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The C-SSRS is the FDA’s standard suicide severity rating in clinical trials. It’s used in emergency departments, primary care, schools, and crisis hotlines. Rivet includes the Screening (Recent) variant: five ideation severity items plus one behavior item covering the past three months.
Columbia explicitly states the C-SSRS is not a self-report instrument. It must be administered by a trained interviewer. Rivet enforces this — the C-SSRS cannot be sent to a client as an async link. You ask the questions in person, in the room or on a video call.

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What it measures

Five ideation severity items, each scored Yes/No, structured so that the highest YES captures the severity level: Plus one behavior item (item 6): Yes/No for actual, aborted, or interrupted suicide attempts or preparatory acts in the past three months.

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When to use it

  • Emergency department screening — every encounter, integrated with safety plan triage
  • Primary care annual screening — particularly in pediatric and adolescent intake
  • Clinical trial safety monitoring — FDA-required for many trial protocols
  • SAMHSA Zero Suicide care model intake screening
  • School gatekeeper training pairs with this scale
The Screening (Recent) variant Rivet includes is the right tool for screening contexts. The Past 1-Month, Lifetime, Intensity of Ideation, and Lethality of Behavior variants are separate Columbia instruments — not in Rivet.

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How you administer it

Solo fill, in person or on a video call with the client. Open C-SSRS from the templates picker and tap New response. The renderer presents the six items in order; you ask each question of the client directly and record the answer. The form cannot be sent to a client — there is no “Send to client” option for this measure. You are in the room (or on the call) for every administration. The Columbia Lighthouse Project provides free training videos at cssrs.columbia.edu. The Screening variant does not require formal training to administer, but inter-rater reliability improves meaningfully with the one-hour training module.

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How Rivet scores it

  • Ideation severity: the highest YES level among items 1-5 (0 if all No)
  • Behavior: YES or NO on item 6
Both subscales are reported independently. The score is not a single sum — it’s the highest ideation level + the behavior flag.

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High-risk items — items 4, 5, and 6

Items 4 (intent), 5 (plan), and 6 (behavior in the past 3 months) trigger immediate clinical action.Any YES on item 4, item 5, or item 6 indicates high-risk presentation and warrants:
  • Immediate safety planning — Rivet’s safety plan template (Stanley-Brown format) is the standard pairing
  • Means restriction counseling — firearms, medications, high-lethality access
  • Level-of-care decision — outpatient with frequent monitoring, crisis stabilization, hospitalization, or emergency-department referral
Rivet captures the data and surfaces the high-risk flags in the response view. Rivet does not auto-escalate, does not notify anyone, does not contact crisis services, and does not substitute for your clinical judgment in the room. The decision is yours.
The standard pairing for a positive C-SSRS is a Stanley-Brown Safety Planning Intervention (Stanley & Brown, 2012) — collaborative identification of warning signs, internal coping strategies, social contacts for distraction, social contacts for asking help, professional contacts, and means restriction. The safety plan template lives in Rivet’s clinical template library and is designed to be filled collaboratively with the client in the same session.

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Mandatory citation

Columbia requires the citation to appear in the clinical record whenever the C-SSRS is administered. Rivet embeds the citation as a display item in the template description so it appears inline as you administer the scale and in the formatted note output.

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What we render vs. the source

Verbatim items from the Columbia Lighthouse Project Screening (Recent) distribution PDF, with the mandatory citation embedded as a display item. Items 1-5 each map to a single Yes/No with the YES value set to the ideation severity score (1-5), so the scoring computes the highest YES — matching Columbia’s published scoring. All six items are flagged sensitive in the response data model.

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What Rivet doesn’t include

These Columbia variants are separate instruments and are not part of the Screening (Recent) version:
  • Past 1-Month variant — separate template
  • Lifetime variant — rarely used in screening contexts
  • Intensity of Ideation subscale — frequency, duration, controllability, deterrents, reasons for ideation
  • Lethality of Behavior subscale — 5-point ratings for actual attempts
If you need any of these, the Columbia Lighthouse Project distributes them at no cost from their training site.

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C-SSRS vs a suicidality item on a screening measure

Most depression measures carry one risk item — Item 9 on the PHQ-9, Item 12 on the QIDS-SR-16, Items 14 and 15 on the CES-D-R. Those items are tripwires. They tell you to ask, and nothing more. The C-SSRS is the asking. It grades ideation across five levels, from a wish to be dead through to a plan with intent, and separately asks about behaviour in the past three months. A positive Item 9 and a C-SSRS of 5 are not the same finding and shouldn’t be recorded as though they were. The other difference is who administers it. The C-SSRS is explicitly not a self-report instrument — it is meant to be asked by a trained interviewer, and it is the reason Rivet won’t let this one be sent ahead of a session. What follows a positive C-SSRS is a safety plan, and the RFL-12 if you want to inventory what protective beliefs the client still has to build that plan on.

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Is it free to use?

Yes — with one condition. The Columbia Lighthouse Project permits free clinical use, and requires the citation to appear in the clinical record. Rivet carries it inline where you administer the measure and includes it in what you copy out, so meeting that condition is not something you have to remember.

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Citations

  • Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). “The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults.” American Journal of Psychiatry, 168(12): 1266-1277.
  • Stanley, B., & Brown, G. K. (2012). “Safety planning intervention: a brief intervention to mitigate suicide risk.” Cognitive and Behavioral Practice, 19(2): 256-264.
Free clinical use per The Columbia Lighthouse Project (cssrs.columbia.edu), with mandatory citation in the clinical record.

HAM-D

Hamilton Depression Rating Scale. Item 3 (suicide) cutoff fires for severity ≥3; pair with C-SSRS for dedicated suicide assessment.

Clinician-administered overview

Why these six measures don’t ship to clients, and how solo fill works.