How a National Approach Transformed Youth Suicide Prevention

Suicide is the second leading cause of death among young people 10-14 years old and third leading cause of death for those between 15-24. In 2024, suicide self-injury made up 34% of visits to children’s hospitals’ emergency rooms, according to Children’s Hospital Association’s Pediatric Health Information System®

In 2021, Children’s Hospital Colorado was the first pediatric health system to declare a state of emergency in pediatric mental health. After the pandemic, children’s hospitals across the country witnessed dramatic increases in emergency department visits for all mental health crises, including suspected suicide attempts, and a national emergency was declared by the Children’s Hospital Association, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry.

A year later, the Preventing Youth Suicide National Collaborative was formed.

Barron Frazier, MD, an emergency medicine physician at Monroe Carell Children’s Hospital at Vanderbilt, helped a teen boy who was contemplating suicide go to intensive outpatient therapy. He also talked with the family about how to make their home safer by securing firearms.

Frazier credits the Preventing Youth Suicide Collaborative for giving him the tools to have these difficult conversations.

“I see how central this work is to what we do in pediatric emergency medicine,” he said. “My involvement in this collaborative didn’t just give me tools — it gave me ownership.”

The nationwide collaborative began as a joint effort of the Children’s Hospital Association, the Cardinal Health Foundation, and the Zero Suicide Institute to accelerate improvement in the identification and care of children at risk of suicide.

Today, 39 children’s hospitals and health systems have implemented changes in suicide care by screening patients, standardizing processes, collecting data, and training staff.

A system for every child to be seen

Pediatric hospitals see kids every day with varying degrees of suicide risk on inpatient floors and in emergency departments, psychiatric units, specialty clinics, primary care, and more.

The collaborative gives children’s hospitals a systematic approach to identify and assess children at risk of suicide.

For example, many hospitals have adopted universal suicide screening protocols or lowered the minimum age of children who are screened.

At Yale New Haven Health System, the initiative has empowered teams with the tools, training, and confidence to intervene early. The effort has deepened collaboration across disciplines, bringing together pediatricians, child psychiatrists and psychologists, nurses, social workers, and families to coordinate mental health care across every setting.

“Since launching this work, we’ve identified individuals at risk and connected them to support,” said Linda Mayes, MD, chief of child psychiatry and chair of the Yale Child Study Center. “With about 500 patients now being screened daily, these aren’t just numbers — they represent lives, families, and futures.”

One hospital used the evidence-based practices and decreased patients’ suicidal thoughts by 54% at discharge, changing the trajectory of children at risk for suicide.

A priority for all staff

Many children's hospitals and health systems are making suicide care a priority for all staff, creating cultures that recognize the importance of this work.

The national collaborative allows pediatric facilities to share their own learnings and approaches to delivering high-quality care for youth experiencing suicidal ideation.

Through their involvement, Mary Bridge Children’s Hospital recognized that they had already implemented several practices found effective by peers. But their participation also revealed a key area for improvement: staff education.

Previously, staff training was fragmented, consisting of onboarding modules and informal, on-the-job training.

The Preventing Youth Suicide Collaborative team at Mary Bridge created the Pediatric Zero Suicide Toolkit, a six-part educational series to enhance staff knowledge and confidence in caring for suicidal patients.

Teams in the emergency department received the education first, and it significantly improved staff preparedness and patient satisfaction. Staff reported the comprehensive education enhanced their ability to communicate effectively with patients and families, explain care processes, and ensure safety.

Mary Bridge staff have since shared the toolkit with other children’s hospitals through the collaborative.

A data-driven approach

To drive systematic change in pediatric health care, the collaborative’s members have attempted to quantify data for five process metrics across their hospitals: total screenings, positive screenings, total assessments, suicide attempts, and deaths.

In Aurora, Children’s Hospital Colorado is consistently screening over 90% of youth 10 and older in the emergency department and inpatient settings and providing resources and care to those who screen positive. Since 2021, there has been an encouraging downward trend in suicide rates among patients ages 10-18.

“The collaborative laid the foundation needed to elevate, raise awareness, and gain endorsement and collaboration for what safer suicide care within our hospital system and beyond could look like,” said Ron-Li Liaw, MD, mental health-in-chief. “It is grounded in the belief that suicide can be eliminated within a population by expanding access to high-quality, evidence-based screening and care.”

The collaborative’s progress to date underscores the importance of standardizing data collection as hospitals seek improvements to save lives.

A path forward

Over the last three years, the Preventing Youth Suicide National Collaborative has improved systems of care, from emergency departments to acute care to mental health specialty clinics to primary care offices.

While efforts have made a difference for children, families, and the workforce who cares for them, the work is far from complete.

The future of the collaborative depends on strong hospital leadership, continued investment, and adequate resource support.

Discover other innovative solutions children's hospitals are using to address the youth behavioral health crisis.