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Ashley E. Bridgmon, MPH, MBA
Jennifer E. McCain, MD
Kathy Monroe, MD, MSQI
William D. King, DrPH

Intentional self-harm (ISH) injuries are an increasing reason for visits to emergency departments (ED). ISH injuries are often the result of various forms of cutting, toxin ingestion, and other acts of bodily harm. Our study was conducted in an effort to quantify the numbers of ISH ED visits in our pediatric tertiary care hospital, and to identify the descriptive epidemiology of this important issue. Through an epidemiologic model approach, we seek to develop important primary and secondary public health interventions for responding to this ever growing child health issue.

A convenience sample of 2022 ED visits for ISH injuries were identified for analysis using an injury surveillance system at our pediatric tertiary hospital. Inclusion criteria included all children evaluated in the ED with ICD 10 codes ranging from X60 – X84. Confirmatory searches of the history of present illness (HPI) containing “intentional injury” were also performed. A nested case-control design was used to compare and contrast the ISH injury visits to non-ISH injury visits. A random selection of non-ISH visits were used as the control group. An Excel datafile was used for data entry and management while MedCalc and Epi info Version 7.2.4.0 (CDC) statistical program were used for data analysis. Odds ratio determinations with 95% Confidence Intervals, t test for means (comparisons) and Z test of proportions were used when appropriate for analysis.

Our study found 368 ISH ED visits during 2022. ISH visits had 4.7 times the odds of being female compared to controls, (OR=4.7, 95%CI (3.4, 6.4)). Specifically, white females accounted for the highest gender-race proportions, 51.9% vs 22.6%, (z=8.4, p<0.00001). Children with ISH visits were significantly older than controls (mean ages, 14.1 yrs vs 7.1 years, respectively), (t=25.8, p<0.00001). ISH visits had a high rate of admission (59.2%) and 71.2% had ESI’s of 2. Mean length of stay among admitted was 7.1 days compared to 2.5 days among controls (t=2.6, p<0.0001). The leading mechanism of ISH injury was poison ingestion (68.8%) which was 5.1 times the proportion of poison among controls, (z=15.6, p<0.00001). Other mechanisms of ISH injury included forms of cutting (glass, knife, sharp objects) at 26.9%.

Intentional self-harm injuries continue to be a growing concern for pediatric ED visits, with children as young as five years old presenting with ISH injuries. These visits more commonly result in admission than other injury types and when admitted, patients have significantly longer lengths of stay than children with non-ISH injuries. With poison ingestion being the leading cause of ISH injury, continuing to advocate for safe storage practices is necessary. Preventative public health interventions that increase awareness and target the at-risk population are needed to combat intentional self-harm injuries.

1. Intentional self-harm injuries are a growing cause for pediatric emergency department visits.
2. A comprehensive Public Health Model approach is needed to combat ISH injuries in our youth.
3. Primary care providers should be alert to this common problem of intentional self-harm and seek early psychiatric care for their patients.

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Guohua Li, MD, DrPH
Stanford Chihuri
Ashley Blanchard, MD, MS
Carolyn DiGuiseppi

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by persistent challenges in social interactions and restricted, repetitive patterns of behavior and interests. The reported prevalence of ASD in the United States has tripled in the past two decades. Recent studies indicate that ASD is associated with increased self-injurious behaviors. The purpose of this study is to assess the excess risk of self-injury associated with ASD.

Data from the 2016-2018 Nationwide Emergency Department Samples were analyzed to examine the epidemiologic patterns and excess risks of self-injury associated with ASD, and attention deficit/hyperactivity disorder (ADHD) or intellectual disability (ID). ED visits for self-injury were identified according to the ICD–10–CM external cause-of-injury matrix. Multivariable logistic regression modeling was used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of self-injury associated with ASD, and ADHD/ID.

The 2016-2018 NEDS recorded a total of 99,602,049 ED visits; of them, 2,488,066 (2.5%) were related to self-injury. Self-injury accounted for 3.6% of ED visits made by patients with a diagnosis of ASD, 5.8% of ED visits by patients with a diagnosis of ADHD, and 4.9% of ED visits by patients with a diagnosis of ID. Relative to patients without ASD, ADHD, and ID, the odds of self-injury increased 84% for patients with ASD but without ADHD or ID (aOR = 1.84; 95% CI: 1.78, 1.89), 189% for patients with ADHD/ID but without ASD (aOR = 2.89; 95% CI: 2.86, 2.93), and 178% for patients with ASD and ADHD or ID (aOR = 2.78; 95% CI: 2.63, 2.94). Poisoning was the leading mechanism of self-injury, accounting for 73.7% of self-injury-related ED visits.

Results of this study indicate that ASD is associated with a significantly increased risk of self-injury and that comorbid ADHD/ID can explain only part of the excess risk of self-injury in people with ASD.

1. Update on the recent trends of autism prevalence in the US.
2. Review recent research on injuries among people with autism.
3. Assess evidence regarding self-injury risk associated with autism and comorbidities.

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Sara Kohlbeck, PhD, MPH
Michelle Pickett, MD, MS

Suicide is the second leading cause of death among adolescents and young people, claiming more than 6,000 young lives in the United States in 2019. Rates of suicide among Black youth are on the rise in comparison to other racial groups. Between 2001 and 2017, suicide among Black females and males increased by 182% and 60%, respectively. In comparison, rates of suicide among white youth have declined over time. Suicide rates for Hispanic high school girls is 30% more than non-Hispanic white girls in the same age group. Mental health is stigmatized within the Black and Hispanic community and as a result, help-seeking in times of mental distress or suicide crisis may be reduced. In a national sample, 10% of Black adults (compared to 5% of the general population) had unmet mental health needs in the past 12 months. Among reasons for not seeking care was minimization of the problem and concerns about the stigma associated with mental illness. ‘Double discrimination’ for being Black and for having a mental illness, is a true concern within the black community and needs to be considered when designing and implementing screening programs with this population. It is critically important to determine relevant and appropriate school-based suicide screening practices and interventions in the context of Black youth suicide in an urban setting, and the aim of this study is to identify language youth employ around mental health to develop responsive suicide risk screening practices.

Focus groups were conducted with Black and Hispanic youth ages 10 to 18 (and their caregivers) in Milwaukee, WI to elucidate relevant considerations for screening, referral, and services that are culturally safe. Additionally, focus groups will also be conducted with caretakers of Black and Hispanic youth in Milwaukee to determine familial attitudes toward youth suicide screening, help-seeking for mental health or suicide-related issues, as well as to evaluate stigma-related barriers that may affect project progress.

A total of six focus groups were conducted - three with Black and Hispanic youth and three with their caregivers. Themes around stigma were identified as well as lack of trust of authority figures (e.g., administration, counselors) within the schools. These issues can negatively impact help-seeking among youth, which can hinder the identification of youth at-risk for suicide in non-responsive screening practices. At the same time, youth and their caretakers highlighted positive aspects of peer support as well as a willingness to support others during a mental health crisis. Peer support, therefore, can be leveraged in screening efforts as well as attempts to increase help-seeking and reduce stigma.

Tailoring suicide risk screening efforts within the school setting to be congruent with youth and caregiver perceptions around mental health and help-seeking may increase the efficacy of these efforts. Culturally-responsive screening practices for Black and Hispanic youth may decrease suicidal behavior in the Black and Hispanic communities.

1. Describe current trends in suicide among Black and Hispanic youth.
2. Detail a qualitative study aimed at identifying youth and caretaker perceptions around mental health and suicide to develop a culturally responsive suicide risk screening program.
3. Explore the qualitative themes from focus groups and highlight how these themes might impact school-based screening for suicide risk.

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Dawn M. Porter, MS, CHES
Dr. Louis S. Nadelson, PhD
Hope Mullins, MPH

Suicide is the 2nd leading cause of death in children 10-18 years old. Suicide deaths among children have profound effect on educational communities. Secondary schools are prime location to provide suicide prevention education as students spend most of their time in classroom learning environments. Unfortunately, many school faculty and staff are inadequately prepared to identify and intervene when a student is at risk for suicide. As the school leader, principals have the opportunity to provide and support suicide prevention programs for their students. Our search of the literature search indicated a research gap in principals’ perceptions of and engagement in implementing suicide prevention programs for their students. To address the gap, we conducted a qualitative research study to explore school principals’ knowledge of suicide prevention programs, their perceptions of logistical and cultural barriers, and justification for adopting suicide prevention programs.

Accessing a publicly accessible database of principals, we recruited participants via email. We focused on principals working in secondary schools where no suicide prevention work was taking place. We conducted semi-structured interviews via zoom of eight secondary school principals working in a south-central region of the United States. Interview protocol consisted of questions that aligned with the concepts of the Health Belief Model and was designed to elicit responses detailing the principal’s experience with suicide among their students, identify potential barriers to implementation, and justifications for adopting suicide prevention programs.

We found principals’ justifications for adopting suicide prevention programs were the desire to address their student’s mental health and improved learning. Principals also recognized the need for suicide prevention programming. Logistical and cultural barriers included limited staffing, lack of knowledge of suicide prevention program resources, and support from the school district central administration. The principals also shared the cultural barriers of stigma and community resistance to school involvement in suicide prevention. Our results indicated for principals seeking to overcome barriers to implementing suicide prevention programs, they will need support and resources and will need to address issues of knowledge and perceptions in their school and community.

School-based suicide prevention programs can have high impact on the well-being on all in the school. There is a need to prepare principals and staff with the training and resources to identify students who may be thinking of suicide. However, there is also a need for extensive communication to ensure accurate knowledge, meaningful interventions, and sustained implementation. Many principals could benefit from professional development focused on implementation of suicide prevention programs, and there may be a high impact by including implementation of the programs as part of the initial leadership preparation.

1. Participants will have an increased knowledge of school principals' justifications for implementation of suicide prevention program in their schools.
2. Participants will have an increased knowledge of school principals' cultural barriers they face that can prevent implementation of suicide prevention programs in their schools.
3. Participants will have an increased knowledge of school principal's logistical barriers they face that can prevent implementation of suicide prevention programs in their schools.

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Vikki Pennington, LMSW, CCLS, CPST

Beginning at one of the busiest pediatric Level 1 trauma centers, a volunteer emotional first aid program (Code Lilac) launched in 2015 with the goal to provide compassionate, confidential, and timely peer-to-peer support to members of the healthcare workforce experiencing stressful work-related events. During the pandemic (March 2022), this not-for-profit health system, comprised of 17 hospitals and more than 30,000 employees in a large metropolitan area, adopted this program as a system-wide approach to support all staff within the community. Psychological distress related to providing health care was present prior to the COVID pandemic and has become a leading factor in provider’s intentions to leave their profession (1, 2). Policy implications also support this type of programming, as the Joint Commission and the National Quality Forum has now recommended healthcare institutions to recognize “second victims’ needs” and establish a support structure to assist them through coping with traumatic medical events (3).

Code Lilac supports peer responder teams to 14-hospital campuses. The interdisciplinary team includes 100 leaders and more than 550 peer responders. These teams were trained and supported from consultants at Johns Hopkins (RISE) Resilience in Stressful Events Program (3). Interventions include individual support, group support and pro-active support services. Data on peer responses was generated as part of program development and improvement process.

To date, this is the largest peer responder program in the United States. Over 5,000 individuals have benefitted from Code Lilac through individual or group support. Since November 2022, 100+ calls have come through the Code Lilac Hotline, which is open to the entire 30,000+-member workforce including nearly 200 outpatient locations, home based services and remote workers. These responses have addressed a variety of traumatic or stressful workplace events including: cumulative stress related to patient care, fetal demise, maternal deaths, death of a child related to non-accidental trauma, suicide of a colleague, and medical errors.

The program’s high utilization demonstrates the need for peer support in the aftermath of stressful events, as well as the receptivity of the workforce members to accessing emotional first aid support. Presenter will discuss core components of the program, ethical and professional considerations, and strategies for ensuring utilization of the services. Next steps include designing a robust prospective psychological study on the impact of participation in a peer responder program.

1. Describe the burden of burnout among Healthcare Professionals
2. Recognize steps to implement a volunteer based peer-to-peer emotional first aid program across a large health system
3. Distinguish outcomes of supporting staff during aftermath of stressful events