ASQ Program
Workgroup Membership
Members of the ASQ Program Workgroup have expertise in areas including: IHS clinical workflows, local level policy requirements, and tribal influence and impact on IHS healthcare systems.
- Dr. Pamela End of Horn
- Dr. Joy McQuerry
- CAPT Wil Darwin
- Nancy Largent
- Dr. Shiloh Martin
- CDR Michelle Livingston
- CDR John Collins
- Dr. Theresa Nez
- Naomi Bruinius
- Theresa Yazzie
Workgroup Objectives
- Increase the proportion of healthcare providers that are trained in suicide care management.
- Increase the rate of screening across the IHS healthcare system through updating of policy and clinical flow processes.
- Increase the proportion of healthcare providers to act as change agents within the Healthcare system to inform and share information on evidence-based practices related to suicide prevention and care.
- Increase subject matter expertise within the IHS healthcare system to provide input into national program, policy and evaluation development.
Emerging Issues
As the ASQ risk screening tool expands its usage in medical facilities, a number of issues will emerge. Responsive planning means expanding awareness of necessary next steps that may include:
- Suicide Risk Assessments: Patients who screen acute positive on the ASQ must be administered an evidence-based suicide risk assessment.
- Safety Planning: Patients at risk of suicide will work collaboratively with appropriate clinical staff to develop a safety plan. Examples of components of a safety plan are recognizing warning signs, developing internal coping strategies, and identifying social relationships and resources as protective factors.
- Lethal Means Restrictions: Lethal means are the materials that can be used to engage in suicide related behavior. Counseling on restricting access to lethal means is an evidence-based strategy that can be part of a patient's safety plan.
Suicide has been recognized as a serious public health issue that disproportionately impacts American Indian and Alaska Natives. To better serve populations at risk and mitigate suicide deaths, IHS has identified and will implement a uniform, research-based screening tool. All IHS federal facilities will implement the Ask Suicide-Screening Questions (ASQ) standardized, universal suicide risk screening tool. The mandate supports the Indian Health Manual, Part 3, Chapter 34, Suicide Prevention and Care policy and states that:
- Screening All patients aged 8 years and older will receive a screening to identify suicide risk at every visit within Emergency Departments and Urgent Care; upon admission into a medical surgical unit or residential programs; and every three months in all other health care clinics and departments to assure accurate assessment, diagnosis, effective treatment, and follow-up services, as clinically indicated.
A diverse cross section of healthcare professionals have joined together to form the ASQ Program Workgroup in support of this initiative. The group selected objectives based on the mandates put forth in the Indian Health Manual Chapter 34, and with the intention to garner multiple perspectives from across healthcare systems to inform and guide the work. The ASQ Program Workgroup participates in bimonthly meetings and focuses on the following core functions:
- Identifying emerging issues including potential barriers and provide solution-oriented feedback;
- Strategizing program rollout based on best practices; and
- Providing recommendations for systemic implementation based on subject matter expertise.
The ASQ implementation will take a phased approach based on regional readiness and with consideration to the number of direct services sites in each area. Regional teams will receive training in partnership with the National Institue of Mental Health, and follow a train the trainer model, allowing key staff to disseminate knowledge to a wider audience. Support for each site will include a policy review, consultation sessions, and on-site training for service providers. The system wide start date for the ASQ to go live across the Indian Health Service will be September 1, 2025.
Read the bibliography of consulted resources [PDF - 120 KB]
