ASQ Program
Background
Suicide has been recognized as a serious public health issue that disproportionately impacts American Indian and Alaska Natives. To better serve populations at risk and mitigate suicide deaths, IHS has identified and is implementing a uniform, research-based screening tool. All IHS federal facilities will implement the Ask Suicide-Screening Questions (ASQ) standardized, universal suicide risk screening tool. The mandate supports the Indian Health Manual, Part 3, Chapter 34, Suicide Prevention and Care policy and states that:
- Screening All patients aged 8 years and older will receive a screening to identify suicide risk at every visit within Emergency Departments and Urgent Care; upon admission into a medical surgical unit or residential programs; and every three months in all other health care clinics and departments to assure accurate assessment, diagnosis, effective treatment, and follow-up services, as clinically indicated.
ASQ Workgroups and Meetings
Members of the ASQ Program Workgroup have expertise in areas including: IHS clinical workflows, local level policy requirements, and tribal influence and impact on IHS healthcare systems.
- Dr. Pamela End of Horn
- CDR Joy McQuery
- CAPT Wil Darwin
- Dr. Shiloh Martin
- CDR John Collins
- Dr. Theresa Nez
- Naomi Bruinius
- Dr. Colleen Campbell Lane
- Donna Enfield
- CAPT John Lester
A diverse cross section of healthcare professionals have joined together to form the ASQ Program Workgroup in support of this initiative. The group selected objectives based on the mandates put forth in the Indian Health Manual Chapter 34, and with the intention to garner multiple perspectives from across healthcare systems to inform and guide the work. The ASQ Program Workgroup participates in bimonthly meetings and focuses on the following core functions:
- Identifying emerging issues including potential barriers and provide solution-oriented feedback;
- Strategizing program rollout based on best practices; and
- Providing recommendations for systemic implementation based on subject matter expertise.
Objectives
- Increase the proportion of healthcare providers that are trained in suicide care management.
- Increase the rate of screening across the IHS healthcare system through updating of policy and clinical flow processes.
- Increase the proportion of healthcare providers to act as change agents within the Healthcare system to inform and share information on evidence-based practices related to suicide prevention and care.
- Increase subject matter expertise within the IHS healthcare system to provide input into national program, policy and evaluation development.
The ASQ Quality group is dedicated to the implementation of the ASQ through the lens of quality improvement. This team has developed a logic model and is working on the practical application of activities that will directly support the enhancement of ASQ policies, procedures, and practices.
The ASQ Monthly Office Hours are held on the third Thursday of the month at 2:00 PM EST. This meeting is open to all IHS employees who have questions about the ASQ. This is a great place to hear from facilities about their challenges and successes in ASQ implementation and pick up ideas for best practices.
IHS employees who would like to learn more about how to join the ASQ meetings and workgroups may contact Dr. Pamela End of Horn.
Implementation
In partnership with the National Institute of Mental Health, the IHS conducted train-the-trainer events for ten service areas, meeting the target goal of training all service units prior to the September 1, 2025, mandated start date. The next phase of implementation includes identifying processes for data collection that will support the tracking of screening rates across the enterprise. Quality improvement teams will initiate a Plan-Do-Study-Act iterative process to develop systems of continuous improvement.
Emerging Issues
As the ASQ risk screening tool expands its usage in medical facilities, a number of issues will emerge. Responsive planning means expanding awareness of necessary next steps that may include:
- Suicide Risk Assessments: Patients who screen acute positive on the ASQ must be administered an evidence-based suicide risk assessment.
- Safety Planning: Patients at risk of suicide will work collaboratively with appropriate clinical staff to develop a safety plan. Examples of components of a safety plan are recognizing warning signs, developing internal coping strategies, and identifying social relationships and resources as protective factors.
- Lethal Means Safety: Lethal means are the materials that can be used to engage in suicide related behavior. Counseling on restricting access to lethal means is an evidence-based strategy that can be part of a patient's safety plan.
References
- Chapter 34 - Suicide prevention and care: Part 3. – The Indian Health Manual (IHM)
- Examination codes: OIT standard code set tables. Standard Code Book (SCB) – IHS
- Indian Health Service Universal Suicide Risk Screening Policy statement: 2024. The Indian Health Manual (IHM). (2024, August 12).
- National patient safety goal for suicide prevention –The Joint Commission, November 27, 2018
- Ask suicide-screening questions (ASQ) toolkit National Institute of Mental Health, U.S. Department of Health and Human Services.
Bibliography
Read the bibliography of consulted resources [PDF - 120 KB]
