> ## Documentation Index
> Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt
> Use this file to discover all available pages before exploring further.
# ASQ — Ask Suicide-Screening Questions
> NIMH's brief 4-item suicide-risk screen plus an acute-risk follow-up, validated in pediatric ED settings and widely used in outpatient mental-health.
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.
## 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.
## 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
## 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.
## How Rivet scores it
### 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.
### 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.
## 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
## Is it free to use?
**Yes — it is public domain.** Developed at NIMH, and therefore a US government work.
## 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.
## Related articles
The natural next step after a positive ASQ — Stanley-Brown safety
planning.
Deeper clinician-administered suicide-risk assessment when the ASQ
flags a positive.
How the ASQ surfaces in the conversation and what to do with the signal.