Fort Worth, TX,
16:07 PM

Team HOPE at Cook Children's Brings Light to Patients at Risk for Suicide

A significant increase of patients in Emergency Department have screened positive for suicide risk, according to trauma data.

Note: If your child is a danger to themselves or someone else, do not delay. Take your child to the nearest emergency room or call 911 if you cannot transport your child safely.  If you feel your child needs support, please click here to find a Cook Children's Behavioral Health location near you. You can also address your concerns with your child’s pediatrician, psychologist or therapist. View mental health resources here.

By Heather Duge

Cook Children’s Emergency Department nurse manager Kara Dorman has seen an alarming trend – a significant increase in patients coming in with a seemingly invisible problem. Patients may enter the ED for an injury or illness but have a mental health concern that also needs to be addressed.

“As we track suicide screening numbers, it has been horrifying and mind-blowing to see all these kids who visit the ED for medical problems and screen positive for suicide risk,” Dorman said. “These are kids we wouldn’t have known about if we didn’t ask.”

Many times asking the hard questions is the most challenging part of identifying those who need help. That’s when Team HOPE, a specially trained group of 25 employees at Cook Children’s, enters the picture. Team HOPE

Dorman and ED chaplain Cameron Brown lead the team, which includes patient care technicians, paramedics, nurses, security officers, chaplains and child life specialists. The team meets monthly, participates in education and shadows the inpatient psychiatry unit for eight-hour shifts.

Dorman and Brown proactively round on patients using Trust Based Relational Intervention (TBRI) to build early rapport. TBRI is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. The team uses the Ask Suicide Questions (ASQ) screening tool and TBRI training has been instrumental in the screening process.

The ED screens patients during intake to ask questions about their mental health. From January through July 2023, 405 patients ages 8 and older who came to the ED for medical conditions were positive for being at risk for suicide and 19 were suicidal at the time. In 2022, Team HOPE assessed 32,000 patients ages 8 and over who came to the ED for medical conditions – 640 were positive for being at risk for suicide and 22 were suicidal at the time.

Building Early Connections

If a nurse in the ED feels like they need help, they can call Team HOPE. An intake therapist will perform a behavioral health intake assessment and provide tailored resources for the patient to get help.

Oftentimes, patients come in and don’t want to speak to anyone.

“A huge factor in saving lives when treating mental health illness is connection,” Dorman said. “Good eye contact and modeling a calm demeanor when entering the room is the first thing. We share power and control with patients such as giving them choices of what drink they would like to take with their medicine and offering green scrubs instead of an open gown. We talk about transitions of care ahead of time and introduce their new nurse before shift change.”

Behavioral health carts filled with games, clay, stress balls, model magic and journals are other tools the team uses for distraction and to get rid of nervous energy. Brown not only provides patient families with support but also the ED staff. She checks in during each shift with team members.

“I ask how they are coping and assess how they are handling things,” Brown said. “I help them when patients are dysregulated and give them permission to ask for help.”

Sometimes that means walking through a scenario such as thinking through how to go in the patient’s room while maintaining a calm presence. 

Suicide Prevention Training

Dorman and Brown attended QPR training, which is an emergency response training for someone in crisis, hosted by the Jordan Elizabeth Harris Foundation. This training helped them learn how to ask difficult questions when concerned about someone having suicidal thoughts.

“This has been helpful in having conversations with friends, family, fellow coworkers and when checking in on each other in different units,” Dorman said. “Team HOPE members are a resource for not only our patients but for ED staff members as well. The QPR training helped our team gain knowledge and feel empowered to role model that having conversations matters.”

Ellen and Tom Harris established the Jordan Elizabeth Harris Foundation in 2014 after their daughter died by suicide. They know how unexpected depression and suicide can be after experiencing it with their daughter.

Jordan was valedictorian of her high school class, a National Merit Scholarship winner, a Stamps scholar at the University of Michigan, an athlete, musician and a friendly, compassionate young woman. The JEH Foundation honors Jordan’s life by raising money to support research on depression and offering training to help people recognize signs of depression.

"Jordan was the kind of person you would never expect to take her life,” Ellen said. “She was a wonderful, kind, funny and loving person with loads of friends and interests.”

After Jordan developed depression during her senior year of college, Ellen and Tom brought Jordan home until she felt ready to go back. Her upbeat personality hid the severity of the depression. Ellen said the confusing part of depression is that people who take their lives don’t want to die – they just don’t see any other way out of the dark hole.

“The night before Jordan passed away, she was on her computer searching for a therapist,” Ellen said. “She was trying to find a way out.”

Ellen and Tom’s goal through the foundation is to help people out of the dark hole. They offer free QPR training to the public.

During the 45-minute sessions focusing on Question, Persuade and Refer, people build confidence in asking the hard questions about suicide, learn how to persuade someone to seek help and understand referral options.

The sessions also include myths and facts about depression, nationwide statistics about the depression epidemic, ways to be aware of someone struggling and verbal versus nonverbal cues. Dorman had the desire to bring their training to Cook Children’s and four months ago 25 employees at the hospital participated in a session.

“If we can save one life, everything we’re doing has been worth it,” Ellen said. “I’m thrilled to provide training for employees at Cook Children’s. It is critical hospitals have this training because the earlier you can catch depression and start treating it the greater the outcome.”

Dorman said one interaction in the ED can be the moment that changes the trajectory of a patient’s life – bringing them hope in a dark time.

“We want to connect with these patients and empower them to seek help,” Dorman said.

September is National Suicide Prevention Month. If you are concerned about a child’s mental health, please reach out to one of these resources or your child’s pediatrician. It is important to get help early so that children can get the support they need.