Children’s Nebraska is improving outcomes for emergency department (ED) patients in suicidal crises with a low-tech solution: handwritten follow-up notes.
"This program lets patients know they have someone who's thinking about them, advocating for them, and supporting them," said Zebulon Timmons, MD, division chief of pediatric emergency medicine. "It lets these kids know someone cares about them, and it helps them out of the isolation that naturally happens with mental health disorders."
The hospital launched Caring Contacts in 2020 based on research showing lower suicide rates among adults who had received letters from care providers following a suicide attempt.
The concept is straightforward: each patient, with a guardian's permission, receives six handwritten notes over the year following their ED visit from the social worker who completed their assessment and assisted in treatment planning.
Although the behavioral health team includes some standard language for each note, they are personalized specifically for the patient — often referencing hobbies or interests discussed during their hospital visit.
For a generation of teens and adolescents raised in a digital age, this show of support takes on added significance. "We have heard from some of the adults in the kids' lives that they keep all of the cards and put them in their drawer or a special place," said Sabrina Schalley, MSW, LCSW, director of Behavioral Health Integration at Children’s Nebraska. "We like the idea that it is a tangible thing the kids can hold on to, and it's not lost in their tech stream."
Qualitative and anecdotal evidence align
Research shows the follow-up notes — in conjunction with ongoing treatment prescribed by the patient's care team at discharge — are effective in preventing future suicides in adults.
Children's Nebraska is seeing similar results. Since the program’s inception, more than 1,000 patients have been enrolled, resulting in more than 5,800 Caring Contacts letters sent in the mail. There have been no deaths among the 1,000 patients.
Additionally, only 17% have experienced a repeat incidence of suicide ideation — compared to a 27% rate of repeat suicide attempts among teens and adolescents nationally, according to a 2018 study.
Beyond the numbers, responses from former patients confirm the program’s positive impact.
"They tell us they felt heard while they were in the ED," said Trisha Graeve, LCSW, medical social worker. "We've had patients tell us we saved their life — the responses are touching."
Here are some of those responses:
- “Thank you for being there when I needed it the most, and for playing such a significant role in my journey toward healing and growth.”
- “I can’t tell you how much it means to me that you wrote to me, it overwhelms me how sweet and caring you are to all your patients.”
- “The cards mean so much to me, each one is hanging up in my room. I wanted to let you know how much of an impact the cards have and to know someone I met once cares so deeply for me.”
The hospital plans to expand the program across specialty clinics, inpatient units, and primary care settings to further support youth at risk. And they’ve shared a “replication kit” with 23 hospitals and 50 schools across the state.
