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GOOD
AFTERNOON. THANK YOU FOR JOINING
US FOR 

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OUR NOVEMBER OHSRP EDUCATION 

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SERIES SESSION TITLED 

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"DETECTING AND MANAGING SUICIDE 

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RISK IN THE MEDICAL SETTING: 

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TURNING RESEARCH INTO PRACTICE".

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OUR SPEAKER TODAY IS DR. LISA 

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HOROWITZ WHO IS A CLINICAL 

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PSYCHOLOGIST AND SENIOR 

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ASSOCIATE SCIENTIST AT THE NIH 

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NATIONAL INSTITUTE OF MENTAL 

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HEALTH.

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DR. HOROWITZ RECEIVED HER 

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DOCTORATE IN CLINICAL 

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PSYCHOLOGY FROM GEORGE 

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WASHINGTON UNIVERSITY, SHE 

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COMPLETED PEDIATRIC RESEARCH 

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FELLOWSHIP AT HARVARD MEDICAL 

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SCHOOL AND OBTAINED A MASTERS 

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IN PUBLIC HEALTH AT THE HARVARD 

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SCHOOL OF PUBLIC HEALTH.

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THE MAJOR FOCUS OF DR. 

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HOROWITZ'S RESEARCH HAS BEEN IN 

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THE AREA OF SUICIDE PREVENTION 

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IN HEALTHCARE SETTINGS, 

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INNOVATING TOOLS FOR CLINICIANS 

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SUCH AS THE SUICIDE SCREENING 

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QUESTIONS, ALSO KNOWN AS THE 

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ASQ TOOL.

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ALSO ONE OF THE CO-AUTHORS OF 

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THE BEFORE YOU PRINT FOR YOUTH 

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SUICIDE PREVENTION, RELEASED BY 

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THE AMERICAN ACADEMY OF 

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PEDIATRICS IN MARCH OF 2022.

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DR. HOROWITZ IS COLLABORATING 

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WITH HOSPITALS AND OUTPATIENT 

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CLINICS BOTH NATIONALLY AND 

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GLOBALLY, ASSISTING WITH 

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IMPLEMENTATION OF SUICIDE RISK 

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SCREENING AND MANAGEMENT OF 

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BOTH ADULT AND PEDIATRIC 

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PATIENTS WITH SCREEN POSITIVE 

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USING THE ASQ TOOLKIT.

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THIS WILL BE ARCHIVED IN THE 

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PAST EVENT SECTION OF THE NIH 

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VIDEOCAST SITE.

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SLIDES WILL ALSO BE POSTED ON 

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THE OHSRP WEBSITE APPROXIMATELY 

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1-2 WEEKS AFTER THE SESSION IN 

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THE PRESENTATION ARCHIVES 

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SCIENCE FICTION OF THE OHSRP 

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EDUCATION AND TRAINING WEB PAGE.

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THROUGHOUT THIS SESSION WE 

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ENCOURAGE VIEWERS  TO SUBMIT 

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QUESTIONS BY CLICKING ON THE 

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LIVE FEEDBACK LINK AND DR. 

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HOROWITZ WILL ADDRESS THESE 

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DURING OUR Q&A SESSION AFTER

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THE PRESENTATION.

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THANK YOU R FOR JOINING US DR. 

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HOROWITZ AND GO AHEAD AND GET 

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STARTED.

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>> Lisa Horowitz: THANK
YOU, 

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IT'S SUCH A PRIVILEGE TO BE 

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HERE TALKING WITH YOU ALL.

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THANK YOU, PEG FOR INVITING ME.

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I WANT TO MAKE SURE MY SLIDES 

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ARE OKAY.

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>> Peg Sanders: YOU NEED
TO GO 

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INTO FULL SCREEN.

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OKAY, PERFECT.

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>> Lisa Horowitz: SO TODAY
WE 

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ARE TALKING ABOUT SOMETHING SO 

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IMPORTANT IT'S THE PUBLIC 

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HEALTH PROBLEM OF SUICIDE AND, 

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IF I WERE THERE IN PERSON, I 

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WOULD ASK FOR A SHOW OF HANDS 

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OF WHO HAS BEEN TOUCHED BY 

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SUICIDE, EITHER PERSONALLY OR 

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PROFESSIONALLY?

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AND INEVITABLY ALMOST EVERY 

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HAND IN THE AUDIENCE GOES UP 

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WHEN I ASK THAT.

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EVEN THOUGH SUICIDE IS A 

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RELATIVELY RARE EVENT, THE 

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RIPPLE EFFECTS ARE REALLY 

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ENDLESS.

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BEFORE I START, I WANT TO SEND 

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MY CONDOLENCES TO ANYONE WHO 

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HAS LOST SOMEONE TO SUICIDE.

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I ALWAYS LIKE TO START MY TALKS 

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WITH MY TAKE-HOME SLIDE.

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AND IT'S GOING TO BE THAT 

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SUICIDE IS A MAJOR PUBLIC 

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HEALTH, AND NOT ONLY NATIONALLY 

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BUT GLOBALLY PUBLIC HEALTH 

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PROBLEM.

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AND THERE ARE SIGNIFICANT 

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DISPARITIES IN THE RATES.

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AND I'M GOING TO TALK A LOT 

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ABOUT HOW YOU START DIFFICULT 

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CONVERSATIONS ABOUT SUICIDE 

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RISK AND IT STARTS WITH, IN 

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HEALTHCARE SETTINGS IT STARTS 

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WITH SUICIDE RISK SCREENING 

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TOOL.

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THAT'S A STRUCTURED WAY FOR 

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PROFESSIONAL HEALTHCARE 

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PROVIDERS TO DETECT SUICIDE 

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RISK.

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BUT WE ARE ALSO GOING TO TALK 

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ABOUT HOW YOU CAN START THESE 

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CONVERSATIONS WITH FAMILY, 

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FRIENDS, CO-WORKERS.

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BECAUSE THESE CONVERSATIONS CAN 

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REALLY HELP SAVE LIVES.

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I ALSO WANT TO TALK ABOUT OUR 

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RESEARCH FROM OUR LAB AT 

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SUICIDE PREVENTION IN THE 

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MEDICAL SETTING AND HOW WE KEEP 

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TURNING THE RESEARCH INTO 

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REASONABLE AND PRACTICAL 

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GUIDELINES.

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THE WAY WE DO THAT IS BY USING 

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A CLINICAL PATHWAY.

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YOU WILL HEAR ME TALK ABOUT 

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THIS A LOT.

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BUT IT STARTS WITH A BRIEF 

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SCREENING TOOL.

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THE SCREENING TOOL IS FURTHER 

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TRIAGED WITH A SUICIDE SAFETY 

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ASSESSMENT AND THAT ASSESSMENT 

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REALLY HELPS THE CLINICIAN TO 

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DETERMINE DISPOSITION, WHAT 

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SHOULD HAPPEN NEXT FOR THE 

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PATIENT TO KEEP THEM SAFE?

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LET'S JUST VIEW A LITTLE BIT OF 

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THE BACKGROUND.

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SUICIDE IS THE 11th LEADING 

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CAUSE OF DEATH FOR ALL AGES IN 

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THE UNITED STATES.

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IT IS ALSO THE THIRD REASON WHY 

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YOUNG PEOPLE DIE.

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WHEN I SAY YOUNG PEOPLE, I'M 

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TALKING ABOUT 10-24.

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NOW YOUNG PEOPLE AREN'T 

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SUPPOSED TO DIE.

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THEY ARE SUPPOSED TO GROW UP 

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AND LIVE LONG HEALTHY LIVES BUT 

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IF YOU LOOK AT THE NUMBER OF 

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YOUTH DEATHS FROM 2022, YOU 

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WILL SEE THAT ALMOST 20%, THAT 

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IS A STUNNINGLY HIGH NUMBER, 

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20% OF THESE DEATHS WERE FROM 

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SOMETHING THAT'S POTENTIALLY 

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PREVENTABLE, SUICIDE.

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I SAY POTENTIALLY PREVENTABLE 

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BECAUSE ALL SUICIDES CANNOT BE 

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PREVINTED.

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-PREVENTED BUT THERE'S SO MUCH 

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WE CAN DO TO TRY TO PREVENT 

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THEM.

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IF YOU LOOK AT THE GRAPH, 

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THAT'S THE SUICIDE RATE IN OUR 

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COUNTRY OVER TIME.

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AND AS YOU CAN SEE IT KEEPS 

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CREEPING UP.

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THIS IS A GRAPH OF SUICIDE 

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RATES BY RACE AND ETHNICITY.

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THE OUT ALLIANCE  OUTLIER 

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AMERICAN INDIANS AND ALASKA 

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NATIVES.

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WE HAVE SEEN INCREASE IN BLACK 

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YOUTH SUICIDE, ASIAN YOUTH 

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SUICIDE, HISPANIC YOUTH SUICIDE.

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THERE ARE SIGNIFICANT 

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DISPARITIES, THEY DON'T STEM 

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FROM THE POPULATIONS 

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THEMSELVES, THEY MORE REFLECT A 

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LACK OF ACCESS TO HEALTHCARE.

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OR THERE'S, YOU KNOW, MORE 

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SYSTEMIC PROBLEMS LIKE RACISM.

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NOW, THERE ARE MANY 

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UNDERSERVED, UNDER STUDIED 

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POPULATIONS THAT ARE AT HIGHER 

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RISK FOR SUICIDE, THAT'S NOT 

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JUST BY RACE AND ETHNICITY BUT 

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ALSO LGBTQ+ INDIVIDUALS, 

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INDIVIDUALS WITH 

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NEURODEVELOPMENTAL DISORDERS 

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LIKE AUTISM.

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CHILDREN IN THE CHILD WELFARE 

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SYSTEM ARE FIVE TIMES THE RISK 

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OF DYING BY SUICIDE.

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ANYONE IN DETENTION CENTERS AND 

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RURAL AREAS.

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ALL OF THESE POPULATIONS ARE AT 

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HIGHER RISK FOR SUICIDE.

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WE BELIEVE UNIVERSAL SUICIDE 

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RISK SCREENING IN MEDICAL 

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SETTINGS CAN HELP PROMOTE 

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HEALTH EQUITY.

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IT'S SCREENING EVERYBODY AND 

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EVERYBODY HAS A CHANCE TO GET 

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LIFE-SAVING MENTAL HEALTHCARE.

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SUICIDE, I GAVE YOU THE 

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STATISTICS FOR DEATH.

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IT'S STILL A RELATIVELY RARE 

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EVENT.

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WHAT'S MORE COMMON ARE SUICIDAL 

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BEHAVIORS AND IDEATIONS.

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ABOUT 1.6 MILLION ADULTS 

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ATTEMPTED SUICIDE AND 13.2 

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MILLION ADULTS HAD SERIOUS 

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THOUGHTS OF SUICIDE.

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THIS IS YOUR AVERAGE HIGH 

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SCHOOL STUDENT, THE CDC GOES 

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AROUND HIGH SCHOOLS AROUND THE 

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COUNTRY, 9.5% HIGH SCHOOL 

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STUDENTS REPORTED ATTEMPTING 

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SUICIDE IN THE LAST YEAR AND 

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20.4% OF HIGH SCHOOL STUDENTS 

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REPORTED THAT THEY SERIOUSLY 

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CONSIDERED KILLING THEMSELVES.

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THESE ARE STAGGERING NUMBERS.

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THEY HAVE BEEN FOR A WHILE.

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PEOPLE SAY WHAT HAPPENED DURING 

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THE PANDEMIC, I CAN TELL YOU 

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THAT EXACERBATED AN ALREADY 

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VERY SERIOUS PUBLIC HEALTH 

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PROBLEM.

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I WAS FORTUNATE ENOUGH TO BE 

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PART OF THIS STUDY LED BY 

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JEFFREY BRIDGE FROM NATIONWIDE 

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CHILDREN'S.

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WHAT WE SAW IS DURING THE FIRST 

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YEAR OF COVID, THE NUMBER OF 

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SUICIDE DEATHS HAD INCREASED 

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WAY PAST WHAT WAS EXPECTED.

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THERE WERE 212 EXCESS DEATHS.

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YOU COULD SEE IT WASN'T, YOU 

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COULD SEE THOSE DISPARITIES, 

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MORE MALES, AGE GROUPS 5-12 

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YEAR OLDS, INCREASED SUICIDE.

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LIKE I MENTIONED AMERICAN 

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INDIANS AND BLACK YOUTH HAD 

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HIGHER RATES AND MORE SUICIDE 

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DEATHS FROM FIREARMS.

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SO MUCH SO THAT IN 2021, THE 

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SURGEON GENERAL ISSUED AN 

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ADVISORY AND DECLARED A YOUTH 

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MENTAL HEALTH CRISIS IN THIS 

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COUNTRY.

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AND THEN THE AMERICAN ACADEMY 

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OF PEDIATRICS, THE AAP AND 

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AMERICAN ACADEMY OF CHILDREN'S 

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HOSPITAL ASSOCIATION ALSO 

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DECLARED A MENTAL HEALTH 

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EMERGENCY.

260
00:09:27,967 --> 00:09:29,835
THE COUNTRY IS PAYING ATTENTION 

261
00:09:29,835 --> 00:09:31,437
TO THIS FROM A PUBLIC HEALTH 

262
00:09:31,437 --> 00:09:32,438
PERSPECTIVE.

263
00:09:32,438 --> 00:09:34,874
AND LET ME JUST GO OVER SOME OF 

264
00:09:34,874 --> 00:09:36,175
THE RISK FACTORS FOR SUICIDE.

265
00:09:36,175 --> 00:09:37,376
I'M NOT GOING TO GO THROUGH ALL 

266
00:09:37,376 --> 00:09:38,711
OF THEM.

267
00:09:38,711 --> 00:09:41,247
BUT I HIGHLIGHTED THE STRONGEST 

268
00:09:41,247 --> 00:09:42,748
RISK FACTORS PREVIOUS ATTEMPT 

269
00:09:42,748 --> 00:09:45,384
IS THE MOST POTENT RISK FACTOR.

270
00:09:45,384 --> 00:09:49,421
WE HAVE A SAYING IN PSYCHOLOGY 

271
00:09:49,421 --> 00:09:52,024
IS BEST PREDICTOR OF FUTURE 

272
00:09:52,024 --> 00:09:53,859
BEHAVIOR IS PAST BEHAVIOR.

273
00:09:53,859 --> 00:09:55,394
THIS IS ABSOLUTELY TRUE FOR 

274
00:09:55,394 --> 00:09:56,762
SUICIDE.

275
00:09:56,762 --> 00:09:58,697
ANYONE WHO HAS TRIED TO KILL 

276
00:09:58,697 --> 00:10:00,833
THEMSELVES IN THE PAST IS MORE 

277
00:10:00,833 --> 00:10:02,234
LIKELY TO TRY AGAIN IN THE 

278
00:10:02,234 --> 00:10:04,837
FUTURE OR HAVING A MENTAL 

279
00:10:04,837 --> 00:10:06,272
ILLNESS THAT PUTS SOMEONE AT 

280
00:10:06,272 --> 00:10:08,440
GREAT RISK FOR SUICIDE.

281
00:10:08,440 --> 00:10:11,210
I HIGHLIGHTED THIS ONE AT THE 

282
00:10:11,210 --> 00:10:12,244
BOTTOM, MEDICAL ILLNESS, 

283
00:10:12,244 --> 00:10:14,780
BECAUSE THAT'S A RISK FACTOR 

284
00:10:14,780 --> 00:10:16,181
THAT'S OFTEN OVERLOOKED.

285
00:10:16,181 --> 00:10:18,584
BUT ONE THAT MY RESEARCH TEAM 

286
00:10:18,584 --> 00:10:21,620
HAS FOCUSED ON.

287
00:10:21,620 --> 00:10:23,355
MANY OF THE BULLET POINTS 

288
00:10:23,355 --> 00:10:26,792
AREN'T GOING TO DIE BY SUICIDE, 

289
00:10:26,792 --> 00:10:29,828
THEY ARE SIMPLY RISK FACTORS.

290
00:10:29,828 --> 00:10:33,332
IF YOU WERE A TRIAGE NURSE IN 

291
00:10:33,332 --> 00:10:37,102
AN EMERGENCY DEPARTMENT AND 

292
00:10:37,102 --> 00:10:39,505
SOMEONE CAME IN WITH RISK 

293
00:10:39,505 --> 00:10:42,441
FACTORS FOR HEART ATTACK.

294
00:10:42,441 --> 00:10:44,777
IF THEY CAME IN WITH WARNING 

295
00:10:44,777 --> 00:10:47,680
SIGNS, LIKE THEY WERE CLUTCHING 

296
00:10:47,680 --> 00:10:50,716
THEIR CHEST IN PAIN AND 

297
00:10:50,716 --> 00:10:51,750
SWEATING PROFUSELY, MIGHT THINK 

298
00:10:51,750 --> 00:10:54,553
THEY ARE HAVING A HEART ATTACK.

299
00:10:54,553 --> 00:10:56,889
THE SAME THING IS TRUE FOR 

300
00:10:56,889 --> 00:10:58,590
SUICIDE, THERE'S RISK FACTORS 

301
00:10:58,590 --> 00:11:00,526
BUT MORE IMPORTANT TO PAY 

302
00:11:00,526 --> 00:11:02,761
ATTENTION TO ARE THE WARNING 

303
00:11:02,761 --> 00:11:02,962
SIGNS.

304
00:11:02,962 --> 00:11:05,164
LET'S GO THROUGH SOME OF THEM.

305
00:11:05,164 --> 00:11:07,700
THE FIRST ONE SEEMS SO OBVIOUS, 

306
00:11:07,700 --> 00:11:08,968
TALKING ABOUT WANTING TO DIE OR 

307
00:11:08,968 --> 00:11:12,338
KILL ONE SELF.

308
00:11:12,338 --> 00:11:15,474
HOWEVER WE OFTEN DON'T TAKE 

309
00:11:15,474 --> 00:11:17,142
TALK OF SUICIDE SERIOUSLY.

310
00:11:17,142 --> 00:11:19,411
SO PEOPLE WHO DIE BY SUICIDE 

311
00:11:19,411 --> 00:11:21,113
SOMETIMES TELL OTHER PEOPLE AND 

312
00:11:21,113 --> 00:11:22,648
THEY STILL DON'T GET HELP.

313
00:11:22,648 --> 00:11:25,584
SO IT'S REALLY IMPORTANT TO PAY 

314
00:11:25,584 --> 00:11:25,851
ATTENTION.

315
00:11:25,851 --> 00:11:27,786
OR IF SOMEONE IS TALKING ABOUT 

316
00:11:27,786 --> 00:11:29,321
FIREARM WHERE THEY DIDN'T 

317
00:11:29,321 --> 00:11:31,623
COLLECT FIREARMS BEFORE, OR 

318
00:11:31,623 --> 00:11:32,491
FEELING HOPELESS, TRAPPED OR 

319
00:11:32,491 --> 00:11:34,793
LIKE YOU ARE A BURDEN.

320
00:11:34,793 --> 00:11:36,128
INCREASED OR EXCESSIVE USE OF 

321
00:11:36,128 --> 00:11:38,230
ALCOHOL OR DRUGS.

322
00:11:38,230 --> 00:11:40,165
OR SIGNS OF DEPRESSION, 

323
00:11:40,165 --> 00:11:42,868
SLEEPING TOO LITTLE OR TOO 

324
00:11:42,868 --> 00:11:43,902
MUCH, BEING ISOLATED, SEVERE 

325
00:11:43,902 --> 00:11:44,803
MOOD SWINGS.

326
00:11:44,803 --> 00:11:46,739
THESE ARE ALL WARNING SIGNS 

327
00:11:46,739 --> 00:11:50,809
SOMEONE MIGHT BE AT IMMINENT 

328
00:11:50,809 --> 00:11:52,311
RISK FOR SUICIDE.

329
00:11:52,311 --> 00:11:55,014
I HAVE JUST LAID SOME VERY 

330
00:11:55,014 --> 00:11:57,249
SOBERING STATISTICS ON YOU.

331
00:11:57,249 --> 00:11:58,951
GIVING YOU THE RISK FACTORS AND 

332
00:11:58,951 --> 00:11:59,985
WARNING SIGNS.

333
00:11:59,985 --> 00:12:01,620
IT SEEMS, THIS IS A VERY HEAVY 

334
00:12:01,620 --> 00:12:02,454
TOPIC.

335
00:12:02,454 --> 00:12:05,224
BUT THIS IS NOT A DEPRESSING 

336
00:12:05,224 --> 00:12:06,825
TALK, NOT AT ALL.

337
00:12:06,825 --> 00:12:08,460
WE USE THESE STATISTICS TO 

338
00:12:08,460 --> 00:12:11,230
CONTINUE TO BE A CALL TO ACTION.

339
00:12:11,230 --> 00:12:14,433
BECAUSE THERE IS SO MUCH WE CAN 

340
00:12:14,433 --> 00:12:15,901
DO ABOUT REDUCING SUICIDE.

341
00:12:15,901 --> 00:12:17,302
SO THAT'S WHAT THIS TALK IS 

342
00:12:17,302 --> 00:12:18,437
GOING TO BE.

343
00:12:18,437 --> 00:12:20,472
IT HAPPENS TO BE A REALLY GOOD 

344
00:12:20,472 --> 00:12:23,475
TIME TO BE TALKING ABOUT MENTAL 

345
00:12:23,475 --> 00:12:25,411
HEALTH ISSUES LIKE SUICIDE.

346
00:12:25,411 --> 00:12:28,147
WE HAVE A SURGEON GENERAL WHO 

347
00:12:28,147 --> 00:12:30,716
ISSUED AN ADVISORY IN 2023 ON 

348
00:12:30,716 --> 00:12:32,785
LONELINESS AND ISOLATION.

349
00:12:32,785 --> 00:12:36,255
AND THE IMPORTANCE OF SOCIAL 

350
00:12:36,255 --> 00:12:39,091
CONNECTEDNESS AND COMMUNITY.

351
00:12:39,091 --> 00:12:41,794
THIS IS VERY WELL SUPPORTED.

352
00:12:41,794 --> 00:12:44,496
AND THE MEDIA, WE HAVE 

353
00:12:44,496 --> 00:12:46,065
CELEBRITIES NOW COMING OULT 

354
00:12:46,065 --> 00:12:48,467
WITH TALKING ABOUT THEIR MENTAL 

355
00:12:48,467 --> 00:12:50,369
HEALTH CONCERNS, TALKING ABOUT 

356
00:12:50,369 --> 00:12:51,036
DEPRESSION, TALKING ABOUT 

357
00:12:51,036 --> 00:12:52,004
SUICIDE RISK.

358
00:12:52,004 --> 00:12:54,373
SO THIS IS A GOOD TIME TO HAVE 

359
00:12:54,373 --> 00:12:56,341
THESE CONVERSATIONS.

360
00:12:56,341 --> 00:12:58,243
THESE VERY DIFFICULT BUT VERY 

361
00:12:58,243 --> 00:13:00,779
CRITICAL CONVERSATIONS.

362
00:13:00,779 --> 00:13:04,249
SO I'M FORTUNATE ENOUGH TO BE 

363
00:13:04,249 --> 00:13:06,652
PART OF A RESEARCH TEAM THAT 

364
00:13:06,652 --> 00:13:09,488
ASKS WITH KE SAVE LIVES BY 

365
00:13:09,488 --> 00:13:10,756
SCREENING FOR SUICIDE RISK IN 

366
00:13:10,756 --> 00:13:12,424
THE MEDICAL SETTING.

367
00:13:12,424 --> 00:13:13,926
I'M HOPING TO CONVINCE YOU THAT 

368
00:13:13,926 --> 00:13:16,762
THE ANSWER TO THIS IS "YES".

369
00:13:16,762 --> 00:13:18,063
WHY DID WE PICK THE MEDICAL 

370
00:13:18,063 --> 00:13:18,864
SETTING?

371
00:13:18,864 --> 00:13:21,500
IF YOU LOOK AT DEATH REGISTRY 

372
00:13:21,500 --> 00:13:22,634
STUDIES, THE MAJORITY OF PEOPLE 

373
00:13:22,634 --> 00:13:24,603
WHO HAVE DIED BY SUICIDE, AND 

374
00:13:24,603 --> 00:13:27,172
THIS IS BOTH ADULTS AND YOUTH 

375
00:13:27,172 --> 00:13:29,575
HAVE VISITED A HEALTHCARE 

376
00:13:29,575 --> 00:13:31,510
PROVIDER, NOT JUST MONTHS BUT 

377
00:13:31,510 --> 00:13:33,712
WEEKS BEFORE THEY DIED.

378
00:13:33,712 --> 00:13:35,747
SO THEY ARE PASSING RIGHT 

379
00:13:35,747 --> 00:13:37,850
THROUGH OUR HEALTHCARE SYSTEM.

380
00:13:37,850 --> 00:13:39,384
HOWEVER, THEY DON'T USUALLY SAY 

381
00:13:39,384 --> 00:13:41,687
THINGS TO THEIR DOCTOR OR THEIR 

382
00:13:41,687 --> 00:13:43,188
NURSES LIKE, I'M THINKING OF 

383
00:13:43,188 --> 00:13:46,058
KILLING MYSELF, RIGHT?

384
00:13:46,058 --> 00:13:48,727
THEY PRESENT WITH SOMATOIC 

385
00:13:48,727 --> 00:13:50,295
MEDICAL COMPLAINTS.

386
00:13:50,295 --> 00:13:51,797
IF SOMEONE DOESN'T ASK THEM 

387
00:13:51,797 --> 00:13:53,632
DIRECTLY, ARE YOU THINKING OF 

388
00:13:53,632 --> 00:13:54,933
KILLING YOURSELF, THEY MOST 

389
00:13:54,933 --> 00:13:57,236
LIKELY WON'T TALK ABOUT THEIR 

390
00:13:57,236 --> 00:13:59,071
SUICIDAL THOUGHTS, SO THE 

391
00:13:59,071 --> 00:14:00,372
MAJORITY OF SUICIDE ATTEMPTERS 

392
00:14:00,372 --> 00:14:02,508
GO UNRECOGNIZED BECAUSE THE 

393
00:14:02,508 --> 00:14:04,009
MAJORITY OF MEDICAL SETTINGS DO 

394
00:14:04,009 --> 00:14:05,844
NOT SCREEN FOR SUICIDE RISK.

395
00:14:05,844 --> 00:14:11,416
THEY DO NOT INITIATE THESE 

396
00:14:11,416 --> 00:14:13,552
REALLY CRITICAL CONVERSATIONS.

397
00:14:13,552 --> 00:14:13,986
STARTING DIFFICULT 

398
00:14:13,986 --> 00:14:14,853
CONVERSATIONS.

399
00:14:14,853 --> 00:14:21,193
AND THIS IS WHY UNIVERSAL 

400
00:14:21,193 --> 00:14:23,462
SUICIDE RISK SCREENING IS SO 

401
00:14:23,462 --> 00:14:24,196
IMPORTANT.

402
00:14:24,196 --> 00:14:25,564
I SHOULD DEFINE UNIVERSAL.

403
00:14:25,564 --> 00:14:27,533
THERE ARE TWO WAYS TO DO 

404
00:14:27,533 --> 00:14:30,035
SCREENING, YOU CAN DO TARGETED 

405
00:14:30,035 --> 00:14:31,870
OR UNIVERSAL.

406
00:14:31,870 --> 00:14:36,842
TARGETED MEANS, FOR EXAMPLE, IN 

407
00:14:36,842 --> 00:14:39,178
MANY HOSPITALS PEOPLE WHO 

408
00:14:39,178 --> 00:14:41,613
PRESENT WITH BEHAVIORAL HEALTH 

409
00:14:41,613 --> 00:14:42,881
OR MENTAL HEALTH COMPLAINTS, 

410
00:14:42,881 --> 00:14:45,017
GET SCREENED FOR SUICIDE RISK 

411
00:14:45,017 --> 00:14:46,451
BUT PEOPLE WITH MEDICAL 

412
00:14:46,451 --> 00:14:48,887
COMPLAINTS DO NOT, RIGHT?

413
00:14:48,887 --> 00:14:50,389
THAT'S TRICKY, BECAUSE WHO 

414
00:14:50,389 --> 00:14:52,724
DOESN'T HAVE MENTAL HEALTH 

415
00:14:52,724 --> 00:14:53,125
CONCERNS AMONG US.

416
00:14:53,125 --> 00:14:54,793
YOU DON'T KNOW THAT.

417
00:14:54,793 --> 00:14:56,061
THAT'S WHY UNIVERSAL SCREENING 

418
00:14:56,061 --> 00:14:58,230
MEANS YOU SCREEN EVERYONE.

419
00:14:58,230 --> 00:15:02,701
YOU DON'T JUST TARGET PEOPLE 

420
00:15:02,701 --> 00:15:03,802
PRESENTING WITH BEHAVIORAL 

421
00:15:03,802 --> 00:15:07,039
HEALTH CHIEF COMPLAINTS.

422
00:15:07,039 --> 00:15:08,907
WHY IS UNIVERSAL SCREENING SO 

423
00:15:08,907 --> 00:15:09,174
IMPORTANT?

424
00:15:09,174 --> 00:15:11,443
JUST A FEW WEEKS AGO THERE WAS 

425
00:15:11,443 --> 00:15:14,313
A JAMA OPEN STUDY, SHOWING THAT 

426
00:15:14,313 --> 00:15:16,715
THE MAJORITY OF YOUNG PEOPLE 

427
00:15:16,715 --> 00:15:18,817
THIS IS 10-24 WHO DIED BY 

428
00:15:18,817 --> 00:15:21,053
SUICIDE, THESE WERE ACTUAL 

429
00:15:21,053 --> 00:15:24,189
DEATHS, 60% OF THEM HAD NO 

430
00:15:24,189 --> 00:15:24,923
PREVIOUSLY DOCUMENTED MENTAL 

431
00:15:24,923 --> 00:15:27,125
HEALTH DIAGNOSIS.

432
00:15:27,125 --> 00:15:29,361
SO THIS PERSON WOULDN'T PRESENT 

433
00:15:29,361 --> 00:15:30,662
WITH THE BEHAVIORAL HEALTH 

434
00:15:30,662 --> 00:15:32,264
CHIEF COMPLAINT YET THEY TOOK 

435
00:15:32,264 --> 00:15:33,265
THEIR OWN LIFE.

436
00:15:33,265 --> 00:15:35,000
SO THIS IS WHY UNIVERSAL 

437
00:15:35,000 --> 00:15:37,202
SCREENING IS SO IMPORTANT.

438
00:15:37,202 --> 00:15:38,637
I WAS FORTUNATE ENOUGH TO BE 

439
00:15:38,637 --> 00:15:41,039
PART OF THIS STUDY.

440
00:15:41,039 --> 00:15:43,609
WE LOOKED AT SUICIDE RATES FOR 

441
00:15:43,609 --> 00:15:44,543
PRE-TEENS, KIDS UNDER THE AGE 

442
00:15:44,543 --> 00:15:45,510
OF 12.

443
00:15:45,510 --> 00:15:49,548
WHAT WE SAW IS FROM 2008-2022, 

444
00:15:49,548 --> 00:15:53,685
EVERY SINGLE YEAR THE RATE ROSE 

445
00:15:53,685 --> 00:15:56,321
BY 8% FOR 8-12-YEAR-OLDS.

446
00:15:56,321 --> 00:15:57,422
AND THERE WERE SIGNIFICANT 

447
00:15:57,422 --> 00:15:59,491
INCREASES.

448
00:15:59,491 --> 00:16:02,094
THERE USED TO BE MORE MALE 

449
00:16:02,094 --> 00:16:04,596
DEATHS THAN FEMALE DEATHS, NOW 

450
00:16:04,596 --> 00:16:06,331
THE FEMALES, THERE'S EQUAL MALE 

451
00:16:06,331 --> 00:16:09,268
AND FEMALE DEATHS FOR PRE-TEENS.

452
00:16:09,268 --> 00:16:10,469
AMERICAN INDIANS, AGAIN, THEY 

453
00:16:10,469 --> 00:16:13,805
HAVE HIGHER RATES.

454
00:16:13,805 --> 00:16:15,841
ASIAN PACIFIC ISLANDERS, 

455
00:16:15,841 --> 00:16:16,842
HISPANIC PRE-TEENS AND YOUNG 

456
00:16:16,842 --> 00:16:19,044
PEOPLE WHO DIED BY FIREARM.

457
00:16:19,044 --> 00:16:22,781
AND THESE WERE TWO STUDIES.

458
00:16:22,781 --> 00:16:24,916
OKAY, SO WHAT STOPS PEOPLE FROM 

459
00:16:24,916 --> 00:16:26,885
TALKING ABOUT SUICIDE?

460
00:16:26,885 --> 00:16:29,054
IF WE WERE ALL TOGETHER IN AN 

461
00:16:29,054 --> 00:16:30,555
AUDITORIUM I WOULD ASK FOR A 

462
00:16:30,555 --> 00:16:31,957
BRAVE SOUL TO RAISE THEIR HAND 

463
00:16:31,957 --> 00:16:34,326
AND SAY WHAT DO YOU THINK THE 

464
00:16:34,326 --> 00:16:35,527
MOST COMMON CONCERN IS, WHY 

465
00:16:35,527 --> 00:16:37,963
DON'T PEOPLE TALK ABOUT SUICIDE?

466
00:16:37,963 --> 00:16:40,165
SO PEOPLE WORRY IF YOU ASK 

467
00:16:40,165 --> 00:16:41,199
PEOPLE ABOUT SUICIDE YOU ARE 

468
00:16:41,199 --> 00:16:42,567
GOING TO PUT THE IDEA INTO 

469
00:16:42,567 --> 00:16:44,303
THEIR HEAD.

470
00:16:44,303 --> 00:16:45,804
BUT THIS IS ACTUALLY THE 

471
00:16:45,804 --> 00:16:47,639
OPPOSITE IS TRUE.

472
00:16:47,639 --> 00:16:49,641
IT'S NOT HARMFUL TO ASK SOMEONE 

473
00:16:49,641 --> 00:16:50,876
ABOUT SUICIDE.

474
00:16:50,876 --> 00:16:51,910
IT'S THE OPPOSITE.

475
00:16:51,910 --> 00:16:53,011
YOU COULD SAVE THEIR LIFE BY 

476
00:16:53,011 --> 00:16:54,012
ASKING.

477
00:16:54,012 --> 00:16:56,014
YOU DON'T HAVE TO TAKE MY WORD 

478
00:16:56,014 --> 00:16:58,550
FOR IT BECAUSE THERE'S AT LEAST 

479
00:16:58,550 --> 00:16:59,951
FOUR RESEARCH STUDIES THAT SHOW 

480
00:16:59,951 --> 00:17:02,287
IT IS NOT HARMFUL TO ASK 

481
00:17:02,287 --> 00:17:05,424
SOMEONE ABOUT SUICIDE RISK.

482
00:17:05,424 --> 00:17:07,526
OKAY, SO.

483
00:17:07,526 --> 00:17:09,728
I'VE JUST WANTED TO SHOW YOU, 

484
00:17:09,728 --> 00:17:13,498
SO THIS IS A TREE IN FRONT OF 

485
00:17:13,498 --> 00:17:17,102
THE NIH CLINICAL CENTER, 

486
00:17:17,102 --> 00:17:19,171
BETHESDA.

487
00:17:19,171 --> 00:17:24,509
IT'S IN MEMORY OF DANIEL ROBERT 

488
00:17:24,509 --> 00:17:26,545
MORENO, THIS IS A PATIENT WHO 

489
00:17:26,545 --> 00:17:29,481
DIED BY SUICIDE IN THE CLINICAL 

490
00:17:29,481 --> 00:17:31,483
SETTING.

491
00:17:31,483 --> 00:17:33,251
IN 2005, IN THE MIDDLE OF THE 

492
00:17:33,251 --> 00:17:34,686
DAY, VERY PUBLIC.

493
00:17:34,686 --> 00:17:36,021
IT WAS DEVASTATING.

494
00:17:36,021 --> 00:17:37,856
THIS WAS NOT ONLY DEVASTATING 

495
00:17:37,856 --> 00:17:39,391
TO THIS PATIENT AND THEIR 

496
00:17:39,391 --> 00:17:40,792
FAMILY BUT TO EVERYBODY IN THE 

497
00:17:40,792 --> 00:17:42,794
CLINICAL CENTER.

498
00:17:42,794 --> 00:17:44,830
AND THE GREATER NIH COMMUNITY.

499
00:17:44,830 --> 00:17:53,605
BUT I PUT THIS UP BECAUSE OF 

500
00:17:53,605 --> 00:17:55,540
THIS PEOPLE GOT VERY INTERESTED 

501
00:17:55,540 --> 00:17:56,641
IN SUICIDE RISK.

502
00:17:56,641 --> 00:18:00,045
AND IT WAS JUST KIND OF A 

503
00:18:00,045 --> 00:18:02,080
COINCIDENCE THAT I MOVED HERE 

504
00:18:02,080 --> 00:18:05,317
TO NIH AND I HAD STUDIED 

505
00:18:05,317 --> 00:18:07,252
SUICIDE RISK SCREENING IN THE 

506
00:18:07,252 --> 00:18:07,986
MEDICAL SETTING UP IN 

507
00:18:07,986 --> 00:18:09,054
MASSACHUSETTS.

508
00:18:09,054 --> 00:18:10,956
AND I HAD COME RIGHT AFTER THIS 

509
00:18:10,956 --> 00:18:12,391
SUICIDE.

510
00:18:12,391 --> 00:18:17,429
BUT I PUT THIS UP BECAUSE SINCE 

511
00:18:17,429 --> 00:18:19,931
2005, WE HAD THAT SUICIDE IN 

512
00:18:19,931 --> 00:18:21,333
THE CLINICAL CENTER.

513
00:18:21,333 --> 00:18:23,602
NOW IN 2024, THERE ARE PEOPLE 

514
00:18:23,602 --> 00:18:30,475
BEING SCREENED IN ETHIOPIA AND 

515
00:18:30,475 --> 00:18:32,110
NEPAL AND ALL OVER THE WORLD 

516
00:18:32,110 --> 00:18:33,311
FOR SUICIDE RISK.

517
00:18:33,311 --> 00:18:34,946
IT STARTED WITH THIS TRAGEDY 

518
00:18:34,946 --> 00:18:36,748
BUT IT WAS ABLE TO BE TURNED 

519
00:18:36,748 --> 00:18:39,050
INTO SOME HOPE AND ACTION.

520
00:18:39,050 --> 00:18:41,286
SO IT STARTED WITH, I WAS 

521
00:18:41,286 --> 00:18:46,558
HAVING LUNCH WITH DR. MARYLAND 

522
00:18:46,558 --> 00:18:48,927
PAO,THE CLINICAL DIRECTOR OF 

523
00:18:48,927 --> 00:18:49,795
NIMH.

524
00:18:49,795 --> 00:18:51,296
I HAD COME FROM CHILDREN'S 

525
00:18:51,296 --> 00:18:55,834
HOSPITAL WHERE I CAME UP WITH A 

526
00:18:55,834 --> 00:18:59,571
SUICIDE RISK SCREENING TOOL FOR 

527
00:18:59,571 --> 00:19:01,807
PEDIATRIC PATIENTS WITH 

528
00:19:01,807 --> 00:19:03,008
PSYCHIATRIC CHIEF COMPLAINTS.

529
00:19:03,008 --> 00:19:05,143
SHE SAID TO ME SHE HAD JUST 

530
00:19:05,143 --> 00:19:07,646
COME FROM BEING HEAD OF 

531
00:19:07,646 --> 00:19:09,114
PSYCHIATRY IN THE EMERGENCY 

532
00:19:09,114 --> 00:19:09,648
DEPARTMENT AT CHILDREN'S 

533
00:19:09,648 --> 00:19:10,982
NATIONAL.

534
00:19:10,982 --> 00:19:14,419
SHE SAID CAN WE USE YOUR TOOL 

535
00:19:14,419 --> 00:19:16,755
ON ALL COMERS TO THE EMERGENCY 

536
00:19:16,755 --> 00:19:18,623
DEPARTMENT, I CALL THIS THE PAO 

537
00:19:18,623 --> 00:19:20,091
FACTOR.

538
00:19:20,091 --> 00:19:21,626
SHE KIND OF SET LET'S DO THIS 

539
00:19:21,626 --> 00:19:22,427
STUDY.

540
00:19:22,427 --> 00:19:24,563
SO WE DID THIS STUDY.

541
00:19:24,563 --> 00:19:26,131
I'M GOING TO TELL YOU ABOUT IT 

542
00:19:26,131 --> 00:19:27,799
IN A MINUTE.

543
00:19:27,799 --> 00:19:29,367
BUT I JUST WANTED TO TELL YOU 

544
00:19:29,367 --> 00:19:30,936
WHAT'S GOING ON WITH THE JOINT 

545
00:19:30,936 --> 00:19:32,137
COMMISSION AND HOSPITAL.

546
00:19:32,137 --> 00:19:34,739
THE JOINT COMMISSION IS THIS 

547
00:19:34,739 --> 00:19:36,308
ACCREDITATION BODY THAT 

548
00:19:36,308 --> 00:19:37,476
ACCREDITS MOST OF THE HOSPITALS 

549
00:19:37,476 --> 00:19:40,245
IN THIS COUNTRY.

550
00:19:40,245 --> 00:19:41,613
SO HOSPITAL-BASED SUICIDES ARE 

551
00:19:41,613 --> 00:19:42,514
RARE BUT VERY DEVASTATING 

552
00:19:42,514 --> 00:19:43,582
EVENTS.

553
00:19:43,582 --> 00:19:45,083
YOU MAY BE SURPRISED TO HEAR 

554
00:19:45,083 --> 00:19:53,058
IT'S ONE OF THE TOP FIVE 

555
00:19:53,058 --> 00:19:55,293
REPORTED SENTINEL EVENT, THAT'S 

556
00:19:55,293 --> 00:19:56,995
WHEN IT HAPPENS SUDDENLY.

557
00:19:56,995 --> 00:20:01,166
A QUARTER OF THEM ARE HAPPENING 

558
00:20:01,166 --> 00:20:02,467
IN NON-BEHAVIORAL HEALTH UNITS, 

559
00:20:02,467 --> 00:20:08,206
LIKE THE EMERGENCY DEPARTMENT, 

560
00:20:08,206 --> 00:20:10,675
ICU, CANCER UNITS, MED-SURGE 

561
00:20:10,675 --> 00:20:11,843
UNITS, OUTPATIENT CLINICS.

562
00:20:11,843 --> 00:20:13,979
I JUST WANTED TO SHOW YOU FROM 

563
00:20:13,979 --> 00:20:16,181
THE SUICIDE THAT WE HAD AT THE 

564
00:20:16,181 --> 00:20:18,450
CLINICAL CENTER, THAT HAPPENED 

565
00:20:18,450 --> 00:20:21,987
IN 2005, A TEAM HERE LED BY DON 

566
00:20:21,987 --> 00:20:24,222
ROSEN STAOEN AT THAT TIME WENT 

567
00:20:24,222 --> 00:20:25,724
TO THE JOINT COMMISSION AND WE 

568
00:20:25,724 --> 00:20:27,459
BELIEVE BECAUSE OF THIS 

569
00:20:27,459 --> 00:20:29,261
PROCESS, THE JOINT COMMISSION 

570
00:20:29,261 --> 00:20:30,896
ACTUALLY ISSUED A NATIONAL 

571
00:20:30,896 --> 00:20:32,597
PATIENT SAFETY GOAL THAT ALL 

572
00:20:32,597 --> 00:20:35,400
HOSPITALS IN THE COUNTRY SHOULD 

573
00:20:35,400 --> 00:20:36,735
SCREEN BEHAVIORAL HEALTH 

574
00:20:36,735 --> 00:20:39,604
PATIENTS FOR SUICIDE RISK.

575
00:20:39,604 --> 00:20:44,009
AND IN 2008, WE LAUNCHED THE 

576
00:20:44,009 --> 00:20:45,343
FIRST SUICIDE-RISK SCREENING 

577
00:20:45,343 --> 00:20:46,945
TOOL STUDY WE DO IN THE 

578
00:20:46,945 --> 00:20:47,646
EMERGENCY DEPARTMENT THAT I 

579
00:20:47,646 --> 00:20:49,180
WILL TELL YOU ABOUT.

580
00:20:49,180 --> 00:20:51,483
AND THEN IN 2010, THE JOINT 

581
00:20:51,483 --> 00:20:53,518
COMMISSION WAS LOOKING AT THEIR 

582
00:20:53,518 --> 00:20:58,256
DATA AND SEEING THAT MORE AND 

583
00:20:58,256 --> 00:21:01,560
MORE NON-BEHAVIORAL HEALTH 

584
00:21:01,560 --> 00:21:02,994
UNITS WERE EXPERIENCING SUICIDE.

585
00:21:02,994 --> 00:21:05,330
THEY BROUGHT IN THEIR ALERT.

586
00:21:05,330 --> 00:21:07,465
AND IN 2012, THE ASK WAS 

587
00:21:07,465 --> 00:21:08,867
PUBLISHED.

588
00:21:08,867 --> 00:21:11,603
AND IN 2016, THE JOINT 

589
00:21:11,603 --> 00:21:12,804
COMMISSION BROADENED IT EVEN 

590
00:21:12,804 --> 00:21:14,506
MORE AND RECOMMENDED ALL 

591
00:21:14,506 --> 00:21:15,907
MEDICAL PATIENTS BE SCREENED 

592
00:21:15,907 --> 00:21:17,475
FOR SUICIDE RISK.

593
00:21:17,475 --> 00:21:19,678
AND IT HAS BEEN SINCE UPDATED 

594
00:21:19,678 --> 00:21:22,280
AND NOW THE ASK IS VALIDATED IN 

595
00:21:22,280 --> 00:21:23,748
NOT ONLY YOUTH BUT IN ADULTS AS 

596
00:21:23,748 --> 00:21:24,616
WELL.

597
00:21:24,616 --> 00:21:26,351
SO WE WERE READY.

598
00:21:26,351 --> 00:21:27,485
SO LET'S TALK ABOUT THIS 

599
00:21:27,485 --> 00:21:30,388
SCREENING.

600
00:21:30,388 --> 00:21:32,090
STARTING THESE CONVERSATIONS IN 

601
00:21:32,090 --> 00:21:33,325
HEALTHCARE SETTINGS.

602
00:21:33,325 --> 00:21:35,594
WE ARE USED TO SCREENING.

603
00:21:35,594 --> 00:21:39,798
EVERYONE WHO GOES TO A MEDICAL 

604
00:21:39,798 --> 00:21:40,632
APPOINTMENT GETS SCREENED FOR 

605
00:21:40,632 --> 00:21:42,200
BLOOD PRESSURE.

606
00:21:42,200 --> 00:21:43,735
THAT'S THE NIH CLINICAL CENTER 

607
00:21:43,735 --> 00:21:47,038
TOP RIGHT WHERE WE SCREENED FOR 

608
00:21:47,038 --> 00:21:50,475
COVID IN 2020 AND SCREENED AT 

609
00:21:50,475 --> 00:21:52,410
AIRPORTS AND SOME KIDS EVEN GET 

610
00:21:52,410 --> 00:21:54,079
SCREENED BEFORE THEY GO ON A 

611
00:21:54,079 --> 00:21:55,413
ROLLER COASTER.

612
00:21:55,413 --> 00:21:57,115
SO PEOPLE ARE USED TO SCREENING.

613
00:21:57,115 --> 00:21:59,451
I WANT TO TELL YOU THE 

614
00:21:59,451 --> 00:22:01,286
DIFFERENCE BETWEEN SCREENING 

615
00:22:01,286 --> 00:22:01,653
AND ASSESSMENT.

616
00:22:01,653 --> 00:22:03,722
SCREENING IS A RAPID WAY TO 

617
00:22:03,722 --> 00:22:05,190
IDENTIFY SOMEONE WHO NEEDS 

618
00:22:05,190 --> 00:22:08,059
FURTHER EVALUATION.

619
00:22:08,059 --> 00:22:10,895
AN ASSESSMENT IS MORE 

620
00:22:10,895 --> 00:22:11,796
COMPREHENSIVE EVALUATION, IT 

621
00:22:11,796 --> 00:22:12,430
CONFIRMS RISK AND ALL THOSE IN 

622
00:22:12,430 --> 00:22:17,268
FAVOUR   --  GUIDES NEXT STEPS.

623
00:22:17,268 --> 00:22:20,805
OUR TEAM ASKS WHAT ARE THESE 

624
00:22:20,805 --> 00:22:21,606
VALID QUESTIONS THAT 

625
00:22:21,606 --> 00:22:23,708
NURSES/PHYSICIANS CAN USE TO 

626
00:22:23,708 --> 00:22:25,644
SCREEN MEDICAL PATIENTS WITHOUT 

627
00:22:25,644 --> 00:22:27,879
OVER BURDENING THEIR PRACTICE?

628
00:22:27,879 --> 00:22:31,816
WE LAUNCHED THIS STUDY IN THREE 

629
00:22:31,816 --> 00:22:35,020
PEDIATRIC EMERGENCY 

630
00:22:35,020 --> 00:22:36,955
DEPARTMENTS, BOSTON CHILDREN'S, 

631
00:22:36,955 --> 00:22:37,589
CHILDREN'S NATIONAL AND 

632
00:22:37,589 --> 00:22:40,992
NATIONWIDE CHILDREN'S.

633
00:22:40,992 --> 00:22:43,094
WE INFUSED THE SAMPLE WITH 

634
00:22:43,094 --> 00:22:44,362
PSYCHIATRIC PATIENTS.

635
00:22:44,362 --> 00:22:46,865
AT THAT TIME WE DIDN'T KNOW IF 

636
00:22:46,865 --> 00:22:48,166
KIDS WOULD BE TALKING ABOUT 

637
00:22:48,166 --> 00:22:49,701
SUICIDE RISK, SO WE WANTED TO 

638
00:22:49,701 --> 00:22:52,704
MAKE SURE THERE WERE KIDS WITH 

639
00:22:52,704 --> 00:22:56,541
SUICIDAL THOUGHTS IN THE SAMPLE.

640
00:22:56,541 --> 00:22:58,977
IN BRIEF TERMS WE TOOK A BUNCH 

641
00:22:58,977 --> 00:23:02,514
OF CANDIDATE ITEMS AND TAKE A 

642
00:23:02,514 --> 00:23:12,223
GOLD STANDARD ASSESSMENT LIKE 

643
00:23:12,223 --> 00:23:13,124
THE SUICIDAL IDEATION 

644
00:23:13,124 --> 00:23:14,926
QUESTIONNAIRE AND THEN WE 

645
00:23:14,926 --> 00:23:16,461
STATISTICALLY MODEL THE 17 

646
00:23:16,461 --> 00:23:18,163
CANDIDATE ITEMS TO SEE WHAT IS 

647
00:23:18,163 --> 00:23:19,998
THE FEWEST NUMBER OF ITEMS THAT 

648
00:23:19,998 --> 00:23:22,000
CAN CAPTURE THE SAME PATIENTS 

649
00:23:22,000 --> 00:23:24,536
AS THE GOLD STANDARD.

650
00:23:24,536 --> 00:23:26,938
AND SO PEOPLE OFTEN STOP ME AND 

651
00:23:26,938 --> 00:23:28,873
SAY, WELL IF YOU HAVE A GOLD 

652
00:23:28,873 --> 00:23:30,341
STANDARD WHY ARE YOU MAKING A 

653
00:23:30,341 --> 00:23:33,011
NEW TOOL.

654
00:23:33,011 --> 00:23:35,547
WE HAD TO DO A VERY BRIEF 

655
00:23:35,547 --> 00:23:36,848
SCREENING TOOL THAT WOULD 

656
00:23:36,848 --> 00:23:39,784
CAPTURE THE SAME KIDS.

657
00:23:39,784 --> 00:23:42,320
AND SO, WE HAD SEVERAL 

658
00:23:42,320 --> 00:23:45,957
DIFFERENT MODELS AND WE PICKED 

659
00:23:45,957 --> 00:23:48,359
ONE THAT REALLY LIMITED 

660
00:23:48,359 --> 00:23:50,562
MISCLASSIFYING PATIENTS AND 

661
00:23:50,562 --> 00:23:50,962
MISSING PATIENTS.

662
00:23:50,962 --> 00:23:53,131
WHAT WE CAME UP WITH IS A TOOL 

663
00:23:53,131 --> 00:23:55,800
THAT HAD VERY STRONG 

664
00:23:55,800 --> 00:23:57,969
SENSITIVITY, TRUE/POSITIVE RATE.

665
00:23:57,969 --> 00:24:01,039
VERY GOOD SPECIFICITY WHICH IS 

666
00:24:01,039 --> 00:24:02,373
THE TRUE-NEGATIVE RATE, LIMITS 

667
00:24:02,373 --> 00:24:06,311
FALSE POSITIVE AND VERY GOOD 

668
00:24:06,311 --> 00:24:07,045
NEGATIVE PREDICTIVE VALUE, 

669
00:24:07,045 --> 00:24:09,147
MEANING WHEN THE TOOL SAYS 

670
00:24:09,147 --> 00:24:11,683
SOMEBODY IS A NEGATIVE, THERE 

671
00:24:11,683 --> 00:24:13,818
WAS A 99.7% OF THEM, THE GOLD 

672
00:24:13,818 --> 00:24:14,686
STANDARD ALSO SAID THEY WERE 

673
00:24:14,686 --> 00:24:15,920
NEGATIVE.

674
00:24:15,920 --> 00:24:18,123
WE WERE REALLY HAPPY ABOUT THE 

675
00:24:18,123 --> 00:24:18,990
HIGH SPECIFICITY BECAUSE WHAT 

676
00:24:18,990 --> 00:24:22,293
WE DIDN'T WANT TO DO IS OVER 

677
00:24:22,293 --> 00:24:24,796
BURDEN MEDICAL SYSTEM WITH 

678
00:24:24,796 --> 00:24:27,031
FALSE POSITIVES.

679
00:24:27,031 --> 00:24:29,467
IN THE PAST FEW WEEKS HAVE YOU 

680
00:24:29,467 --> 00:24:31,202
WISHED YOU WERE DEAD.

681
00:24:31,202 --> 00:24:34,005
IN THE PAST FEW WEEKS HAVE YOU 

682
00:24:34,005 --> 00:24:35,707
THOUGHT YOU OR YOUR FAMILY 

683
00:24:35,707 --> 00:24:40,178
WOULD BE BETTER OFF DEAD.

684
00:24:40,178 --> 00:24:42,046
HAVE YOU BEEN HAVING THOUGHTS 

685
00:24:42,046 --> 00:24:43,281
ABOUT KILLING YOURSELF?

686
00:24:43,281 --> 00:24:44,449
HAVE YOU EVER TRIED TO KILL 

687
00:24:44,449 --> 00:24:46,518
YOURSELF?

688
00:24:46,518 --> 00:24:49,354
WE KNOW FROM BIG DATASETS, I 

689
00:24:49,354 --> 00:24:53,291
WILL PICK ONE STUDY ON MY MIND 

690
00:24:53,291 --> 00:24:55,727
FROM PARKLAND HOSPITAL IN 

691
00:24:55,727 --> 00:24:57,228
DALLAS, TEXAS, THINK HAD 90,000 

692
00:24:57,228 --> 00:24:58,329
ASKS.

693
00:24:58,329 --> 00:25:01,099
WE KNOW THAT MAYBE 97% OF 

694
00:25:01,099 --> 00:25:01,866
PATIENTS ARE GOING TO SCREEN 

695
00:25:01,866 --> 00:25:02,901
LIKE THIS.

696
00:25:02,901 --> 00:25:04,202
IT WILL BE 20 SECONDS AND 

697
00:25:04,202 --> 00:25:05,136
YOU'RE DONE.

698
00:25:05,136 --> 00:25:06,538
THEY ARE NEGATIVE.

699
00:25:06,538 --> 00:25:09,140
THIS IS WHAT MAKES UNIVERSAL 

700
00:25:09,140 --> 00:25:10,375
SUICIDE RISK SCREENING FEASIBLE 

701
00:25:10,375 --> 00:25:12,277
IN THE MEDICAL SETTING.

702
00:25:12,277 --> 00:25:13,411
BECAUSE MOST PATIENTS AREN'T 

703
00:25:13,411 --> 00:25:15,413
GOING TO BE POSITIVE.

704
00:25:15,413 --> 00:25:18,283
NOW IF YOU DO SCREEN POSITIVE, 

705
00:25:18,283 --> 00:25:20,718
THERE'S TWO WAYS, ACUTE AND 

706
00:25:20,718 --> 00:25:20,985
NON-ACUTE.

707
00:25:20,985 --> 00:25:22,854
IF YOU SAY YES TO ANY 

708
00:25:22,854 --> 00:25:24,556
COMBINATION, YOU ARE GIVEN THAT 

709
00:25:24,556 --> 00:25:26,991
FIFTH QUESTION, YOU SAY NO, 

710
00:25:26,991 --> 00:25:29,093
THAT'S A NON-ACUTE POSITIVE.

711
00:25:29,093 --> 00:25:33,832
IN THE SAME STUDY, 99.5% OF THE 

712
00:25:33,832 --> 00:25:36,568
POSITIVES WERE NON-ACUTE.

713
00:25:36,568 --> 00:25:38,603
WHICH MEANT IT WAS GREAT THAT 

714
00:25:38,603 --> 00:25:39,838
YOU PICKED SOMETHING UP BECAUSE 

715
00:25:39,838 --> 00:25:42,040
NOW YOU CAN HELP THE PATIENT 

716
00:25:42,040 --> 00:25:43,641
BUT IT WAS NOT AN EMERGENCY.

717
00:25:43,641 --> 00:25:46,177
WE ARE GOING TO TALK A LOT MORE 

718
00:25:46,177 --> 00:25:47,812
ABOUT THIS, THIS IS NOT A TRIP 

719
00:25:47,812 --> 00:25:48,780
TO THE EMERGENCY ROOM.

720
00:25:48,780 --> 00:25:50,915
THIS IS NOT A ONE-TO-ONE.

721
00:25:50,915 --> 00:25:53,551
HOWEVER, YOU DO HAVE TO BE 

722
00:25:53,551 --> 00:25:55,153
READY IF SOMEONE SAYS YES TO 

723
00:25:55,153 --> 00:25:57,388
FIVE, THAT IS AN ACUTE POSITIVE 

724
00:25:57,388 --> 00:25:59,190
AND THAT IS AN EMERGENCY.

725
00:25:59,190 --> 00:26:01,726
AND THAT IS FULL ON SAFETY 

726
00:26:01,726 --> 00:26:03,962
PRECAUTIONS, BUT THAT HAPPENS 

727
00:26:03,962 --> 00:26:05,663
AT A 0.5% OF THE TIME.

728
00:26:05,663 --> 00:26:07,365
IT'S NOT THE MOST COMMON 

729
00:26:07,365 --> 00:26:08,199
RESPONSE.

730
00:26:08,199 --> 00:26:10,568
IT'S A HIGHER RESPONSE IN 

731
00:26:10,568 --> 00:26:11,936
BEHAVIORAL HEALTH PATIENTS.

732
00:26:11,936 --> 00:26:15,006
BUT IT'S STILL NOT THE MAJORITY.

733
00:26:15,006 --> 00:26:19,210
SO THE ASK WAS VALIDATED 

734
00:26:19,210 --> 00:26:21,145
THROUGH RESEARCH IN INPATIENT 

735
00:26:21,145 --> 00:26:23,181
MEDICAL SURGICAL UNIT, 

736
00:26:23,181 --> 00:26:24,449
OUTPATIENT PRIMARY CARE, 

737
00:26:24,449 --> 00:26:26,351
SPECIALTY CLINICS AND IN ADULT 

738
00:26:26,351 --> 00:26:27,185
MEDICAL PATIENTS.

739
00:26:27,185 --> 00:26:29,420
SO THIS IS ONE OF THOSE TOOLS 

740
00:26:29,420 --> 00:26:30,889
THAT USUALLY TOOLS GO FROM THE 

741
00:26:30,889 --> 00:26:32,290
ADULT WORLD TO THE PEDIATRIC 

742
00:26:32,290 --> 00:26:32,924
WORLD.

743
00:26:32,924 --> 00:26:34,726
THIS IS A TOOL THAT WENT FROM 

744
00:26:34,726 --> 00:26:35,627
THE PEDIATRIC WORLD TO AT DULT 

745
00:26:35,627 --> 00:26:36,661
WORLD.

746
00:26:36,661 --> 00:26:39,364
THE PLACES IN BLACK WE HAVE 

747
00:26:39,364 --> 00:26:39,864
ONGOING RESEARCH.

748
00:26:39,864 --> 00:26:42,367
I'M SO EXCITED ABOUT OUR INDIAN 

749
00:26:42,367 --> 00:26:43,201
HEALTH SERVICE PARTNERSHIP 

750
00:26:43,201 --> 00:26:45,336
BECAUSE OF THE DATA I SHOWED 

751
00:26:45,336 --> 00:26:46,537
YOU THAT AMERICAN INDIANS HAVE 

752
00:26:46,537 --> 00:26:54,746
THE HIGHEST RATE.

753
00:26:54,746 --> 00:26:59,684
THEY HAVE SELECTED ASQ TOOL.

754
00:26:59,684 --> 00:27:04,656
WE ARE TESTING THE ASQ IN 

755
00:27:04,656 --> 00:27:05,590
PEOPLE WITH NEURODEVELOPMENTAL 

756
00:27:05,590 --> 00:27:07,392
DISORDERS LIKE AUTISM.

757
00:27:07,392 --> 00:27:09,427
IT HAS BEEN TRANSLATED IN OVER 

758
00:27:09,427 --> 00:27:11,396
23 LANGUAGES AND COMES WITH A 

759
00:27:11,396 --> 00:27:11,863
TOOLKIT.

760
00:27:11,863 --> 00:27:14,065
THE PLACES IN GREEN ARE PLACES 

761
00:27:14,065 --> 00:27:17,335
THAT ACTUALLY VALIDATED THE ASQ 

762
00:27:17,335 --> 00:27:19,237
THROUGH RESEARCH.

763
00:27:19,237 --> 00:27:21,239
ALSO BECAUSE OF THE RISE IN 

764
00:27:21,239 --> 00:27:23,574
BLACK YOUTH SUICIDE, WE WENT 

765
00:27:23,574 --> 00:27:26,244
BACK AND REANALYZED TO COMPARE 

766
00:27:26,244 --> 00:27:30,648
BLACK YOUTH AND WHITE YOUTH 

767
00:27:30,648 --> 00:27:33,985
WITH VALIDITY ASQ AND WE SAW 

768
00:27:33,985 --> 00:27:36,321
AMONG BLACK YOUTH IT HAD STRONG 

769
00:27:36,321 --> 00:27:39,223
PSYCHO METRIC PROPERTIES.

770
00:27:39,223 --> 00:27:41,659
THE ASQ WASN'T DEVELOPED TO BE 

771
00:27:41,659 --> 00:27:43,261
PREDICTIVE OF SUICIDE ALABI 

772
00:27:43,261 --> 00:27:45,797
HAIFOR BUT THERE ARE SEVERAL 

773
00:27:45,797 --> 00:27:48,433
STUDIES THAT THAT SHOW IT HAS 

774
00:27:48,433 --> 00:27:53,471
SOME PREDICTIVE HAVE A LIT ID 

775
00:27:53,471 --> 00:27:55,440
FOR POST EMERGENCY DEPARTMENT 

776
00:27:55,440 --> 00:27:59,544
DISCHARGE.

777
00:27:59,544 --> 00:28:01,379
SUICIDAL BEHAVIOR.

778
00:28:01,379 --> 00:28:03,381
THE WAY YOU CAN MAKE IT 

779
00:28:03,381 --> 00:28:05,516
FEASIBLE AND NOT OVER BURDEN IS 

780
00:28:05,516 --> 00:28:07,452
MAKE IT PART OF THE CLINICAL 

781
00:28:07,452 --> 00:28:08,753
PATHWAY.

782
00:28:08,753 --> 00:28:09,721
WE HAVE IT FOR ASTHMA AND 

783
00:28:09,721 --> 00:28:11,656
DIABETES.

784
00:28:11,656 --> 00:28:14,292
WE NEED CLINICAL PATHWAYS FOR 

785
00:28:14,292 --> 00:28:15,360
TREATING MENTAL HEALTH PROBLEMS 

786
00:28:15,360 --> 00:28:16,728
AS WELL.

787
00:28:16,728 --> 00:28:18,429
SO THIS PATHWAY, THE BARE BONES 

788
00:28:18,429 --> 00:28:20,832
OF IT IS A BRIEF SCREEN, 

789
00:28:20,832 --> 00:28:23,334
FOLLOWED BY A BRIEF SUICIDE 

790
00:28:23,334 --> 00:28:24,402
SAFETY ASSESSMENT THAT FURTHER 

791
00:28:24,402 --> 00:28:25,670
TRIAGES THE SCREEN.

792
00:28:25,670 --> 00:28:27,038
AND THAT HELPS YOU DETERMINE 

793
00:28:27,038 --> 00:28:28,339
WHAT HAPPENS NEXT WITH THE 

794
00:28:28,339 --> 00:28:29,307
PATIENT.

795
00:28:29,307 --> 00:28:32,343
DO THEY NEED A FULL MENTAL 

796
00:28:32,343 --> 00:28:34,545
HEALTH EVALUATION, OR CAN THEY 

797
00:28:34,545 --> 00:28:35,980
TAKE AN OUTPATIENT REFERRAL.

798
00:28:35,980 --> 00:28:38,783
OR NO FURTHER ACTION AT THIS 

799
00:28:38,783 --> 00:28:38,983
TIME?

800
00:28:38,983 --> 00:28:40,718
WHAT I'VE SEEN FROM CONSULTING 

801
00:28:40,718 --> 00:28:45,256
TO HOSPITALS AROUND THE COUNTRY 

802
00:28:45,256 --> 00:28:47,158
IS THAT THERE ARE A HUNDRED 

803
00:28:47,158 --> 00:28:48,893
DIFFERENT WAYS TO DO THESE 

804
00:28:48,893 --> 00:28:50,094
THREE STEPS BUT THESE THREE 

805
00:28:50,094 --> 00:28:51,929
STEPS ARE THE IMPORTANT STEPS.

806
00:28:51,929 --> 00:28:54,665
WHAT REALLY MAKES IT FEASIBLE, 

807
00:28:54,665 --> 00:28:57,035
IT'S ALL IN THE NUANCE.

808
00:28:57,035 --> 00:28:58,870
SO EVERY PLACE IS GOING TO DO 

809
00:28:58,870 --> 00:29:01,406
THIS A LITTLE BIT DIFFERENT AND 

810
00:29:01,406 --> 00:29:04,342
THROUGH A QUALITY IMPROVEMENT 

811
00:29:04,342 --> 00:29:06,044
PROCESS, AN ITERATIVE PROCESS, 

812
00:29:06,044 --> 00:29:09,580
THEY CAN KEEP STUDYING HOW THIS 

813
00:29:09,580 --> 00:29:11,516
CLINICAL PATHWAY WORKS AND KEEP 

814
00:29:11,516 --> 00:29:12,917
TWEAKING IT UNTIL IT GETS TO 

815
00:29:12,917 --> 00:29:14,986
THE PLACE WHERE IT'S REALLY 

816
00:29:14,986 --> 00:29:17,488
WORKING EFFICIENTLY.

817
00:29:17,488 --> 00:29:19,390
OKAY, SO LET'S TALK ABOUT THE 

818
00:29:19,390 --> 00:29:22,060
FIRST LEVEL IS A BRIEF SCREEN.

819
00:29:22,060 --> 00:29:24,462
AND SO, WHAT WE TELL PEOPLE IS 

820
00:29:24,462 --> 00:29:27,365
TRAIN EVERYONE IN YOUR OFFICE 

821
00:29:27,365 --> 00:29:28,399
ABOUT SUICIDE RISK.

822
00:29:28,399 --> 00:29:30,101
AND THEN ANYONE WHO IS TRAINED 

823
00:29:30,101 --> 00:29:33,037
TO SCREEN CAN SCREEN.

824
00:29:33,037 --> 00:29:36,140
I MEAN, THE ASQ WAS CREATED FOR 

825
00:29:36,140 --> 00:29:38,042
A NURSE, MEDICAL TECHNICIAN OR 

826
00:29:38,042 --> 00:29:38,910
MEDICAL ASSISTANT.

827
00:29:38,910 --> 00:29:41,779
BUT IT CAN ALSO BE USED BY 

828
00:29:41,779 --> 00:29:42,747
PHYSICIANS AND OTHER PEOPLE WHO 

829
00:29:42,747 --> 00:29:43,881
ARE TRAINED.

830
00:29:43,881 --> 00:29:45,183
AND THEN THEY DECIDE, ARE THEY 

831
00:29:45,183 --> 00:29:47,618
GOING TO DO IT SELF-REPORT OR 

832
00:29:47,618 --> 00:29:48,953
IS SOMEONE GOING TO DO IT VERB 

833
00:29:48,953 --> 00:29:51,355
BALLY.

834
00:29:51,355 --> 00:29:53,991
--  VERBALLY.

835
00:29:53,991 --> 00:29:55,359
THEY SET THE FREQUENCY, HOW 

836
00:29:55,359 --> 00:29:58,529
OFTEN ARE WE GOING TO SCREEN.

837
00:29:58,529 --> 00:30:00,264
THESE ARE DECISIONS MADE AT THE 

838
00:30:00,264 --> 00:30:01,232
LOCAL LEVEL.

839
00:30:01,232 --> 00:30:03,367
ARE THEY GOING TO START AT 10, 

840
00:30:03,367 --> 00:30:05,903
WHAT WE RECOMMEND OR ARE THEY 

841
00:30:05,903 --> 00:30:07,538
GOING TO START AT 12.

842
00:30:07,538 --> 00:30:09,941
SO THAT HAS TO DO WITH STARTING 

843
00:30:09,941 --> 00:30:10,975
THE DIFFICULT CONVERSATIONS 

844
00:30:10,975 --> 00:30:12,143
THROUGH SCREENING IN A 

845
00:30:12,143 --> 00:30:13,878
HEALTHCARE SETTING.

846
00:30:13,878 --> 00:30:15,680
BUT WHAT HAPPENS WHEN A PATIENT 

847
00:30:15,680 --> 00:30:16,080
SCREENS POSITIVE?

848
00:30:16,080 --> 00:30:17,515
RIGHT?

849
00:30:17,515 --> 00:30:19,450
HERE IS WHAT SHOULD NOT HAPPEN.

850
00:30:19,450 --> 00:30:20,952
THIS IS SO IMPORTANT.

851
00:30:20,952 --> 00:30:22,253
YOU CANNOT TREAT EVERY PERSON 

852
00:30:22,253 --> 00:30:23,688
WHO HAS A THOUGHT ABOUT SUICIDE 

853
00:30:23,688 --> 00:30:26,457
LIKE THEY ARE AN EMERGENCY.

854
00:30:26,457 --> 00:30:27,525
BECAUSE OTHERWISE THEY END UP 

855
00:30:27,525 --> 00:30:29,227
IN THE EMERGENCY DEPARTMENT IN 

856
00:30:29,227 --> 00:30:32,663
A PAPER GOWN, THEY ARE GIVEN A 

857
00:30:32,663 --> 00:30:33,564
VERY COSTLY ONE-TO-ONE SITTER, 

858
00:30:33,564 --> 00:30:36,300
THEY ARE THERE FOR HOURS, THEIR 

859
00:30:36,300 --> 00:30:37,668
BELONGINGS LIKE THEIR PHONES 

860
00:30:37,668 --> 00:30:39,670
ARE TAKEN AWAY, AND THIS PERSON 

861
00:30:39,670 --> 00:30:41,005
MAY FEEL PUNISHED.

862
00:30:41,005 --> 00:30:43,574
YOU MIGHT BE, IF YOU ARE A 

863
00:30:43,574 --> 00:30:44,709
PROVIDER, THIS PROVIDER MIGHT 

864
00:30:44,709 --> 00:30:47,211
BE THE FIRST PERSON TO ASK THEM 

865
00:30:47,211 --> 00:30:48,846
ABOUT SUICIDE RISK AND THEY 

866
00:30:48,846 --> 00:30:50,848
OPENED UP AND NOW THEY FEEL 

867
00:30:50,848 --> 00:30:52,984
SORRY THAT THEY TOLD ANYONE AND 

868
00:30:52,984 --> 00:30:54,285
MAYBE THEY WILL NEVER TELL 

869
00:30:54,285 --> 00:30:55,486
ANYONE AGAIN.

870
00:30:55,486 --> 00:30:57,722
SO WE CANNOT HAVE THIS HAPPEN.

871
00:30:57,722 --> 00:30:59,323
SO THAT'S WHERE THESE CLINICAL 

872
00:30:59,323 --> 00:31:00,458
PATHWAYS COME IN.

873
00:31:00,458 --> 00:31:03,294
THEY COME IN TO AVOID THESE 

874
00:31:03,294 --> 00:31:03,728
KIND OF UNNECESSARY 

875
00:31:03,728 --> 00:31:04,495
INTERVENTIONS.

876
00:31:04,495 --> 00:31:06,531
I CAN'T TELL YOU HOW MANY 

877
00:31:06,531 --> 00:31:08,332
HOSPITALS I WENT IN WHERE 

878
00:31:08,332 --> 00:31:09,834
SOMEONE JUST MAYBE HAD A 

879
00:31:09,834 --> 00:31:11,169
PASSIVE THOUGHT OF SUICIDE AND 

880
00:31:11,169 --> 00:31:12,870
THEY ENDED UP LIKE THIS.

881
00:31:12,870 --> 00:31:15,072
THAT'S NOT OKAY.

882
00:31:15,072 --> 00:31:17,441
THAT'S NOT A COMPASSIONATE WAY.

883
00:31:17,441 --> 00:31:19,844
NOW, WHEN SOMEONE IS AT ACUTE 

884
00:31:19,844 --> 00:31:22,380
RISK THERE'S A VERY 

885
00:31:22,380 --> 00:31:23,881
COMPASSIONATE WAY TO KEEP THEM 

886
00:31:23,881 --> 00:31:27,919
IS A, SOMETIMES THEY DO NEED A 

887
00:31:27,919 --> 00:31:29,554
1:1 SITTER AND PUT IN A ROOM 

888
00:31:29,554 --> 00:31:31,255
WHERE THEY ARE SAFE.

889
00:31:31,255 --> 00:31:32,890
BUT THERE'S A COMPASSIONATE WAY 

890
00:31:32,890 --> 00:31:34,592
TO EXPLAIN YOU ARE TRYING TO 

891
00:31:34,592 --> 00:31:37,528
KEEP THEM SAFE AND HAVE THEM BE 

892
00:31:37,528 --> 00:31:39,564
PART OF THAT PROCESS AS WELL.

893
00:31:39,564 --> 00:31:41,632
TWO WAYS TO SCREEN POSITIVE, 

894
00:31:41,632 --> 00:31:42,600
ACUTE AND NON-ACUTE.

895
00:31:42,600 --> 00:31:44,502
I'M NOT GOING TO GO THROUGH ALL 

896
00:31:44,502 --> 00:31:46,504
THESE DETAILS BUT THE 

897
00:31:46,504 --> 00:31:47,738
ACUTE-POSITIVE IS THE EMERGENCY.

898
00:31:47,738 --> 00:31:50,274
AND THERE'S A WHOLE LIST OF 

899
00:31:50,274 --> 00:31:51,576
THINGS THIS PATIENT CANNOT 

900
00:31:51,576 --> 00:31:53,377
LEAVE THE HOSPITAL UNTIL THEY 

901
00:31:53,377 --> 00:31:54,412
HAVE THE FURTHER SAFETY 

902
00:31:54,412 --> 00:31:56,914
EVALUATION.

903
00:31:56,914 --> 00:31:59,150
AND THEN MORE COMMONLY, THE 

904
00:31:59,150 --> 00:32:03,688
POSITIVES ARE NON-ACUTE, A YES, 

905
00:32:03,688 --> 00:32:06,224
1-4, NO TO #5.

906
00:32:06,224 --> 00:32:08,559
RISK IS DETECTED BUT NOT 

907
00:32:08,559 --> 00:32:08,826
IMMINENT.

908
00:32:08,826 --> 00:32:10,361
WE WORKED WITH THE JOINT 

909
00:32:10,361 --> 00:32:12,196
COMMISSION TO GET THEM TO 

910
00:32:12,196 --> 00:32:13,464
AGREE, WHILE THE PERSON IS 

911
00:32:13,464 --> 00:32:16,234
ASKED TO STAY FOR THE FOLLOW-UP 

912
00:32:16,234 --> 00:32:17,235
SUICIDE SAFETY ASSESSMENT, IF 

913
00:32:17,235 --> 00:32:19,570
THEY DECIDE TO LEAVE, THEY CAN 

914
00:32:19,570 --> 00:32:20,238
LEAVE.

915
00:32:20,238 --> 00:32:23,407
JUST LIKE IF SOMEONE HAS A SKY 

916
00:32:23,407 --> 00:32:24,408
ROCKETING BLOOD PRESSURE AND 

917
00:32:24,408 --> 00:32:26,510
HOSPITAL SAYS WE WANT YOU TO 

918
00:32:26,510 --> 00:32:28,145
WAIT FOR A CARDIOLOGY CONSULT 

919
00:32:28,145 --> 00:32:29,447
AND THEY MAKE THE DECISION NOT 

920
00:32:29,447 --> 00:32:31,215
TO WAIT, THEY ARE ALLOWED TO 

921
00:32:31,215 --> 00:32:33,084
WAIT.

922
00:32:33,084 --> 00:32:35,086
SECURITY DOES NOT ASCEND ON 

923
00:32:35,086 --> 00:32:35,286
THEM.

924
00:32:35,286 --> 00:32:36,721
THEY SIGN OUT AGAINST MEDICAL 

925
00:32:36,721 --> 00:32:38,522
ADVICE.

926
00:32:38,522 --> 00:32:39,857
WE WANTED PARITY, THEY WANT 

927
00:32:39,857 --> 00:32:41,392
THIS TO BE THE SAME FOR PEOPLE 

928
00:32:41,392 --> 00:32:42,493
AT RISK OF SUICIDE.

929
00:32:42,493 --> 00:32:44,495
YOU DON'T HAVE TO READ THESE 

930
00:32:44,495 --> 00:32:47,231
BUT I SHOW YOU, THAT INVERTED 

931
00:32:47,231 --> 00:32:49,033
TRIANGLE, THIS IS FLESHED OUT 

932
00:32:49,033 --> 00:32:50,101
IN AN OUTPATIENT CLINIC FOR 

933
00:32:50,101 --> 00:32:50,935
ADULTS.

934
00:32:50,935 --> 00:32:53,104
BUT IT COMES DOWN TO THOSE 

935
00:32:53,104 --> 00:32:54,472
THREE STEPS I TOLD YOU ABOUT.

936
00:32:54,472 --> 00:32:57,742
AND THIS IS ONE OF THE 

937
00:32:57,742 --> 00:32:59,343
OUTPATIENT YOUTH FLESHED OUT 

938
00:32:59,343 --> 00:33:00,711
PATHWAY, BUT IT COMES DOWN TO 

939
00:33:00,711 --> 00:33:03,614
THOSE THREE STEPS.

940
00:33:03,614 --> 00:33:05,816
SO EACH PLACE FLESHES OUT THEIR 

941
00:33:05,816 --> 00:33:08,919
OWN PATHWAY AND THROUGH THIS 

942
00:33:08,919 --> 00:33:10,588
ITERATIVE QI PROCESS KEEPS 

943
00:33:10,588 --> 00:33:11,555
GETTING BETTER UNTIL IT'S 

944
00:33:11,555 --> 00:33:12,790
EFFICIENT.

945
00:33:12,790 --> 00:33:14,458
BUT IT ALL COMES DOWN TO THESE 

946
00:33:14,458 --> 00:33:16,027
THREE STEPS.

947
00:33:16,027 --> 00:33:17,328
WHAT IS THE MIDDLE ROLE?

948
00:33:17,328 --> 00:33:19,397
IS THE ROLE OF THE CLINICIAN, 

949
00:33:19,397 --> 00:33:20,364
RIGHT?

950
00:33:20,364 --> 00:33:23,301
THIS IS USUALLY, AND IDEALLY A 

951
00:33:23,301 --> 00:33:26,003
MENTAL HEALTH CLINICIAN WHO 

952
00:33:26,003 --> 00:33:27,138
FURTHER TRIAGES THE SCREEN.

953
00:33:27,138 --> 00:33:31,275
BUT IT COULD BE A NURSE 

954
00:33:31,275 --> 00:33:32,143
PRACTITIONER OR NURSE ASSISTANT 

955
00:33:32,143 --> 00:33:34,679
OR PHYSICIAN.

956
00:33:34,679 --> 00:33:40,284
SOME CASES LIKE WITH OUR WORK 

957
00:33:40,284 --> 00:33:42,820
WITH THE INDIAN HEALTH, WE 

958
00:33:42,820 --> 00:33:44,588
TRAINED THE PHARMACISTS TO DO 

959
00:33:44,588 --> 00:33:45,556
THE BRIEF SUICIDE SAFETY 

960
00:33:45,556 --> 00:33:47,558
ASSESSMENT.

961
00:33:47,558 --> 00:33:49,760
NOW, IDEALLY AT THE CLINICAL 

962
00:33:49,760 --> 00:33:52,863
CENTER AT NIH, WE USE THE ASQ 

963
00:33:52,863 --> 00:33:55,533
AND SCREEN OUR PATIENTS AND 

964
00:33:55,533 --> 00:33:57,201
SOCIAL WORK DOES THIS BRIEF 

965
00:33:57,201 --> 00:33:58,436
SUICIDE SAFETY ASSESSMENT.

966
00:33:58,436 --> 00:34:01,872
WE ARE LUCKY THAT WE HAVE 

967
00:34:01,872 --> 00:34:02,239
SOCIAL WORKERS.

968
00:34:02,239 --> 00:34:04,208
BUT PLACES THAT DON'T, WE HAVE 

969
00:34:04,208 --> 00:34:06,043
TO MAKE IT, IT'S NOT IDEAL BUT 

970
00:34:06,043 --> 00:34:08,045
WE HAVE TO MAKE IT GOOD ENOUGH.

971
00:34:08,045 --> 00:34:09,747
IT DOESN'T HAVE TO BE PERFECT.

972
00:34:09,747 --> 00:34:10,815
WE ARE TRYING TO GET PEOPLE 

973
00:34:10,815 --> 00:34:11,782
HELP.

974
00:34:11,782 --> 00:34:15,820
THAT'S AN IMPORTANT THING.

975
00:34:15,820 --> 00:34:19,457
THERE'S TWO SAFETY ASSESSMENTS, 

976
00:34:19,457 --> 00:34:26,731
EITHER THE COLUMBIA SUICIDE 

977
00:34:26,731 --> 00:34:29,633
SAFETY SCALE, AND WE CAME UP 

978
00:34:29,633 --> 00:34:30,868
WITH THE OTHER.

979
00:34:30,868 --> 00:34:33,404
WE HAVE THREE FOR ADULTS, THREE 

980
00:34:33,404 --> 00:34:35,239
FOR YOUTH AND FOR THE DIFFERENT 

981
00:34:35,239 --> 00:34:36,607
VENUES.

982
00:34:36,607 --> 00:34:38,442
BUT THE PURPOSE, WHATEVER TOOL 

983
00:34:38,442 --> 00:34:40,378
YOU USE, THE PURPOSE IS TO 

984
00:34:40,378 --> 00:34:42,279
COME, HELP DECIDE WHICH ONE OF 

985
00:34:42,279 --> 00:34:44,115
THESE THREE PLANS ARE YOU GO TO 

986
00:34:44,115 --> 00:34:46,150
MAKE FOR THE PATIENT?

987
00:34:46,150 --> 00:34:47,752
ARE THEY IN IMMINENT RISK?

988
00:34:47,752 --> 00:34:50,054
ARE THEY AT LOW RISK AND NO 

989
00:34:50,054 --> 00:34:51,489
FURTHER ACTION IS NEEDED?

990
00:34:51,489 --> 00:34:52,656
OR THE HARDER CATEGORY IS THE 

991
00:34:52,656 --> 00:34:54,091
ONE IN YELLOW.

992
00:34:54,091 --> 00:34:56,026
IT'S NOT AN EMERGENCY BUT THE 

993
00:34:56,026 --> 00:34:57,762
PATIENT DOES REQUIRE FURTHER 

994
00:34:57,762 --> 00:35:00,164
MENTAL HEALTH EVALUATION.

995
00:35:00,164 --> 00:35:02,166
OKAY, SO I'M GOING TO JUST SHOW 

996
00:35:02,166 --> 00:35:06,937
YOU SOME OF HOW WE MAKE THIS AN 

997
00:35:06,937 --> 00:35:08,672
ITERATIVE PROCESS AND KEEP 

998
00:35:08,672 --> 00:35:09,440
REVISING THIS PATHWAY THROUGH 

999
00:35:09,440 --> 00:35:10,374
RESEARCH.

1000
00:35:10,374 --> 00:35:13,611
I'M GOING TO TELL YOU ABOUT 

1001
00:35:13,611 --> 00:35:20,951
SUICIDE RISK VERSUS DEPRESSION 

1002
00:35:20,951 --> 00:35:21,485
SCREENING, VERSUS SUICIDE 

1003
00:35:21,485 --> 00:35:22,787
SCREENING.

1004
00:35:22,787 --> 00:35:24,088
WHEN THE JOINT COMMISSION CAME 

1005
00:35:24,088 --> 00:35:26,424
OUT AND SAID IT'S IMPORTANT YOU 

1006
00:35:26,424 --> 00:35:27,958
SCREEN FOR SUICIDE RISK.

1007
00:35:27,958 --> 00:35:32,663
THEY SAID WE ARE SCREENING FOR 

1008
00:35:32,663 --> 00:35:33,297
DEPRESSION, DEPRESSION/SUICIDE 

1009
00:35:33,297 --> 00:35:34,331
RISK THEY ARE KIND OF THE SAME, 

1010
00:35:34,331 --> 00:35:35,833
RIGHT?

1011
00:35:35,833 --> 00:35:38,636
WE DON'T THINK SO.

1012
00:35:38,636 --> 00:35:42,940
THERE'S A COMMONLY USED 

1013
00:35:42,940 --> 00:35:45,075
DEPRESSION SCREEN, THE PHQ-9.

1014
00:35:45,075 --> 00:35:50,448
EACH OF THE NINE ITEMS ASSESS 

1015
00:35:50,448 --> 00:35:52,049
DIFFERENT DSM FOR DEPRESSION.

1016
00:35:52,049 --> 00:35:55,486
IT HAS A NINTH ITEM CONSIDERED 

1017
00:35:55,486 --> 00:35:57,221
THE SUICIDE RISK ITEM, HOW 

1018
00:35:57,221 --> 00:35:59,523
OFTEN HAVE YOU BEEN BOTHERED BY 

1019
00:35:59,523 --> 00:36:01,058
THE FOLLOWING SYMPTOMS DURING 

1020
00:36:01,058 --> 00:36:02,293
THE PAST TWO WEEKS, THOUGHTS 

1021
00:36:02,293 --> 00:36:05,029
THAT YOU WOULD BE BETTER OFF 

1022
00:36:05,029 --> 00:36:06,664
DEAD OR OF HURTING YOURSELF IN 

1023
00:36:06,664 --> 00:36:09,967
SOME WAY.

1024
00:36:09,967 --> 00:36:10,835
THERE'S THREE THINGS ACTUALLY 

1025
00:36:10,835 --> 00:36:12,436
WRONG WITH THIS QUESTION.

1026
00:36:12,436 --> 00:36:15,372
ONE IS, IT HAS AN "OR".

1027
00:36:15,372 --> 00:36:18,175
SO YOU NEVER KNOW WHICH SIDE OF 

1028
00:36:18,175 --> 00:36:19,710
THE QUESTION THE PATIENT IS 

1029
00:36:19,710 --> 00:36:21,946
RESPONDING TO, SO IT BOTH OVER 

1030
00:36:21,946 --> 00:36:23,080
AND UNDER DETECTS FOR SUICIDE 

1031
00:36:23,080 --> 00:36:25,049
RISK.

1032
00:36:25,049 --> 00:36:27,051
SECOND IT SAYS HURTING, IT 

1033
00:36:27,051 --> 00:36:27,985
DOESN'T SAY KILLING.

1034
00:36:27,985 --> 00:36:30,221
WE KNOW PEOPLE, ESPECIALLY 

1035
00:36:30,221 --> 00:36:32,423
YOUNG PEOPLE THINK OF HURTING 

1036
00:36:32,423 --> 00:36:33,257
THEMSELVES AND KILLING 

1037
00:36:33,257 --> 00:36:33,924
THEMSELVES AS TWO DIFFERENT 

1038
00:36:33,924 --> 00:36:36,660
THINGS.

1039
00:36:36,660 --> 00:36:40,598
THE THIRD THING, IT SAYS 

1040
00:36:40,598 --> 00:36:41,599
"BOTHERED", YOU HAVE TO BE 

1041
00:36:41,599 --> 00:36:42,333
BOTHERED.

1042
00:36:42,333 --> 00:36:47,404
IT HAS TO BE DYSTONIC, INSTEAD 

1043
00:36:47,404 --> 00:36:49,173
OF SYNTONIC.

1044
00:36:49,173 --> 00:36:50,441
THIS HAS PROBLEMS BUT WE WANTED 

1045
00:36:50,441 --> 00:36:52,510
TO LOOK INTO IT.

1046
00:36:52,510 --> 00:36:56,480
THERE'S ACTUALLY 13 STUDIES 

1047
00:36:56,480 --> 00:36:58,182
SHOWING THE PHQ-9 WHILE GOOD 

1048
00:36:58,182 --> 00:36:59,083
FOR DEPRESSION SCREENING MAY 

1049
00:36:59,083 --> 00:37:01,218
NOT BE SUFFICIENT FOR 

1050
00:37:01,218 --> 00:37:02,019
IDENTIFYING PATIENTS AT RISK 

1051
00:37:02,019 --> 00:37:03,854
FOR SUICIDE.

1052
00:37:03,854 --> 00:37:07,758
WE HAD OVER 700 INPATIENT 

1053
00:37:07,758 --> 00:37:10,494
ADULTS AND 116 SCREENED 

1054
00:37:10,494 --> 00:37:13,230
POSITIVE FOR SUICIDE RISK AND 

1055
00:37:13,230 --> 00:37:16,500
175 SCORED POSITIVE ON THE 

1056
00:37:16,500 --> 00:37:19,169
PHQ-9.

1057
00:37:19,169 --> 00:37:21,605
HAD YOU ONLY SCREENED WITH PHQ 

1058
00:37:21,605 --> 00:37:23,641
YOU WOULD HAVE MISSED A THIRD 

1059
00:37:23,641 --> 00:37:25,442
OF THE ADULTS AT RISK FOR 

1060
00:37:25,442 --> 00:37:28,078
SUICIDE, HAD YOU ONLY USED #9 

1061
00:37:28,078 --> 00:37:31,015
YOU WOULD HAVE MISSED 63, 

1062
00:37:31,015 --> 00:37:31,949
TWO-THIRDS OF PATIENTS AT RISK 

1063
00:37:31,949 --> 00:37:33,651
FOR SUICIDE.

1064
00:37:33,651 --> 00:37:35,753
SO THE BOTTOM LINE, THIS IS BY 

1065
00:37:35,753 --> 00:37:36,954
ALL MEANS SCREEN FOR DEPRESSION.

1066
00:37:36,954 --> 00:37:40,724
BUT IF YOU ARE GOING TO SCREEN 

1067
00:37:40,724 --> 00:37:43,761
FOR SUICIDE RISK, USE A 

1068
00:37:43,761 --> 00:37:46,196
SUICIDE-SPECIFIC SCREENING TOOL.

1069
00:37:46,196 --> 00:37:52,236
SOME DO SEQUENTIALLY, THEY DO 

1070
00:37:52,236 --> 00:37:55,940
THE PHQ-2, IF THAT IS POSITIVE, 

1071
00:37:55,940 --> 00:37:58,042
THEN THE PHQ-9, THEN THE 

1072
00:37:58,042 --> 00:38:00,010
SUICIDE RISK ASSESSMENT.

1073
00:38:00,010 --> 00:38:01,412
WHY MAKE THEM JUMP THROUGH THE 

1074
00:38:01,412 --> 00:38:02,947
HOOPS.

1075
00:38:02,947 --> 00:38:07,384
WE STUCK THE ASK ON THE BOTTOM 

1076
00:38:07,384 --> 00:38:11,221
OF THE PHQ-2.

1077
00:38:11,221 --> 00:38:13,290
BECAUSE MANY SAID THEY WANT ONE 

1078
00:38:13,290 --> 00:38:13,490
TOOL.

1079
00:38:13,490 --> 00:38:16,660
WE ALSO SAW THE MOST COMMON 

1080
00:38:16,660 --> 00:38:18,696
PRESENTATION OF A POSITIVE ASQ 

1081
00:38:18,696 --> 00:38:20,130
LOOKS LIKE THIS.

1082
00:38:20,130 --> 00:38:22,032
OF A POSITIVE, THE MOST COMMON 

1083
00:38:22,032 --> 00:38:24,468
PRESENTATION LOOKS LIKE THIS.

1084
00:38:24,468 --> 00:38:27,204
A SOLE YES TO, "HAVE YOU EVER 

1085
00:38:27,204 --> 00:38:28,005
TRIED TO KILL YOURSELF?

1086
00:38:28,005 --> 00:38:29,940
".

1087
00:38:29,940 --> 00:38:32,476
THERE'S GOOD NEWS AND BAD NEWS, 

1088
00:38:32,476 --> 00:38:34,645
THERE'S A LOT OF PEOPLE WHO TRY 

1089
00:38:34,645 --> 00:38:35,779
TO KILL THEMSELVES.

1090
00:38:35,779 --> 00:38:39,483
THE GOOD NEWS FOR THE SCREENER, 

1091
00:38:39,483 --> 00:38:40,784
THIS MAY NOT BE YOUR BUSINESS 

1092
00:38:40,784 --> 00:38:42,019
OF THE DAY.

1093
00:38:42,019 --> 00:38:43,954
SOMEONE MIGHT COME INTO THE 

1094
00:38:43,954 --> 00:38:45,556
EMERGENCY DEPARTMENT WITH A 

1095
00:38:45,556 --> 00:38:46,490
BROKEN ANKLE AND THEY SCREEN 

1096
00:38:46,490 --> 00:38:47,992
LIKE THIS.

1097
00:38:47,992 --> 00:38:50,794
AND MAYBE THEY ARE 60 YEARS OLD 

1098
00:38:50,794 --> 00:38:52,529
AND THEY HAD SOME THOUGHTS 

1099
00:38:52,529 --> 00:38:54,465
ABOUT SUICIDE OR TRIED TO KILL 

1100
00:38:54,465 --> 00:38:57,368
THEMSELVES WHEN THEY WERE 20.

1101
00:38:57,368 --> 00:38:58,902
SO THAT PERSON SHOULDN'T GO 

1102
00:38:58,902 --> 00:39:00,904
THROUGH THE PATHWAY AND USE UP 

1103
00:39:00,904 --> 00:39:01,905
THE RESOURCES, IF THEY DON'T 

1104
00:39:01,905 --> 00:39:03,240
NEED IT.

1105
00:39:03,240 --> 00:39:05,976
SO THE OTHER THING THAT HAPPENS 

1106
00:39:05,976 --> 00:39:07,678
IS THIS PERSON IS ALWAYS GOING 

1107
00:39:07,678 --> 00:39:08,979
TO BE POSITIVE.

1108
00:39:08,979 --> 00:39:10,581
IF THEY SEE YOU IN APRIL AND 

1109
00:39:10,581 --> 00:39:12,416
THEY COME BACK TO THE CLINIC IN 

1110
00:39:12,416 --> 00:39:13,951
NOVEMBER, THEY ARE STILL GOING 

1111
00:39:13,951 --> 00:39:15,819
TO LOOK LIKE THIS, IF THEY ARE 

1112
00:39:15,819 --> 00:39:17,554
ANSWERING HONESTLY.

1113
00:39:17,554 --> 00:39:19,189
WE ADDED A SIXTH QUESTION, THE 

1114
00:39:19,189 --> 00:39:21,592
NEXT TIME THEY COME IN WE SAY, 

1115
00:39:21,592 --> 00:39:23,427
IF THEY LOOK EXACTLY LIKE THIS 

1116
00:39:23,427 --> 00:39:26,163
AND THERE ARE NO OTHER CONCERNS 

1117
00:39:26,163 --> 00:39:27,464
WE SAY "SINCE LAST VISIT HAVE 

1118
00:39:27,464 --> 00:39:31,135
YOU TRIED TO KILL YOURSELF", IF 

1119
00:39:31,135 --> 00:39:32,736
THAT IS NO, AND EVERYTHING ELSE 

1120
00:39:32,736 --> 00:39:35,172
IS NO, THEY MOVE OUT THE 

1121
00:39:35,172 --> 00:39:36,874
PATHWAY.

1122
00:39:36,874 --> 00:39:38,375
WE ALSO DO RESEARCH HOW LONG 

1123
00:39:38,375 --> 00:39:41,145
AGO IN THE PAST IS AN ATTEMPT 

1124
00:39:41,145 --> 00:39:42,146
CONSIDERED SAFE ENOUGH.

1125
00:39:42,146 --> 00:39:45,516
SO WE LOOKED AT 

1126
00:39:45,516 --> 00:39:47,317
PUBLICLY-AVAILABLE DATABASE, 

1127
00:39:47,317 --> 00:39:50,621
FUNDED BY NIMH, I BELIEVE A $9 

1128
00:39:50,621 --> 00:39:56,794
MILLION GRANT, 13 EMERGENCY 

1129
00:39:56,794 --> 00:39:58,162
DEPARTMENTS, THE EDSTARS 

1130
00:39:58,162 --> 00:39:58,429
DATABASE.

1131
00:39:58,429 --> 00:40:00,330
WHAT WE FOUND IS YOUTH GREATER 

1132
00:40:00,330 --> 00:40:04,268
THAN A YEAR AGO WERE SAFER, 

1133
00:40:04,268 --> 00:40:07,204
LESS LIKELY TO REATTEMPT 

1134
00:40:07,204 --> 00:40:08,205
SUICIDE THAN THE YOUNG PEOPLE 

1135
00:40:08,205 --> 00:40:09,840
WHO HAD THE SUICIDE ATTEMPT 

1136
00:40:09,840 --> 00:40:11,341
WITHIN THREE MONTHS.

1137
00:40:11,341 --> 00:40:12,242
THAT AGAIN, HELPED US WITH OUR 

1138
00:40:12,242 --> 00:40:13,343
PATHWAY.

1139
00:40:13,343 --> 00:40:14,845
MAYBE IF THE SUICIDE ATTEMPT IS 

1140
00:40:14,845 --> 00:40:17,314
MORE THAN A YEAR AGO, WE CAN 

1141
00:40:17,314 --> 00:40:19,183
CONSIDER THEM A BIT SAFER.

1142
00:40:19,183 --> 00:40:21,852
OKAY.

1143
00:40:21,852 --> 00:40:23,754
SO NOW, THIS IS WHAT 

1144
00:40:23,754 --> 00:40:24,354
PEDIATRICIANS NEED TO SCREEN 

1145
00:40:24,354 --> 00:40:26,390
FOR.

1146
00:40:26,390 --> 00:40:28,192
I DON'T EXPECT YOU TO READ THIS.

1147
00:40:28,192 --> 00:40:33,697
BUT THESE ARE ALL THE THINGS ON 

1148
00:40:33,697 --> 00:40:36,400
THE LEFT.

1149
00:40:36,400 --> 00:40:38,402
ON THE RIGHT IS BY PERIOD OF 

1150
00:40:38,402 --> 00:40:38,602
CHILD.

1151
00:40:38,602 --> 00:40:40,037
THAT'S A LOT.

1152
00:40:40,037 --> 00:40:42,873
IN FEBRUARY 2022, THE BEST 

1153
00:40:42,873 --> 00:40:46,110
THING TO EVER HAPPEN TO SUICIDE 

1154
00:40:46,110 --> 00:40:48,812
PREVENTION FOR YOUNG PEOPLE IS 

1155
00:40:48,812 --> 00:40:51,415
AAP RECOMMENDED SUICIDE RISK 

1156
00:40:51,415 --> 00:40:52,449
SCREENING ALONGSIDE DEPRESSION 

1157
00:40:52,449 --> 00:40:55,085
SCREENING FOR 12 AND ABOVE.

1158
00:40:55,085 --> 00:40:56,286
THAT MEANS PEDIATRICIANS ARE 

1159
00:40:56,286 --> 00:40:57,387
SCREENING FOR SUICIDE RISK.

1160
00:40:57,387 --> 00:41:01,658
A BUNCH OF US AT NIH JOINED THE 

1161
00:41:01,658 --> 00:41:03,894
AAP AND AMERICAN FOUNDATION FOR 

1162
00:41:03,894 --> 00:41:06,096
SUICIDE PREVENTION AND PUT 

1163
00:41:06,096 --> 00:41:08,132
TOGETHER A BLUEPRINT FOR 

1164
00:41:08,132 --> 00:41:16,440
SUICIDE PREVENTION, LOOK AT 

1165
00:41:16,440 --> 00:41:20,244
AAP.ORG/SUICIDEPREVENTION.

1166
00:41:20,244 --> 00:41:22,980
REALLY GOOD WEBSITE THAT HELPS 

1167
00:41:22,980 --> 00:41:24,181
PRACTITIONERS EMBED SUICIDE 

1168
00:41:24,181 --> 00:41:27,818
RISK IN THEIR PRACTICE.

1169
00:41:27,818 --> 00:41:29,319
WE HEARD IT'S TOO HARD TO 

1170
00:41:29,319 --> 00:41:31,355
SCREEN BECAUSE WE DON'T HAVE 

1171
00:41:31,355 --> 00:41:35,559
ACCESS TO MENTAL HEALTHCARE.

1172
00:41:35,559 --> 00:41:40,030
I HAVE THIS KID, THIS KID IS AT 

1173
00:41:40,030 --> 00:41:42,166
RISK FOR SUICIDE, I HAVE NO 

1174
00:41:42,166 --> 00:41:44,902
RESOURCES TO GIVE THEM.

1175
00:41:44,902 --> 00:41:46,336
PEOPLE THINKING OF SUICIDE ARE 

1176
00:41:46,336 --> 00:41:47,771
THINKING ABOUT IT WHETHER YOU 

1177
00:41:47,771 --> 00:41:49,273
SCREEN IT OR NOT.

1178
00:41:49,273 --> 00:41:50,908
SO LET'S GIVE YOU THREE THINGS 

1179
00:41:50,908 --> 00:41:52,576
YOU CAN DO RIGHT AWAY THAT 

1180
00:41:52,576 --> 00:41:54,144
WOULD MAKE A DIFFERENCE.

1181
00:41:54,144 --> 00:41:56,613
SAFETY PLANNING.

1182
00:41:56,613 --> 00:41:58,882
SAFETY COUNSELING AND PROVIDING 

1183
00:41:58,882 --> 00:42:00,284
988.

1184
00:42:00,284 --> 00:42:01,985
SAFETY PLANNING IS A WAY TO 

1185
00:42:01,985 --> 00:42:05,823
HELP SOMEONE WHEN THEY ARE NOT 

1186
00:42:05,823 --> 00:42:10,494
IN A SUICIDAL STATE TO THINK IF 

1187
00:42:10,494 --> 00:42:13,197
IT WAS 2:00 IN THE MORNING AND 

1188
00:42:13,197 --> 00:42:15,132
THEY WANTED TO KILL THEMSELF, 

1189
00:42:15,132 --> 00:42:19,469
WHAT WOULD THEY DO.

1190
00:42:19,469 --> 00:42:22,272
AND MAKING SURE THERE'S NO 

1191
00:42:22,272 --> 00:42:23,073
DANGEROUS MEDICATIONS OR 

1192
00:42:23,073 --> 00:42:24,441
UNSECURED FIREARMS.

1193
00:42:24,441 --> 00:42:26,844
WE TALK ABOUT EVERYONE HAVING 

1194
00:42:26,844 --> 00:42:31,415
988 IN THEIR PHONES.

1195
00:42:31,415 --> 00:42:34,418
THIS IS 24/7 HOTLINE, ALSO A 

1196
00:42:34,418 --> 00:42:36,353
CRISIS TEXT LINE THAT'S 

1197
00:42:36,353 --> 00:42:38,355
MONITORED BY PEOPLE THAT ARE 

1198
00:42:38,355 --> 00:42:40,190
TRAINED TO HELP PEOPLE AT RISK 

1199
00:42:40,190 --> 00:42:46,363
FOR SUICIDE AND ANYONE CAN CALL.

1200
00:42:46,363 --> 00:42:47,931
WE LEARNED FROM OUR RESEARCH 

1201
00:42:47,931 --> 00:42:49,666
HOW IMPORTANT IT IS TO BE 

1202
00:42:49,666 --> 00:42:55,539
CULTURALLY RESPONSIVE.

1203
00:42:55,539 --> 00:43:00,577
SOME EXAMPLES,WITH THE TRIBE 

1204
00:43:00,577 --> 00:43:05,549
THEY FELT IF THEY USED THE WORD 

1205
00:43:05,549 --> 00:43:07,484
DEATH, IT WOULD BRING DEATH.

1206
00:43:07,484 --> 00:43:12,522
SO WE CHANGED SOME OF THE WORDS.

1207
00:43:12,522 --> 00:43:14,424
STUDIES GLOBALLY, IN PAKISTAN, 

1208
00:43:14,424 --> 00:43:17,761
FOR EXAMPLE, THE WORD WISH IN 

1209
00:43:17,761 --> 00:43:20,130
URDU MEANS SOMETHING LIKE A 

1210
00:43:20,130 --> 00:43:23,567
BIRTHDAY WISH.

1211
00:43:23,567 --> 00:43:27,070
WE ASKED HAVE YOU WISHED YOU 

1212
00:43:27,070 --> 00:43:29,706
WERE DEAD AND THAT SOUNDED 

1213
00:43:29,706 --> 00:43:32,509
CRAZY.

1214
00:43:32,509 --> 00:43:34,711
IT'S IMPORTANT THAT OUR TOOLS 

1215
00:43:34,711 --> 00:43:35,946
ARE SENSITIVE AND RESPONSIVE TO 

1216
00:43:35,946 --> 00:43:37,014
THE CULTURES WE ARE USING THEM 

1217
00:43:37,014 --> 00:43:42,419
IN.

1218
00:43:42,419 --> 00:43:45,022
SO THE ASQ RESEARCH STARTED IN 

1219
00:43:45,022 --> 00:43:45,956
THREE STATES BEING USED AROUND 

1220
00:43:45,956 --> 00:43:47,557
THE COUNTRY.

1221
00:43:47,557 --> 00:43:49,993
WE HAVE VALIDATED IT IN THESE 

1222
00:43:49,993 --> 00:43:51,495
PLACES IN THE WORLD.

1223
00:43:51,495 --> 00:43:52,963
HOPEFULLY ONGOING.

1224
00:43:52,963 --> 00:43:55,332
THESE ARE SOME EXAMPLES OF 

1225
00:43:55,332 --> 00:43:57,134
HOSPITALS USING THE ASQ, 

1226
00:43:57,134 --> 00:43:57,768
INCLUDING THE NIH CLINICAL 

1227
00:43:57,768 --> 00:44:00,103
CENTER.

1228
00:44:00,103 --> 00:44:03,140
OKAY, SO NOW I'M SHIFTING TO 

1229
00:44:03,140 --> 00:44:03,907
STARTING THESE CONVERSATIONS 

1230
00:44:03,907 --> 00:44:06,043
ABOUT SUICIDE WITH YOUR FAMILY, 

1231
00:44:06,043 --> 00:44:06,877
FRIENDS AND COLLEAGUES AT WORK, 

1232
00:44:06,877 --> 00:44:11,581
RIGHT?

1233
00:44:11,581 --> 00:44:17,354
SO PEOPLE OFTEN SAY, HOW DO WE 

1234
00:44:17,354 --> 00:44:17,821
START THESE DIFFICULT 

1235
00:44:17,821 --> 00:44:18,689
SITUATIONS?

1236
00:44:18,689 --> 00:44:20,724
AND SHOULD I USE A SCREENING 

1237
00:44:20,724 --> 00:44:23,393
TOOL TO START THESE DIFFICULT 

1238
00:44:23,393 --> 00:44:24,828
CONVERSATIONS?

1239
00:44:24,828 --> 00:44:26,263
THE ANSWER IS ABSOLUTELY NOT.

1240
00:44:26,263 --> 00:44:28,165
YOU DON'T WANT TO START 

1241
00:44:28,165 --> 00:44:30,400
SCREENING YOUR FAMILY MEMBERS, 

1242
00:44:30,400 --> 00:44:31,401
FRIENDS, COLLEAGUES AT WORK.

1243
00:44:31,401 --> 00:44:33,036
THAT'S BECAUSE YOU HAVE THE 

1244
00:44:33,036 --> 00:44:35,238
LUXURY OF HAVING A RELATIONSHIP.

1245
00:44:35,238 --> 00:44:37,274
THESE SCREENING TOOLS ARE 

1246
00:44:37,274 --> 00:44:38,108
STRUCTURED FOR HEALTHCARE 

1247
00:44:38,108 --> 00:44:39,009
PROVIDERS IN TALKING ABOUT 

1248
00:44:39,009 --> 00:44:40,210
SUICIDE RISK.

1249
00:44:40,210 --> 00:44:42,045
BUT IF YOU HAVE SOMEONE THAT 

1250
00:44:42,045 --> 00:44:44,247
YOU KNOW, YOU CAN USE SOME OF 

1251
00:44:44,247 --> 00:44:45,749
THE LANGUAGE FROM THE SCREENING 

1252
00:44:45,749 --> 00:44:47,484
TOOL, BUT YOU DON'T WANT TO 

1253
00:44:47,484 --> 00:44:49,019
PULL OUT A SCREENING TOOL AND 

1254
00:44:49,019 --> 00:44:50,053
SCREEN THEM, YOU WANT TO TALK 

1255
00:44:50,053 --> 00:44:52,055
TO THEM.

1256
00:44:52,055 --> 00:44:53,757
HERE ARE SOME WAYS YOU CAN 

1257
00:44:53,757 --> 00:44:54,958
BRING UP, YOU CAN ENGAGE 

1258
00:44:54,958 --> 00:44:57,694
SOMEONE IF YOU ARE CONCERNED.

1259
00:44:57,694 --> 00:44:59,629
YOU CAN SAY SOMETHING LIKE, I 

1260
00:44:59,629 --> 00:45:05,469
NOTICE YOU HAVE NOT  BEEN 

1261
00:45:05,469 --> 00:45:07,104
YOURSELF LATELY, IS THERE 

1262
00:45:07,104 --> 00:45:09,806
SOMETHING BOTHERING YOU?

1263
00:45:09,806 --> 00:45:11,475
OR I'M SORRY YOU ARE FEELING SO 

1264
00:45:11,475 --> 00:45:13,043
BAD.

1265
00:45:13,043 --> 00:45:14,945
IF YOU KNOW THEM, YOU CAN SAY I 

1266
00:45:14,945 --> 00:45:16,713
KNOW YOU FEEL AWFUL RIGHT NOW, 

1267
00:45:16,713 --> 00:45:18,382
I PROMISE YOU, YOU WILL NOT 

1268
00:45:18,382 --> 00:45:20,417
ALWAYS FEEL THIS WAY.

1269
00:45:20,417 --> 00:45:21,585
OR SIMPLY SAY, LET'S GET YOU 

1270
00:45:21,585 --> 00:45:23,120
SOME HELP.

1271
00:45:23,120 --> 00:45:24,521
THESE ARE ALL WAYS TO ENGAGE 

1272
00:45:24,521 --> 00:45:26,056
SOMEBODY.

1273
00:45:26,056 --> 00:45:28,692
AND WHAT DOES SOMEONE AT RISK 

1274
00:45:28,692 --> 00:45:29,793
FOR SUICIDE WANT FROM YOU.

1275
00:45:29,793 --> 00:45:31,595
I WILL ASK YOU TONIGHT.

1276
00:45:31,595 --> 00:45:33,964
WHEN YOU GO AND BRUSH YOUR 

1277
00:45:33,964 --> 00:45:36,266
TEETH AND LOOKING IN THE 

1278
00:45:36,266 --> 00:45:38,502
MIRROR, PICTURE YOURSELF ASKING 

1279
00:45:38,502 --> 00:45:41,738
THEM IF THEY WERE THINKING OF 

1280
00:45:41,738 --> 00:45:43,673
KILLING THEMSELVES, THINK ABOUT 

1281
00:45:43,673 --> 00:45:47,377
WHAT YOU WOULD DO WITH ANY 

1282
00:45:47,377 --> 00:45:47,811
NON-NO ANSWER.

1283
00:45:47,811 --> 00:45:50,213
WHAT WILL YOU SAY BACK?

1284
00:45:50,213 --> 00:45:52,749
THE FIRST THING IS TO NOT PANIC.

1285
00:45:52,749 --> 00:45:55,685
YOUR JOB IS NOT TO FIX THIS OR 

1286
00:45:55,685 --> 00:45:56,987
CONVINCE THEM THEY DON'T WANT 

1287
00:45:56,987 --> 00:45:58,588
TO KILL THEMSELVES.

1288
00:45:58,588 --> 00:46:01,558
YOUR JOB IS TO BE PRESENT, 

1289
00:46:01,558 --> 00:46:04,061
LISTEN, EXPRESS EMPATHY.

1290
00:46:04,061 --> 00:46:05,162
LISTENING TO SOMEONE TALK ABOUT 

1291
00:46:05,162 --> 00:46:06,997
THEIR PAIN IS A GIFT.

1292
00:46:06,997 --> 00:46:08,899
AND IF YOU KNOW THIS PERSON, 

1293
00:46:08,899 --> 00:46:11,635
YOU CAN PROVIDE HOPE, RIGHT?

1294
00:46:11,635 --> 00:46:14,471
YOU CAN SAY I KNOW YOU HAVE 

1295
00:46:14,471 --> 00:46:16,873
BEEN THROUGH A LOT, AND I KNOW 

1296
00:46:16,873 --> 00:46:18,208
HOW RESILIENT YOU ARE, YOU CAN 

1297
00:46:18,208 --> 00:46:20,243
CONNECT THEM WITH A MENTAL 

1298
00:46:20,243 --> 00:46:21,044
HEALTH PROVIDER AS SOON AS 

1299
00:46:21,044 --> 00:46:22,245
POSSIBLE.

1300
00:46:22,245 --> 00:46:23,413
EVERYONE SHOULD HAVE A TRUSTED 

1301
00:46:23,413 --> 00:46:25,282
ADULT.

1302
00:46:25,282 --> 00:46:27,084
WE TELL PARENTS MAKE SURE YOUR 

1303
00:46:27,084 --> 00:46:29,719
KID HAVE A TRUSTED ADULT.

1304
00:46:29,719 --> 00:46:33,457
OFTEN TIMES IT'S NOT THE PARENT.

1305
00:46:33,457 --> 00:46:35,092
IT'S BECAUSE KIDS KEEP THESE 

1306
00:46:35,092 --> 00:46:36,793
THINGS TO THEMSELVES AND THEY 

1307
00:46:36,793 --> 00:46:39,296
NEED SOMEONE ELSE THEY CAN TALK 

1308
00:46:39,296 --> 00:46:41,331
TO SOMETIMES. SOMETIMES IT'S A 

1309
00:46:41,331 --> 00:46:43,400
COACH, OR NEIGHBOR, OR UNCLE OR 

1310
00:46:43,400 --> 00:46:44,367
AUNT.

1311
00:46:44,367 --> 00:46:46,403
AND THEN ANYONE AT RISK SHOULD 

1312
00:46:46,403 --> 00:46:49,005
HAVE A SAFETY PLAN.

1313
00:46:49,005 --> 00:46:50,941
A LETHAL MEANS, SAFETY CHECK, 

1314
00:46:50,941 --> 00:46:53,677
LIKE MAKING SURE THEY DON'T 

1315
00:46:53,677 --> 00:46:55,879
HAVE LETHAL MEANS AND EVERYBODY 

1316
00:46:55,879 --> 00:46:58,115
SHOULD HAVE THE 988 NUMBER.

1317
00:46:58,115 --> 00:46:59,216
AND THEN WHAT'S REALLY 

1318
00:46:59,216 --> 00:47:00,550
IMPORTANT, THIS IS SUPER 

1319
00:47:00,550 --> 00:47:01,618
IMPORTANT, I'M HEARING THIS 

1320
00:47:01,618 --> 00:47:03,753
MORE AND MORE, YOU HAVE TO TAKE 

1321
00:47:03,753 --> 00:47:05,021
CARE OF YOURSELF AND YOUR OWN 

1322
00:47:05,021 --> 00:47:05,989
WELL-BEING.

1323
00:47:05,989 --> 00:47:08,391
I TELL PEOPLE WHEN WE TRAIN 

1324
00:47:08,391 --> 00:47:10,427
NURSES AND PHYSICIANS AND 

1325
00:47:10,427 --> 00:47:13,130
MEDICAL TECHNICIANS TO SCREEN 

1326
00:47:13,130 --> 00:47:16,967
FOR SUICIDE RISK, SOMETIMES 

1327
00:47:16,967 --> 00:47:19,202
SCREENING TRIGGERS THOUGHTS  -- 

1328
00:47:19,202 --> 00:47:21,104
 IT DOESN'T PUT THOUGHTS IN 

1329
00:47:21,104 --> 00:47:22,639
THEIR HEAD BUT SOMETIMES IT 

1330
00:47:22,639 --> 00:47:24,975
TRIGGERS THEM FROM THEIR OWN 

1331
00:47:24,975 --> 00:47:26,042
PROBLEMS THEY ARE HAVING IN 

1332
00:47:26,042 --> 00:47:27,077
THEIR LIFE.

1333
00:47:27,077 --> 00:47:29,646
SO HOW DO WE TAKE CARE OF 

1334
00:47:29,646 --> 00:47:30,213
OURSELVES?

1335
00:47:30,213 --> 00:47:33,550
HERE AT THE NIH WE HAVE EAP, 

1336
00:47:33,550 --> 00:47:34,951
EMPLOYEE ASSISTANT PROGRAM.

1337
00:47:34,951 --> 00:47:37,521
YOU CAN GET FREE COUNSELING 

1338
00:47:37,521 --> 00:47:38,788
THERE, THEY ARE AVAILABLE AND 

1339
00:47:38,788 --> 00:47:41,324
THEY ARE REALLY GOOD HERE.

1340
00:47:41,324 --> 00:47:42,859
SO I ENCOURAGE ANYONE WHO NEEDS 

1341
00:47:42,859 --> 00:47:45,762
HELP TO GO TO EAP.

1342
00:47:45,762 --> 00:47:48,198
ALSO, WE HAVE HAD AT THE NIH 

1343
00:47:48,198 --> 00:47:50,700
CLINICAL CENTER WE HAVE HAD 

1344
00:47:50,700 --> 00:47:53,136
SOME STAFF SUICIDES LAST YEAR.

1345
00:47:53,136 --> 00:47:56,373
AND THE CEO, DR. GILMAN WAS 

1346
00:47:56,373 --> 00:47:57,040
VERY SUPPORTIVE OF PEOPLE 

1347
00:47:57,040 --> 00:47:58,308
GETTING HELP.

1348
00:47:58,308 --> 00:48:01,545
HE USED TO SAY SEEKING HELP IS 

1349
00:48:01,545 --> 00:48:05,649
A SIGN OF STRENGTH, NOT 

1350
00:48:05,649 --> 00:48:05,916
WEAKNESS.

1351
00:48:05,916 --> 00:48:08,218
HE WANTED US TO DO SUICIDE 

1352
00:48:08,218 --> 00:48:09,553
PREVENTION TOWN HALLS FOR STAFF.

1353
00:48:09,553 --> 00:48:12,189
I WILL TELL YOU THAT THE NEXT 

1354
00:48:12,189 --> 00:48:16,526
ONE IS ON DECEMBER 10th AT THE 

1355
00:48:16,526 --> 00:48:19,029
NIH CLINICAL CENTER BETWEEN 

1356
00:48:19,029 --> 00:48:20,130
1:30-3:00.

1357
00:48:20,130 --> 00:48:23,166
I ENCOURAGE YOU ALL TO SHOW UP 

1358
00:48:23,166 --> 00:48:24,401
AT OUR SUICIDE PREVENTION TOWN 

1359
00:48:24,401 --> 00:48:26,303
HALL SO WE CAN HAVE THESE 

1360
00:48:26,303 --> 00:48:28,838
DIFFICULT CONVERSATIONS.

1361
00:48:28,838 --> 00:48:30,440
SO JUST TO SUMMARIZE, THERE WAS 

1362
00:48:30,440 --> 00:48:32,909
A SUICIDE AT THE CLINICAL 

1363
00:48:32,909 --> 00:48:34,978
CENTER IN 2005.

1364
00:48:34,978 --> 00:48:37,714
AND THE JOINT COMMISSION 

1365
00:48:37,714 --> 00:48:39,816
IMPLEMENTED NATIONAL PATIENT 

1366
00:48:39,816 --> 00:48:41,451
SAFETY GOAL IN 2007.

1367
00:48:41,451 --> 00:48:45,322
AND WE LAUNCHED OUR STUDY, OUR 

1368
00:48:45,322 --> 00:48:48,425
FIRST ASQ STUDY IN 2008.

1369
00:48:48,425 --> 00:48:50,493
WE PUBLISHED OUR FIRST PAPER IN 

1370
00:48:50,493 --> 00:48:52,362
2012.

1371
00:48:52,362 --> 00:48:53,763
THE JOINT COMMISSION BROADENED 

1372
00:48:53,763 --> 00:48:55,632
THEIR RECOMMENDATIONS.

1373
00:48:55,632 --> 00:48:57,200
WE CREATED SUICIDE RISK 

1374
00:48:57,200 --> 00:48:58,635
CLINICAL PATHWAYS THAT WERE 

1375
00:48:58,635 --> 00:48:59,936
PUBLISHED.

1376
00:48:59,936 --> 00:49:03,506
ESTABLISHED A PARTNERSHIP WITH 

1377
00:49:03,506 --> 00:49:04,541
IHS.

1378
00:49:04,541 --> 00:49:09,145
LAUNCHED THE TESTING THE ASQ IN 

1379
00:49:09,145 --> 00:49:09,779
PEOPLE WITH NEURODEVELOPMENTAL 

1380
00:49:09,779 --> 00:49:11,081
DISORDERS.

1381
00:49:11,081 --> 00:49:12,916
PUBLISHED STUDIES ON THE 

1382
00:49:12,916 --> 00:49:17,587
PREDICTIVE HAVE   --  VALIDITY 

1383
00:49:17,587 --> 00:49:22,025
OF THE ASQ.

1384
00:49:22,025 --> 00:49:24,160
NOW WE HAVE TELEHEALTH PATHWAYS 

1385
00:49:24,160 --> 00:49:25,762
DURING COVID.

1386
00:49:25,762 --> 00:49:27,397
HOW DO YOU ADMINISTER SUICIDE 

1387
00:49:27,397 --> 00:49:29,833
RISK SCREENING TOOL OVER THE 

1388
00:49:29,833 --> 00:49:31,801
TELEPHONE?

1389
00:49:31,801 --> 00:49:34,638
HELPING THEM GET THERE IN 2022, 

1390
00:49:34,638 --> 00:49:36,072
RECOMMENDED PEDIATRICIAN SCREEN 

1391
00:49:36,072 --> 00:49:39,409
ALL PEDIATRICIAN PATIENTS FOR 

1392
00:49:39,409 --> 00:49:39,843
SUICIDE RISK.

1393
00:49:39,843 --> 00:49:42,846
WE CREATED THE BLUEPRINT FOR 

1394
00:49:42,846 --> 00:49:45,148
YOUTH SUICIDE PREVENTION.

1395
00:49:45,148 --> 00:49:48,151
WE VALIDATED THE ASQ IN BLACK 

1396
00:49:48,151 --> 00:49:51,488
YOUTH AND FORMER NIH DIRECTOR 

1397
00:49:51,488 --> 00:49:53,823
FRANCIS CULLEN HIGHLIGHTED THE 

1398
00:49:53,823 --> 00:49:56,359
ASQ AS A MAJOR ADVANCE IN 

1399
00:49:56,359 --> 00:49:59,329
MENTAL HEALTH RESEARCH IN THE 

1400
00:49:59,329 --> 00:50:00,997
IRP IN 2023.

1401
00:50:00,997 --> 00:50:03,733
WE ARE CURRENTLY NOT ONLY 

1402
00:50:03,733 --> 00:50:05,335
VALIDATING THE ASQ NATIONALLY 

1403
00:50:05,335 --> 00:50:06,770
BUT GLOBALLY AS WELL.

1404
00:50:06,770 --> 00:50:10,173
SO FOR ALL OUR WORK AND ALL OUR 

1405
00:50:10,173 --> 00:50:12,008
RESEARCH WE ACKNOWLEDGE, I WANT 

1406
00:50:12,008 --> 00:50:14,210
TO ACKNOWLEDGE THE 

1407
00:50:14,210 --> 00:50:17,047
CONTRIBUTIONS OF NIMH STAFF, 

1408
00:50:17,047 --> 00:50:18,148
TRAINEES, EXTRAMURAL SUICIDE 

1409
00:50:18,148 --> 00:50:19,049
PREVENTION COMMUNITY AND 

1410
00:50:19,049 --> 00:50:21,584
PATIENTS AND THEIR FAMILIES AND 

1411
00:50:21,584 --> 00:50:23,620
OF COURSE, OHSRP FOR ALL YOU DO 

1412
00:50:23,620 --> 00:50:25,322
MAKING SURE WE HAVE SAFE 

1413
00:50:25,322 --> 00:50:26,856
PROTOCOLS AND WE ARE ABLE TO DO 

1414
00:50:26,856 --> 00:50:28,258
OUR RESEARCH.

1415
00:50:28,258 --> 00:50:30,293
SO I WILL PUT UP A BIGGER THANK 

1416
00:50:30,293 --> 00:50:32,195
YOU SLIDE AND I WILL END IT 

1417
00:50:32,195 --> 00:50:35,398
THERE AND OPEN IT UP TO 

1418
00:50:35,398 --> 00:50:36,566
QUESTIONS.

1419
00:50:36,566 --> 00:50:38,234
>> Peg Sanders: THANK YOU.

1420
00:50:38,234 --> 00:50:40,170
FOR THOSE OF YOU WHO DO HAVE 

1421
00:50:40,170 --> 00:50:41,771
QUESTIONS PLEASE GO AHEAD AND 

1422
00:50:41,771 --> 00:50:44,341
SUBMIT THEM BY CLICKING ON THE 

1423
00:50:44,341 --> 00:50:48,178
BOX BELOW THE VIDEO TITLED LIVE 

1424
00:50:48,178 --> 00:50:49,079
FEEDBACK LINK.

1425
00:50:49,079 --> 00:50:50,880
WE HAVE A COUPLE QUESTIONS HERE.

1426
00:50:50,880 --> 00:50:53,016
AT THE BEGINNING YOU SHOWED A 

1427
00:50:53,016 --> 00:50:54,617
LIFE LINE PHONE NUMBER.

1428
00:50:54,617 --> 00:50:56,920
IS THAT ONLY AVAILABLE IN 

1429
00:50:56,920 --> 00:50:59,456
ENGLISH OR AVAILABLE IN OTHER 

1430
00:50:59,456 --> 00:51:01,091
LANGUAGES, SPANISH, MANDARIN?

1431
00:51:01,091 --> 00:51:03,360
>> Lisa Horowitz: LIFE
LINE IS 

1432
00:51:03,360 --> 00:51:05,028
AVAILABLE IN SPANISH.

1433
00:51:05,028 --> 00:51:06,629
ACTUALLY, THAT'S A GREAT  --  I 

1434
00:51:06,629 --> 00:51:08,298
DON'T THINK IT'S AVAILABLE IN 

1435
00:51:08,298 --> 00:51:09,699
OTHER LANGUAGES.

1436
00:51:09,699 --> 00:51:14,838
I HAVE MY TWO RESEARCH 

1437
00:51:14,838 --> 00:51:20,844
ASSISTANTS, TESIA, AND 

1438
00:51:20,844 --> 00:51:21,845
[INDISCERNIBLE], CAN YOU LOOK 

1439
00:51:21,845 --> 00:51:23,313
THAT UP AND PUT IT IN THE CHAT, 

1440
00:51:23,313 --> 00:51:24,581
PLEASE.

1441
00:51:24,581 --> 00:51:25,982
I KNOW IT'S AVAILABLE IN 

1442
00:51:25,982 --> 00:51:26,816
SPANISH, FOR SURE.

1443
00:51:26,816 --> 00:51:29,252
>> Peg Sanders: NEXT
QUESTION, 

1444
00:51:29,252 --> 00:51:33,256
YOU TALKED ABOUT THE ASQ IN 

1445
00:51:33,256 --> 00:51:34,791
CHILDREN AND THEN ADULTS.

1446
00:51:34,791 --> 00:51:36,726
WHAT ARE THE DIFFERENCES 

1447
00:51:36,726 --> 00:51:37,360
BETWEEN SCREENING ADULTS VERSUS 

1448
00:51:37,360 --> 00:51:38,027
CHILDREN?

1449
00:51:38,027 --> 00:51:38,862
>> Lisa Horowitz: THAT'S A

1450
00:51:38,862 --> 00:51:39,963
GREAT QUESTION.

1451
00:51:39,963 --> 00:51:41,264
WHENEVER YOU WORK WITH CHILDREN 

1452
00:51:41,264 --> 00:51:42,499
YOU ARE REALLY WORKING WITH A 

1453
00:51:42,499 --> 00:51:44,300
FAMILY, RIGHT?

1454
00:51:44,300 --> 00:51:46,703
CHILDREN USUALLY SHOW UP WITH 

1455
00:51:46,703 --> 00:51:48,805
PARENTS OR GUARDIANS.

1456
00:51:48,805 --> 00:51:50,974
ONE OF THE BIGGEST LIFE 

1457
00:51:50,974 --> 00:51:51,841
STRESSORS THERE ARE IS LOSING A 

1458
00:51:51,841 --> 00:51:53,476
CHILD.

1459
00:51:53,476 --> 00:51:55,178
BUT HAVING A CHILD THAT WANTS 

1460
00:51:55,178 --> 00:51:58,214
TO TAKE THEIR OWN LIFE IS 

1461
00:51:58,214 --> 00:51:58,748
INCREDIBLY STRESSFUL FOR 

1462
00:51:58,748 --> 00:51:59,549
PARENTS.

1463
00:51:59,549 --> 00:52:00,850
SO IT'S REALLY IMPORTANT YOU 

1464
00:52:00,850 --> 00:52:03,987
HAVE A WAY TO BRING THE PARENT 

1465
00:52:03,987 --> 00:52:05,989
IN, IN A NON-DEFENSIVE, A WAY 

1466
00:52:05,989 --> 00:52:07,223
TO PUT THEM NOT ON THE 

1467
00:52:07,223 --> 00:52:08,892
DEFENSIVE.

1468
00:52:08,892 --> 00:52:11,661
FOR EXAMPLE, IF A PROVIDER SAYS 

1469
00:52:11,661 --> 00:52:13,897
SOMETHING LIKE OH YOUR CHILD IS 

1470
00:52:13,897 --> 00:52:17,400
SAYING THEY ARE HAVING SUICIDAL 

1471
00:52:17,400 --> 00:52:19,536
THOUGHTS, DID YOU KNOW ABOUT 

1472
00:52:19,536 --> 00:52:23,373
THIS, EVEN IF THEY SAY THAT IN 

1473
00:52:23,373 --> 00:52:25,108
THE NICEST POSSIBLE WAY, YOU 

1474
00:52:25,108 --> 00:52:28,144
MAY NOT KNOW ABOUT THIS.

1475
00:52:28,144 --> 00:52:30,447
WE TRAIN THEM TO SAY IS THIS 

1476
00:52:30,447 --> 00:52:31,381
SOMETHING YOUR CHILD SHARED 

1477
00:52:31,381 --> 00:52:32,782
WITH YOU.

1478
00:52:32,782 --> 00:52:35,285
THEY CAN SAY, NO, THEY NEVER 

1479
00:52:35,285 --> 00:52:37,821
TOLD ME ABOUT THAT, I DIDN'T 

1480
00:52:37,821 --> 00:52:38,021
KNOW.

1481
00:52:38,021 --> 00:52:39,522
YOU CAN NORMALIZE THAT, MANY 

1482
00:52:39,522 --> 00:52:42,091
PARENTS DON'T KNOW.

1483
00:52:42,091 --> 00:52:44,594
NOT BECAUSE YOU ARE A BAD 

1484
00:52:44,594 --> 00:52:46,296
PARENT BUT KIDS KEEP THESE 

1485
00:52:46,296 --> 00:52:47,630
THINGS TO THEMSELVES.

1486
00:52:47,630 --> 00:52:49,065
THERE'S WAYS TO WORK WITH 

1487
00:52:49,065 --> 00:52:50,366
PARENTS.

1488
00:52:50,366 --> 00:52:51,968
ALSO WHEN YOU SCREEN A CHILD, 

1489
00:52:51,968 --> 00:52:54,604
IF THEY ARE UNDER 18, WE ARE 

1490
00:52:54,604 --> 00:52:55,939
ALL MANDATED REPORTERS TO TELL 

1491
00:52:55,939 --> 00:52:56,906
THE PARENTS.

1492
00:52:56,906 --> 00:52:59,442
SO ONE WAY TO DO THAT WITH THE 

1493
00:52:59,442 --> 00:53:01,044
CHILD IS, YOU KNOW, YOU MIGHT 

1494
00:53:01,044 --> 00:53:02,846
SAY TO THE CHILD, NOW I'M GOING 

1495
00:53:02,846 --> 00:53:04,881
TO TALK WITH YOUR PARENT ABOUT 

1496
00:53:04,881 --> 00:53:06,115
THIS, THEY MIGHT SAY NO, I 

1497
00:53:06,115 --> 00:53:07,450
DON'T WANT YOU TO TELL MY 

1498
00:53:07,450 --> 00:53:08,318
PARENT.

1499
00:53:08,318 --> 00:53:10,019
IN ORDER TO GIVE THEM SOME 

1500
00:53:10,019 --> 00:53:11,955
AGENCY, YOU SAY SOMETHING LIKE, 

1501
00:53:11,955 --> 00:53:13,990
WELL I WANT TO KEEP YOU SAFE, 

1502
00:53:13,990 --> 00:53:15,391
HOW ABOUT IF YOU DECIDE IF YOU 

1503
00:53:15,391 --> 00:53:17,126
WANT TO BE IN THE SAME ROOM 

1504
00:53:17,126 --> 00:53:19,429
WHEN I TELL YOUR PARENT OR WANT 

1505
00:53:19,429 --> 00:53:21,764
ME TO TELL THEM ALONE, SO THAT 

1506
00:53:21,764 --> 00:53:24,367
GIVES THE CHILD SOME AGENCY, 

1507
00:53:24,367 --> 00:53:26,836
SOME CHOICE, SO IT'S NOT JUST 

1508
00:53:26,836 --> 00:53:29,939
I'M TELLING YOUR PARENT, YOU 

1509
00:53:29,939 --> 00:53:30,907
DID THIS, IT'S MORE 

1510
00:53:30,907 --> 00:53:31,274
COMPASSIONATE.

1511
00:53:31,274 --> 00:53:34,711
>> Peg Sanders: THERE WAS
A 

1512
00:53:34,711 --> 00:53:35,545
RESPONSE ABOUT THE OTHER 

1513
00:53:35,545 --> 00:53:36,880
LANGUAGES.

1514
00:53:36,880 --> 00:53:39,549
IT SAYS WHEN CALLING 988 PRESS 

1515
00:53:39,549 --> 00:53:44,187
2 TO SPEAK WITH A TRAINED 

1516
00:53:44,187 --> 00:53:44,687
SPANISH SPEAKING CRISIS 

1517
00:53:44,687 --> 00:53:48,725
COUNSELOR.

1518
00:53:48,725 --> 00:53:49,859
WHEN ASKED TO TYPE, YOU WILL BE 

1519
00:53:49,859 --> 00:53:54,697
ASKED.

1520
00:53:54,697 --> 00:53:57,934
FOR OTHERS WHO SPEAK EITHER 

1521
00:53:57,934 --> 00:54:00,837
LANGUAGES CALL 988 AND YOU WILL 

1522
00:54:00,837 --> 00:54:03,039
BE PROVIDED TRANSLATION MORE 

1523
00:54:03,039 --> 00:54:06,309
THAN 240 ADDITIONAL LANGUAGES 

1524
00:54:06,309 --> 00:54:07,544
THROUGH LANGUAGE LINES, THROUGH 

1525
00:54:07,544 --> 00:54:08,978
VOICE CALLING ONLY.

1526
00:54:08,978 --> 00:54:11,047
>> Lisa Horowitz: THANK
YOU, SO 

1527
00:54:11,047 --> 00:54:12,482
I GOT EDUCATED ABOUT IT TOO, 

1528
00:54:12,482 --> 00:54:13,983
APPRECIATE THAT.

1529
00:54:13,983 --> 00:54:16,786
>>  >> Peg Sanders:
SHOULD WE 

1530
00:54:16,786 --> 00:54:19,455
SCREEN EMPLOYEES IS A QUESTION.

1531
00:54:19,455 --> 00:54:22,258
>> Lisa Horowitz: IF
EMPLOYEES 

1532
00:54:22,258 --> 00:54:24,961
SHOW UP AT OMS, I THINK IF IT'S 

1533
00:54:24,961 --> 00:54:26,596
A HEALTHCARE CENTER THEY CAN BE 

1534
00:54:26,596 --> 00:54:29,032
SCREENED BUT WE DON'T WANT TO 

1535
00:54:29,032 --> 00:54:30,033
BE MANAGERS SCREENING OUR 

1536
00:54:30,033 --> 00:54:31,367
EMPLOYEES.

1537
00:54:31,367 --> 00:54:34,904
THAT GOES BACK TO WHAT I WAS 

1538
00:54:34,904 --> 00:54:36,506
SAYING AT THE END.

1539
00:54:36,506 --> 00:54:41,611
IT'S IMPORTANT TO HAVE A 

1540
00:54:41,611 --> 00:54:43,346
CONVERSATION CERTAINLY TALK 

1541
00:54:43,346 --> 00:54:45,582
WITH PEOPLE IF YOU ARE WORRIED 

1542
00:54:45,582 --> 00:54:47,617
ABOUT THEM, BUT WE DON'T WANT 

1543
00:54:47,617 --> 00:54:49,953
TO BE GIVING THEM SCREENING 

1544
00:54:49,953 --> 00:54:52,255
TOOLS BECAUSE THAT'S REALLY 

1545
00:54:52,255 --> 00:54:53,022
MEANT FOR HEALTHCARE PROVIDERS 

1546
00:54:53,022 --> 00:54:57,727
TO DO.

1547
00:54:57,727 --> 00:54:59,495
WE CAN HAVE CONVERSATIONS WITH 

1548
00:54:59,495 --> 00:54:59,862
OUR EMPLOYEES.

1549
00:54:59,862 --> 00:55:03,399
>> Peg Sanders: WHAT IF
SOMEONE 

1550
00:55:03,399 --> 00:55:03,800
DOESN'T WANT HELP?

1551
00:55:03,800 --> 00:55:04,734
>> Lisa Horowitz: THAT'S A

1552
00:55:04,734 --> 00:55:06,936
REALLY GOOD QUESTION.

1553
00:55:06,936 --> 00:55:13,376
SO SOMETIMES THAT HAPPENS.

1554
00:55:13,376 --> 00:55:19,549
I THINK PEOPLE HAVING THOUGHTS 

1555
00:55:19,549 --> 00:55:22,251
IN THE SUICIDAL STATE ARE IN A 

1556
00:55:22,251 --> 00:55:24,287
STATE OF UNBEARABLE SUFFERING.

1557
00:55:24,287 --> 00:55:25,822
OFTEN TIMES THEY WANT SOMEBODY 

1558
00:55:25,822 --> 00:55:27,290
TO HELP AND WANT SOMEONE TO 

1559
00:55:27,290 --> 00:55:29,359
CARE ABOUT THEM.

1560
00:55:29,359 --> 00:55:30,360
HOWEVER, THERE ARE PEOPLE THAT 

1561
00:55:30,360 --> 00:55:31,761
DON'T WANT THAT.

1562
00:55:31,761 --> 00:55:33,262
AND THAT'S REALLY HARD WHEN YOU 

1563
00:55:33,262 --> 00:55:34,464
CARE ABOUT SOMEONE AND THEY 

1564
00:55:34,464 --> 00:55:35,698
REJECT HELP.

1565
00:55:35,698 --> 00:55:38,101
THAT'S HARD FOR ANYTHING.

1566
00:55:38,101 --> 00:55:39,836
BUT THIS ONE MAKES PEOPLE WORRY.

1567
00:55:39,836 --> 00:55:44,807
SO YOU CAN DO YOUR BEST TO 

1568
00:55:44,807 --> 00:55:46,109
CONVINCE THEM THAT THEY SHOULD 

1569
00:55:46,109 --> 00:55:47,510
GET HELP.

1570
00:55:47,510 --> 00:55:50,346
BUT IT'S ALSO OKAY TO LET IT BE 

1571
00:55:50,346 --> 00:55:51,547
AND FOLLOW-UP WITH THEM.

1572
00:55:51,547 --> 00:55:53,249
MAYBE YOU FOLLOW-UP IN A FEW 

1573
00:55:53,249 --> 00:55:55,318
DAYS, YOU KNOW, I WAS THINKING 

1574
00:55:55,318 --> 00:55:57,220
MORE ABOUT OUR CONVERSATION.

1575
00:55:57,220 --> 00:55:58,855
IS THERE SOMEONE I CAN CONNECT 

1576
00:55:58,855 --> 00:56:00,056
YOU WITH THAT CAN HELP.

1577
00:56:00,056 --> 00:56:02,091
OR I WANT TO MAKE SURE YOU HAVE 

1578
00:56:02,091 --> 00:56:03,693
THE LIFELINE IN YOUR PHONE SO 

1579
00:56:03,693 --> 00:56:05,495
YOU CAN CALL FOR HELP IF YOU 

1580
00:56:05,495 --> 00:56:06,696
EVER CHANGE YOUR MIND.

1581
00:56:06,696 --> 00:56:07,930
IT'S TRICKY.

1582
00:56:07,930 --> 00:56:11,134
IT'S VERY TRICKY.

1583
00:56:11,134 --> 00:56:14,003
IT'S ALSO OKAY TO DECLARE THIS 

1584
00:56:14,003 --> 00:56:18,207
IS AWKWARD, RIGHT?

1585
00:56:18,207 --> 00:56:20,143
IT IS NEVER COMFORTABLE TO HAVE 

1586
00:56:20,143 --> 00:56:21,577
A CONVERSATION WITH SOMEONE 

1587
00:56:21,577 --> 00:56:23,379
ABOUT THEM TAKING THEIR OWN 

1588
00:56:23,379 --> 00:56:23,880
LIFE.

1589
00:56:23,880 --> 00:56:26,582
THAT SHOULD NEVER EVEN BE 

1590
00:56:26,582 --> 00:56:26,883
COMFORTABLE.

1591
00:56:26,883 --> 00:56:28,651
EVEN SOMEONE TRAINED TO ASSESS 

1592
00:56:28,651 --> 00:56:30,253
PEOPLE FOR SUICIDE RISK, IT'S 

1593
00:56:30,253 --> 00:56:31,988
HARD EVERY SINGLE TIME, EVERY 

1594
00:56:31,988 --> 00:56:33,489
SINGLE PATIENT I ASSESS AND 

1595
00:56:33,489 --> 00:56:35,925
SEND HOME, I WALK AWAY AND I 

1596
00:56:35,925 --> 00:56:38,127
JUST THINK, OH I HOPE I MADE 

1597
00:56:38,127 --> 00:56:39,295
THAT RIGHT DECISION TO SEND 

1598
00:56:39,295 --> 00:56:40,063
THEM HOME.

1599
00:56:40,063 --> 00:56:41,764
SO THIS IS HARD.

1600
00:56:41,764 --> 00:56:44,100
AND IT'S OKAY TO SAY TO YOUR 

1601
00:56:44,100 --> 00:56:45,401
FRIEND, COLLEAGUE, YOUR FAMILY 

1602
00:56:45,401 --> 00:56:47,203
MEMBER, THIS IS REALLY AWKWARD 

1603
00:56:47,203 --> 00:56:50,373
TO SAY, BUT, YOU KNOW, I WANT, 

1604
00:56:50,373 --> 00:56:54,110
I JUST NOTICED YOU'RE NOT 

1605
00:56:54,110 --> 00:56:55,611
ACTING LIKE YOURSELF LATELY, 

1606
00:56:55,611 --> 00:56:57,980
I'M WORRIED ABOUT YOU.

1607
00:56:57,980 --> 00:57:01,484
THERE'S ACTUALLY A WEBSITE 

1608
00:57:01,484 --> 00:57:03,019
CALLED SEIZE THE AWKWARD.

1609
00:57:03,019 --> 00:57:04,887
IT HAS A LITTLE VIDEO CLIP OF 

1610
00:57:04,887 --> 00:57:06,823
PEOPLE TRYING TO HAVE A VERY 

1611
00:57:06,823 --> 00:57:07,857
AWKWARD START TO THIS 

1612
00:57:07,857 --> 00:57:09,158
CONVERSATION.

1613
00:57:09,158 --> 00:57:13,796
AND I ENCOURAGE YOU ALL TO GO 

1614
00:57:13,796 --> 00:57:18,568
TO SEIZE THE AWKWARD.

1615
00:57:18,568 --> 00:57:20,269
IT MIGHT BE SEIZETHEAWKWARD.ORG.

1616
00:57:20,269 --> 00:57:23,473
THANK YOU.

1617
00:57:23,473 --> 00:57:25,007
>> Peg Sanders: THIS IS
NOT 

1618
00:57:25,007 --> 00:57:28,444
COMING ACROSS ON THE VIDEOCAST.

1619
00:57:28,444 --> 00:57:30,747
SEIZE THE AWKWARD, TALK WITH A 

1620
00:57:30,747 --> 00:57:36,919
FRIEND ABOUT MENTAL HEALTH.

1621
00:57:36,919 --> 00:57:47,196
YOU ARE RIGHT, 

1622
00:57:47,463 --> 00:57:47,830
SEIZETHEAWKWARD.ORG.

1623
00:57:47,830 --> 00:57:48,431
WHAT IF PATIENT SCREENS 

1624
00:57:48,431 --> 00:57:49,432
POSITIVE OVER THE PHONE AND 

1625
00:57:49,432 --> 00:57:53,202
EITHER YOU OR THE PATIENT 

1626
00:57:53,202 --> 00:57:54,303
INSIDE THE CLINICAL CENTER, IT 

1627
00:57:54,303 --> 00:57:57,740
SEEMS LIKE A LOT OF RESOURCES 

1628
00:57:57,740 --> 00:57:59,876
REFER TO CALLING A SOCIAL 

1629
00:57:59,876 --> 00:58:02,411
WORKER FOR AN INPATIENT OR 

1630
00:58:02,411 --> 00:58:03,379
OUTPATIENT OFFICE.

1631
00:58:03,379 --> 00:58:04,814
>> Lisa Horowitz: YEAH,
THAT 

1632
00:58:04,814 --> 00:58:06,649
HAPPENS, WE HAVE A PROTOCOL FOR 

1633
00:58:06,649 --> 00:58:08,918
WHAT HAPPENS WHEN PEOPLE CALL.

1634
00:58:08,918 --> 00:58:10,253
IT'S AVAILABLE ONLINE.

1635
00:58:10,253 --> 00:58:11,988
IT'S CALLED THE RED BOOK, 

1636
00:58:11,988 --> 00:58:13,456
BECAUSE IT'S ACTUALLY A RED 

1637
00:58:13,456 --> 00:58:15,625
BINDER WE KEEP IN OUR OFFICE, 

1638
00:58:15,625 --> 00:58:16,492
BUT IT'S ONLINE NOW ON THE 

1639
00:58:16,492 --> 00:58:17,827
WEBSITE.

1640
00:58:17,827 --> 00:58:20,263
IT WALKS YOU THROUGH, IT'S 

1641
00:58:20,263 --> 00:58:21,697
REALLY IMPORTANT TO GET THEIR 

1642
00:58:21,697 --> 00:58:23,866
NAME AND THEIR ADDRESS.

1643
00:58:23,866 --> 00:58:25,301
AND IS THERE ANYONE ELSE IN THE 

1644
00:58:25,301 --> 00:58:26,302
HOUSE YOU WOULD ALLOW US TO 

1645
00:58:26,302 --> 00:58:27,236
TALK TO.

1646
00:58:27,236 --> 00:58:29,338
I WANT TO KEEP YOU SAFE.

1647
00:58:29,338 --> 00:58:32,141
AND IF ALL ELSE FAILS AND YOU 

1648
00:58:32,141 --> 00:58:34,510
ARE REALLY WORRIED YOU CAN CALL 

1649
00:58:34,510 --> 00:58:36,846
9-1-1 AND TRY TO FIGURE OUT IN 

1650
00:58:36,846 --> 00:58:39,382
THEIR AREA HOW TO DO A 

1651
00:58:39,382 --> 00:58:41,284
WELL-CHECK.

1652
00:58:41,284 --> 00:58:43,586
YOU KNOW, BUT THAT DEFINITELY 

1653
00:58:43,586 --> 00:58:44,320
HAPPENS.

1654
00:58:44,320 --> 00:58:45,688
AND IT'S IMPORTANT THAT, ONE, 

1655
00:58:45,688 --> 00:58:47,223
THE PERSON WHO ANSWERS THE 

1656
00:58:47,223 --> 00:58:47,790
PHONE ISN'T LEFT ALONE WITH 

1657
00:58:47,790 --> 00:58:48,958
THAT.

1658
00:58:48,958 --> 00:58:50,760
BECAUSE THAT'S HARD.

1659
00:58:50,760 --> 00:58:52,128
ESPECIALLY ON A COLD CALL, YOU 

1660
00:58:52,128 --> 00:58:53,396
KNOW.

1661
00:58:53,396 --> 00:58:54,397
EVERYONE SHOULD BE TRAINED.

1662
00:58:54,397 --> 00:58:56,432
HERE IS WHAT YOU DO.

1663
00:58:56,432 --> 00:58:58,668
HERE IS HOW YOU ALERT ANOTHER 

1664
00:58:58,668 --> 00:59:00,169
PERSON IN YOUR OFFICE WHILE YOU 

1665
00:59:00,169 --> 00:59:01,671
KEEP THEM ON THE PHONE AND THEN 

1666
00:59:01,671 --> 00:59:03,005
YOU JUST HAVE TO DO THE BEST 

1667
00:59:03,005 --> 00:59:04,207
YOU CAN DO.

1668
00:59:04,207 --> 00:59:06,609
THAT'S A REALLY HARD ONE, YEAH.

1669
00:59:06,609 --> 00:59:08,444
>> Peg Sanders: I THINK
THIS 

1670
00:59:08,444 --> 00:59:15,384
NEXT QUESTION SORT OF GETS AT 

1671
00:59:15,384 --> 00:59:21,757
THE ACUTE INTERVENTION.

1672
00:59:21,757 --> 00:59:23,292
>> Lisa Horowitz:
UNFORTUNATELY 

1673
00:59:23,292 --> 00:59:26,529
THAT'S WHEN YOU HAVE TO CALL 

1674
00:59:26,529 --> 00:59:27,930
9-1-1 BECAUSE YOU WANT TO DO 

1675
00:59:27,930 --> 00:59:29,498
EVERYTHING YOU CAN TO KEEP THEM 

1676
00:59:29,498 --> 00:59:30,466
SAFE.

1677
00:59:30,466 --> 00:59:32,134
IF YOU REALLY DO THINK SOMEONE 

1678
00:59:32,134 --> 00:59:35,071
IS GOING TO KILL THEMSELVES IN 

1679
00:59:35,071 --> 00:59:41,811
THAT MINUTE, THEN IT'S NOT THE 

1680
00:59:41,811 --> 00:59:43,746
MOST, THE POLICE WILL SHOW UP 

1681
00:59:43,746 --> 00:59:45,081
AND DO A WELL-CHECK AT 

1682
00:59:45,081 --> 00:59:46,182
SOMEONE'S HOUSE.

1683
00:59:46,182 --> 00:59:48,184
SOMETIMES THAT'S NECESSARY.

1684
00:59:48,184 --> 00:59:50,086
SOMETIMES THAT PERSON GETS VERY 

1685
00:59:50,086 --> 00:59:52,455
MAD AT YOU THAT YOU DID THAT.

1686
00:59:52,455 --> 00:59:54,390
THIS HAPPENED ACTUALLY IN MY 

1687
00:59:54,390 --> 00:59:56,792
OWN FAMILY WITH A COUSIN WHO WE 

1688
00:59:56,792 --> 00:59:58,394
HAD TO SEND THE POLICE TO HER 

1689
00:59:58,394 --> 01:00:00,730
HOUSE AND SHE WAS VERY ANGRY, 

1690
01:00:00,730 --> 01:00:02,999
DIDN'T TALK TO US FOR A WHILE.

1691
01:00:02,999 --> 01:00:04,901
BUT, WHAT WE SAID TO HER, WE 

1692
01:00:04,901 --> 01:00:07,637
ARE SORRY YOU ARE MAD, BUT WE 

1693
01:00:07,637 --> 01:00:09,538
DIDN'T WANT TO SEE ANYTHING BAD 

1694
01:00:09,538 --> 01:00:11,340
HAPPEN TO YOU AND WE CARE ABOUT 

1695
01:00:11,340 --> 01:00:13,075
YOUR SAFETY.

1696
01:00:13,075 --> 01:00:14,443
SO THAT'S AN UNFORTUNATE 

1697
01:00:14,443 --> 01:00:15,177
CIRCUMSTANCE.

1698
01:00:15,177 --> 01:00:17,313
BUT IF YOU DO WORRY LIKE THAT, 

1699
01:00:17,313 --> 01:00:20,016
YOU SHOULD DO THAT.

1700
01:00:20,016 --> 01:00:23,552
>> Peg Sanders: OKAY.

1701
01:00:23,552 --> 01:00:25,888
IN RESPONSE TO WHAT SOMEBODY 

1702
01:00:25,888 --> 01:00:27,490
ASKED, THIS PARTICULAR SESSION, 

1703
01:00:27,490 --> 01:00:29,926
THE VIDEOCAST WILL BE AVAILABLE 

1704
01:00:29,926 --> 01:00:31,060
TO ANYBODY WHO WANTS IT.

1705
01:00:31,060 --> 01:00:34,563
SO WHEN YOU GO TO THE ARCHIVES 

1706
01:00:34,563 --> 01:00:36,599
ON THE NIH VIDEOCAST, THIS IS 

1707
01:00:36,599 --> 01:00:44,173
NOT  LIMITED TO NIH OR HHS ONLY.

1708
01:00:44,173 --> 01:00:45,775
ON THE VIDEOCAST WITHIN A FEW 

1709
01:00:45,775 --> 01:00:47,276
DAYS YOU CAN CERTAINLY PROVIDE 

1710
01:00:47,276 --> 01:00:49,445
THAT LINK TO OTHERS AS WELL.

1711
01:00:49,445 --> 01:00:50,179
>> Lisa Horowitz: GREAT.

1712
01:00:50,179 --> 01:00:51,747
>> Peg Sanders: I THINK WE
HIT 

1713
01:00:51,747 --> 01:00:54,684
OUR TIME HERE AT 4:00.

1714
01:00:54,684 --> 01:00:56,919
THANK YOU, DR. HOROWITZ, THIS 

1715
01:00:56,919 --> 01:00:59,155
HAS BEEN ENLIGHTENING, NOT JUST 

1716
01:00:59,155 --> 01:01:00,523
A PROFESSIONAL STANDPOINT BUT 

1717
01:01:00,523 --> 01:01:02,758
AS YOU SAID AT THE BEGINNING, 

1718
01:01:02,758 --> 01:01:07,396
SO MANY OF US HAVE HAD AT LEAST 

1719
01:01:07,396 --> 01:01:09,298
TANGENTIAL EXPERIENCES.

1720
01:01:09,298 --> 01:01:11,767
THIS HAS BEEN HELPFUL ON SO 

1721
01:01:11,767 --> 01:01:12,201
MANY LEVELS.

1722
01:01:12,201 --> 01:01:12,768
THANK YOU.

1723
01:01:12,768 --> 01:01:14,370
>> Lisa Horowitz: THANK
YOU.

1724
01:01:14,370 --> 01:01:16,372
>> Peg Sanders: BYE-BYE.