Engage: Suicide Care Management Plan

Developing suicide care pathways helps standardize care and promote consistency in clinical practice. These pathways clearly outline staff roles and responsibilities across each step of suicide risk screening, assessment, and management, ensuring a coordinated and evidence-based approach. By providing structured guidance, care pathways also support staff in building confidence and competency within their specific roles, fostering a more responsive and effective system of care. Suicide care pathways can be including policies as well as in the electronic health record.

• Example: Suicide care pathway developed by the American Academy of Child and Adolescent Psychiatry in the body of the text about pathways (Suicide risk screening in pediatric hospitals: Clinical pathways to address a global health crisis - PMC)

Collaborative safety planning engages youth and families in a joint process to promote safety and enhance communication. The safety plan intervention was initially developed by Barbara Stanley and Gregory Brown as a resource to support during a psychiatry crisis. Ensuring patients are discharged with a safety plan can reduce risk by helping identify and plan for how to respond if a psychiatric crisis occurs. Safety planning focuses on identifying warning signs, coping skills, supports to call for both distraction and during a crisis, local and national crisis contact information, as well as steps to make the environment safer.

Collaborative safety planning emphasizes engagement from supports like parents and guardians during the process and sharing their perspective. Collaborative safety planning  also allows parents and guardians to be aware of the content of the safety plan to remind their loved one of the content and to utilize it during a crisis.

Standardizing safety planning throughout your institution is an important step to promote standard of care. This includes ensuring safety planning is included in policies focusing on care for individuals with suicide risk. Safety planning is often completed on physical paper however many electronic health records offer electronic safety plans that can support communication across settings and improve access for patients and families. Apps can also be a resource in safety planning and an accessible resource, especially for youth. Effective collaborative safety plans involve 1) standardizing workflows including training and using the Stanley-Brown template , 2) engaging patients, families, and supports around a collaborative process to develop a shared safety plan, 3) leveraging technology and ensuring documentation of safety planning.

Lethal means counseling is a critical, evidence-based intervention for reducing suicide risk. Safety planning creates time and distance between a young person in crisis and access to potentially harmful items. Lethal means counseling saves lives.

Firearm safety is especially important, as firearms are a leading cause of death among youth in the U.S. Temporarily removing or securely storing firearms during periods of risk is a key step in promoting safety. When talking with families, it’s essential to take a respectful, nonjudgmental, and collaborative approach that centers on shared goals of keeping youth safe, while acknowledging differing perspectives.

In addition to firearms, providers should address safe storage or removal of other potentially dangerous items, including medications, sharp objects, ligatures (e.g., belts, ropes), and toxic substances. Ensuring staff complete Counseling on Access to Lethal Means (CALM) training can strengthen consistency, confidence, and effectiveness in these conversations with the goal of creating safer outcomes for youth and families.