Inside 988: A conversation with SAMSHA leaders



Our next Mind Matters ECHO meeting will be held on Thursday, September 21, 2023 from 5:30-7:00pm with James Wright, LCSW, Chief of Crisis Center Operations for the 988 team, Robyn Filler, LPC, Manager of Clinical Standards for Vibrant Emotional Health, and Eva Korolishin, Senior Manager for 988 Center Engagement at Vibrant Emotional Health.

Attendees will learn about the 988 service and what both providers seeking support and individuals in crisis can expect when calling or texting the hotline with a particular focus on where the 988 service and primary care settings intersect.

If you have a case you'd like to share for consultation and support, please email Anitha Iyer, PhD, Course Director.

For children and teens with anxiety, depression, and ADHD, the change in routine and expectations that come along with the return to school may exacerbate symptoms that fade during the summertime. Relationships with their classmates may prove challenging and pressure to perform well in classes can cause additional stress.

Parents too may struggle with these disorders more during the school year as they navigate busier schedules, new routines, and social relationships with teachers and other parents.

Refer to these screening tools for patients with anhedonia, worry, difficulty managing emotions, inattentive and/or restless behavior, and other behavioral issues

• The Screen for Child Anxiety Related Disorders (SCARED) has a questionnaire for both children and their parents
• The PHQ-2/9 are validated for patients 12 years and older
• The Center for Epidemiological Studies Depression Scale for Children (CES-DC) can be used for patients aged 6-17
• Parents and teachers can complete Vanderbilt Assessment Scales on behalf of children with suspected ADHD or difficulty with attentiveness, restlessness, managing emotions, and other behavioral challenges

Pediatricians, you can also play an important role in identifying parents with postpartum depression. Consider asking parents if they have any concerns about depression at well-child visits.

This systematic review of meta-analyses assesses the existing evidence for exercise as a strategy to manage depression in children and teens. The literature review found physical exercise to have a small to medium, but consistently positive, effect on depression in youth.

Provider's Guide to Suicide Risk Assessment

Contrary to a commonly held myth, asking patients about whether they experience thoughts of suicide does not put the thought in their mind. In fact, it typically opens the door for the patient to share their thoughts, and lets them know that you are open to listening and supporting them.

This guide offers you strategies to assess and treat patients at risk for suicidality to determine the nature of the risk and plan for the patient’s safety.

Screening for suicidality

Predicting which patients will die by suicide has proven to be extremely difficult, as no statistical method to identify these patients has been found that would improve treatment. About half of all patients who die by suicide denied any suicidal ideation or behaviors at their last visit and about half of all completed suicides are by patients identified as “low risk.” Given this reality, what can providers reasonably do to mitigate suicide risk among their patients?

Amy Bennett-Staub, RN, MPA, Deputy Director of Quality Improvement at the New York State Psychiatric Institute, explains how a holisitc approach using the SAFE-T paradigm can help identify patients most in need of intervention.

The Columbia Suicide Severity Rating Scale (C-SSRS) is a “gold standard” measure of suicide severity that is often used in primary care settings. Jonathan M. DePierro, PhD, Clinical Director of the Center for Stress, Resilience and Personal Growth (CSRPG) at the Mount Sinai Health System shared some tips for administering and interpreting the C-SSRS on our blog.

Lastly, a 2021 study published in Annals of Family Medicine found that augmenting the PHQ-9 with self-report items from the Suicide Cognitions Scale (SCS) can significantly improve screening accuracy.

Item 13 on the SCS asks patients to rate to what extent they agree with the statement "There is nothing redeeming about me." Asking both item 9 of the PHQ-9 with item 13 of the SCS improved the specificity and sensitivity of suicidality screening more than machine learning and advanced predictive modeling.

Whichever screening tools you use in your practice the key is to always ask the questions exactly as written.

Safety planning tools

Safety planning is an effective intervention to help your patients develop a plan to cope during a crisis before it happens. Read this blog post or watch this brief video to learn how to effectively craft a safety plan with your patients. Therapist Aid offers a free printable template in English and Spanish.

It's no secret that there is high stigma surrounding mental health which can be incredibly harmful to people living with mental health conditions and interfere with their treatment and recovery.

The CDC offers a variety of provider resources on mental health literacy, including a CME course from the University of Texas at Austin on stigma-free communication about mental health.

Information to share with your patients: ADHD