Suicide Prevention Program

Suicide Screening: What to Expect

ASQ: Ask Suicide-Screening Questions

At your child’s clinic appointment, we may do a suicide screening that we call “ASQ screening.” 

Patients 10 and older will be asked questions about suicide so that we may provide preventative care for youth at risk for suicide. Research shows that asking about suicide does not increase risk, in fact, evidence shows that screening with follow-up reduces suicide attempts and suicide deaths.  

  ASQ: Ask Suicide-Screening Questions (pdf)

Also available in Amharic, Arabic, Russian, Simplified Chinese, Somali, Spanish and Vietnamese.

Why do you screen for suicide? 

We have seen a steady increase in suicide and suicide attempts in children and youth over the past several years. National safety guidelines recommend evidence-based screening of children and adolescents 10 years and older for suicide risk.  

Evidence shows that when we can detect suicidal thoughts early and take steps to support children through safety planning and providing the necessary care, we can be more successful in preventing suicides.  

Many times, youth may be thinking about suicide and may not show signs that caregivers or providers can notice. To know about these risk factors, we are directly asking youth about suicidal thoughts and behaviors.  

In most of our hospital and clinic settings, we will screen patients 10 and older. Patients who come for multiple visits or are staying in the hospital will be screened every 30 days. Patients who cannot respond because of developmental delay can opt out. 

What happens during an ASQ screening, and why am I being asked to leave the room?

During the screening, we will ask for privacy while we ask your child questions about suicide risk and safety. Questions may be asked on a paper form, a tablet or verbally by a member of the healthcare team. 

You know your child best, and we respect your participation and involvement in their care. However, when screening for suicide risk, research shows that giving patients privacy is a more effective approach.  

What are the questions that will be asked during the ASQ screening? 

The questions we ask during the screening will help us get the right information about your child’s needs. Research shows that asking these questions does not increase the risk for suicide. Here are the questions your child will be asked: 

  1. In the past few weeks, have you wished you were dead? 
  2. In the past few weeks, have you felt that you or others would be better off if you were dead? 
  3. In the past week, have you been having thoughts about killing yourself? If yes, do you have a plan? 
  4. Have you ever tried to kill yourself? If yes, when and how? 
  5. Are you having thoughts of killing yourself right now? 

Is it safe to ask these questions?  

Asking youth questions about suicide is safe and is very important for suicide prevention. Research has shown that asking youth about thoughts of suicide is not harmful and does not put thoughts or ideas into their heads. If we have any concerns about your child’s safety after the screening, we will let you know. 

Is this screening required?  

Suicide screening is important. Seattle Children’s is committed to the whole health of your child, including their mental well-being. Although we strongly recommend the ASQ screening, it is not required. 

Sometimes youth may decline even though they are experiencing suicidal thoughts. If a parent or youth declines to complete the ASQ screening 3 times in a row, a care team member will contact you to better understand what, if any, supports may be useful.  

Youth who have intellectual disability or are otherwise unable to answer these questions can opt out. Parents should indicate they are declining due to cognitive impairment. This will delay screening for 1 year. You can decline again in 1 year if you believe this screening is not appropriate for your child.

What happens after the screening? 

Your child’s healthcare provider reviews responses and follows up with a mental health professional as appropriate. A referral may be given to a care team member for further evaluation. A mental health professional will reach out to your child to provide resources as appropriate.  

Teens (ages 13 and older) have privacy rights for some health issues. To provide the best care and comply with state laws, we may ask to talk with your teen in private. If a teen chooses to keep information they disclose private from their parents and it falls within the area of confidential services under state law, then we will keep it private. Safety concerns or any life-threatening information will be discussed with caregivers to develop a safety plan or appropriate next steps. 

For more information about privacy, see Teens and Privacy Rights (PDF). (Spanish) 

Whom do I ask if I have more questions? 

If you have any questions about our patient safety efforts, ask your child’s Seattle Children’s healthcare provider or ask to speak with a mental health professional. They may need to follow up with you by phone after your appointment. 

You may also send an email or call 206-987-4442 to ask more questions about the Suicide Prevention Program and how we conduct screenings. This email address and phone number are not resources for crisis support.

In a crisis?  

If you, your child, family or friend needs help right away, call  or text  988. Chat  is another option. The 988 Suicide & Crisis Lifeline provides free and confidential support for people in distress, as well as prevention and crisis resources. The Lifeline is available 24 hours a day, 7 days a week in the United States

Hotlines for Youth (PDF) provides other options for immediate help for children and teens. (Also available in Amharic, Arabic, Russian, Simplified Chinese, Somali, Spanish, Ukrainian  and Vietnamese.)