Editor’s note: This story talks about topics related to suicide. If you or anyone else needs resources, please call or text 988 or visit 988colorado.com.

For Dr. Maya Haasz, it didn’t feel right to use a tool to screen children for suicide risk that might not work for kids who live in rural places.

The emergency room physician at Children’s Hospital Colorado in Aurora had plenty of experience asking kids who came in for stomach pain, migraines and any other ailment about whether they had thought about suicide. But she didn’t feel great, knowing the tool hadn’t been developed with the perspective of kids who live outside cities, who might not be receptive to the questions or how they were asked.

Now, she’s hoping to get input and perspective from teens and their caregivers who live in rural areas, who have experience with past suicidal thoughts or attempts and are in a place where they feel OK talking about it now.

The goal is to develop a screening tool relevant to youth who live outside cities, to ask them whether the way questions are worded is actually helpful, and find out what changes need to be made.

The tool would be used by emergency room doctors, primary care doctors and others to help teens and their caregivers and help prevent suicide.

At Children’s Hospital, all kids age 10 and older who come in to the emergency room are screened for suicide risk with a questionnaire, whether they come in for something related to self-harm or other injuries, like a broken arm from a bike crash.

Approximately 7% of the kids who are screened with the suicide questionnaire now have had suicidal thoughts, Haasz said. And 90% of those kids only see an emergency room doctor, not a mental health expert.

“They might be reporting that for the first time,” Haasz said. “That might be a cry for help. And so that is basically going through these charts and seeing a child say, ‘Yes, in the past two weeks, I wish I was dead, and in the past few weeks, I thought my family would be better off if I was dead.’ And we weren’t, apart from giving them a paper with resources that may or may not be available, we weren’t doing enough to support them.”

In these moments where she and her colleagues were trained to deal with crisis in the emergency room, they are also on the front line to intercept kids who are at risk of harming themselves.

Maybe they weren’t thinking about it at that moment at the hospital, but if kids told the doctor they had those thoughts in the past, she wanted a better way to help them.

“One of the high-yield things we’re talking about (is) lethal means safety at home,” she said.

That term – lethal means safety – refers to developing a plan to store things children and teens could use to hurt themselves in a less-accessible way, if they’re in crisis. It includes everything from medications to sharp instruments and firearms. These kinds of safety plans have been made for adults, and for caregivers of teenagers, but Haasz wanted a better tool for teens themselves, and not just the ones who live in urban places.

The firearms part is something Haasz knows she needs input on from rural survey participants. While families with guns in the home in urban areas might value them for personal protection, she knows there’s a cultural difference for those who keep firearms in rural places, where they may be used more for hunting or protecting livestock. How people talk about that potential risk in a screening tool with those who live in rural places matters, she said.

“So much of our research, period, happens in these academic centers, and then, at the end, we put this little limitation of this study, that we did not do it in rural settings, so we don’t know if it applies,” Haasz said.

That tiny disclaimer on these studies bothered her, the part where the researchers had to admit they weren’t sure if the tool worked outside of cities.

By doing this study and the work to get rural perspectives, “We can actually try to make it apply more broadly,” she said.

“I want to come out with something that actually is relevant to people who are in urban and rural settings. And I think people view safety planning very differently in these two areas.”

So far, she said she’s learning people view suicide differently in rural areas, and she hopes to gain more perspective.

During interviews conducted with teens in Aurora for a new suicide screening tool, Haasz had 34 interviews, and she said she knows those teens who offered their opinions made a difference.

“Looking at what the teens had to say, their lived experience, will make this more relevant for people who come after them,” she said. “Learning from them what they want to hear, how they want to hear it, what would make things worse. We can’t know those things if we don’t talk to them.”

Now, Haasz is asking for teenagers who live in rural areas and their caregivers to help her develop that tool. She knows it’s not easy, but she hopes people will be willing to participate and help her create a better tool to help others in the future.

“We just want to talk to teens, 13 to 19 years old, who have had lived experience, either had a suicide attempt or suicidal thoughts, and their caregivers,” Haasz said.

Selected participants will have a 30 to 60 minute interview and compensation is provided. Teens and caregivers can participate separately or together. Participants ages 18 or 19 do not need parental consent. Information provided by participants is kept confidential.

Haasz is looking for participants who have past experience with this topic but are not struggling at the moment, as the survey interview does not offer intervention.

Haasz hopes to get at least 15 participants in the next few months, and said she has had some challenges recruiting.

“I’m not giving up on it,” she said. “I could speak to people here in Denver, Aurora, and they will just not have the same experience and it will not come up with as good of a tool.”

To participate, click here.