CHOP ER behavioral health screening identifies teens in need of support

This story contains references to suicide. If you or someone you know is thinking of suicide, call or text 988.

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Whether they’re seeking treatment for a sprained ankle, stomach pain, or a panic attack, teenagers who come to the Children’s Hospital of Philadelphia emergency department are handed a 10-minute health survey with questions about anxiety, depression, and self harm.

About one in three reports symptoms of depression or suicidal thoughts that may otherwise have gone unnoticed.

Asking all patients aged 12 to 19 about mental health challenges has improved CHOP’s early detection of needs, especially among teens and adolescents being treated for physical ailments.

“There’s this tension of we don’t want to ask a 12-year-old these questions, these are grown-up questions,” said Polina Krass, a pediatric emergency medicine attending physician at CHOP, who helped develop the survey. “But then we miss the mark and are getting kids the help they need only when they’re already in crisis.”

CHOP’s screening initiative, launched in 2023, targets a problem hospitals across the region and country are facing: Mental health issues account for about one out of every eight emergency department visits, according to the Centers for Disease Control and Prevention. Yet hospitals are often ill-prepared to respond to these patients’ complex needs, which can put patient and staff safety at risk.

Safety experts say that one of the most meaningful solutions is for hospitals to treat suicide risk and mental health issues as a core patient safety issue that all staff are trained to recognize, akin to postpartum hemorrhage, heart attack, or stroke.

“This isn’t just a behavioral health issue — this is a system-wide patient safety priority,” said Shannon Kooker, vice president of clinical excellence and patient safety at ECRI, a patient safety organization in Fort Washington.

Patients at risk of suicide often turn to emergency departments for care, according to a new ECRI report.

ECRI analyzed patient safety incident reports from hospitals, outpatient clinics, and behavioral health programs between 2021 and 2025, looking specifically at suicide deaths and attempts, and instances in which patients expressed having thoughts of killing themselves.

Nearly three-quarters of the 406 incidents ECRI analyzed occurred in emergency departments. That’s partly because hospitals have established protocols for reporting incidents, whereas urgent care and ambulatory centers may be less likely to self-report, Kooker said.

People experiencing a mental health crisis may also be more likely to seek care at hospitals, which typically have specialized behavioral health workers on staff, she said.

Deaths were rare, accounting for just 2.7% of cases analyzed by ECRI. Much more common were cases in which a patient tried to kill themselves or expressed a desire to — a sign that providers have an opportunity to intervene before harm occurs, if they can identify risks quickly, ECRI analysts found.

Improving safety for patients at risk of self harm should be a hospital-wide effort, Kooker said.

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That can mean changing the emergency room environment, such as installing breakaway doors that open upon impact to reduce the risk of patients harming themselves and using paper scrubs that can’t be knotted into ropes.

More importantly, hospitals should make suicide prevention part of their safety culture, emphasized at the highest leadership levels, she said.

She urged hospitals to standardize policies for responding to mental health emergencies.

That starts with training all staff to recognize warning signs, such as being extremely agitated or anxious, acting erratically or withdrawn, or expressing feelings of being a nuisance or burden to others.

Not every patient needs to be screened for suicide risk, but staff should quickly call for help when they recognize troubling behaviors, Kooker said.

“It shouldn’t be a question mark to the staff — it should be standardized and tested,” she said.

At CHOP, about 10% of emergency department visits involve patients whose primary concern is a mental health issue.

Krass worries about the many more teens and adolescents whose mental health needs may go unnoticed in emergency departments because no one thought to ask.

The optional behavioral health screening survey — now taken by some 600 patients a month at CHOP’s Philadelphia and King of Prussia emergency departments — is designed to better identify those individuals, said Krass, a research scholar at CHOP’s Center for Violence Prevention.

When a patient’s survey answers indicate anxiety, depression, or other mental health concerns, doctors connect them with a behavioral health specialist or social worker for follow-up care.

Patients can complete the 37-question survey on their phone or on a tablet provided by the hospital. Krass and her colleagues have found that youth are more likely to share details about their mental health through this quasi-private format than if doctors ask questions directly.

One of the survey’s final questions is whether it’s a good idea for CHOP to probe so deeply into their young patients’ mental health.

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Almost all answer yes.