Three-to-six questions to save a life: The Columbia-Suicide Severity Rating Scale

Talking about suicide – whether with an acquaintance, friend or family member – isn’t easy. Even for psychologists and social workers, knowing what to say or how to ask can be difficult. This is why

Columbia University, the University of Pennsylvania, and the University of Pittsburgh – supported by the National Institute of Mental Health – developed a screening tool in 2007 called the Columbia-Suicide Severity Rating Scale. This series of yes-and-no questions, using clear, plain language, has been saving lives in 45 countries around the world.

The C-SSRS was introduced in the Milwaukee Public Schools in 2016.

“The C-SSRS provides a reliable, semi-structured tool to identify and rate the risk of suicide,” said Melannie Litscher, MPS school psychologist.

Litscher, together with a team that included another school psychologist and two school social workers, researched ways to improve suicide intervention at MPS during the summer before the 2016-17 school year. The C-SSRS is one of several suicide screening tools listed on the Wisconsin Department of Public Instruction website.

The C-SSRS includes a maximum of six questions to quickly and simply identify whether someone might be at risk and needs help. The actual number of questions used depends on each individual’s answers, and there are several versions of the questions geared to specific populations, including friends, neighbors and family members.

Several factors made the C-SSRS a good fit for MPS. “We liked that the tool was free of charge, and Dr. Kelly Posner Gerstenhaber, who helped develop the scale, was easily accessible to answer questions and provide support and information,” Litscher said.

That fall, Litscher and her team trained approximately 500 school counselors, registered nurses, school psychologists and school social workers at the beginning of the school year.

“During the 2016-17 school year, the MPS staff logged approximately 1500 risk assessments (although some of these assessments were for the same student) and created comprehensive safety plans for those at higher risk,” explained Litscher. “We were able to identify 500 more situations of students who were at risk than we had the previous school year, and for all of the students who received risk assessments, not one completed suicide. It seems clear that with better training and identification and an excellent tool, we can better identify and help those students who are at risk.”

This school year, MPS has been working to further improve their suicide intervention and prevention program. MPS is working on collecting better data for the current, 2017-18 school year.

“Every risk assessment is logged into our system,” Litscher said. “We will use the data to identify ways we can improve our prevention and intervention efforts. We’re also working to expand the use of the C-SSRS tool with our partners in the community. It would be great if everyone – the police, the crisis response team, the clinical psychologists who work with our school – was using the same tool.”

In 2012, the Food and Drug Administration recognized the C-SSRS as the standard for measuring suicidal ideation and behavior in clinical trials.

For more information about the development and research behind the C-CSSR, or to download additional versions of the questions (geared toward different groups), on a printable card, visit http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/about-the-scale/

If you would like to learn more about how MPS uses the C-SSRS, contact the Office of Psychological Services for Milwaukee Public Schools at (414) 438- 3677.