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:
Please refer to the images below as examples of where this flag may appear in your Provider Dashboard.
Figure A. Sessions tab
Figure B. Clients tab
Although Modern Health will send an automatic email with crisis resources to clients who complete the Crisis Support Follow-Up Questions, we recommend further follow-up care with the client. More information on the Crisis Support Follow-Up, as well as recommendations for how to plan follow-up care with your clients can be found below.
This alert icon indicates that the client has completed the “Crisis Support Follow-Up Questions”, which is a screening designed to identify someone who might need further crisis assessment. Responses to these follow-up questions will be used to screen whether the member is in imminent crisis or not in imminent crisis. A client will be directed to complete this assessment 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.
If you see this icon, it means that the client has reported a level of crisis risk. Evidence suggests that any touchpoint (e.g., meeting with a primary care provider or care professional like a coach) can be helpful in identifying and screening for clinical risk.
Please note, when the client completes these questions, they automatically receive an email from Modern Health with relevant crisis information, should the client wish to engage with deeper support.
| Scenario | Steps |
| Client completes Questions and does not have a session scheduled |
For new clients, email them per our standard intro template. We recommend that you wait to discuss the Crisis Support Questions 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 will follow the steps outlined below in the row for when your “client has an upcoming session scheduled.”
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 response in email/chat. |
| Client is unresponsive to outreach | If the client has not responded after at least 2 attempts to engage them (since completing the Crisis Support Questions), no further action is needed. Our team reaches out directly to any client that reports a safety risk to check if they are receiving the support that they need or need help connecting with a different provider. |
| Client completes Questions and has an upcoming session scheduled |
See: Coaching Best Practices for a script on discussing confidentiality with your client. For the safety plan template, click here. |
| You do not feel comfortable coaching this client |
Refer to mental health coaching or therapy with the client’s consent See: Modern Health University: Best Practices for Referring to Mental Health Coaching or Therapy (includes downloadable quick reference guide) |
| You feel comfortable coaching this client and they want to continue coaching with you |
Example Script: If you have these thoughts in the future, would you feel okay telling me about it? Because I’m open to talking about that and finding a way to be helpful. And are you open to me asking you about it in the future?
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Please review the High Risk Assessment training on Modern Health University. Below are points summarized from the training.
Table below:
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Introducing the risk assessment:
You know how Modern Health asks you to complete questions about your well-being either when you first register or before meeting with me?Thanks for filling that out, it helps me get a better sense of what you may be experiencing.
I wanted to follow up on one of the items that asked about thoughts of death and suicide.
- coach proceeds to questions below:
| Situation | Coach question to ask client | Example responses that might indicate a ‘Yes’ to the coach's question. | Next steps |
| Passive thoughts | Have you wished you were dead or wished you could go to sleep and not wake up? |
“Things would be easier if I were gone,” “People would be better off without me around,” “It would be a relief if I had a car accident” “Sometimes I think about those things” |
Risk: Low
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| Active thoughts** | Have you had any actual thoughts of killing yourself? |
“I’ve been thinking about ending it all”
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Risk: Moderate
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| Intent | Have you had these thoughts and had some intention of acting on them? | “I’m planning to hurt myself” |
Risk: High
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| Plan | Have you been thinking about how you may do this? | “I’m planning to hurt myself this weekend when my family is out of the house” |
Risk: Urgent
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| Means | Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan? | “I have the pills I would need to do it” | |
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*Note: Protective factors example “What are the things keeping you from harming yourself?” Factors might include: spirituality, a sense of responsibility to family, children in the home, pregnancy, positive social support/coping skills/ therapeutic relationship **Note: Active thoughts without an intent nor a plan | |||
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Concluding the risk assessment and/or providing validation and support:
Example: I know it can be difficult to talk about these feelings, so I appreciate you for your openness and vulnerability.
Example: These thoughts you’re having about suicide are very common. While you’re not alone in this, I understand it can certainly feel that way.
Example: Seems like you’re someone who knows how to get through hard things, I’m glad you’re here.
- 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)
- Evidence suggests that any touchpoint (e.g., meeting with a primary care provider or care professional like a coach) can be helpful in identifying and screening for suicide risk.
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Can I tell the client I’m aware of their Crisis Support Follow Up responses?
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 -
Why did the client not get triaged to therapy?
It is possible that the client completed these Crisis Support questions after being matched with a coach. You can conduct an assessment (see High Risk Assessment training offered through Modern Health) and determine if they would be better served by mental health coaching or therapy. - What language should I use when talking about suicide?
| 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)
Note: For coaches practicing in languages other than English, we recommend using culturally-centered language that is appropriate for that language.