Since 2017, the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Service Members, Veterans, and their Families Technical Assistance (SMVF TA) Center has had the honor of working with the U.S. Department of Veterans Affairs (VA)/SAMHSA Governor’s Challenge to Prevent Suicide Among SMVF (Governor’s Challenge) state and territory teams to develop strategies and implement suicide prevention best practices. As one of its three key priority areas, the Governor’s Challenge initiative emphasizes the importance of screening for suicide risk within the SMVF population.
The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), is an evidence-based suicide screening tool that many teams have implemented through their Governor’s Challenge efforts in emergency departments, primary care offices, health clinics, and more. The Columbia Protocol screens for suicide risk and the severity of risk through a series of simple, evidence-supported questions. The Columbia Protocol is now also available as an app on your mobile device, making it easier to provide the questionnaire to anyone, anywhere, at any time. You can download the free app to your mobile device through the Apple App Store or Google Play Store.
Kelly Posner, Ph.D., lead scientist of the C-SSRS and director of the Columbia Lighthouse Project, has worked diligently with the Governor’s Challenge teams to implement the Columbia Protocol in state- and territory-wide clinical settings. The SMVF TA Center had the opportunity to interview Dr. Posner regarding the new Columbia Protocol app, and she provided some key insights on the development of the app and how it enhances the suicide screening process for SMVF.
- Could you start by telling us about the inspiration behind the development of the C-SSRS app?
The C-SSRS itself was born out of the need for a direct, interpretable, portable, and comprehensive suicide risk screening method. Making suicide risk screening accessible electronically was a natural extension, which we have been pursuing since 2008. As the suicide risk screening momentum grew across public health, we wanted to leverage technology to enable the broader public health goals of suicide prevention. Since launching the Columbia app, we have collaborated with various agencies and states (Pennsylvania and Virginia) to customize the app for specific groups and empowering suicide prevention at local, national, and international levels. The growing versatility and the broadening reach of the app continues to be our inspiration. In all 50 states it is being integrated into suicide prevention programs and customized to include local resources. When Virginia integrated the C-SSRS as part of the state agency for Veteran services for benefits contacts, it helped improve community capacity and incentivizing. This is a good example of the public health approach to suicide prevention, where we find Veterans where they work, live, and thrive, and which spreads the use to other state agencies like transportation, parks, legal services, and even places where Veterans work out. The app also clarifies the role and the purpose of the screening, as far as focusing on who is at risk. Importantly, including risk factors in the screening helps identify hotspots to improve our knowledge of risk in real time.
- What message would you like to convey to both healthcare professionals and the general public about the importance of suicide risk assessment?
People at risk of suicide suffer in silence, and we really need to reach them where they live, learn, and work. There is always hope because we can save people up until the last minute, and screening wherever possible, like we do for blood pressure, ensures that we have timely lifesaving conversations. This is why the app is being integrated into workforce wellness/EAP resources, schools, local communities. Asking the simple C-SSRS questions creates an important opening. Sometimes people are afraid to ask because of worrying about liability or because they are afraid of making someone suicidal—both are not true risks. These questions help, not hurt. And even if we cannot predict every time who might attempt suicide, asking consistently removes any suspicion of negligence.
We are living in an opportune time to really make a difference. By leveraging technology in suicide risk screening, we are building bridges where suicide prevention historically stumbled, where we have lost so many lives. Relying on traditional methods meant that we were always behind in collecting and analyzing the data. Having an ability to get real-time data is a real breakthrough in suicide prevention. This is why we need campaigns to get the tool into all hands. We have seen the importance of equipping Veteran and military families with the tool, as they are often the first line around the person at risk. The Columbia app in particular empowers us to save lives locally, nationally, and across the globe. This is why the National Strategy for Suicide Prevention highlighted the C-SSRS as an example of what success looks like.
- How does the app differ from the traditional C-SSRS, and how does it enhance the suicide screening process, especially for our service members and Veterans?
The C-SSRS has made suicide risk screening accessible to all. Its simplicity has made it acceptable and portable. The app version of Columbia takes the power of simplicity and utility to the next level. Leveraging technology is especially important for suicide prevention. The portability is especially salient for difficult-to-reach groups such as Veterans in rural areas. The app also allows the option of responding to questions privately, which facilitates disclosure. We have seen this working with VA and the Department of Defense (DoD). In fact, the VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide encourages use of validated screening tools and highlights the C-SSRS as the most widely-used example. Crucially, the app is customizable to include easy-access community resources, connecting Veterans and their families to local support.
- Since its launch, is there any initial data or feedback you can share that highlights the app’s impact on suicide prevention efforts? Have there been any notable trends or outcomes with regards to its usage with service members and Veterans?
We are in the early stages of gathering data on the app use. One really positive change we have seen is in a recent VA study that showed that the C-SSRS screening actually increased follow-ups and treatment engagement. Also, under the auspices of the USAA grant, we have specifically targeted Veteran Service Organizations in delivering group workshops on suicide prevention, focusing on suicide risk screening implementation via traditional and electronic methods. We know that legal and financial troubles are some of the more pronounced prompts for suicidal ideation or action among Veterans, implementing routine screening in all the places where Veterans come for any type of support or counsel is vital. Based on some remarkable precedents—such as total force rollout of the C-SSRS in the Marines leading to a decrease in suicide deaths, as well as reduced domestic violence, alcohol incidents, and sexual assault—we are highly optimistic about the potential of the app.
SAMHSA’s SMVF TA Center is honored to provide TA to states, territories, and communities seeking to strengthen their behavioral health support for those who have served in the armed forces. For TA inquiries, please email smvftacenter@prainc.com. For more information about the SMVF TA Center and the resources offered, please visit SAMHSA’s SMVF TA Center’s web pages.
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