Table 1.

Map of Operationalizing SPRC/SAMHSA Decision Tool Items to ED-SAFE Data Items

SPRC/SAMHSA item	ED-SAFE data item(s)
1. Thoughts of carrying out a plan
Recently, have you been thinking about how you might kill yourself?	Yes to one of: - ‘At any time during the past week, including today, have you thought about HOW you might do this [kill yourself]?’ - ‘At any time during the past week, including today, have you started to work out, or actually worked out, the details of how to kill yourself?’
2. Suicide intent
Do you have any intention of killing yourself?	Yes to: - ‘At any time during the past week, including today, have you had any intention of acting on these thoughts of killing yourself?
3. Past suicide attempt?
Have you ever tried to kill yourself?	Yes to: ‘At any time in your life, including today, have you made a suicide attempt?
4. Significant mental health conditions
Have you had treatment for emotional problems? Do you have a mental health issue that affects your ability to do things in life?	Yes to any one of: - Diagnosed with (List: Depression; Bipolar disorder; An anxiety disorder; Attention Deficit Disorder (ADD/ADHD); An eating disorder, like anorexia or bulimia; Schizophrenia or schizoaffective disorder; Any other psychiatric disorder - ‘Are you currently taking ANY medication(s) for an emotional or psychological problem?’ - ‘Have you ever been hospitalized for a psychological or emotional problem?’ - ‘Did you stay overnight in the hospital because of psychiatric or other mental health problems, including suicidal thoughts or actions?’
5. Substance use problems
Has drinking or drug use ever been a problem for you? Or, administer CAGE or another standardized substance use disorder screener	Positive response to any one of: - ‘Which of these drugs, if any, have you used (not for medical purposes? (List Marijuana, Painkillers, Cocaine, Tranquilizers or sedatives, Hallucinogens, Stimulants, Ecstasy, Heroin, Cold or cough medicines) - Diagnosed with ‘An alcohol use disorder, like alcohol abuse or dependence?’ - Diagnosed with ‘Any drug use disorder, like drug abuse or dependence?’ - A score of 8 or over for patients under 65 years of age or a score 7 or more for patients over 65 years on the first three items of the AUDIT (Babor et al., 2001): (1) “How often do you have a drink containing alcohol?” Never=0; Monthly or less=1; 2 to 4 times a month=2; 2 to 3 times a week=3; 4 or more times a week=4 PLUS (2) “How many drinks containing alcohol do you have on a typical day when you are drinking?” 1 or 2= 0; 3 or 4= 1; 5 or 6=2; 7, 8, or 9= 3; 10 or more= 4 PLUS (3) “How often do you have four or more drinks on one occasion?” Never= 0; Less than monthly= 1; Monthly=2; Weekly= 3; Daily or almost daily=4
6. Irritability/agitation/aggression
(Recently, have you felt so anxious or agitated that you could just jump out of your skin? Have you been having conflicts or getting into fights with other people?)	Yes to one of: - ‘Feeling so restless you couldn’t sit still’ - Diagnosed with ‘An anxiety disorder?’

Any individual who screened positive in any one of the questions above will be defined as meeting the “elevated risk” criteria.