Integrating Suicide Risk Screening into Pediatric Ambulatory Subspecialty Care.

BACKGROUND: Suicide risk screening is recommended in pediatric care. To date, no previous studies illustrate the implementation of suicide risk screening in pediatric subspecialty care, even though chronic medical conditions are associated with a higher risk of suicide. METHODS: A large multidivision pediatric ambulatory clinic implemented annual suicide risk screening. Patients ages 9-21 years participated in suicide risk screening using the Ask Suicide-Screening Questions during the project. A multidisciplinary team employed quality improvement methods and survey-research design methods to evaluate the feasibility and acceptability of the screening process for patients, families, and medical providers. RESULTS: During the quality improvement project period, 1,934 patients were offered screening; 1,301 (67.3%) patients completed screening; 82 patients (6.3% of 1,301 patients) screened positive. The monthly compliance rate held steady at 86% following several Plan-Do-Study-Act cycles of improvement. The survey results demonstrate that providers rated the suicide risk screening process positively; however, a subset of providers indicated that the screening process was out of their scope of practice or impeded their workflow. CONCLUSIONS: Suicide risk screening is feasible in pediatric specialty care and can identify at-risk patients. Continued efforts are needed to standardize suicide risk screening practices. Future directions include identifying factors associated with suicide risk in patients in pediatric subspecialty care settings.

Moderating effects of neurocognitive abilities on the relationship between temperament and global functioning.

Clear links between temperament, psychopathology, and neuropsychological functioning exist; however the interrelations among temperament and neuropsychology, and their impact on functioning in typically developing children is not as well understood. This study examined the degree to which neuropsychological functioning, as measured by the NEPSY, moderates the impact of temperament on global functioning, as measured by the Children's Global Assessment Scale (CGAS), in 74 typically developing preschoolers. Temperament was assessed via parent ratings on the Children's Behavior Questionnaire (CBQ) and teacher ratings on the Temperament Assessment Battery for Children--Revised (TABC-R). Moderation analyses revealed significant interactions between verbal-executive skills and both child emotionality and lack of task persistence in predicting global functioning. The interaction patterns were mostly consistent across measures and indicated that when lower neurocognitive scores were coupled with higher levels of expressed negative emotions and more difficulties in task persistence, global functioning was at its lowest. In contrast better neurocognitive functioning mitigated the impact of high expressed emotions on global functioning. These findings support past literature and indicate that emotional and cognitive functioning interact to effect young children's global functioning.