May 5, 2020
Cheryl A. King, PhD, clinical psychologist and professor in the
department of psychiatry at Michigan Medicine, the academic health
system at the University of Michigan, Ann Arbor, joined Nick
Andrews at TEDMED2020.
King spoke with Nick (@Nick_Andrews_) at @TEDMed about
a suicide risk screen for teens that is based on computerized
- Dr. King is a longtime researcher in teen suicide, and her
current project is creating a personalized adaptive suicide risk
screen for teens called CASSY (Computerized Adaptive Screen for
- In an adaptive algorithm, subsequent questions will change
based on the previous answer. The aim is to create a profile of
risk factors and warning signs to generate a risk level that will
guide the type of mental health interventions required in the ED
- CASSY also is being developed as a universal screen for those
who might come to the ED without a mental health history. Many
teens who die by suicide do not have previous contact with mental
- More research is being done to create and validate treatment
interventions for at-risk teens so the risk levels generated in the
ED can be met with evidence-based interventions for preventing
- With the scarce mental health resources in some areas, Dr. King
and associates have created an intervention that trains
youth-nominated adults from within families to intervene in times
- The CASSY is based on computerized algorithms from data
collected by the Pediatric Emergency Care Applied Research Network
this network, thousands of teens in mental health crisis, after
suicide attempt or not, have completed a suicide risk survey aimed
at modeling specific warning signs and risk factors for predicting
suicide attempts in the next 3 months. In an adaptive algorithm,
subsequent questions will change based on the previous answer.
- The risk factors for teen suicide are well established, but
teens who attempt are a heterogeneous group. The key to predicting
an imminent risk of suicide depends on developing profiles of risk
based on how the risk factors and warning signs group together. The
result of the CASSY is a level of risk. Individual institutions can
set their risk levels.
- CASSY is being developed as a universal screen for those who
might come to the ED without a mental health history. Many teens
who die by suicide do not have previous contact with mental health
professionals. The goal is for CASSY to be integrated into a
medical system’s EHR in order to make it easier to use on a broad
- The most common intervention in an ED for suicide risk is
creating a safety plan that involves identifying warnings signs for
decompensated mood, brainstorming coping skills, and delineating
emergency contacts and a plan of action for suicidal
- Dr. King and associates developed the Youth-Nominated Support
Team intervention, which harnesses the strength of the adults in
the family to bolster treatment as usual. The teens nominate
“caring adults” who they want to support them after
hospitalization, and the adults are provided psychoeducation and
training to more effectively support the teens.
- Dr. King is also working on a National Institute of Mental
Health–supported study to identify the 24-hour warning signs for
suicide attempts. Dr. King thinks there is more work to be done
combining the screening tools with interventions in the ED and
King CA. J
Am Acad Child Adolesc Psychiatry. 2019 Oct;58(10):S305.
King CA et al. J Clin
Psychol Med Settings. 2017 Mar;24(1):8-20.
King CA et al.
JAMA Psychiatry. 2019 Feb 6;76(5):492-8.
King CA et al. J Am Acad Child Adolesc Psychiatry. 2019 Dec 9.
ASQ toolkit for suicide screening:
Show notes by Jacqueline Posada, MD, who is associate producer
of the Psychcast and consultation-liaison psychiatry fellow with
the Inova Fairfax Hospital/George Washington University program in
Falls Church, Va. Dr. Posada has no conflicts of interest.
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