Resources and References


Resources by Slide



LEARN Method of Suicide Prevention

LEARN Quick Steps Reference

Screening for Suicide Risk

Updated Joint Commission Recommendations (December 2018)


National Action Alliance for Suicide Prevention, Best Practices in Care Transitions for Individuals with Suicide Risk: Inpatient Care to Outpatient Care


Washington State Bree Collaborative Standards

Review: Depression Screening in Primary Care Settings

Patient Health Questionnaire-2 (PHQ-2) Tool

Patient Health Questionnaire-9 (PHQ-9) Tool

Screening Special Populations: Pediatric


Severity Measure for Depression[DR1] , Ask Suicide-Screening Questions (ASQ)

Screening Special Populations: Pregnant & Post-Partum Women

Edinburgh Postnatal Depression Scale (EPDS)

Screening Special Populations: LBG & Transgender

APA Practice Guidelines for LGB Clients

Pause & Reflect, LEARN Steps: Look

Suicide Prevention Protocol

SAFE-T Assessment


SAFE-T Step 3: What is C-SSRS

Columbia Suicide Severity Rating Scale (C-SSRS)

Plan for Safety

UW AIMS Center Patient Safety Plan Template (template is on page 9)

Crisis Lines & Other Supports

LGB & Transgender and Veteran Hotlines:


Veterans Crisis Line

Confidential, national, available 24/7/365, and serves all Veterans, Service members, National Guard and Reserve, and their families and friends.

Contact options:

·         Call: 1-800-273-8255 and Press 1

·         Text: 838255

·         Chat: connect at

·         Support for deaf and hard of hearing: 1-800-799-4889


Military Crisis Line

Confidential, national, available 24/7/365, and serves active duty, Guard and reserve members, and their families and friends. Contact options:

·         Call: 1-800-273-8255 and Press 1

·         Text: 838255


The Trevor Project

National, confidential, available 24/7/365, with 3 contact options:

·         TrevorLifeline, 1-866-488-7386 (phone)

·         TrevorChat (online IM)

·         TrevorText (texting)


Trans Lifeline

National, staffed exclusively by trans operators, currently has no middle of night guaranteed coverage

·         Call: 1-877-565-8860


LGBT National Senior Hotline

National, confidential, limited hours

·         Call: 1-888-234-7243

·         Email:


Tony: Safety Planning

UW AIMS Center Patient Safety Plan Template (template is on page 9)


Additional Resources

National Suicide Prevention Lifeline: Call 1-800-273-8255 (Available 24 hours every day)


Safer Homes:

AIMS Center:

American Association of Suicidology:

Beacon Health Call to Action:

Suicide Prevention Resource Center:

Zero Suicide:



Slide Title

Specific Detail from Source


Screening for Suicide Risk (cont’d)

USPSTF recommendations to screen adolescents and adults for depression when appropriate systems are in place to ensure adequate diagnosis, treatment, and follow-up.


Screening for Suicide Risk (contd)

2018 Joint Commission recommendations

US Preventive Services Task Force

2016 USPSTF recommendations



Patient Health Questionnaire-9 (PHQ-9)

Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues (accessed Aug. 17, 2015). Kroenke K., Spitzer R. L., & Williams J. B. (2003). The patient health questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284–1292.

Retrieved from

Patient Health Questionnaire-2 (PHQ-2)

Kroenke K, et al. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care 2003, (41) 1284-1294 (accessed Aug. 17, 2015).

Zero Suicide in Health and Behavioral Health Care

Screening for and assessing suicide risk. (Accessed July 27, 2015).

Screening Special Populations:  Pediatric


Johnson JG, Harris ES, Spitzer RL, Williams JBW: The Patient Health Questionnaire for Adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolescent Health 30:196–204, 2002.

Ask Suicide Screening Questions

Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M. Ask Suicide-Screening Questions (ASQ). A Brief Instrument for the Pediatric Emergency Department Archives of Pediatrics and Adolescent Medicine. December 2012. 166(12):1170–1176.


Diamond G, Levy S, Bevans KB, et al. Development, validation, and utility of Internet-based, behavioral health screen for adolescents. Pediatrics 2010;126(1):163–70.

Screening Special Populations:  Pregnant & Post-Partum Women

General reference

Orsolini, Laura et al. “Suicide during Perinatal Period: Epidemiology, Risk Factors, and Clinical Correlates.” Frontiers in Psychiatry 7 (2016): 138. PMC. Web. 6 Sept. 2017.


KL Wisner, BL Parry, CM Piontek. Postpartum Depression. 347(3): N Engl J Med 194-199. 2002.


JL Cox, JM Holden, R Sagovsky. Detection of Postnatal Depression: Development of the 10-item Edinburgh Postnatal Depression Scale. 150: Br J Psychiatry 782-786. 1987.

PHQ-9 and EPDS may be applied with equal confidence in screening for MDE in the community.

Santos IS, Tavares BF, Munhoz TN, et al. Patient Health Questionnaire-9 versus Edinburgh Postnatal Depression Scale in screening for major depressive episodes: a cross-sectional population-based study. BMC Research Notes. 2017;10:57.


Screening Special Populations: LGB and Transgender


Risk Factors


Suicide Assessment in Medical Setting

Suicide Assessment in Medical Setting

Columbia Suicide Severity Rating Scale (C-SSRS)


SAFE-T Assessment


SAFE-T Assessment


SAFE-T Step 1: Risk Factors

Risk factors

Pediatric-Specific Risk Factors

Non-completion of high school

Han, B., Compton, W. M., Eisenberg, D., Milazzo-Sayre, L., McKeon, R., & Hughes, A. (2016). Prevalence and mental health treatment of suicidal ideation and behavior among college students aged 18-25 years and their non-college-attending peers in the United States. The Journal of Clinical Psychiatry, 77(6), 815-824.

30% of youth who die by suicide are LGBT


LGBT youth

Social media and youth suicide

LGBT homelessness

Peer victimization

JAMA. 2014 Aug 6;312(5):545-6. doi: 10.1001/jama.2014.3212.

Peer victimization, cyberbullying, and suicide risk in children and adolescents.

Gini G, Espelage DL.

Suicide contagion

Media Contagion and Suicide Among the Young MADELYN GOULD, PATRICK JAMIESON, DANIEL ROMER AMERICAN BEHAVIORAL SCIENTIST, Vol. 46 No. 9, May 2003 1269-1284 DOI: 10.1177/0002764202250670


J Abnorm Psychol. 2013 Feb;122(1):231-7. doi: 10.1037/a0030278. Epub 2012 Oct 15. The relationship between nonsuicidal self-injury and attempted suicide: converging evidence from four samples.

Klonsky ED1, May AM, Glenn CR.

Veteran-Specific Risk Factors

Veteran Content

Pregnant & Post-Partum-Specific Risk Factors

Risk factors


Front Psychiatry. 2016; 7: 138. Published online 2016 Aug 12.  doi:  10.3389/fpsyt.2016.00138 PMCID: PMC4981602

Suicide during Perinatal Period: Epidemiology, Risk Factors, and Clinical Correlates


Laura Orsolini,1,2,3,4,* Alessandro Valchera,2,3 Roberta Vecchiotti,2,3,4 Carmine Tomasetti,3,5,6 Felice Iasevoli,3,6 Michele Fornaro,3,7 Domenico De Berardis,3,8,9 Giampaolo Perna,10,11 Maurizio Pompili,12 and Cesario Bellantuono13

SAFE-T Step 2: Identify Protective Factors



SAFE-T Step 2: Identify Protective Factors

Protective factors


SAFE-T Step 3: Conduct Suicide Inquiry



SAFE-T Step 3: What is C-SSRS

Columbia Suicide Severity Rating Scale (C-SSRS)

SAFE-T Step 3: How to use C-SSRS

Columbia Suicide Severity Rating Scale (C-SSRS)

How to Step Through the C-SSRS

Columbia Suicide Severity Rating Scale (C-SSRS)

Scenario #1: Questions 1 & 2

Columbia Suicide Severity Rating Scale (C-SSRS)

Scenario #1:   Question 6

Columbia Suicide Severity Rating Scale (C-SSRS)

Scenario #2: Questions 1 & 2

Columbia Suicide Severity Rating Scale (C-SSRS)

Scenario #3: Questions 3 through 5

Columbia Suicide Severity Rating Scale (C-SSRS)

Scenario #2:   Question 6

Columbia Suicide Severity Rating Scale (C-SSRS)

SAFE-T Step 4: Determine Level of Risk



SAFE-T Step 4: Determining Level of Risk



Low Risk

Columbia Suicide Severity Rating Scale (C-SSRS)

Moderate Risk

Columbia Suicide Severity Rating Scale (C-SSRS)

High Risk

Columbia Suicide Severity Rating Scale (C-SSRS)

SAFE-T Step 5: Document



Breaking Confidentiality and HIPAA (2 slides)

Circumstances where it is allowed to break confidentiality

HIPPA and Mental Health


Applicable laws

The HIPAA Privacy Rule permits a health care provider to disclose protected health information about an individual, without the individual’s authorization, to another health care provider for that provider’s treatment of the individual. See 45 CFR 164.506 and the definition of “treatment” at 45 CFR 164.501.

Pediatric Population: Confidentiality and State Law


18 is the WA State’s age of majority for health RCW 26.28.010



Parental participation in treatment decisions RCW 71.34.010


Outpatient Mental Health RCW 71.34.530


Inpatient Mental Health RCW 71.34.510

Special Situations: Intoxicated Patients

Guidelines for emergency departments

In this guide , there is information on how to manage intoxicated patients: 

Guidelines for emergency departments

In this article, there is guidance on how to manage intoxicated patient:  

Plan for Safety

Example Guide

Safety Plan is on page 9:

Safety planning quick guide for clinicians

Safety plan form

Wallet card

Suicide Contracts are Outdated and Don’t Work

No evidence that safety contracts are effective, and they can provide a false sense of security

J Clin Psychol. 2006 Feb;62(2):243-51. The case against no-suicide contracts: the commitment to treatment statement as a practice alternative. Rudd MD1, Mandrusiak M, Joiner Jr TE.

Making a Referral for Hospitalization

Resources for ED evaluation 

Example protocols  for involuntary detention (King County, WA)


Washington Specific


Care Transition after Hospitalization

Zero Suicide – Structured Follow-up and Monitoring


Care Transition

Caring Contacts Intervention


Suicide Life Threat Behav. 1976 Winter;6(4):223-30.

Suicide prevention for high-risk persons who refuse treatment.

Motto JA.


Psychiatr Serv. 2001 Jun;52(6):828-33.

A randomized controlled trial of postcrisis suicide prevention.

Motto JA1, Bostrom AG.


Crisis. 2012 Jan 1;33(1):5-12. doi: 10.1027/0227-5910/a000093.

Caring Letters Project: a military suicide-prevention pilot program.

Luxton DD1, Kinn JT, June JD, Pierre LW, Reger MA, Gahm GA.


Comtois KA, Kerbrat AH, DeCou CR, Atkins DC, Majeres JJ, Baker JC, Ries RK. Effect of Augmenting Standard Care for Military Personnel With Brief Caring Text Messages for Suicide Prevention. JAMA Psychiatry, 2019 May 1;76(5):474-483; DOI: 10.1001/jamapsychiatry.2018.4530


How and When to Use Caring Contacts Intervention

Sample Letters


Review: Antidepressants


N Engl J Med. 2014 Oct 30;371(18):1666-8. doi: 10.1056/NEJMp1408480.

Antidepressants' black-box warning--10 years later.

Friedman RA

Specific Anti-Suicide Medications

Patients with mood disorders have a 30-fold greater risk of suicide compared to the general population.

Rihmer Z, Kiss K. Bipolar disorders and suicidal behaviour
Bipolar Disord 2002: 4(Suppl. 1): 21–25.

Compelling evidence provides strong support that lithium has a suicide protective effect over the long-term course in patients with mood disorders.

Suicide Specific Psychosocial Interventions



Evidence-based psychotherapies for suicide prevention

Become a Practice Champion


Resources for more structured approach

SPRC sample protocol development kit

How to Get Started

Read Zero Suicide introductory materials

Complete Zero Suicide Organizational Self Study



AIMS Center


Next Steps for Suicide Protocol

Zero Suicide Work Plan


 [DR1]The PHQ-A should precede this measure here, but the original link no longer works and I wasn’t able to find a public domain version. We can ask around and add PHQ-A back when we have a good source.