’s Responsibility
Integrating suicide evaluation tools like the ASQ into routine healthcare practice is a crucial step towards suicide prevention. By proactively screening patients and utilizing available resources, healthcare providers can play a vital role in identifying and supporting individuals at risk, ultimately saving lives.
For further information or questions about implementing the ASQ toolkit, please contact Lisa Horowitz, PhD, MPH at [email protected] or Debbie Snyder, MSW at [email protected].
Suicide Prevention Resources:
- National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
- Crisis Text Line: Text HOME to 741-741
- Suicide Prevention Resource Center: http://www.sprc.org
- National Institute of Mental Health: [/]
- Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov
References:
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