A red alert icon will appear next to a client’s name on the Sessions and Clients tabs of the Provider Dashboard when the member has completed the Crisis Support Follow-Up Questions—a screening for further crisis assessment. This process helps determine if a member is or is not in imminent crisis. Clients are prompted to complete the assessment if they indicate thoughts of self-harm on PHQ9 question 9 or access the “Crisis Resource” link in their Modern Health account.
The alert icon looks like:
This alert icon can indicate one of three scenarios:
- The member has completed the “Crisis Support Follow-Up Questions”, which is a new screening designed to identify someone who might need further assessment related to their safety. Responses to these follow-up questions will be used to screen whether the member has immediate safety concerns or not; .
- The member indicated passive thoughts of death or hurting themselves on the PHQ-9 item 9 within the last three months;
- The member has both endorsed PHQ-9 item 9 and indicated immediate safety concerns via the "Crisis Support Follow-up Questions".
Please refer to the images below as examples of where this alert icon may appear in your provider dashboard.
Figure A. Sessions tab
Figure B. Clients tab
Although Modern Health will send an automatic email to members who indicate imminent crisis, we recommend further follow-up care with the client. Below details our recommendations and more information on the Crisis Support Follow-Up Questions and the PHQ-9 item 9.
Important: if the member triggered the alert before being matched with you, we will display the alert for your awareness, but you will not be required to resolve it. In these cases you will not see the 'Resolve' link on the Assessment card.
If you see this alert icon, it means that the client has endorsed questions on the Crisis Support Follow-Up Questions within the last 60 days that suggest they have immediate safety concerns. A client is asked to answer the Crisis Support Follow-Up Questions either if they endorse the 9th question on the PHQ9 (experiencing thoughts they would be better off dead, or thoughts of hurting themself in some way) or click on the “Crisis Resource” link within their Modern Health account.
- Reach out to your client within 72 hours of receiving notification of this alert.
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Once outreach has been conducted, “resolve” the alert in your Provider Dashboard and indicate the outcome of your outreach (as seen in the example image below).
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Of note, if your client is in care with multiple providers (ie. a therapist and a couple’s therapist; a therapist and a psychiatrist; etc), each provider will be required to follow the above steps. Once each provider resolves the alert and reports an outcome, that information will be visible within the original alert on your Client’s page in your dashboard (as seen in the example image below).
- The Patient Health Questionnaire (PHQ9) is a clinically validated assessment for screening symptoms of depression.
- It measures symptoms of depression over the past 2 weeks
- Question 9 asks how often someone has been bothered by “thoughts that you would be better off dead, or thoughts of hurting yourself in some way?” in the past two weeks
- Question 9 response options include: 1) not at all, 2) several days, 3) more than half the days, or 4) nearly every day.
- Current evidence suggests that it is unclear whether PHQ9 item 9 is a good predictor of suicide risk and that item 9 is insufficient for assessing suicide risk (Na et al., 2018).
- Studies indicate that PHQ9 item 9 yields a high false-positive ratio, meaning that it can incorrectly identify someone as having high suicide risk when they are not actually at risk of acting on suicidal thoughts.
- Research suggests that suicidal ideation is common and part of the human condition, with prevalence rates ranging from 9% to 45% depending on the population studied (Bauer et al., 2013; Tomitaka et al., 2018)
- If after the assessment you are concerned about the client’s safety:
- The recommended next step is to complete a safety plan with the client
- Please refer to these public resources if you need support in conducting a risk assessment:
- Now Matters Now (Suicide Safe Care - free 2 hour, service provider course)
- If you’re looking for additional rating scales to use to supplement the Crisis Support Follow-Up Questions in assessing suicidal ideation and behavior, the Columbia Suicide Severity Rating Scale is well-validated and researched for this purpose.
- Reducing access to lethal means
- Digital tool for clinicians to use with their clients to reduce access to lethal means: Lock 2 Live
- References: Harvard: Means Reduction Saves Lives - Caring contacts
- Non-demanding messages that express care and support
- References: Caring Contacts: A Simple, Scalable Intervention to Reduce Suicidal Ideation and Attempts
To learn more, see Now Matters Now - Suicide Safe Care Free 2 Hour Training
| Recommended language | Inaccurate & non-compassionate language |
| Died of/by suicide | Committed suicide |
| Suicide | Successful attempt |
| Suicide attempt | Unsuccessful attempt |
| Describe behavior | Manipulative/attention seeking |
| Describe behavior | Suicidal gesture/cry for help |
| Diagnosed with | They’re borderline/schizophrenic |
| Working with | Dealing with suicidal patients |
Resource: Now Matters Now (Suicide Safe Care - free 2 hour, service provider course)
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Purpose [from Zero Suicide recommended standard of care] |
Sample Script |
| Bringing up the Modern Health well-being check-in |
You know how Modern Health asks you to complete questions about your well-being either when you first register or before meeting with me?
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| If they are no longer experiencing suicidal ideation or perhaps you haven’t asked about suicidal ideation yet |
I know you’re going through a lot right now, and it’s not uncommon that when people are going through those things they have suicidal thoughts. So I’m curious, if you were having those thoughts, would you feel okay telling me about it? Because I’m open to talking about that and finding a way to be helpful. |
| Validating and psychoeducation about suicidal ideation |
I know it can be difficult to talk about these feelings, so I appreciate you for your openness and vulnerability. These thoughts you’re having about suicide are very common [share statistics here]. While you’re not alone in this, I understand it can certainly feel that way. Seems like you’re someone who knows how to get through hard things, I’m glad you’re here. |
| High risk assessment, safety planning, and reducing access to lethal means |
See Now Matters Now - Suicide Safe Care Free 2 Hour Training Discuss access to lethal means; arrange and confirm removal or reduction of lethal means as feasible I have a tool called a safety plan, and I was hoping we could work on it together - it may be helpful for you. |
| Caring contacts |
See reference for sample script here
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What happens when a member completes the Crisis Support Follow Up Questionnaire or endorses the PHQ9 item 9? Does Modern Health do anything?
Any member who completes the Questionnaire or endorses the PHQ9 item 9 will receive an automated email checking in on if they are receiving the care that they need. They are also provided with crisis resources and hotlines in this email. If needed, they are able to schedule a phone call with a Member Care Specialist. If this member is matched to a provider and has an upcoming session, we notify the provider with the warning symbol on the provider dashboard. -
What if I get an alert about a member completing the Crisis Support Follow Up Questionnaire or endorsing item 9 of the PHQ-9 and I have never met them before or haven’t met with them in a while?
For new clients, email them per our standard intro template. We recommend that you wait to discuss the Crisis Support Follow Up Questionnaire or the PHQ-9 score until you’re in a session. Therefore, you do not have to mention it in your outreach. The goal for this initial outreach is to introduce yourself and get them to schedule a session with you, at which point you can discuss their responses.For a client you’ve previously worked with, email or chat with them and encourage them to schedule a session. You do not need to mention their Crisis Support Follow Up Questionnaire or PHQ-9 score in the email/chat.
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Why does the alert icon only show up for some Crisis Support Follow Up Questionnaires or PHQ-9 item 9 endorsements but not others?
Currently, the alert icon is shown if a member has completed the Crisis Support Follow Up Questionnaire or endorsed item 9 of the PHQ-9 in the last 60 days. This time period was selected to identify members with a recent history of indicating a recent imminent crisis. You will always be able to view a client’s profile and see the score history of all completed assessments. From there, we leave it to our providers to use their clinical expertise and judgment to follow-up on conducting risk assessments when necessary. -
Can I tell the client I’m aware of their Crisis Support Follow Up Questionnaire and PHQ-9 score?
Clients consented to having their information shared with their care providers before they completed the assessment. If needed, you can remind the client that they agreed to have their information shared with you as their care provider when they signed up for the platform. If there are any concerns about this, the client can express their feedback to help@modernhealth.com. -
What if a former client completes the Crisis Support Follow Up Questionnaire or endorses item 9 of the PHQ-9 and I can still see their updated scores?
Our team will reach out to any client that completes the Questionnaire or endorses item 9 to check if they are receiving the support that they need. Therefore, no additional action is needed on your end if you have already stopped working with this former client. -
What if the client who has completed the Crisis Support Follow Up Questionnaire or endorsed item 9 of the PHQ-9 doesn’t reply to my messages or doesn’t schedule a session?
If the client has not responded after at least 2 attempts to engage them since the completion of the Questionnaire or endorsement of item 9, no further action is needed. Our team reaches out directly to any client that completes the Questionnaire or endorses item 9 to check if they are receiving the support that they need or need help connecting with a different provider.