C-SSRS

www.SuicideAwarenessAndPreventionCouncil.org
 

C-SSRS Columbia-Suicide Severity Rating Scale Risk Assessment
A Unique Suicide Risk Assessment Tool
The Columbia Protocol for Your Setting
The Columbia Protocol for Families, Friends, and Neighbors
Training for Communities and Healthcare
Columbia-Suicide Severity Rating Scale (C-SSRS) 5 page PDF
Preventing Student Suicide with Just a Few Simple Questions

Youth and students
Friends and Family
Teachers
First responders

C-SSRS Columbia-Suicide Severity Rating Scale Risk Assessment


The Columbia-Suicide Severity Rating Scale (C-SSRS), the most evidence-supported tool of its kind, is a simple series of questions that anyone can use anywhere in the world to prevent suicide.

JUST ASK.

YOU CAN SAVE A LIFE.

The first step is to ask. We used research and real-world experience to determine the right questions to ask to identify people of all ages at risk for suicide. The C-SSRS is designed for use around the world for research, communities and healthcare, and families, friends, and neighbors.

C-SSRS Helping to Reduce Suicide and Decrease Workload via Evidence-Based Thresholds for Imminent Risk

Kevin Hines, suicide attempt survivor, says “Most people considering suicide want someone to save them. What we need is a culture in which no one is afraid to ask. What we needed were the questions people could use to help save us. That’s why the pioneering change the C-SSRS is enabling is so essential to humanity.”
Source: www.colorado.gov/pacific/cssrc/trainings

A Unique Suicide Risk Assessment Tool


The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), supports suicide risk assessment through a series of simple, plain-language questions that anyone can ask. The answers help users identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs. Users of the tool ask people:

  • Whether and when they have thought about suicide (ideation)
  • What actions they have taken — and when — to prepare for suicide
  • Whether and when they attempted suicide or began a suicide attempt that was either interrupted by another person or stopped of their own volition

Suicide Prevention Benefits

The first step in effective suicide prevention is to identify everyone who needs help. The Columbia Protocol was the first scale to address the full range of suicidal thoughts and behaviors that point to heightened risk. That means it identifies risk not only if someone has previously attempted suicide, but also if he or she has considered suicide, prepared for an attempt (for example, buying a gun, collecting pills, or writing a suicide note), or aborted plans for suicide because of a last-minute change of heart or a friend’s intervention.

The Columbia Protocol screens for this wide range of risk factors without becoming unwieldy or overwhelming, because it includes the most essential, evidence-supported questions required for a thorough assessment. The Columbia Protocol is:

Simple. Ask all the questions in a few moments or minutes — with no mental health training required to ask them.

Efficient. Use of the protocol redirects resources to where they’re needed most. It reduces unnecessary referrals and interventions by more accurately identifying who needs help — and it makes it easier to correctly identify the level of support a person needs, such as patient safety monitoring procedures, counseling, or emergency room care.

Effective. Real-world experience and data show the protocol has helped prevent suicide.

Evidence-supported. An unprecedented amount of research has validated the relevance and effectiveness of the questions used in the Columbia Protocol to assess suicide risk, making it the most evidence-based tool of its kind.

Universal. The Columbia Protocol is suitable for all ages and special populations in different settings and is available in more than 100 country-specific languages.

Free. The protocol and the training on how to use it are available free of charge for use in community and healthcare settings, as well as in federally funded or nonprofit research.

Endorsed, Recommended, or Adopted by:

Action Alliance, CDC, FDA, NIH, SAMHSA, The Joint Commission, World Health Organization

Using the Columbia Protocol

Asking Questions

Protocol administrators ask a series of questions about suicidal thoughts and behaviors. The number and choice of questions they ask depend on each person’s answers. The questioner marks “yes” or “no,” as well as how recently the thought or behavior occurred and — for some versions of the protocol — a scoring of its severity. The shortest screeners are condensed to a minimum of two and a maximum of six questions, depending on the answers, to most quickly and simply identify whether a person is at risk and needs assistance. For a more thorough assessment of a person’s risk, Columbia Protocol askers should use the standard versions.

The Columbia Protocol questions use plain and direct language, which is most effective in eliciting honest and clear responses. For example, the questioner may ask:

  • “Have you wished you were dead or wished you could go to sleep and not wake up?”
  • “Have you been thinking about how you might kill yourself?”
  • “Have you taken any steps toward making a suicide attempt or preparing to kill yourself (such as collecting pills, getting a gun, giving valuables away, or writing a suicide note)?”

Determining Next Steps

To use the Columbia Protocol most effectively and efficiently, an organization can establish criteria or thresholds that determine what to do next for each person assessed. Decisions about hospitalization, counseling, referrals, and other actions are informed by the “yes” or “no” answers and other factors, such as the recency of suicidal thoughts and behaviors.

The Columbia Lighthouse Project provides many examples of triage documents that Columbia Protocol users in hospitals, primary care practices, behavioral health care facilities, military services, prisons, and other settings employ to make these decisions. The Project also provides assistance to any organization that is thinking through its policy and establishing a care plan.

Origins of the Columbia Protocol

Columbia University, the University of Pennsylvania, and the University of Pittsburgh — supported by the National Institute of Mental Health (NIMH) — developed the screening tool for a 2007 NIMH study of treatments to decrease suicide risk among adolescents with depression. The Columbia Protocol, based on more than 20 years of scientific study, filled an urgent need for suicide research and prevention: a better way to uniformly and reliably identify people who are at risk. The Columbia Protocol achieved accurate and comparable results by using consistent, well-defined, and science-based terminology. Just as important as its ability to identify who might attempt suicide, it was the first tool to assess the full range of a person’s suicidal ideation and behavior, including intensity, frequency, and changes over time. .

In 2011, the Centers for Disease Control and Prevention adopted the protocol’s definitions for suicidal behavior and recommended the use of the Columbia Protocol for data collection. In 2012, the Food and Drug Administration declared the Columbia Protocol the standard for measuring suicidal ideation and behavior in clinical trials. Today, the Columbia Protocol is used in clinical trials, public settings, and everyday situations, such as in schools, faith communities, hospitals, and the military, to identify who needs help — saving lives in 45 nations on six continents.
Source: cssrs.columbia.edu/the-columbia-scale-c-ssrs/about-the-scale/

The Columbia Protocol for Families, Friends, and Neighbors


How do you help someone who is suicidal? The first step in suicide prevention is awareness — knowing when someone is in crisis. That’s often not obvious, because many people suffer in silence or give no sign that they might harm themselves. As a family member, friend, neighbor, or colleague, you can make a difference by using the Columbia Protocol — also known as Columbia-Suicide Severity Rating Scale (C-SSRS) — to help determine when someone is at risk for suicide and how to help.

The Community Card version of the Columbia Protocol is the one best suited for use by family members, friends, and others who have a relationship with a person who may be at risk. It involves asking just three to six questions, but the answers provide enough information to determine whether someone needs help and if immediate action is needed. The questions’ plain language also may make it easier for you to talk to someone who may be suicidal. Start the conversation now.

(2 page PDF each)

The Columbia Protocol for Your Setting


Columbia Lighthouse Project provides versions of the Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), for use in community and healthcare settings. These are places where individuals and teams have the access and opportunity to systematically assess risk and save lives. Examples include:

(2 page PFD each)

You do not need special permission from us to take the Columbia Protocol tools and use them in your setting, create your own unique triage next steps, or embed the Columbia Protocol in your electronic health record keeping systems (EHR). We are happy to look at any materials you develop, policies you write or screenshots of your EHR to confirm their accuracy. You can send them to us at posnerk@nyspi.columbia.edu

See our C-SSRS for Research page for versions of the scale and information for researchers.

Configure Your Toolkit

It’s easy to assemble and download a toolkit of the Columbia Protocol versions and related documents you need to assess suicidal ideation and behavior using the versions of the protocol that are appropriate for your setting. Just make the selections below.

Note: The screener versions require just two to six questions and are commonly used for clinical triage by first responders, emergency room and crisis call center staff, and non-mental health users like teachers or clergy.
Source: cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-families-friends-and-neighbors/

Preventing Student Suicide with Just a Few Simple Questions


Suicide among children and teens is shockingly on the rise. In the wake of each tragedy, parents, peers, and educators are filled with devastation and regret. Spending so much time with children, teachers often feel guilty that they didn’t realize their student was suicidal. Other times, they sensed something was wrong but weren’t sure how to effectively intervene. So how can teachers determine if their students are at risk for suicide, and what can they do about it?

Learning these simple steps could help you save a student’s life:

1. Separate suicide and NSSI

One of the obstacles in providing proper interventions is educators not grasping the difference between suicidal behavior and non-suicidal self-injury (NSSI). Both are serious and require intervention, but the response for suicidality is different than for NSSI. Properly identifying a student’s behaviors is an important first step in getting them the right help. A few key characteristics of the two include:

Suicidal behavior/ideation:

  • The person has some intention of dying
  • They know that their behavior could result in death
  • May seek the most painless way to do it

NSSI:

  • Has no intention of dying
  • Does not believe their actions could result in death
  • Seeks physical pain to escape emotional pain
  • NSSI has 3 possible functions:
    • To obtain relief from a negative feeling or cognitive state e.g. stress, worry thoughts, loneliness, emptiness
    • To resolve interpersonal conflict e.g. family arguments, divorce, sibling rivalry, peer conflict
    • To induce a positive feeling state e.g. euphoria, decrease numbness
For an in-depth look at NSSI and what to do about it, click here

2. Explore the C-SSRS

The Columbia-Suicide Severity Rating Scale (C-SSRS) was developed to provide a simple, accurate, and effective tool that anyone can use to evaluate risk for suicide. You do not need to be a mental health professional to administer it; all it requires is asking a series of simple questions and referring them to mental health services if their answers raise any red flags.

The full C-SSRS screening tool is available in several versions.

Below are a few quick links to commonly used versions.

Click here to access all versions of the C-SSRS.

  • C-SSRS for Teachers
  • C-SSRS for Family and Friends
  • C-SSRS for Teens to Talk to Friends
  • C-SSRS for Parents

3. Identify ideation

The first step in applying the C-SSRS is identifying ideation. If you are concerned your student may be at risk for suicide, start by asking these 2 questions:

  • “Have you wished you were dead or wished you could go to sleep and not wake up?”
  • “Have you actually had any thoughts of making yourself not alive anymore?”

4. Ask more as needed

When administering the C-SSRS, you only need to ask as many questions as it takes to determine whether your student has had suicidal ideation or behaviors. If your student answered no to both ideation questions, you can rule out ideation and jump right into the behavior questions listed in our next point. If they answered yes to either or both ideation questions, ask a few more ideation questions to gain understanding:

  • “Have you been thinking about how you might do this?”
  • “Have you had these thoughts and had some intention of acting on them?”
  • “Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?”

5. Assess for behaviors

Whether or not your student has indicated ideation, you must also ask behavioral questions. Determine whether they’ve engaged in suicidal behaviors by asking the following questions:

  • “Have you made a suicide attempt?”
  • “Have you done anything to harm yourself?”
  • “Have you done anything dangerous to where you could have died?”

6. Inquire about interruptions

Next, ask your student if there were ever times where they had attempts that were either stopped by someone interrupting them, or by them having second thoughts:

  • “Has there been a time when you started to do something to end your life but someone or something stopped you before you actually did anything?”
  • “Has there been a time when you started to do something to end your life but you stopped yourself before you actually did anything?”

7. Ask about preparatory behaviors

Even if your student has not indicated making any attempts, it’s important to find out if they’ve done anything to prepare to end their life. Examples could include collecting pills, purchasing a gun, writing a suicide note, or giving valuables away.

“Have you taken any steps toward making a suicide attempt or preparing to kill yourself?”

8. Know when it’s an emergency

If your student answers yes to any questions regarding ideation, behaviors, or non-suicidal self-injury, it’s important to refer them to mental health resources. For a student to require a 911 call and/or immediate escort to emergency services, they should meet either of the following criteria:

  • Active suicidal ideation with some intent to act, without specific plan
  • Active suicidal ideation with specific plan and intent
Learn how to ask C-SSRS questions
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9. Reach out and speak up

If your student’s answers have indicated suicidal ideation, suicidal behaviors, or non-suicidal self-injury, quickly share your findings with the school leadership, crisis response team, school psychologist, school counselor or other mental health professional on campus. If you’re not sure who to alert, call 911. As a preventative measure, advocate for mental health programming to be offered on campus so that all students learn healthy coping skills and become aware of available resources.

10. Host a C-SSRS training

The best way to prevent tragedy on campus is to get your faculty on the same page with effective tools that address mental health emergencies. While you don’t have to be a mental health professional to administer the C-SSRS, it’s best to complete a brief online training and receive additional in-person education from a mental health professional to fully grasp how to evaluate student answers in real-life scenarios.

Here is a listing of C-SSRS training options including pre-recorded and live webinars.

If you represent a private school or district that would like to do an in-service teacher training, our Specialists can:

  • Visit your campus for in-person training
  • Answer questions and review key concepts of applying the C-SSRS
  • Provide realistic examples of evaluating students’ risk for self-harm
  • Help teachers prepare students for educational units or aspects of popular culture that may romanticize suicide (example: Romeo and Juliet, TV shoes depicting suicide, etc.)

The purpose of this article is to provide an overview of the highlighted topic.

References:

The Columbia Lighthouse Project (2018). The Columbia Protocol for Your Setting. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/#filter=.general-use.english

The Columbia Lighthouse Project (2018). Community Card for Teachers. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-Teachers-2018c.pdf

The Columbia Lighthouse Project (2018). Community Card for Friends and Family. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-2women-2018c.pdf

The Columbia Lighthouse Project (2018). Community Card for Teens. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-Teens-2018c.pdf

The Columbia Lighthouse Project (2018). Community Card for Parents. The Columbia Protocol for Communities and Healthcare. Retrieved from http://cssrs.columbia.edu/wp-content/uploads/Community-Card-Parents-2018c.pdf

The Columbia Lighthouse Project (2017). C-SSRS Training. [Video webinar]. Retrieved from https://www.youtube.com/watch?v=epTDFFv3uwc&list=PLZ6DpvOfzN1kV1F_lDw9-26JifBSDlIbF&index=2&app=desktop

Shinn, M.M. (2018). Cutting & Other Self-Harm: What Every Parent Needs to Know. Psychologically Speaking. [Variations Psychology blog post]. Retrieved from https://www.variationspsychology.com/blogs/cutting-other-self-harm-what-every-parent-needs-to-know

Shinn, M.M. (2018). 8 Tips to Create a Mentally Healthy Classroom. Psychologically Speaking. [Variations Psychology blog post]. Retrieved from https://www.variationspsychology.com/blogs/8-tips-to-create-a-mentally-healthy-classroom

Shinn. M.M. (2019). Parent’s Guide: What to do When Your Child’s Friend Dies by Suicide. Psychologically Speaking. [Variations Psychology blog post]. Retrieved from https://www.variationspsychology.com/blogs/parents-guide-what-to-do-when-your-childs-friend-dies-by-suicide

Shinn. M.M. (2019). Suicide Prevention in the School Setting. Variations Psychology, Futures Academy. [Webinar].
Source: 
www.variationspsychology.com/blogs/preventing-student-suicide-with-just-a-few-simple-questions

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