This post will answer some questions about suicide risk assessment but doesn’t include training just which tools can be used together and the age groups for which they are validated for in addition to questions that Dr. Horowitz answered during the webinar.
Video: Suicide Assessment Tools: Which One Should We Use? C-SSRS (Columbia) or NIMH BSSA Tool?
Begin with a Suicide Screening Tool like the ASQ Suicide Screening Tool, which takes about 20 seconds. Unless someone has told you they are suicidal, in which case you’d go straight to an assessment.
According to Dr. Horowitz, the most important part of this process is that the screening tool is research-validated. The NIMH ASQ suicide screening tool and the PSS-3 are both research-validated suicide screening tools.
The assessment is to determine if further evaluation is needed. The combinations below are often used but the BSSA, Brief Suicide Safety Assessment, is approved by the Joint Commission for Emergency Departments because it does meet the criteria of risk and protective factors.
Here are a few combinations for Screening Tool + Assessment Tool:
- ASQ (ages 10+) + BSSA (10-24 yo version) Youth ASQ Toolkit with these two tools
- ASQ (ages 10+) + BSSA (18+ version) Adult ASQ Toolkit with these two tools
- ASQ (ages 10+) + C-SSRS (Most children and adults)
- With the ASQ screening, youth aged 8-10 can be screened if clinically indicated.
- Link to all NIMH Screening and Assessment Tools
- For more versions of suicide screening and assessment tools, go to the Zero Suicide Resource Database
The following questions and answers are either quoted or paraphrased from the video and the transcript that was presented in a webinar by Lisa Horowitz, PhD, MPH. You can see the whole video here.
What is the difference between a suicide screening and an assessment?
People tend to mix these terms up and use them interchangeably, but they are absolutely not interchangeable.
Screening is a very brief way to identify someone who needs further assessment for suicide risk. It’s quick and takes about 20 seconds. The assessment is a more comprehensive evaluation. It confirms risk and guides next steps.
So keep this in mind: if you hear someone interchanging screening and assessment, stop them, because screening and assessment are two different things.
Who should do the Suicide Safety Assessment?
The brief suicide safety assessment (BSSA) is ideally is done by a social worker, but many places don’t have that luxury. So another clinician, a nurse practitioner, or a physician assistant may do it. In the Indian Health Service, where they now use the ASQ + the BSSA, pharmacists were trained to do the assessment.
Residents, trainees, and fellows can also be trained. There are two assessment tools people typically use: either the Columbia Suicide Severity Rating Scale (C-SSRS) or the ASQ Brief Suicide Safety Assessment (BSSA) which was created so people could do further triage after the ASQ.
But really, whatever tool you use, it’s helping the clinician decide the next steps for the patient.
If a patient screens positive, they are either low risk (non-acute positive) and need a different kind of follow-up, or they are at imminent risk (acute positive) and need an emergency visit. The harder category is the yellow.
You identified something—it’s not an emergency, but they need further evaluation as soon as possible. There are eight versions of the BSSA because there is a telehealth version now. They’re all available on the NIH ask toolkit.
Is there a difference between the ASQ and the Columbia screener?
The Columbia Suicide Severity Rating Scale was made as a surveillance tool when the FDA had a black box warning put on SSRIs. It was not created as a suicide risk screening tool—it was a surveillance tool. It makes a better assessment tool than a first-line screener.
That’s because the screening part of the Columbia actually was never formally created through research. If you look, you can’t find a true screener version that was developed that way.
I recommend that people who use the Columbia (C-SSRS) start with the ASQ as the primary screener and then use the Columbia as the assessment.
The ASQ is very quick, was created through research, tested, and validated. The Columbia makes a better assessment tool because that’s how it was developed and tested.
Does the risk assessment have to be the BSSA, or can it be CSSRS with Safe-T?
The Joint Commission says you don’t even have to use a tool. But if you’re going to use a tool, it has to have certain elements—and two of those elements are risk and protective factors. The ASQ BSSA includes risk and protective factors, and the CSSRS doesn’t, which is why it’s often paired with the Safe-T.
It doesn’t matter what tool you’re using—you just have to make sure you do a good assessment.
The screening tool does matter. Not just the ASQ, as the PSS-3 is also a good screening tool.
Using an evidence-based and validated screener is really important. And if there is a positive result, which will likely be less than 5% of those you screen, then you use an assessment tool like the BSSA.
The links below will go to the exact location in the video where this question is answered.
AnneMoss Rogers is a leading wellness and suicide education expert and one of the top mental health speakers and suicide prevention speakers. Known for her powerful, motivational keynotes, AnneMoss combines her personal story of loss with proven strategies to help organizations build a wellness culture that drives results and saves lives. She speaks at conferences, workplaces, K-12 schools, and universities, delivering impactful presentations that inspire change and promote mental health awareness.
AnneMoss does this work in memory of her son, Charles, who struggled with anxiety, depression, and addiction, and died by suicide at age 20 in 2015.