Lisa Farmer, nursing director of Psychiatric Services at Cook Children's Health Care System, explains, “Just as with a medical emergency, we do not want to wait until somebody is in crisis to treat an illness.”

This proactive approach is critical, as research shows that 50% of people who die by suicide have visited a health care provider in the month prior.

A depression screening tool called the PHQ-9-M is now used in pediatric primary care, urgent care, and some specialty clinics to identify at-risk children as young as twelve. According to Farmer, this early screening is the most effective way to manage depression and suicide risk. These questions focus on whether a child is depressed and are asked to kids 12 and up. The ASQ tool is also used for children age 8 to 11 who present to urgent care with a behavioral health concern.

Through the screening tool, doctors can provide early intervention and treatment to reduce the likelihood of a crisis. Farmer says research shows the best way to manage depression and suicide risk is to provide early screening to identify those at risk.

“By seeking treatment earlier, either through psychoeducation, individual and/or family therapy and possible medication management, we are able to treat depression to decrease the risk of suicide,” explained Farmer.

According to the U.S. Center for Disease Control and Prevention, suicide is one of the leading causes of death in the United States. One person dies every 11 minutes due to suicide. Data by the CDC in 2023 shows 1.5 million people attempted suicide and 12.8 million have seriously thought about suicide.

Farmer understands parents may have concerns about talking about mental health issues and suicide with their child but emphasizes that having the conversation does not create suicidal ideation. The Academy of Child and Adolescent Psychiatry offers educational material for caregivers on multiple topics, including how to talk to your child about mental health concerns.

“At Cook, we have found that youth have expressed they feel relieved that someone has finally asked these difficult questions,” said Farmer. “It can provide assurance that somebody cares and will give them a chance to talk about problems.”

The Impact on Patients 

In 2024, Cook Children’s screened more than 36,000 patients who presented to the ED for non-behavioral health concerns with the ASQ tool. Of those, 848 screened positive for suicide risk.  Another 2,394 kids struggling with sadness and worrying were provided with a crisis contact information sheet.

How do parents talk to their kids about the flooding in Central Texas?

First, allow the child to approach you and see what type of questions they have. Let them speak freely and stick to age-appropriate facts, while also validating their emotions or what they might be expressing.

You do not want to give them too much information or detail because they may become more overwhelmed, stressed, and anxious about the situation.

How do you make your child feel comfortable approaching you with their concerns and emotions?

We always want the child to approach us without us putting our perspective into the situation. I would try sitting at the table together, bringing out what they love best. For example, a 5-year-old might like to color, or a 12-year-old may enjoy crafting. Let them take part in the activity and ask them how they feel about the recent events.

 If they do bring it up, this is when you can put them at ease by talking through their feelings. You can tell them, "Okay. Let's do this activity together and as we're doing this activity, let's express how we are feeling."    

Let them guide the conversation. Listening and answering questions age appropriately while reassuring them.

Why is it important to have conversations with your children?

We must talk to them because not talking about it can cause trauma, distress, anxiety and even PTSD. Children might see the news and reflect on themselves, thinking, "It could happen to me."

Parents and caregivers should explain that you are there for them. If the child is going to camp and has concerns, families can come up with a plan to offer reassurance.

What should parents do if their child is worried, but they, too, are grappling with their own emotions?

If you are not ready to have the conversation, we can assist them or have the other parent/ caregiver step in.  It is always great to have someone who is calm and collected, rather than someone who is anxious, overwhelmed and distressed, because you will just pass on that anxiety to the child.

Cook Children’s wants to reassure parents and caregivers that you are not alone. If you are not ready to have the conversation, you can seek professional help.  Learn more about Cook Children's behavioral health services or to schedule an appointment for your child, contact 682-885-3917.

When should you seek out professional help?

 If your child is having symptoms:

• Loss of appetite
• Feelings of overwhelm
• Feelings of helplessness
• Jittery
• Difficulty concentrating
• They are not able to do their daily routine.

Learn more about Cook Children's resources online and behavioral health services.  Families can access mental health resources 24/7 through MHMR by calling 1-800-866-2465.

Despite this, medical professionals at Cook Children’s Health Care System often hear from families concerned about bullying at their children’s schools. Lisa Elliott, Ph.D., a neuropsychologist at Cook Children's, works with children throughout North Texas. She helps equip children and their parents on how to deal with bullies.

“Bullies thrive on the perception of power and control over another person’s emotions,” Elliott said.

While many have heard the rhyme, “sticks and stones may break my bones, but words will never hurt me,” that is not how to respond to a bully. Elliott has developed a nearly foolproof method.

“It’s critical for children to respond to a bully, but how they respond is just as important,” Elliott said.

Do not feed the rat

She explains that it is about using one or two words and tone.

Words she suggests are:

• Okay
• Who cares?
• Whatever
• So what?
• Big deal

However, the tone is just as critical, she explains. The tone should not show negative emotion, pain, frustration, anger, or hurt.

“What that communicates to the bully is, ‘I’ve heard you, but what you’re saying does not bother me,’” Elliott said. “It’s really important for a child to respond to a bully in the appropriate way.”

She adds that this tactic works best for verbal, emotional, and social bullying. If a child is being physically bullied, adults need to take the appropriate steps and inform authorities immediately.

However, if verbal bullying continues and intensifies despite using this method, Elliott says it is time for parents to report it to the proper authorities.

“Texas schools are required to adopt anti-bullying policies, and they’re supposed to establish procedures for reporting those incidents,” Elliott said.

What should parents do?

Elliott encourages parents to have daily conversations with their children. She says being inquisitive and having constant dialogue with children helps build their self-esteem.

The questions she suggests are:

• How was your day?
• What is going on?
• Have there been any bullies?
• Have you bullied anyone?
• Have you seen bullying done to other children?
• How did that make you feel?
• How did that make the other child feel?

It is also an opportunity, Elliott said, for parents to teach lessons in kindness. She encourages parents to take the time to identify their children’s strengths, what makes them special and unique, and empower and develop those skills. Doing so will help build their confidence.

As parents, it is important to have self-awareness that one’s child could be the bully.

“We have to remember our kids may be a bully because they’ve been bullied, they’ve seen it from other kids, or they’ve seen it on the news or from family members,” Elliott said.

She emphasizes it’s not about blaming parents but using the moment to start the dialogue. What are the circumstances or thoughts that led them to this? Elliott says this can help to know how to address those issues.

It helps to lead by example.

“What we expose our children to, in terms of our behavior, what we expose them to in media, any kind of online activities,” Elliott said. “It is our responsibility to teach them how to act.”

She explains it is important for children to learn that everyone needs to be respected, valued, important, and significant, regardless of cultural identity.

“One of the best things we can do is teach our kids to be a positive bystander and how they can stand up for somebody who is being bullied,” Elliott said.

Beyond proactively fostering positive behaviors, parents should be vigilant in recognizing signs of distress in their children.

Parents should look for changes in behavior, like eating habits, trends, isolation, dropping grades, and irritability, and to reach out to their children’s pediatrician. Their doctor can make a referral, or parents can call Cook Children's Behavioral intake.

“A parent should never dismiss those behaviors,” Elliott said.

Addressing these potential warning signs directly, including open discussions about suicide, is a crucial step in ensuring children's safety and well-being.

She adds that no studies have found that discussing suicide leads to suicide; on the contrary, it can help prevent it. However, if a parent feels uncertain about having the conversation, they should speak to their pediatrician.

Ultimately, fostering resilience and providing access to professional help when needed are the most powerful tools parents have to protect their children and guide them toward a healthy and fulfilling life.