ATTACHMENT 30 - Suicide Risk Doc Template KNART XML_2018-06-21.pdf

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Template” is to support documentation of findings and decisions from screening for suicide risk, including options for using the Patient Health Questionnaire (PHQ), suicidality-related components of a mental health intake assessment, and suicide risk assessment."/>

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Suidicality"/>

30 <identifier root="LocalDocBook" extension="sr1" identifierName="CCWP"/>

31 </identifiers> 32 <title value="Mental Health: Suicidality Clinical Content White

Paper"/> 33 <description value="Clinical Content White Paper"/> 34 </resource> 35 </resources> 36 </relatedResource> 37 <relatedResource> 38 <relationship value="AssociatedResource"/> 39 <resources> 40 <resource> 41 <identifiers> 42 <identifier root="LocalDocBook" identifierName="CSD" extension="sr2"/> 43 <identifier root=

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44 </identifiers> 45 <title value="Mental Health: Suicide Risk Assessment

Documentation Template Conceptual Structure Document"/> 46 </resource> 47 </resources> 48 </relatedResource> 49 <relatedResource> 50 <relationship value="AssociatedResource"/> 51 <resources> 52 <resource> 53 <identifiers> 54 <identifier root="LocalDocBook" identifierName="KVRpt" extension="sr3"/> 55 <identifier root=

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VA118-16-D-1008, Task Order (TO): VA-118-16-F-1008-0007, CLIN0005AP"/>

56 </identifiers> 57 <title value="Mental Health: Suicide Risk Assessment

Documentation Template KNART Validation Report"/> 58 </resource> 59 </resources> 60 </relatedResource> 61 </relatedResources> 62 <supportingEvidence> 63 <evidence> 65 <resources> 66 <resource> 67 <identifiers> 68 <identifier extension="e1" identifierName="CLP 2017" root=

"LocalDocBook"/> 69 </identifiers> 70 <title value="Columbia–Suicide Severity Rating Scale Screen

Version – Recent."/> 71 <location value=

"https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-c ommunities-and-healthcare"/>

72 <citation value="Columbia–Suicide Severity Rating Scale Screen Version – Recent. Columbia Lighthouse Project website. Accessed October 2017"/>

73 </resource> 74 </resources> 75 </evidence> 76 <evidence> 77 <resources> 78 <resource> 79 <identifiers> 80 <identifier extension="e2" identifierName="IOM 2013" 81 root="LocalDocBook"/> 82 </identifiers> 83 <title value="Returning Home from Iraq and Afghanistan:

Assessment of Readjustment Needs of Veterans, Service Members, and Their Families."/>

84 <location value="https://www.ncbi.nlm.nih.gov/books/NBK206864/"/> 85 <citation 86 value="Committee on the Assessment of the Readjustment

Needs of Military Personnel, Veterans, and Their Families, Board on the Health of Select Populations, Institute of Medicine. Returning Home from Iraq and Afghanistan:

Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington (DC): National Academies Press (US); Mar 2013. Available from https://www.ncbi.nlm.nih.gov/books/NBK206864/."

87 /> 88 </resource> 89 </resources> 90 </evidence> 91 <evidence> 92 <resources> 93 <resource> 94 <identifiers> 95 <identifier extension="e3" identifierName="Kroenke 2001" root="LocalDocBook"/> 96 </identifiers> 97 <title value="The PHQ-9: validity of a brief depression severity measure."/> 98 <location value="J Gen Intern Med."/> 99 <citation value="Kroenke K, Spitzer RL, Williams JB. The PHQ-9:

validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613."/>

100 </resource> 101 </resources> 102 </evidence> 103 <evidence> 104 <resources> 105 <resource> 106 <identifiers> 107 <identifier extension="e4" identifierName="OMHSP 2017" root=

"LocalDocBook"/> 108 </identifiers> 109 <title value="Suicide Among Veterans and Other Americans

2001–2014"/> 110 <location value=

"https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf"

111 <citation 112 value="Office of Mental Health and Suicide Prevention.

Suicide Among Veterans and Other Americans 2001–2014. U.S.

Department of Veterans Affairs Mental Health website.

https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pd

f. Updated August 2017."

113 /> 114 </resource> 115 </resources> 116 </evidence> 117 <evidence> 118 <resources> 119 <resource> 120 <identifiers> 121 <identifier extension="e5" identifierName="FedRegist 2012" root="LocalDocBook"/> 122 </identifiers> 123 <title value="Condition of participation: Patient's rights"/> 124 <location value="https://www.federalregister.gov/"/> 125 <citation value="Title 42 - Public Health. Condition of participation: Patient's rights. 71 FedRegist 71426, Dec. 8, 2006, as amended at 75 FedRegist 70844, Nov. 19, 2010; 77 FedRegist 29074, May 16, 2012. 42 CFR §482.13."/>

126 </resource> 127 </resources> 128 </evidence> 129 <evidence> 130 <resources> 131 <resource> 132 <identifiers> 133 <identifier extension="e6" identifierName="TSWF 2017" root=

"LocalDocBook"/> 134 </identifiers> 135 <title value="TSWF-CORE AIM Form Version Jan-Apr 2017"/> 136 <location value="Mental Health-20170921T220116Z-001.zip

September 21, 2017"/> 137 <citation 138 value="Tri-Service Workflow (TSWF). TSWF-CORE AIM Form

Version Jan-Apr 2017. TSWF CORE Paper Backup Jan Apr 2017.pdf. (Veterans Administration, materials provided in Mental Health-20170921T220116Z-001.zip, September 21, 2017)."

139 /> 140 </resource> 141 </resources> 142 </evidence> 143 <evidence> 144 <resources> 145 <resource> 146 <identifiers> 147 <identifier extension="e7" identifierName="VA 2016" root=

"LocalDocBook"/> 148 </identifiers> 149 <title value="VA Suicide Prevention Program Facts about Veteran

Suicide"/> 150 <location value=

"https://www.va.gov/opa/publications/factsheets/Suicide_Preventio n_FactSheet_New_VA_Stats_070616_1400.pdf"/>

151 <citation 152 value="U.S. Department of Veterans Affairs. VA Suicide

Prevention Program Facts about Veteran Suicide. U.S.

Department of Veterans Affairs Office of Public and Intergovernmental Affairs website.

https://www.va.gov/opa/publications/factsheets/Suicide_Preven tion_FactSheet_New_VA_Stats_070616_1400.pdf. Published July 2016."

153 /> 154 </resource> 155 </resources> 156 </evidence> 157 <evidence> 158 <resources> 159 <resource> 160 <identifiers> 161 <identifier extension="e8" identifierName="VADOD 2013" root=

"LocalDocBook"/> 162 </identifiers> 163 <title value="VA/DoD Clinical Practice Guideline for the

Assessment and Management of Patients at Risk for Suicide"/> 164 <location value=

"https://www.healthquality.va.gov/guidelines/MH/srb/VADODCP_Suici deRisk_Full.pdf"/>

165 <citation 166 value="U.S. Department of Veterans Affairs; U.S. Department of Defense (DoD0. VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide. Version 1.0 – June 2013. VA/DoD Clinical Practice Guidelines website.

https://www.healthquality.va.gov/guidelines/MH/srb/VADODCP_Su icideRisk_Full.pdf. Published June 2013."

167 /> 168 </resource> 169 </resources> 170 </evidence> 171 <evidence> 172 <resources> 173 <resource> 174 <identifiers> 175 <identifier extension="e9" identifierName="VADOD 2016" root=

"LocalDocBook"/> 176 </identifiers> 177 <title value="VA/DoD Clinical Practice Guideline for the

Management of Major Depressive Disorder"/>

178 <location value= "https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFI NAL82916.pdf"/>

179 <citation 180 value="U.S. Department of Veterans Affairs; U.S. Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder. Version 3.0 – 2016. VA/DoD Clinical Practice Guidelines website.

https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCP GFINAL82916.pdf. Published April 2016."

181 /> 182 </resource> 183 </resources> 184 </evidence> 185 <evidence> 186 <resources> 187 <resource> 188 <identifiers> 189 <identifier extension="e10" identifierName="APA 2018" root=

"LocalDocBook"/> 190 </identifiers> 191 <title value="Patient Health Questionnaire (PHQ-9 &amp; PHQ-2)"/> 192 <location value=

"https://www.apa.org/pi/about/publications/caregivers/practice-se ttings/assessment/tools/patient-health.aspx"/>

193 <citation value="American Psychological Association. Patient Health Questionnaire (PHQ-9 &amp; PHQ-2).

https://www.apa.org/pi/about/publications/caregivers/practice-set tings/assessment/tools/patient-health.aspx"/>

194 </resource> 195 </resources> 196 </evidence> 197 <evidence> 198 <resources> 199 <resource> 200 <identifiers> 201 <identifier extension="e11" identifierName="Arrol 2010" root

="LocalDocBook"/> 202 <identifier root="https://doi.org" extension=

"10.1370/afm.1139"/> 203 </identifiers> 204 <title value="Validation of PHQ-2 and PHQ-9 to Screen for Major

Depression in the Primary Care Population"/> 205 <location value="https://doi.org/10.1370/afm.1139"/> 206 <citation 207 value="Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., … Hatcher, S. (2010).

Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population. Annals of Family Medicine, 8(4), 348–353. http://doi.org/10.1370/afm.1139"

208 /> 209 </resource> 210 </resources> 211 </evidence> 212 </supportingEvidence> 213 <applicability> 214 <coverage> 215 <focus value="TargetUser"/> 216 <description value="Mental health providers; other physicians and nurses performing screening"/> 217 </coverage> 218 <coverage> 219 <focus value="ClinicalFocus"/> 220 <description value="Patients identified as being at risk for suicide;

members of patient cohorts identified for suicide risk screening"/> 221 </coverage> 222 <coverage>

223 <focus value="ClinicalVenue"/> 224 <description value="Mental Health Primary Care"/> 225 </coverage> 226 <coverage> 227 <focus value="ClinicalVenue"/> 228 <description value="Outpatient"/> 229 <value code="33022008 |Hospital-based outpatient department

(environment)|" codeSystem="SNOMED CT"/> 230 </coverage> 231 </applicability> 232 <status value="Draft"/> 233 <eventHistory> 234 <artifactLifeCycleEvent> 235 <eventType value="Published"/> 236 <eventDateTime value="20180618"/> 237 <!-- Completed rework. --> 238 </artifactLifeCycleEvent> 239 <artifactLifeCycleEvent> 240 <eventType value="Published"/> 241 <eventDateTime value="20180427"/> 242 </artifactLifeCycleEvent> 243 <artifactLifeCycleEvent> 244 <eventType value="Reviewed"/> 245 <eventDateTime value="20180427"/> 246 </artifactLifeCycleEvent> 247 <artifactLifeCycleEvent> 248 <eventType value="Created"/> 249 <eventDateTime value="20180406"/> 250 </artifactLifeCycleEvent> 251 <artifactLifeCycleEvent> 252 <eventType value="Pre-published"/> 253 <eventDateTime value="20180406"/> 254 </artifactLifeCycleEvent> 255 </eventHistory> 256 <contributions> 257 <contribution> 258 <contributor xsi:type="Person"> 259 <name> 260 <dt:part type="GIV" value="Rani"/> 261 <dt:part type="FAM" value="Hoff"/> 262 <dt:part type="TITLE" value="PhD, MPH"/> 263 </name> 264 <affiliation> 265 <name value="Director, Northeast Program Evaluation Center

Office of Mental Health and Suicide Prevention (10NC5) VA Central Office; Professor of Psychiatry

266 Yale University School of Medicine"/> 267 </affiliation> 268 </contributor> 269 <role value="Reviewer"/> 270 </contribution> 271 <contribution> 272 <contributor xsi:type="Person"> 273 <name> 274 <dt:part type="GIV" value="Bridget"/> 275 <dt:part type="FAM" value="Matarazzo"/> 276 </name> 277 <affiliation> 278 <name value="Director of Clinical Services 279 Rocky Mountain Mental Illness Research, Education and

Clinical Center (MIRECC) 280 Denver, CO 80220"/> 281 </affiliation> 282 </contributor> 283 <role value="Reviewer"/> 284 </contribution> 285 <contribution>

286 <contributor xsi:type="Person"> 287 <name> 288 <dt:part type="GIV" value="Ira"/> 289 <dt:part type="FAM" value="Katz"/> 290 </name> 291 <affiliation> 292 <name value="Senior Consultant for Mental Health Program

Analysis"/> 293 </affiliation> 294 </contributor> 295 <role value="Reviewer"/> 296 </contribution> 297 <contribution> 298 <contributor xsi:type="Person"> 299 <name> 300 <dt:part type="GIV" value="Edd"/> 301 <dt:part type="FAM" value="Post"/> 302 </name> 303 <affiliation> 304 <name value="VA HSR&amp;D"/> 305 </affiliation> 306 </contributor> 307 <role value="Reviewer"/> 308 </contribution> 309 </contributions> 310 <publishers> 311 <publisher xsi:type="Organization"> 312 <name value="Department of Veterans Affairs"/> 313 </publisher> 314 </publishers> 315 <usageTerms> 316 <rightsDeclaration> 317 <assertedRights 318 value="Copyright 2018 B3 Group, Inc.

319 NOTICE OF GOVERNMENT COPYRIGHT LICENSE AND UNLIMITED RIGHTS LICENSE

320 Licensed under the Apache License, Version 2.0 (the

&quot;License&quot;); you may not use this file except in compliance with the License.

321 You may obtain a copy of the License at http://www.apache.org/licenses/LICENSE-2.0

322 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License.

323 Portions of this content are derivative works from content produced by Cognitive Medical Systems, Inc. licensed under the Apache License, Version 2.0.

324 Additional portions of this content are derivative works from content contributed by Motive Medical Intelligence Inc., under Creative Commons Attribution-ShareAlike 4.0.

325 Contributions from 2013-2018 were performed either by US Government employees, or under US Veterans Health Administration contracts.

326 US Veterans Health Administration contributions by government employees are work of the U.S. Government and are not subject to copyright protection in the United States. Portions contributed by government employees are USGovWork (17USC §105). Not subject to copyright.

327 See: https://www.usa.gov/government-works 328 Contribution by contractors to the US Veterans Health

Administration during this period are contractually contributed under the Apache License, Version 2.0 and US Government sponsorship is acknowledged under Contract VA118-16-D-1008, Task Order

VA11817F10080007."/>

329 <rightsHolder xsi:type="Organization"> 330 <addresses> 331 <address>

332 <dt:part type="AL" value="10156 Tapestry Ct"/> 333 <dt:part type="ADL" value=""/> 334 <dt:part type="CTY" value="Fairfax"/> 335 <dt:part type="STA" value="VA"/> 336 <dt:part type="ZIP" value="22032"/> 337 </address> 338 </addresses> 339 <name value="B3 Group, Inc."/> 340 </rightsHolder> 341 </rightsDeclaration> 342 <rightsDeclaration> 343 <assertedRights 344 value="Copyright 2018 Cognitive Medical Systems, Inc.

345 Licensed under the Apache License, Version 2.0 (the

&quot;License&quot;); you may not use this file except in compliance with the License.

346 You may obtain a copy of the License at http://www.apache.org/licenses/LICENSE-2.0

347 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License.

348 This and related content produced by Cognitive Medical Systems, Inc. licensed under the Apache License, Version 2.0 is available at: https://bitbucket.org/cogmedsys/hl7-kas-examples

349 Additional portions of this content are derivative works from content contributed by Motive Medical Intelligence Inc., under Creative Commons Attribution-ShareAlike 4.0.

https://bitbucket.org/cogmedsys/kas-source-material

350 Contributions from 2013-2018 were performed either by US Government employees, or under US Veterans Health Administration contracts.

351 US Veterans Health Administration contributions by government employees are work of the U.S. Government and are not subject to copyright protection in the United States. Portions contributed by government employees are USGovWork (17USC §105). Not subject to copyright. See: https://www.usa.gov/government-works

352 Contribution by contractors to the US Veterans Health Administration during this period are contractually contributed under the Apache License, Version 2.0 and US Government sponsorship is acknowledged under Contract VA118-16-D-1008-0007."/>

353 <rightsHolder xsi:type="Organization"> 354 <addresses> 355 <address> 356 <dt:part type="AL" value="9444 Waples Street"/> 357 <dt:part type="ADL" value="Suite 300"/> 358 <dt:part type="CTY" value="San Diego"/> 359 <dt:part type="STA" value="CA"/> 360 <dt:part type="ZIP" value="92121"/> 361 </address> 362 </addresses> 363 <name value="Cognitive Medical Systems, Inc."/> 364 </rightsHolder> 365 </rightsDeclaration> 366 </usageTerms> 367 </metadata> 368 <externalData> 369 <codesystem name="SNOMED CT" id="2.16.840.1.113883.6.96" version="United States

Edition 20180301"/> 370 </externalData> 371 <actionGroup> 372 <subElements> 373 <actionGroup> 374 <behaviors> 375 <behavior xsi:type="GroupSelectionBehavior" value="Any"/> 376 </behaviors> 377 <title value="Reason for Visit"/>

378 <subElements> 379 <simpleAction xsi:type="CollectInformationAction"> 380 <documentationConcept> 381 <prompt value="Reason for patient encounter in the VA today"

382 <responseDataType value="String"/> 383 </documentationConcept> 384 </simpleAction> 385 </subElements> 386 </actionGroup> 387 <!-- Technical Note If: The answer to question 3, question 4, question 5, or question 6b is “Yes,” then display the following section prompt.

Section Prompt: This screen has resulted in a positive result on the C-SSRS and the VA Comprehensive Suicide Risk Assessment should be administered and used for risk factors and warning signs, protective factors, history of suicide attempts, and assessment and plan. Clinical Note: Note that, as of January 2018, the VA Comprehensive Suicide Risk Assessment was being developed; when it becomes available, a link to it should be made available to users here if the screen is positive for suicide risk.

388 [If: The answer to question 3, question 4, question 5, and question 6b are all “No,” Then display the following section prompt]

389 [Section Prompt: This screen has resulted in a negative result on the C-SSRS.] --> 390 <!-- Provide link to Documentation Template-Consult Request: Mental Health

- Consult for Depression KNART. Link: Provide link to depression screen. --> 391 <actionGroup> 392 <title value="Screening"/> 393 <subElements> 394 <actionGroup> 395 <behaviors> 396 <behavior xsi:type="GroupSelectionBehavior" value="Any"/> 397 </behaviors> 398 <title value="Primary Screen - Patient Health Questionnaire –

Plus (PHQ-plus)"/> 399 <description 400 value="Responses to the PHQ-plus are interpreted using the numbers following each response option below. Any score greater than 0 on the third question is a positive result for suicide risk. A score >=3 on the combined responses from the first 2 questions is considered a positive screen for depression."/>

401 <subElements> 402 <simpleAction xsi:type="CollectInformationAction"> 403 <documentationConcept> 404 <prompt value="Acknowledge"/> 405 <responseDataType value="Boolean"/> 406 </documentationConcept> 407 </simpleAction> 408 </subElements> 409 </actionGroup> 410 <actionGroup> 411 <behaviors> 412 <behavior xsi:type="GroupSelectionBehavior" value="Any"/> 413 </behaviors> 414 <title value="Primary screen (PHQ-plus) is defined as questions

1, 2, and 9 from PHQ-9, and the PHQ-2 is defined as questions 1 and 2 from the PHQ-9"/>

415 <description value="Components of this form below are adapted from (Kroenke 2001)"/>

416 <subElements> 417 <simpleAction xsi:type="CollectInformationAction"> 418 <supportingEvidence> 419 <evidence> 420 <resources> 421 <resource> 422 <identifiers> 423 <identifier root="LocalDocBook" extension="e10"/>

424 </identifiers> 425 </resource> 426 </resources> 427 </evidence> 428 <evidence> 429 <resources> 430 <resource> 431 <identifiers> 432 <identifier root="LocalDocBook" extension="e11"/> 433 </identifiers> 434 </resource> 435 </resources> 436 </evidence> 437 <evidence> 438 <resources> 439 <resource> 440 <identifiers> 441 <identifier root="LocalDocBook" extension="e3"/> 442 </identifiers> 443 </resource> 444 </resources> 445 </evidence> 446 </supportingEvidence> 447 <documentationConcept> 448 <prompt value="Acknowledge"/> 449 <responseDataType value="Boolean"/> 450 </documentationConcept> 451 </simpleAction> 452 </subElements> 453 </actionGroup> 454 <actionGroup> 455 <title value="Ask the patient the following questions:"/> 456 <description value="Over the past two weeks, how often have you been bothered by any of the following problems?"/> 457 <subElements> 458 <actionGroup> 459 <behaviors> 460 <behavior xsi:type="RequiredBehavior" value="Must"/> 461 </behaviors> 462 <title value="Little interest or pleasure in doing things?"/> 463 <subElements> 464 <simpleAction xsi:type="CollectInformationAction"> 465 <documentationConcept> 466 <prompt value="Select one."/> 467 <responseDataType value="Integer"/> 468 <responseCardinality value="Single"/> 469 <responseRange xsi:type=

"EnumerationConstraint"> 470 <constraintType value="List"/> 471 <item> 472 <value xsi:type="elm:Literal" value=

"0" valueType="elm:Integer"/> 473 <displayText value="Not at all

(score =0)"/> 474 </item> 475 <item> 476 <value xsi:type="elm:Literal" value=

"1" valueType="elm:Integer"/> 477 <displayText value="Several days

(score =1)"/> 478 </item> 479 <item> 480 <value xsi:type="elm:Literal" value=

"2" valueType="elm:Integer"/>

481 <displayText value="More than half the days (score =2)"/>

482 </item> 483 <item> 484 <value xsi:type="elm:Literal" value=

"3" valueType="elm:Integer"/> 485 <displayText value="Nearly every day (score =3)"/> 486 </item> 487 </responseRange> 488 </documentationConcept> 489 </simpleAction> 490 </subElements> 491 </actionGroup> 492 <actionGroup> 493 <behaviors> 494 <behavior xsi:type="RequiredBehavior" value="Must"/> 495 </behaviors> 496 <title value="Feeling down, depressed, or hopeless?"/> 497 <subElements> 498 <simpleAction xsi:type="CollectInformationAction"> 499 <documentationConcept> 500 <prompt value="Select One"/> 501 <responseDataType value="Integer"/> 502 <responseCardinality value="Single"/> 503 <responseRange xsi:type=

"EnumerationConstraint"> 504 <constraintType value="List"/> 505 <item> 506 <value xsi:type="elm:Literal" value=

"0" valueType="elm:Integer"/> 507 <displayText value="Not at all

(score =0)"/> 508 </item> 509 <item> 510 <value xsi:type="elm:Literal" value=

"1" valueType="elm:Integer"/> 511 <displayText value="Several days

(score =1)"/> 512 </item> 513 <item> 514 <value xsi:type="elm:Literal" value=

"2" valueType="elm:Integer"/> 515 <displayText value="More than half the days (score =2)"/> 516 </item> 517 <item> 518 <value xsi:type="elm:Literal" value=

"3" valueType="elm:Integer"/> 519 <displayText value="Nearly every day (score =3)"/> 520 </item> 521 </responseRange> 522 </documentationConcept> 523 <responseBinding property="feelingDown"/> 524 </simpleAction> 525 </subElements> 526 </actionGroup> 527 <actionGroup> 528 <behaviors> 529 <behavior xsi:type="RequiredBehavior" value="Must"/> 530 </behaviors> 531 <title value="Thoughts that you would be better off dead or of hurting yourself in some way?"/> 532 <subElements> 533 <simpleAction xsi:type="CollectInformationAction"> 534 <documentationConcept>

535 <prompt value="Select one."/> 536 <responseDataType value="Integer"/> 537 <responseCardinality value="Single"/> 538 <responseRange xsi:type=

"EnumerationConstraint"> 539 <constraintType value="List"/> 540 <item> 541 <value xsi:type="elm:Literal" value=

"0" valueType="elm:Integer"/> 542 <displayText value="Not at all

(score =0)"/> 543 </item> 544 <item> 545 <value xsi:type="elm:Literal" value=

"1" valueType="elm:Integer"/> 546 <displayText value="Several days

(score =1)"/> 547 </item> 548 <item> 549 <value xsi:type="elm:Literal" value=

"2" valueType="elm:Integer"/> 550 <displayText value="More than half the days (score =2)"/> 551 </item> 552 <item> 553 <value xsi:type="elm:Literal" value=

"3" valueType="elm:Integer"/> 554 <displayText value="Nearly every day (score =3)"/> 555 </item> 556 </responseRange> 557 </documentationConcept> 558 <responseBinding property="betterOffDead"/> 559 </simpleAction> 560 </subElements> 561 </actionGroup> 562 </subElements> 563 </actionGroup> 564 <actionGroup> 565 <!-- Positive screen:

566 If the score is > 0 on the question “Thoughts that you would be better off dead or of hurting yourself in some way”

567 or combined score >= 3 --> 568 <conditions> 569 <condition> 570 <logic xsi:type="elm:Or"> 571 <elm:operand xsi:type="elm:Greater"> 572 <elm:operand xsi:type="elm:Property" path=

"betterOffDead"> 573 <elm:source xsi:type="elm:ParameterRef" name

="Responses"/> 574 </elm:operand> 575 <elm:operand xsi:type="elm:Literal" value="0" valueType="Integer"/> 576 </elm:operand> 577 <elm:operand xsi:type="elm:GreaterOrEqual"> 578 <elm:operand xsi:type="elm:Add"> 579 <elm:operand xsi:type="elm:Add"> 580 <elm:operand xsi:type="elm:Property" path="betterOffDead"> 581 <elm:source xsi:type=

"elm:ParameterRef" name="Responses"/> 582 </elm:operand> 583 <elm:operand xsi:type="elm:Property" path="feelingDown"> 584 <elm:source xsi:type=

"elm:ParameterRef" name="Responses"/> 585 </elm:operand> 586 </elm:operand> 587 <elm:operand xsi:type="elm:Property" path=

"feelingDown"> 588 <elm:source xsi:type="elm:ParameterRef" name="Responses"/> 589 </elm:operand> 590 </elm:operand> 591 <elm:operand xsi:type="elm:Literal" value="3" valueType="Integer"/> 592 </elm:operand> 593 </logic> 594 <conditionRole/> 595 </condition> 596 </conditions> 597 <title value="PHQ-plus results for suicide risk"/> 598 <subElements> 599 <!-- 600 [Technical Note: A score weighting > 0 on the question “Thoughts that you would be better off dead or of hurting yourself in some way” constitutes a positive result for suicide risk on the primary screen (PHQ-plus).

601 If the primary screen (PHQ-plus) is positive for suicide risk, then the secondary screen [Columbia-Suicide Severity Rating Scale (C-SSRS) screen] is required;

602 if the primary screen (PHQ-plus) is negative for suicide risk, then the secondary screen (C-SSRS screen) is optional and the following statement should be displayed to users: “The secondary screen (C-SSRS screen) is not required.”

603 No restriction should be placed on the availability of the secondary screen (C-SSRS screen), but it should be required if the primary screen (PHQ-plus) is positive for suicide risk and optional if the primary screen (PHQ-plus) is negative for suicide risk.]

604 --> 605 <simpleAction xsi:type="CollectInformationAction"> 606 <!-- Calculate by adding the values of the above questions --> 607 <behaviors> 608 <behavior xsi:type="ReadOnlyBehavior" value="true"/> 609 </behaviors> 610 <textEquivalent value="Calculate and display score"/> 611 <documentationConcept> 612 <prompt value="PHQ-plus score for depressive symptoms"/> 613 <responseDataType value="Integer"/> 614 </documentationConcept> 615 </simpleAction> 616 <simpleAction xsi:type="CollectInformationAction"> 617 <!-- Positive is a score >= 3, or if conditions described above are met --> 618 <behaviors> 619 <behavior xsi:type="ReadOnlyBehavior" value="true"/> 620 </behaviors> 621 <documentationConcept> 622 <prompt value="PHQ-plus result: indicate if negative or positive screen for depressive symptoms"

623 <responseDataType value="EntityName"/> 624 <responseRange xsi:type="EnumerationConstraint"> 625 <constraintType value="List"/> 626 <item> 627 <displayText value="Negative"/> 628 </item> 629 <item> 630 <displayText value="Positive"/> 631 </item> 632 </responseRange> 633 </documentationConcept> 634 <responseBinding property="phqPlusResult"/> 635 </simpleAction>

637 </subElements> 638 </actionGroup> 639 <actionGroup> 640 <behaviors> 641 <behavior xsi:type="GroupSelectionBehavior" value="Any"/> 642 </behaviors> 643 <!-- Condition on positive screen --> 644 <conditions> 645 <condition> 646 <logic xsi:type="elm:Equal"> 647 <elm:operand xsi:type="elm:Property" path=

"phqPlusResult"> 648 <elm:source xsi:type="elm:ParameterRef" name=

"Responses"/> 649 </elm:operand> 650 <elm:operand xsi:type="elm:Literal" value="Positive" valueType="String"/> 651 </logic> 652 <conditionRole/> 653 </condition> 654 </conditions> 655 <title value="This screen has resulted in a positive result for suicide risk on the primary screen (PHQ-plus)"/> 656 <description value="The secondary screen [Columbia-Suicide

Severity Rating Scale (C-SSRS) screen] is required."/> 657 <representedConcepts> 658 <concept code="3f4b945e-12b0-4733-a438-f07249f7a3a2

|Suicide risk assessment using Columbia-Suicide Severity Rating Scale (procedure)" codeSystem="SNOMED CT"/>

659 </representedConcepts> 660 <subElements> 661 <simpleAction xsi:type="CollectInformationAction"> 662 <documentationConcept> 663 <prompt value="Acknowledge"/> 664 <responseDataType value="Boolean"/> 665 </documentationConcept> 666 </simpleAction> 667 </subElements> 668 </actionGroup> 669 <actionGroup> 670 <behaviors> 671 <behavior xsi:type="GroupSelectionBehavior" value="Any"/> 672 </behaviors> 673 <!-- Condition on negative screen --> 674 <conditions> 675 <condition> 676 <logic xsi:type="elm:Equal"> 677 <elm:operand xsi:type="elm:Property" path=

"phqPlusResult"> 678 <elm:source xsi:type="elm:ParameterRef" name=

"Responses"/> 679 </elm:operand> 680 <elm:operand xsi:type="elm:Literal" value="Negative" valueType="String"/> 681 </logic> 682 <conditionRole/> 683 </condition> 684 </conditions> 685 <title value="This screen has resulted in a negative result for suicide risk on the primary screen (PHQ-plus)"/> 686 <description value="The secondary screen [Columbia-Suicide

Severity Rating Scale (C-SSRS) screen] is not required."/> 687 <representedConcepts> 688 <concept code="3f4b945e-12b0-4733-a438-f07249f7a3a2

|Suicide risk assessment using Columbia-Suicide Severity Rating Scale (procedure)" codeSystem="SNOMED CT"/>

689 </representedConcepts> 690 <subElements> 691 <simpleAction xsi:type="CollectInformationAction"> 692 <documentationConcept> 693 <prompt value="Acknowledge"/> 694 <responseDataType value="Boolean"/> 695 </documentationConcept> 696 </simpleAction> 697 </subElements> 698 </actionGroup> 699 <actionGroup> 700 <!-- These screening questions are required for positive screen above, and optional if above screen is negative --> 701 <behaviors> 702 <behavior xsi:type="RequiredBehavior" value="Must"/> 703 </behaviors> 704 <title value="Secondary Screen [Columbia-Suicide Severity

Rating Scale (C-SSRS) Screen]"/> 705 <description 706 value="The secondary screen (C-SSRS screen) must be evaluated based on a step-wise analysis of question answers as described in the behaviors below. Adapted from Posner 2009 and Tri-Service Workflow 2017. Select one response per question.The timeframe for questions 1 through 5 is within the past month"/>

707 <subElements> 708 <actionGroup> 709 <title value="The timeframe for questions 1 through 5 is within the past month"/> 710 <subElements> 711 <actionGroup> 712 <title value="Wish to be dead: Person endorses thoughts about a wish to be dead or not alive anymore, or wish to fall asleep and not wake up."/>

713 <subElements> 714 <simpleAction xsi:type=

"CollectInformationAction"> 715 <documentationConcept> 716 <prompt value="1. Patient response to &quot;Have you wished you were dead or wished you could go to sleep and not wake up?&quot;"/>

717 <responseDataType value="Boolean"/> 718 <responseCardinality value="Single"/> 719 <responseRange xsi:type=

"EnumerationConstraint"> 720 <constraintType value="List"/> 721 <item> 722 <value xsi:type=

"elm:Literal" value="True" valueType="elm:Boolean"/>

723 <displayText value="Yes"/> 724 </item> 725 <item> 726 <value xsi:type=

"elm:Literal" value="False" valueType="elm:Boolean"/>

727 <displayText value="No"/> 728 </item> 729 </responseRange> 730 </documentationConcept> 731 </simpleAction> 732 </subElements> 733 </actionGroup> 734 <actionGroup> 735 <title

736 value="Suicidal thoughts: General non-specific thoughts of wanting to end one’s life/die by suicide, “I’ve thought about killing myself” without general thoughts of ways to kill oneself/associated methods, intent, or plan."/>

737 <subElements> 738 <simpleAction xsi:type=

"CollectInformationAction"> 739 <documentationConcept> 740 <prompt value="2. Patient response to: &quot;Have you actually had any thoughts of killing yourself?&quot;"

741 <responseDataType value="Boolean"/> 742 <responseCardinality value="Single"/> 743 <responseRange xsi:type=

"EnumerationConstraint"> 744 <constraintType value="List"/> 745 <item> 746 <value xsi:type=

"elm:Literal" value="True" valueType="elm:Boolean"/>

747 <displayText value="Yes"/> 748 </item> 749 <item> 750 <value xsi:type=

"elm:Literal" value="False" valueType="elm:Boolean"/>

751 <displayText value="No"/> 752 </item> 753 </responseRange> 754 </documentationConcept> 755 <responseBinding property=

"thoughtOfKilling"/> 756 </simpleAction> 757 </subElements> 758 </actionGroup> 759 <!-- Condition: Skip to question 6 if answer to question 2 is No. Continue to question 3 if answer to question 2 is Yes -->

760 <actionGroup> 761 <title value="Suicidal thoughts with method

(without specific plan or intent to act):

Person endorses thoughts of suicide and has thought of at least one method during the assessment period."/>

762 <description 763 value="This is different than a specific plan with time, place or method details worked out. &quot;I thought about taking an overdose, but I never made a specific plan as to when where or how I would actually do it....and I would never go through with it.&quot;"/>

764 <subElements> 765 <simpleAction xsi:type=

"CollectInformationAction"> 766 <!-- Condition on question 2 TRUE --> 767 <conditions> 768 <condition> 769 <logic xsi:type="elm:IsTrue"> 770 <elm:operand xsi:type=

"elm:Property" path= "thoughtOfKilling">

771 <elm:source xsi:type= "elm:ParameterRef" name=

"Responses"/> 772 </elm:operand> 773 </logic> 774 <conditionRole/> 775 </condition> 776 </conditions> 777 <documentationConcept> 778 <prompt value="3. Patient response to &quot;Have you been thinking about how you might do this?&quot;"/>

779 <responseDataType value="Boolean"/> 780 <responseCardinality value="Single"/> 781 <responseRange xsi:type=

"EnumerationConstraint"> 782 <constraintType value="List"/> 783 <item> 784 <value xsi:type=

"elm:Literal" value="True" valueType="elm:Boolean"/>

785 <displayText value="Yes"/> 786 </item> 787 <item> 788 <value xsi:type=

"elm:Literal" value="False" valueType="elm:Boolean"/>

789 <displayText value="No"/> 790 </item> 791 </responseRange> 792 </documentationConcept> 793 <responseBinding property=

"beenThinkingAboutHow"/> 794 </simpleAction> 795 </subElements> 796 </actionGroup> 797 <actionGroup> 798 <title 799 value="Suicidal intent (without specific plan): Active suicidal thoughts of killing oneself and patient reports having some intent to act on such thoughts, as opposed to &quot;I have the thoughts, but I definitely will not do anything about them.&quot;"/>

800 <subElements> 801 <simpleAction xsi:type=

"CollectInformationAction"> 802 <!-- Condition on question 2 TRUE --> 803 <conditions> 804 <condition> 805 <logic xsi:type="elm:IsTrue"> 806 <elm:operand xsi:type=

"elm:Property" path= "thoughtOfKilling">

807 <elm:source xsi:type= "elm:ParameterRef" name= "Responses"/>

808 </elm:operand> 809 </logic> 810 <conditionRole/> 811 </condition> 812 </conditions> 813 <documentationConcept> 814 <prompt value="4. Have you had these thoughts and had some intention of acting on them?"/>

815 <responseDataType value="Boolean"/> 816 <responseCardinality value="Single"/>

817 <responseRange xsi:type= "EnumerationConstraint">

818 <constraintType value="List"/> 819 <item> 820 <value xsi:type=

"elm:Literal" value="True" valueType="elm:Boolean"/>

821 <displayText value="Yes"/> 822 </item> 823 <item> 824 <value xsi:type=

"elm:Literal" value="False" valueType="elm:Boolean"/>

825 <displayText value="No"/> 826 </item> 827 </responseRange> 828 </documentationConcept> 829 <responseBinding property=

"intentionOfActing"/> 830 </simpleAction> 831 </subElements> 832 </actionGroup> 833 </subElements> 834 </actionGroup> 835 <actionGroup> 836 <subElements> 837 <actionGroup> 838 <title value="Suicide intent with specific plan: Thoughts of killing oneself with details of plan fully or partially worked out and person has some intent to carry it out."/>

839 <subElements> 840 <simpleAction xsi:type=

"CollectInformationAction"> 841 <!-- Condition on question 2 TRUE --> 842 <conditions> 843 <condition> 844 <logic xsi:type="elm:IsTrue"> 845 <elm:operand xsi:type=

"elm:Property" path= "thoughtOfKilling">

846 <elm:source xsi:type= "elm:ParameterRef" name= "Responses"/>

847 </elm:operand> 848 </logic> 849 <conditionRole/> 850 </condition> 851 </conditions> 852 <documentationConcept> 853 <prompt 854 value="5. Patient response to

&quot;have you had these thoughts and had some intention of acting on them? Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?&quot;"/>

855 <responseDataType value="Boolean"/> 856 <responseCardinality value="Single"/> 857 <responseRange xsi:type=

"EnumerationConstraint"> 858 <constraintType value="List"/> 859 <item> 860 <value xsi:type=

"elm:Literal" value="True" valueType="elm:Boolean"/> 861 <displayText value="Yes"/> 862 </item> 863 <item> 864 <value xsi:type=

"elm:Literal" value="False" valueType="elm:Boolean"/>

865 <displayText value="No"/> 866 </item> 867 </responseRange> 868 </documentationConcept> 869 <responseBinding property=

"hadThoughtsAndHadSomeIntentionOfActing"

870 </simpleAction> 871 </subElements> 872 </actionGroup> 873 </subElements> 874 </actionGroup> 875 <actionGroup> 876 <title value="The timeframe for question 6a is the patient’s entire lifetime"/> 877 <description value="Suicidal behavior question:"/> 878 <subElements> 879 <simpleAction xsi:type="CollectInformationAction"> 880 <documentationConcept> 881 <prompt 882 value="6a. Patient response to:

&quot;Have you ever done anything, started to do anything, or prepared to do anything to end your life? Examples:

Collected pills, obtained a gun, gave away valuables, wrote a will or suicide note, took out pills but didn’t swallow any, held a gun but changed your mind or it was grabbed from your hand, went to the roof but didn’t jump; or actually took pills, tried to shoot yourself, cut yourself, tried to hang yourself, etc.&quot;"/>

883 <responseDataType value="Boolean"/> 884 <responseCardinality value="Single"/> 885 <responseRange xsi:type=

"EnumerationConstraint"> 886 <constraintType value="List"/> 887 <item> 888 <value xsi:type="elm:Literal" value=

"True" valueType="elm:Boolean"/> 889 <displayText value="Yes"/> 890 </item> 891 <item> 892 <value xsi:type="elm:Literal" value=

"False" valueType="elm:Boolean"/> 893 <displayText value="No"/> 894 </item> 895 </responseRange> 896 </documentationConcept> 897 <responseBinding property="preparedToEndLife"/> 898 </simpleAction> 899 </subElements> 900 </actionGroup> 901 <actionGroup> 902 <title value="The timeframe for question 6b is the past

3 months"/> 903 <subElements> 904 <simpleAction xsi:type="CollectInformationAction"> 905 <!-- Condition: Display question 6b if answer to question 6a is Yes. --> 906 <conditions> 907 <condition> 908 <logic xsi:type="elm:IsTrue"> 909 <elm:operand xsi:type="elm:Property" path="preparedToEndLife"> 910 <elm:source xsi:type=

"elm:ParameterRef" name= "Responses"/>

911 </elm:operand> 912 </logic> 913 <conditionRole/> 914 </condition> 915 </conditions> 916 <documentationConcept> 917 <prompt value="6b. Were any of these in the past 3 months?"/> 918 <responseDataType value="Boolean"/> 919 <responseCardinality value="Single"/> 920 <responseRange xsi:type=

"EnumerationConstraint"> 921 <constraintType value="List"/> 922 <item> 923 <value xsi:type="elm:Literal" value=

"True" valueType="elm:Boolean"/> 924 <displayText value="Yes"/> 925 </item> 926 <item> 927 <value xsi:type="elm:Literal" value=

"False" valueType="elm:Boolean"/> 928 <displayText value="No"/> 929 </item> 930 </responseRange> 931 </documentationConcept> 932 <responseBinding property=

"preparedToEndLifeInPast3Months"/> 933 </simpleAction> 934 </subElements> 935 </actionGroup> 937 </subElements> 938 </actionGroup> 939 <actionGroup> 940 <!-- Condition: If: The answer to question 3, question 4, question 5, or question 6b is “Yes,” then display this section prompt -->

941 <behaviors> 942 <behavior xsi:type="GroupSelectionBehavior" value="Any"/> 943 </behaviors> 944 <conditions> 945 <condition> 946 <logic xsi:type="elm:AllTrue"> 947 <elm:source xsi:type="elm:List"> 948 <elm:element xsi:type="elm:Property" path=

"beenThinkingAboutHow"> 949 <elm:source xsi:type="elm:ParameterRef" name

="Responses"/> 950 </elm:element> 951 <elm:element xsi:type="elm:Property" path=

"intentionOfActing"> 952 <elm:source xsi:type="elm:ParameterRef" name

="Responses"/> 953 </elm:element> 954 <elm:element xsi:type="elm:Property" path=

"hadThoughtsAndHadSomeIntentionOfActing"> 955 <elm:source xsi:type="elm:ParameterRef" name

="Responses"/>

956 </elm:element> 957 <elm:element xsi:type="elm:Property" path=

"preparedToEndLifeInPast3Months"> 958 <elm:source xsi:type="elm:ParameterRef" name

="Responses"/> 959 </elm:element> 960 </elm:source> 961 </logic> 962 <conditionRole/> 963 </condition> 964 </conditions> 965 <title 966 value="This screen has resulted in a positive result on the

C-SSRS and the VA Comprehensive Suicide Risk Assessment should be administered and used for risk factors and warning signs, protective factors, history of suicide attempts, and assessment and plan."/>

967 <subElements> 968 <simpleAction xsi:type="CollectInformationAction"> 969 <documentationConcept> 970 <prompt value="Additional Information"/> 971 <responseDataType value="String"/> 972 </documentationConcept> 973 </simpleAction> 974 </subElements> 975 </actionGroup> 976 <actionGroup> 977 <!-- Condition: The answer to question 3, question 4, question

5, and question 6b are all “No,” Then display this section prompt -->

978 <behaviors> 979 <behavior xsi:type="GroupSelectionBehavior" value="Any"/> 980 </behaviors> 981 <conditions> 982 <condition> 983 <logic xsi:type="elm:Not"> 984 <elm:operand xsi:type="elm:AnyTrue"> 985 <elm:source xsi:type="elm:List"> 986 <elm:element xsi:type="elm:Property" path=

"beenThinkingAboutHow"> 987 <elm:source xsi:type="elm:ParameterRef" name="Responses"/> 988 </elm:element> 989 <elm:element xsi:type="elm:Property" path=

"intentionOfActing"> 990 <elm:source xsi:type="elm:ParameterRef" name="Responses"/> 991 </elm:element> 992 <elm:element xsi:type="elm:Property" path=

"hadThoughtsAndHadSomeIntentionOfActing"> 993 <elm:source xsi:type="elm:ParameterRef" name="Responses"/> 994 </elm:element> 995 <elm:element xsi:type="elm:Property" path=

"preparedToEndLifeInPast3Months"> 996 <elm:source xsi:type="elm:ParameterRef" name="Responses"/> 997 </elm:element> 998 </elm:source> 999 </elm:operand>

1000 </logic> 1001 <conditionRole/> 1002 </condition> 1003 </conditions> 1004 <title value="This screen has resulted in a negative result on the C-SSRS."/> 1005 <subElements>

1006 <simpleAction xsi:type="CollectInformationAction"> 1007 <documentationConcept> 1008 <prompt value="Acknowledge"/> 1009 <responseDataType value="Boolean"/> 1010 </documentationConcept> 1011 </simpleAction> 1012 </subElements> 1013 </actionGroup> 1014 </subElements> 1015 </actionGroup> 1016 <actionGroup> 1017 <behaviors> 1018 <behavior xsi:type="GroupSelectionBehavior" value="Any"/> 1019 </behaviors> 1020 <title value="Plan"/> 1021 <subElements> 1022 <simpleAction xsi:type="CollectInformationAction"> 1023 <documentationConcept> 1024 <prompt value="If the patient is to continue routine ambulatory care, please provide details."/> 1025 <responseDataType value="String"/> 1026 </documentationConcept> 1027 </simpleAction> 1028 <actionGroup> 1029 <behaviors> 1030 <behavior xsi:type="GroupSelectionBehavior" value=

"AtMostOne"/> 1031 </behaviors> 1032 <subElements> 1033 <simpleAction xsi:type="CollectInformationAction"> 1034 <documentationConcept> 1035 <prompt value="Plan to refer to mental health provider (routine)?"/> 1036 <responseDataType value="Boolean"/> 1037 </documentationConcept> 1038 </simpleAction> 1039 <simpleAction xsi:type="CollectInformationAction"> 1040 <documentationConcept> 1041 <prompt value="Plan to refer to mental health provider now (same day)?"/> 1042 <responseDataType value="Boolean"/> 1043 </documentationConcept> 1044 </simpleAction> 1045 </subElements> 1046 </actionGroup> 1047 </subElements> 1048 </actionGroup> 1049 <actionGroup> 1050 <behaviors> 1051 <behavior xsi:type="RequiredBehavior" value="Must"/> 1052 </behaviors> 1053 <title value="Patient and Caregiver Education."/> 1054 <subElements> 1055 <simpleAction xsi:type="CollectInformationAction"> 1056 <documentationConcept> 1057 <prompt 1058 value="Confirm: Provide the following information to the Veteran: We know that suicidal thoughts and urges can come on quick. If that happens for you, please reach out for some support by calling either the Veterans Crisis Line (1-800-273-TALK) or your local VA facility (___)."/>

1059 <responseDataType value="Boolean"/> 1060 </documentationConcept> 1061 </simpleAction> 1062 <!-- Technical Note: Allow users to set the default local VA facility telephone number in the space provided. Technical Note:

Upon completion of this documentation template, with a positive screen for suicide risk, activate the Order Set: Mental Health - Positive Suicide Risk Screening KNART. End Documentation Template –Suicide Risk Assessment. -->

1063 </subElements> 1064 </actionGroup> 1065 </subElements> 1066 </actionGroup> 1067 </knowledgeDocument>