Request for Information (RFI): Pediatric Suicide Prevention in Emergency Medicine Settings

Notice Number: NOT-MH-12-035

Key Dates
Release Date: October 5, 2012
Response Date:  November 9, 2012

Issued by
National Institute of Mental Health (NIMH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
National Institute on Drug Abuse (NIDA)

Purpose

The National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA), and National Institute on Alcoholism and Alcohol Abuse (NIAAA) are seeking input on strategies to enhance suicide prevention efforts targeted at children and adolescents within emergency medicine department (ED) settings, where many individuals at high risk for suicide are seen.  Advice on identifying the most important research questions related to mental health, alcohol- and other substance-use disorders is sought from a wide variety of stakeholders.  These include:  emergency medicine and clinical research communities, mental health and substance abuse professionals; suicide prevention and patient advocates; individuals who have survived a suicide attempt; family members who have experience with emergency or other care for suicidal youth; private and public mental health and substance abuse service systems and providers; the pharmaceutical and biotechnology industry; and other interested groups or individuals.

Background

Research that will reduce the burden of suicidality (deaths, attempts, and ideation) in the U.S continues to be a major focus of the NIH. In 2009 the NIMH funded the Emergency Department-Safety Assessment and Follow-up Evaluation (ED-SAFE) cooperative agreement (U01MH088278).  ED-SAFE is designed to evaluate a feasible approach to identifying and intervening with adults at-risk for suicide within ED settings.  While there have been substantial strides in our understanding of suicide risk factors and initial progress in reducing suicidal behaviors per se, the development and implementation of practical screening tools and procedures as well as practical interventions for children and adolescents are critically needed.  Although pediatric psychiatry and substance abuse-related visits account for a relatively small number of ED visits annually, these, as well as the substantial number of alcohol-related visits, are resource intensive.  They result in increased lengths of stay without the benefit of evidence-based interventions for this patient population.  EDs are seeing increasing numbers of youth who are presenting for psychiatric and substance abuse reasons, with suicidal behavior included as a common presenting complaint.  Despite this increase in demand, there are few empirically-based practices for suicide-specific screening, further evaluation of high-risk youth, or for appropriate referrals for follow-up care that have been developed and/or tested in ED settings.  In the recently revised U.S. National Strategy for Suicide Prevention (http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/full_report-rev.pdf), Objective 9.6 identified the need to “Develop standardized protocols for use within emergency departments based on common clinical presentation to allow for more differentiated responses based on risk profiles and assessed clinical needs.”  Objectives 7.5, 8.4, 8.8, and 9.4 also highlight opportunities for suicide prevention in the ED setting.

For these reasons, NIMH, NIDA, and NIAAA seek the perspectives of their multiple stakeholders to ensure that the right questions are being addressed related to youth suicide prevention efforts within the ED setting.  This is in keeping with a major theme in the NIMH’s National Advisory Mental Health Council (NAMHC) Council Workgroup Report: The Road Ahead: Research Partnerships to Transform Services (http://www.nimh.nih.gov/council/advis.cfm).  NIH research is improved when it is informed by broad scientific and public input.

Request for Information

Feedback is requested from any and all organizations and individuals interested in youth suicide prevention research in the ED setting.  Specifically, information on the following topics is sought with regard to their potential to reduce suicide attempt or re-attempt rates within a 6 month follow-up period of being seen in an ED.  Information should be limited to responses that speak to the specific needs of pediatric patients.

1.  Prioritizing the current unanswered research questions for youth suicide prevention in ED settings (e.g., need for screening tools, risk stratification approaches, and/or practical interventions).
2.  Discussion of what ED providers should be screening for when assessing suicide risk in child/adolescent patients. (e.g., suicide related behaviors, impulsivity, depression, use of alcohol and other substances, other risk factors, etc.).
3.  Discuss any existing reliable and valid screening instruments for ED providers (for use by ED nurses in particular) to assess suicide risk and/or related risk factors among youth.
4.  The most appropriate approaches for further suicide risk evaluation to optimize appropriate discharge and referral efforts. 
5.  Strategies for addressing screening and intervention for youth when guardianship is not with the parents.
6.  Types of interventions or strategies that may be appropriate when the parent declines consent.
7.  Approaches to screening or intervention that may be applied nationally if states vary with respect to the age at which a youth may consent for treatment.
8.  The patterns of service utilization post discharge from the ED with regard to referral adherence and/or later risk of attempt.
9.  Practical, promising, and/or effective brief interventions that can take place in the ED to improve adherence to an appropriate referral after discharge. Interventions (in person, printed materials, electronic resources) that can facilitate continuity of care post discharge from the ED.
10.  Interventions that can provide practical strategies to help community providers best serve high-risk youth referred from the ED.

Responses

Responses to this RFI are voluntary and will be accepted through November 9, 2012. You will receive an electronic confirmation acknowledging receipt of your response, but will not receive individualized feedback on any suggestions.  No basis for claims against the U.S. Government shall arise as a result of a response to this request for information or from the Government’s use of such information.  Results will be shared internally with scientific working groups convened by the NIH and the National Action Alliance for Suicide Prevention, as appropriate. Proprietary, classified, confidential, or sensitive information should not be included in your response.  This request for information is for planning purposes only and shall not be construed as a solicitation for applications or as an obligation on the part of the government.  The NIH does not intend to make any awards based on responses to this RFI or pay for the preparation of any information submitted or for the Government's use of such information.

Responses will be accepted through November 9, 2012.  Electronic responses are preferred and may be addressed to NIMHsuicideprevention@nih.gov (Please include the Notice number NOT-MH-12-035 in the subject line).  Responses may also be sent by letter or FAX to the following address:

NIMH Suicide Prevention
Division of Services and Intervention Research
6001 Executive Boulevard, Room 7133, MSC 9629
Rockville, MD  20852-9629
FAX:  (301) 443-4045

Sills MR, Bland SD.  Summary statistics for pediatric psychiatric visits to US emergency departments, 1993-1999.  Pediatrics. 2002 Oct;110(4):e40.

Inquiries

Inquiries regarding this RFI  may be directed to:

NIMH Suicide Prevention
Division of Services and Intervention Research
6001 Executive Boulevard, Room 7133, MSC 9629
Rockville, MD  20852-9629
FAX:  (301) 443-4045
Email: NIMHsuicideprevention@nih.gov


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