Teaching Caregivers How to Restrict Lethal Means for Patients with Suicidality

Teaching Caregivers How to Restrict Lethal Means for Patients with Suicidality

Best practices for improving counseling on restricting access to lethal means based on the Pediatric Hospital Care Improvement Project (P-HIP).

Pediatric mental health disorders are a significant issue in health care. An estimated 20% of children and adolescents in the United States meet diagnostic criteria for a mental health disorder. Inpatient admissions and hospitalizations for mental health problems among youth has been on the rise for decades and increased significantly during the COVID-19 pandemic.

The American Academy of Child and Adolescent Psychiatry recommends that parents and 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 teach lethal means restriction.

Funded by the Pediatric Quality Measures Program, the Center of Excellence on Quality of Care Measures for Children with Complex Needs 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 was to increase the number of parents or caregivers who were counseled on how to restrict access to potentially lethal means of suicide prior to their child or adolescent’s discharge for dangerous self-harm or suicidality.

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
  • 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
  • Mount Sinai Kravis 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.


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