C-SSRS: Versions, Terms of Use, and How to Document a Screen
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What is the C-SSRS and how do you document it?
The Columbia-Suicide Severity Rating Scale (C-SSRS), also called the Columbia Protocol, is a set of plain-language questions that identify suicide risk, its severity and immediacy. Document which version you used, the time frame, the result as the tool reports it, and the actions you took under your setting's protocol.
If someone is in immediate danger, call 911 or local emergency services. For crisis support, call, text or chat 988 (Suicide and Crisis Lifeline).
The C-SSRS comes from the Columbia Lighthouse Project and was validated in studies by Posner and colleagues. Columbia describes it as a set of questions that help identify suicide risk, its severity and its immediacy, and the support a person needs.
This page covers the versions Columbia publishes, the terms of use, and how to record a screen in a progress note. It deliberately stops short of clinical triage: what to do after a screen depends on your setting, and Columbia states that the next steps are setting-specific. It does not reproduce the questions. Use the official materials linked in the sources.
C-SSRS at a glance
| Detail | What the sources say |
|---|---|
| What it is | The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale, a set of plain-language questions about suicidal ideation and behavior. |
| Owner | The Columbia Lighthouse Project. |
| Validation paper | Posner et al., American Journal of Psychiatry, 2011;168(12):1266 to 1277. |
| Screener length | Columbia says the shortest screeners are condensed to a minimum of two and a maximum of six questions. |
| Full scale | For a more thorough risk screening, Columbia says to use the standard scale. |
| Risk levels on the screener | Columbia describes the screener result as low, moderate or high risk, depending on where the affirmative answers fall. |
| Next steps | Columbia says the only thing that changes between settings is the next steps, which are setting specific. |
Common versions Columbia publishes (not a complete list)
| Version | Time frame it covers | Notes |
|---|---|---|
| Screener Basic Recent | Varies by version; see the official form | Listed by Columbia as a screener. |
| Screener Basic Since Last Contact | Varies by version; see the official form | Listed by Columbia as a screener. |
| Screener Recent Self-Report | Over recent months | Listed by Columbia as a screener, self-report. |
| Screener Since Last Asked Self-Report | Varies by version; see the official form | Listed by Columbia as a screener, self-report. |
| Screener for Children 6 to 11 | Varies by version; see the official form | Listed by Columbia as a screener for ages 6 to 11. |
| Screener for Inpatient Discharge | Varies by version; see the official form | Listed by Columbia as a screener for inpatient discharge. |
| Full Scale Lifetime/Recent | Full and recent history | Assesses full and recent history of suicidal ideation and behavior. |
| Full Scale Since Last Contact | Since the most recent assessment | Assesses ideation and behavior since the last assessment. |
Which C-SSRS version should you choose?
Columbia publishes screener versions and full scale versions, and a version for each of several settings. Use the version your agency, payer or program has adopted. If there is none, Columbia's free training pages and its list of versions are the place to decide, not this page.
Whichever you choose, name it in the note. "C-SSRS screener" is not specific enough, because the screeners cover different time frames and settings. Write the full name as Columbia titles it, for example "C-SSRS Screener Basic Recent", so that a later reader can find the same form.
What does the C-SSRS result mean?
Columbia states that the screener result is low, moderate or high risk depending on where the affirmative answers fall, and that answers are color coded on the form for easy identification. The exact mapping from answers to a risk level is printed on the official form. This page does not restate it, so read it from the version you are using.
Columbia also notes that interventions should be changed to reflect your setting's resources and policies and are flexible enough to be modified using clinical judgment. A C-SSRS result is therefore one input to your own risk formulation, and your note should show the formulation, not only the label.
What should you avoid writing in the note?
- Do not copy the question text into the note. Record the version name and the result.
- Do not write "negative C-SSRS" without the version and time frame. A negative result on a recent-period screener says nothing about lifetime history.
- Do not record a risk label without the actions you took, or the reason you took none.
- Do not use the screen as a substitute for your own clinical judgment. Write the judgment in the Assessment.
How do you document it in a progress note?
- Step 1: Write the full name of the version used and the date and time it was administered.
- Step 2: State who asked or who completed it (clinician-administered or self-report).
- Step 3: Record the result in the tool's own terms (the risk level the form reports).
- Step 4: Record the client's own words where they matter to your formulation, in quotation marks.
- Step 5: Record the actions you took under your setting's protocol, such as consultation, a safety plan or a referral, and who was informed.
- Step 6: Put your clinical judgment about risk and protective factors in the Assessment, and the follow-up in the Plan.
Where a C-SSRS screen goes in each note format
| Note format | Where the screen goes | Where the judgment and actions go |
|---|---|---|
| SOAP | Objective: version, date, result as the form reports it. | Assessment: risk formulation. Plan: protocol steps taken and follow-up. |
| DAP | Data: version, date, result as the form reports it. | Assessment: risk formulation. Plan: protocol steps taken and follow-up. |
Example wording (fictional, for illustration only)
Objective: C-SSRS screener administered on 10/09 (version per agency policy); responses and the resulting risk category recorded on the form. Assessment: [clinician's risk formulation in their own words]. Plan: actions taken per agency protocol: [document here].
Is the C-SSRS free to use?
Columbia states that "the protocol and the training on how to use it are available free of charge for use in community and healthcare settings, as well as in federally funded or nonprofit research," and, on its versions page, "You do not need special permission from us to take the Columbia Protocol tools and use them in your setting." The pages carry the notice "All Rights Reserved," so the materials are free to use but not placed in the public domain.
Download the forms from Columbia rather than copying them from elsewhere. Columbia lists free training for individuals and systems, which is the place to learn the administration steps.
Frequently Asked Questions
What does C-SSRS stand for?
C-SSRS stands for Columbia-Suicide Severity Rating Scale. Columbia also calls it the Columbia Protocol.
Is the C-SSRS free?
Columbia states that the protocol and its training are free of charge for community and healthcare settings and for federally funded or nonprofit research, and that you do not need special permission to use the tools in your setting. The materials remain copyrighted by the Columbia Lighthouse Project.
How many questions are on the C-SSRS screener?
Columbia says the shortest screeners are condensed to a minimum of two and a maximum of six questions. The number depends on the version, so check the form you are using.
What should a progress note say about a C-SSRS screen?
Name the exact version, the date, who administered it, the result in the form's own terms, the actions taken under your setting's protocol, and your clinical judgment about risk. Do not copy the question text.
Where does the C-SSRS go in a SOAP note?
Put the version, date and result in Objective, your risk formulation in Assessment, and the protocol steps and follow-up in Plan.
Does WellNotes administer or score the C-SSRS?
No. WellNotes does not administer or score screening tools or assess risk. It drafts your session note from what you type or dictate, and you review and edit it.
Related references
Sources
- Columbia Lighthouse Project: about the C-SSRS
- Columbia Lighthouse Project: C-SSRS for communities and healthcare (versions and free use)
- Columbia Lighthouse Project: risk identification
- Columbia Lighthouse Project: free training options
- Posner et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings. Am J Psychiatry 2011;168(12):1266-1277
- 988 Suicide & Crisis Lifeline
This page is general reference information, not clinical, coding, or legal advice. Scoring rules and usage terms can change, so confirm them on the instrument owner's current materials and with your payer or supervisor before relying on them. WellNotes does not administer or score screening tools. The treating clinician interprets every result.
Draft the session note with the score in it
Type or dictate the session, include the score and your interpretation, and WellNotes drafts the note in SOAP, DAP, or BIRP. You review and edit every note.