Interpreting C-SSRS scores

This article explains the Columbia-Suicide Severity Rating Scale (C-SSRS) screening tool. Learn what it is, how it helps assess suicide risk, and how you can use the results to track symptoms, monitor progress, and guide treatment decisions.

Definition and purpose

Routine screenings help therapists identify suicide risk and provide appropriate care. The C-SSRS is a standardized, self-report measure that can be used to quickly assess for passive and active suicidal ideation, plan, and intent in clients ages 13+. The results help therapists understand the risk level and provide the best care in a safe and least restrictive environment.

Items and scoring

The C-SSRS Screener is comprised of between 2 to 6 self-reported "Yes" or "No" questions asking clients if they experienced the item "since your last visit." 

The number of questions asked is dependent upon client responses.

All clients are asked questions #1 and #2

  1. Have you wished you were dead or wished you could go to sleep and not wake up? (Y/N)
  2. Have you actually had any thoughts of killing yourself? (Y/N)


If the client says NO to #2
, they will be directed to question 6.

If the client responds YES to #2, they will be asked questions 3, 4, 5, and 6. 

  1. Have you been thinking about how you might do this? (Y/N)
  2. Have you had these thoughts and had some intention of acting on them? (Y/N)
  3. Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan? (Y/N)
  4. Have you ever done anything, started to do anything, or prepared to do anything to end your life? (Y/N)


If YES
, ask: Was this within the past three months? (Y/N)

Interpreting scores

Affirmative ("Yes") responses count as 1 point, which are then summed to indicate level of suicide risk on a scale of 0 - 6. 


0 = No risk reported (all “no” responses)

1 – 2 = Low risk 

3 – 6 = Moderate to high risk 

  • A "Yes" on  question 3 or 6a  = Moderate Risk (development of possible plan and/or history (lifetime) of engagement in preparatory behaviors.)
  • A "Yes" on questions 4 or 5 or 6B = High Risk  (presence of active plan, that may also be accompanied by intent to act on that plan, and/or preparatory behaviors in the past 3 months.)


*It is a clinical best practice to complete a safety plan when any level of risk is present, even if low. When the risk level is moderate or high, a safety plan is required.

C-SSRS clinical benchmarks border.png


For client safety, Rula automatically flags potential risks based on the client’s responses. If a client responds “yes” to ANY item of the C-SSRS Screener they’ll see a real-time pop-up with the following information:  

“We are glad you are in care with us. Based on your survey responses, we’ve noticed you might need some additional support or resources. If you are experiencing a mental health crisis, please call or text 988 to be connected with the 24-hour Suicide and Crisis Helpline. If this is a life-threatening emergency, please call 911 or go to your nearest emergency room. Additional resources that might be helpful at this time can be found here.”

This screen offers immediate crisis resources, however, management of each client's risk remains the responsibility of the therapist. When a client reports any thoughts of suicide,  even if passive, be sure to follow up, conduct a thorough risk assessment, and develop a safety plan. 

Monitoring

The C-SSRS Screen is a powerful tool to assess for the presence of, and changes in, suicidal ideation, plan, and intent. This clinical information is important to ensure proper risk assessment and risk response is carried out, as well as inform treatment planning.

 

The C-SSRS  is publicly available: CMS https://www.cms.gov/files/document/cssrs-screen-version-instrument.pdf

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