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The ASQ is a short, validated suicide-risk screen — four yes/no questions that take under a minute, plus a fifth acuity question asked only if any of the first four is yes. Developed by NIMH for pediatric emergency-department use and widely adopted in adult medical settings and outpatient mental-health practice.

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What it measures

Four screening questions about recent suicide-related thoughts and lifetime attempt history, plus one acute-risk question about thoughts of suicide right now. Every item is sensitive — every item asks directly about suicide or self-harm.

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When to use it

  • Any session where suicide risk is in question and you want a quick structured screen
  • New-client intake when the presenting concern hints at suicidal ideation
  • Re-screening when something destabilises — a relapse, a loss, a hospitalisation
  • As a screen before deciding whether to administer a deeper risk assessment

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How clients fill it out

Under a minute. Yes/no on each item. Comfortable to administer verbally in session — many practitioners read the items aloud and capture the answers in the form.

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How Rivet scores it

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Items 1-4 — the screen

Any yes on items 1-4 is a positive screen and triggers a deeper suicide-risk assessment. Horowitz et al. (2012) reported sensitivity 96.9% and specificity 87.6% in a pediatric ED sample.

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Item 5 — acute risk (ask only after a positive screen)

If items 1-4 are all “no”, you don’t ask item 5. If any of items 1-4 is “yes”, you ask item 5.
A “yes” on Item 5 (“Are you having thoughts of killing yourself right now?”) means acute risk. Do not leave the client alone. Complete a safety plan, address means restriction, and arrange immediate clinical evaluation. This is built into the template’s scoring config explicitly so the signal can’t be missed.

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What to do after a positive screen

The ASQ is a screen, not a complete risk assessment. After a positive screen:
  1. Move to the Safety plan template to walk through warning signs, coping strategies, social contacts, and means restriction together
  2. Document the conversation in the session note
  3. Decide on disposition — outpatient with safety plan, urgent follow-up, or emergency-room referral — based on acuity

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Citation

Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenstein, D. L., Wharff, E. A., Ginnis, K., Cannon, E., Joshi, P., & Pao, M. (2012). Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 166(12), 1170-1176. US government / NIMH public domain.

Safety plan

The natural next step after a positive ASQ — Stanley-Brown safety planning.

C-SSRS

Deeper clinician-administered suicide-risk assessment when the ASQ flags a positive.

Risk flagging

How the ASQ surfaces in the inbox and what to do with the signal.