Background: Suicide risk screening is recommended in pediatric care. To date, no previous studies illustrate the implementation of suicide risk screening in pediatric subspecialty care, even though chronic medical conditions are associated with a higher risk of suicide. Methods: A large multidivision pediatric ambulatory clinic implemented annual suicide risk screening. Patients ages 9–21 years participated in suicide risk screening using the Ask Suicide-Screening Questions during the project. A multidisciplinary team employed quality improvement methods and survey-research design methods to evaluate the feasibility and acceptability of the screening process for patients, families, and medical providers. Results: During the quality improvement project period, 1,934 patients were offered screening; 1,301 (67.3%) patients completed screening; 82 patients (6.3% of 1,301 patients) screened positive. The monthly compliance rate held steady at 86% following several Plan-Do-Study-Act cycles of improvement. The survey results demonstrate that providers rated the suicide risk screening process positively; however, a subset of providers indicated that the screening process was out of their scope of practice or impeded their workflow. Conclusions: Suicide risk screening is feasible in pediatric specialty care and can identify at-risk patients. Continued efforts are needed to standardize suicide risk screening practices. Future directions include identifying factors associated with suicide risk in patients in pediatric subspecialty care settings.

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The evidence-base for engaging and integrating children’s voices and their families in healthcare decision-making is emerging and of critical need. In this chapter, the authors review best practices in engaging and communicating with children of all ages and their families, foundational ethical principles and decision-making constructs in pediatric care, and the role of the interdisciplinary healthcare team in supporting children and their families in finding their voices in decision-making throughout the illness continuum. The powerful, illuminating perspectives of Faith, a young adult living with cystic fibrosis, and Jen, the mother of a young boy living with a rare, progressive, metabolic condition, as well as Yong and Mateo’s clinical vignettes, interwoven throughout, highlight critical and common decision-making conflicts, challenges, and successes. Children, adolescents, young adults, families, and interdisciplinary healthcare teams must come together to develop the next generation of innovative, effective shared decision-making strategies, frameworks, skills, and tools.