• Report
  • November 21, 2019

Improving Rates of Counseling Parents/Caregivers of Patients with Suicidality on Restricting Access to Lethal Means

Best practices for improving counseling on restricting access to lethal means developed based on the Pediatric Hospital Care Improvement Project (P-HIP) 12-month learning collaborative

Pediatric mental health disorders are becoming a significant issue in healthcare. An estimated 20% of children and adolescents in the United States meet diagnostic criteria for a mental health disorder and inpatient admissions and hospitalizations for mental health problems among youth increased significantly in the past several decades.

The American Academy of Child and Adolescent Psychiatry recommends that parents/caregivers of children and adolescents admitted to the hospital for suicidality should be counseled on restricting access to lethal means as a minimal standard of care. Yet, studies have shown that clinicians are not trained in and do not routinely counsel on lethal means restriction.

Funded by the Pediatric Quality Measures Program (PQMP), the Center of Excellence on Quality of Care Measures for Children with Complex Needs (COE4CCN) developed quality measures related to Mental Healthcare in Hospital Settings as well as Transitions of Care. As part of this effort, the P-HIP tested the measures at eight children’s hospitals in a Quality Improvement Collaborative.

The Mental Healthcare in Hospital Settings Collaborative sought to improve overall performance on Lethal Means Restriction Counseling. The goal of the collaborative was to increase the number of children/adolescents who were admitted to the hospital for dangerous self-harm or suicidality whose parent/caregiver was counseled on how to restrict access to potentially lethal means of suicide prior to their child’s/adolescent’s discharge.

Eight CHA member hospitals serving children insured by Medicaid or the Child Health Insurance Program (CHIP) participated in the collaborative:

  • Seattle Children's Hospital
  • UCSF Benioff Children's Hospital, Children's Hospital and Research Center Oakland
  • The Children's Hospital Colorado
  • University of Iowa Children's Hospital
  • Monroe Carell Jr. Children's Hospital at Vanderbilt
  • Cincinnati Children's Hospital
  • Medical University of South Carolina Children's Hospital
  • Mt. Sinai Children's Hospital

The change package includes a set of evidence-based practices that are based on the findings from the improvement work performed by the eight collaborative teams. It contains valuable information about the effective strategies identified by the participating hospitals and provides guidance on how other teams can improve these practices in their own hospitals. Appendices contain examples of tools and templates that can be of assistance as this work is done.