6 - (IOP18) Clinician and Caregiver Confidence with Routine Suicide Risk Screening for Autistic Youth

While routine suicide risk screening is a recommended practice in child mental health (MH) care, implementation of screening with autistic youth is inconsistent despite elevated suicide rates in this group. Because clinician confidence screening autistic youth for suicide risk as well as caregiver confidence in clinicians screening their child may both impact implementation rates, we used a mixed method research design to understand the attitudes of MH clinicians and caregivers of autistic youth, including factors associated with confidence. Eighty-two youth MH clinicians and 48 caregivers of autistic youth completed online surveys inquiring about their experience with and attitudes toward suicide risk screening for autistic youth. Five questions about confidence were asked in both clinician and caregiver surveys (e.g., “I have the skills needed to screen autistic patients for suicide risk” and “I am confident in a healthcare providers ability to accurately screen my autistic child for suicide risk”). Twenty percent of survey respondents were then selected to engage in qualitative interviews. MH clinicians rated their confidence statistically significantly lower caring for autistic compared to non-autistic youth across all areas of suicide risk screening and management (all p< 0.005). Higher clinician confidence was associated with more experience with autistic patients at risk for suicide and more training in autism (both p< 0.001). No differences in clinician confidence were found by clinician discipline, years of experience, proportion of autistic youth on their caseload, and their current strategies for screening autistic youth. Caregiver confidence was significantly positively correlated with satisfaction with child outpatient MH services on the Service Assessment for Children and Adolescents (ρ=0.41; p=0.029). However, no differences in caregiver confidence were found across youth characteristics (e.g., age, race, intellectual ability, autism features, co-occurring diagnoses, history of suicide symptoms) or care experiences (e.g., prior inpatient or outpatient treatment, previous experience with screening). There were no significant differences in clinician and caregiver confidence regarding suicide risk screening and management for autistic youth. However, caregivers recommended screening significantly more frequently (i.e., at every visit) than clinicians endorsed implementing screening (i.e., primarily when there are concerns), X2(3)=38.92, p< 0.001. These results suggest education and implementation support is warranted to promote improved screening rates. Important considerations for training and supporting caregivers of and clinicians serving autistic youth were identified in subsequent interviews and included disseminating screening guidelines specific to autistic youth, ensuring sufficient clinician training in autism, using accessible language and strategies to reduce social communication demands, ensuring caregiver understanding of screen results and next steps, and assisting families in navigating the service system. These preliminary results will be updated after qualitative data collection ends in April 2025.