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Some items on standardized measures carry weight beyond their contribution to a total score. PHQ-9 Item 9 (suicidal ideation) is the canonical example: a “nearly every day” answer is clinically significant regardless of where the total lands. What follows is how Rivet surfaces those items — and, more importantly, what Rivet does not do when they fire.
Rivet does not auto-escalate. No automatic text to a crisis line, no message to a supervisor, no notification to an external service. Clinical action — risk assessment, safety planning, escalation — remains yours.

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What gets flagged

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PHQ-9 Item 9 — suicidal ideation

Item 9 reads:
“Thoughts that you would be better off dead, or of hurting yourself in some way”
The published rule, from Kroenke 2001 forward, is that any non-zero answer warrants suicide risk assessment regardless of the total PHQ-9 score. A client with a PHQ-9 of 6 (“mild depression”) and Item 9 = “several days” needs the same Item 9 follow-up as a client with a PHQ-9 of 22. The PHQ-9 template description in Rivet states this rule inline so it appears in the “Copy for session notes” output and in the PDF download alongside the response. The practitioner is the layer that reads the rule and acts on it.

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C-SSRS items 4, 5, and 6

The Columbia Suicide Severity Rating Scale is a clinician-administered measure. Rivet includes the Screening (Recent) variant with five ideation severity items plus one behavior item. Three of these trigger a cutoff the moment you answer YES:
  • Item 4 — active suicidal ideation with some intent to act, without specific plan
  • Item 5 — active suicidal ideation with specific plan and intent
  • Item 6 — past 3-month suicidal behavior (actual / aborted / interrupted attempts / preparatory acts)
When you (the rater) answer YES on any of items 4, 5, or 6, the corresponding cutoff fires. It surfaces inline in your practitioner view as a high-risk flag and in the score block as a labelled cutoff message:
  • Items 4–5: “Any YES on items 4 (intent) or 5 (plan) — high-risk; immediate safety planning + means restriction indicated”
  • Item 6: “YES on past-3-month suicidal behavior — high-risk; emergency evaluation indicated”
The exact label text is what the C-SSRS literature uses; Rivet renders it verbatim.

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Other sensitive items, by measure

A number of other items across the library are flagged as sensitive and surface inside the score block when they fire:
  • EPDS Item 10 — self-harm in the postnatal context
  • CES-D-R Items 14 + 15 — death wishes / self-harm
  • QIDS-SR Item 12 — suicidal ideation
  • CPSS-5 Items 9, 10, 16 — trauma-related self-harm / suicidality
  • BSL-23 Items 5, 7, 12, 18 — self-harm / suicide subscale
  • ASQ — all 5 items — NIMH suicide screen (positive on items 1–4 = positive screen; item 5 YES = acute risk)
  • All 10 ACE items — childhood adversity (handled with the same sensitivity flag for trauma-informed UX)
For each of these, the published rule and the cutoff text from the source paper are embedded in the template. Rivet shows the rule; the practitioner takes the clinical action.

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What Rivet does on a flag

Concretely:
  • The cutoff appears in your practitioner view as the measure is filled
  • The cutoff appears in the score block of the “Copy for session notes” output (e.g. [Any YES on items 4 (intent) or 5 (plan) — high-risk; immediate safety planning + means restriction indicated])
  • The cutoff appears in the PDF download
That’s the entire surface.

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What Rivet does not do on a flag

No automatic crisis-line dial. Rivet does not send a text or open a call to a crisis line, a hotline, or 911 when a high-risk item fires.No automatic notification. Rivet does not message a supervisor, a consulting clinician, a partner practice, or anyone outside the session.No automatic chart write. Rivet does not write to your EHR, flag a chart in Jane or Owl, or escalate a record into a triage workflow.No automatic safety-plan open. Rivet does not auto-launch the Safety plan template when PHQ-9 Item 9 or a C-SSRS cutoff fires. That remains your decision.Clinical judgment + clinical action are yours.
This is a deliberate design choice. Auto-escalation in clinical contexts can fire at clinically inappropriate moments, pathologize normal-range responses (e.g. a “several days” PHQ-9 Item 9 in a long-stable client), or interrupt a session at exactly the wrong therapeutic moment. The practitioner’s judgment is the right interpretation layer. What Rivet provides is structured detection — the item is captured, the cutoff is computed, the flag is surfaced inline and in your record. What to do about it is the practice of psychotherapy.

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What pairs well with risk flagging

For positive ideation screens (PHQ-9 Item 9 > 0; C-SSRS item 4 or 5 YES), the natural follow-on is a structured safety plan. The Rivet library includes the Safety plan template — a 6-step crisis safety plan based on the Stanley-Brown method. You can open it directly after a flag fires, fill it collaboratively with the client during the same session, and export it the same way (Copy for session notes, or Download as PDF) so the safety plan goes home in writing. A typical flow:
1

A flag fires during a PHQ-9 or C-SSRS

Item 9 > 0 on PHQ-9; or items 4/5/6 YES on C-SSRS.
2

You complete the current measure

Don’t abandon mid-fill — the score block + cutoff text are what land in your record. Finish, copy, and close.
3

Open the Safety plan template

From the Templates picker, pick Safety plan. The template walks through warning signs → internal coping → social distractions → people for help → professionals + agencies → means safety.
4

Fill collaboratively, then export

The client fills warning signs, coping strategies, contacts; you annotate where relevant. Click “Download” for a PDF the client can keep on their phone.
5

Clinical action is yours

Risk assessment, escalation, after-session contact, supervisor consultation — Rivet doesn’t do any of these automatically. Rivet captures the structured data; you decide what comes next.
For information on what’s covered in the Safety plan template, see Crisis → Safety plan in the Clinical templates section.

What MBC is in Rivet

The full scope of what Rivet does — and doesn’t — around outcome measures.

Safety plan

The 6-step crisis safety plan template that pairs with positive suicide screens.

Administering measures in session

The collaborative fill flow that surfaces these flags in front of you while you can still talk about them.