Barriers to and Facilitators of Implementing Suicide Risk Screening in Pediatric Primary Care: A Qualitative Study

Universal suicide risk screening in pediatric primary care settings is lacking, despite the endorsement of this practice by several national organizations. This study explores barriers to and facilitators of implementing universal suicide risk screening in pediatric primary care clinics, with a focus on clinics that had not yet adopted this practice.

We conducted a qualitative study consisting of semistructured interviews with primary care clinicians and support staff involved in suicide risk screening, risk assessment, and disposition planning. Participants were recruited from 15 pediatric clinics in the Midwestern United States. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

From 55 interviews, we identified barriers at 3 levels: clinic, provider, and patient. Clinic-level barriers included time, workflow, and staffing. Provider-level barriers included lack of training/self-efficacy, frustration at not being able to offer solutions, and burnout. Patient-level barriers included irritation with repetitiveness of screening questions, concerns about honesty and openness, parent/caregiver buy-in, and discomfort and stigma in discussing the topic of suicide. Facilitators included perceived value and effectiveness of screening, comfort with screening, clinic buy-in, a team approach to care, providing privacy, and providing context. Suggestions to enhance these suicide prevention practices were also described.

Overall, clinicians and support staff reported seeing value in implementing suicide risk screening in pediatric primary care. Our findings underscore the importance of reducing barriers and enhancing facilitators associated with implementing suicide risk screening, risk assessment, and disposition planning to expand suicide prevention efforts to more youths.