Protocol

NSDUH Main Study Pretest
Attachment J – Distressed Respondent Protocol

NSDUH Main Study Pretest
Distressed Respondent Protocol for Adolescent and Adult Participants
Adolescent Participant Overview
Due to the nature of the sample targeted for the NSDUH Main Study Pretest and the nature of the questions asked
during cognitive interviews, it is possible that a respondent will indicate during their interactions with the cognitive
interview recruiter or the cognitive interviewers that he or she poses a likely threat to his or her own safety or the safety
of others. It is essential that NSDUH project staff members be prepared to handle these situations appropriately.
The study recruiter and cognitive interviewers will be instructed to be alert to signs of distress or agitation, or indication
of imminent danger of harm to oneself or another based on indirect and direct statements made by respondents. In
such circumstances, the recruiter or cognitive interviewer will follow the protocol outlined in this document. (For
respondents aged 18 or older, see the study’s Distressed Respondent Protocol for Adult Respondents, page 12.)
There are essentially two situations that would constitute imminent danger of harm:
1. A respondent tells the interviewer that he/she is thinking about killing or harming himself or herself, has a
plan, and has a means to carry out that plan.
2. A respondent tells the interviewer that he/she intends to hurt or kill someone else (not necessarily someone
living in the household) has a plan and has a means to carry out that plan.
In cases where imminent danger is or may be involved, the cognitive interview recruiter or cognitive interviewer will
contact Ms. Nicole Croteau-Johnson (919-316-3581), when appropriate based on the instructions in the tables below.
Ms. Croteau-Johnson is a licensed Master Psychological Associate with 17 years of clinical experience. Ms. CroteauJohnson will act primarily as a sounding board for the recruiter/cognitive interviewer. If there is a question about what
action to take in response to the recruiter’s/cognitive interviewer’s interactions with a respondent, Ms. Croteau-Johnson
and the recruiter/cognitive interviewer will discuss the situation and Ms. Croteau-Johnson will make the final decision as
to what action, if any beyond documenting the situation in an incident form, should be taken. If emergency psychiatric
services, including 911, might need to be called (imminent danger, Scenario 1), and Ms. Croteau-Johnson is unavailable
within 15 minutes of the recruiter/cognitive interviewer attempting to contact her, attempt will be made to contact Dr.
Mark Edlund (919-597-5132), a licensed psychiatrist. Any questions about whether to contact emergency psychiatric
services or 911 will be made by Ms. Croteau-Johnson or Dr. Edlund. The following table will be printed on the inside
cover of the cognitive interviewer handbook and in the instructions for handling distressed respondents:

Call:

Cell Phone Numbers:

Nicole Croteau-Johnson

919-316-3581

Dr. Mark Edlund

919-641-5460

The addresses of individuals calling to indicate interest in participation in a cognitive interview will be unknown. The
recruiter will ask the respondent for the address of his/her current location if appropriate based on these guidelines.
Even if the respondent refuses, we believe that having at least the respondent’s phone number adequately minimizes
respondent risk to themselves or others because the screening questions are short and fairly innocuous. Furthermore,
1

we do not anticipate any cognitive interview recruitment respondents to become distressed or agitated or to indicate
imminent danger of harm to oneself or another. Nevertheless, the recruiter will be provided this protocol and instructed
to follow the guidelines herein.
All cognitive interviewers hired to work on this study will confirm that these guidelines are consistent with all legal and
ethical guidelines by which they must abide. They will report that they are under no obligation to, nor will they, convey
any information about this study or about respondents to anyone not involved with this study. They also will also
confirm that they are under no legal or ethical obligation to provide mental health services or counseling to a
respondent beyond referring individuals to other resources or contacting authorities as specified in this document.
Moreover, RTI legal counsel Chris Buchholz confirmed via e-mail to David Hunter (then Cunningham) on April 25, 2007
that in his judgment the guidelines are consistent with all pertinent “duty to warn” laws in the states in which the
certification recruiter, cognitive interviewers, and respondents reside because the individuals working on the project,
even the cognitive interviewers clinically trained in mental health issues, will not be participating in a medical or
psychological professional capacity. Furthermore, RTI legal counsel Chris Buchholz outlined, via e-mail, to Dr. Cristie
Glasheen on January 12, 2018 the legal requirements for mandatory reporting laws of child abuse or neglect for each
state where adolescents may be interviewed (Scenario 3). All cognitive interviewers will be trained in these
requirements.
Although some situations may require consultation with IRB representatives, we believe these procedures will provide
comprehensive guidelines to protect the safety of our human subjects.

2

Specific Guidelines
There are 3 scenarios in which you might need to use the DRP with adolescents:
1. A suicidal adolescent respondent
2. A distressed or upset (but not suicidal) adolescent respondent
3. A case of suspected child abuse or neglect
This document will guide your statements and actions for these scenarios.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Scenario 1: Suicidal Adolescent Respondent. If a respondent answers questions that indicate thoughts of harming him
or herself, ask the respondent this series of questions: “Have you thought about what you might do? Are you going to do
this? Have you done anything to prepare for killing yourself?” As indicated in training, a suicidal plan is present if one of
the following criteria is met in the past 3 months:
•

a specific plan (e.g., I would overdose on Tylenol, I could get my mother’s sleeping pills), over which no
action was taken, OR

•

a specific plan, considered with preparatory action taken, for example storing up pills.

IF A SUICIDAL PLAN IS PRESENT IN THE PAST 3 MONTHS, STOP THE INTERVIEW AND FOLLOW THE SCRIPT BELOW. Note
that you only need to read this script to the adolescent respondent when he or she reports a suicidal plan in the past 3
months and not before.
These scenarios require contact with the parent or a national helpline to make sure that the adolescent will be safe
when you finish the interview. We expect that you will almost always be able to reach either the parent or the helpline.
However, in an emergency, please do the following:
•

IF SOMETHING HAPPENS AND YOU ARE UNABLE TO CONNECT TO THE PARENT OR TO EITHER HELPLINE: KEEP
THE ADOLESCENT RESPONDENT WITH YOU AND CALL MS. CROTEAU-JOHNSON (919-316-3581).

•

IF SOMETHING HAPPENS AND YOU ARE UNABLE TO CONNECT TO THE PARENT OR CONNECT TO EITHER
HELPLINE AND YOU ARE SERIOUSLY CONCERNED THAT THE ADOLESCENT IS IN IMMEDIATE DANGER, CALL MS.
CROTEAU-JOHNSON (919-316-3581). SHE WILL SEARCH FOR THE LOCAL 911 NUMBER FOR THAT PART OF THE
COUNTRY. SHE WILL CALL 911 AND GIVE THE CHILD’S CONTACT INFORMATION.

3

Scenario Number
1a—Suicidal Child Respondent

Script for:
INFORMING CHILD RESPONDENT OF NEED TO CONTACT PARENT

STEPS
1. INTERVIEWER READS: I promised that I would need to contact someone else only if you were in danger of
getting seriously hurt. What you have told me about hurting yourself has me concerned about your safety
and well-being. So, first I would like you to write down a phone number where there is always an adult to
talk to about how you are feeling 24-hours a day. They can also help you find a counselor in your area.
•

If on telephone, INTERVIEWER READS: Do you have a pen or pencil? (WAIT ON RESPONDENT) To
contact the national helpline, call 1-800-448-3000. Could you repeat that number back to me? (IF
RESPONDENT CANNOT REPEAT, READ THE TELEPHONE NUMBER AGAIN). If you feel that this is an
emergency now or later, you should tell an adult, go to a hospital emergency room, or call 911 for
help.

If in person: (Provide phone number), INTERVIEWER READS: To contact the national helpline, call 1-800-4483000. If you feel that this is an emergency now or later, you should tell an adult, go to a hospital emergency
room, or call 911 for help.
2. INTERVIEWER READS: Now, I also have to tell one of your parents about what you told me so they can
make sure that you are safe. I will also have to tell my supervisor.
•

If on telephone, INTERVIEWER READS: Can you get your parent on the telephone?

If in person: ADOLESCENT RESPONDENT MAY CALL PARENT DIRECTLY TO COME TO THE ROOM
OR REMAIN IN THE ROOM WHILE THE INTERVIEWER CALLS THE PARENT OR CALLS A
COLLEAGUE TO BRING THE PARENT TO THE ROOM. ASK ADOLESCENT TO STAY IN THE ROOM
WHILE YOU SPEAK TO THE PARENT.
3. If on telephone, and THE PARENT IS NOT REACHED, INTERVIEWER READS: What is another number we
can call to reach your parent right now?
4. ATTEMPT TO REACH THE PARENT.
5. IF THE RESPONDENT GETS EXTREMELY ALARMED AT THE IDEA OF YOU TALKING TO THE PARENT, YOU
SHOULD LINK THE ADOLESCENT DIRECTLY TO A HELPLINE. THIS SHOULD BE A RARE EVENT. SEE
INSTRUCTIONS BELOW.

4

Scenario Number
1a—Suicidal Child Respondent

Script for:
PARENT CAN BE REACHED RIGHT AWAY, Either telephone or in
person

STEPS
1. TO PARENT—INTERVIEWER READS: Your teenager was just completing his/her interview for the
NSDUH cognitive interview study. During that interview, your teenager told me that she/he
sometimes has serious thoughts about harming her/himself, and we want to make sure she/he is
safe. I am not a trained counselor so I cannot tell you more about what this means. However, I would
like to let you know so that you can talk to your teenager and decide what to do. You may want to
contact your teenager’s doctor or health care professional to discuss this further or call a local
behavioral health professional. I have a helpline number where counselors are available 24 hours a
day to speak with you or your teenager. They may also help you find a counselor in your area. (If on
telephone) Do you have something to write with? (Wait for parent to get pen/pencil). The national
helpline number is 1-800-448-3000. If you feel that this is an emergency now or later, please take
your teenager to a hospital emergency room or call 911 for help.
2. INTERVIEWER ACTION: DOCUMENT THE CALL WITH AN INCIDENT REPORT. NOTE YOUR ACTION
TAKEN: REPORTED TO PARENT, LEFT MESSAGE FOR PARENT, CONNECTED TO HELPLINE (note
whether the Boys Town or Lifeline number was used).
3. INTERVIEWER ACTION: Contact Ms. Croteau-Johnson and notify her of the situation.
4. INTERVIEWER ACTION: Call Scott Payne and leave a message on his answering machine indicating
that you have a distressed respondent and be sure to leave the Case ID number. Do not leave the
respondent’s name or telephone number on this message.

5

Scenario Number
1b—Suicidal Child Respondent

Script for:
PARENT HAS LEFT THE INTERVIEW LOCATION OR DOES NOT
ANSWER PHONE: LEAVING A MESSAGE AND CONTACTING HELPLINE

STEPS
1. IF PARENT IS NOT AVAILABLE—INTERVIEWER LEAVES A MESSAGE: Hello, this is [insert your name]
calling from RTI International. I have just conducted the NSDUH interview with [insert child respondent’s
name]. I would like to speak with you as soon as possible about this interview. Please call Scott Payne at
RTI International as soon as you get a chance. His number is 919-541-6698. We will attempt to call you
back if we do not hear from you soon. Thank you.
2. INTERVIEWER ACTION: RETURN TO TEENAGER.
3. INTERVIEWER READS: I was not able to reach your parent and I left a message for him/her to call RTI.
Since I can’t reach your parent, I still want to make sure that you are safe. I would like for you to be able
to talk to another adult about how you are feeling. So, I would like to connect you with a helpline where
counselors are available to speak with you. Please stay on the line while I call. If we get disconnected, I
will call you back.
4.

IF ON TELEPHONE: PUT CHILD RESPONDENT ON HOLD AND CALL BOYS TOWN NATIONAL
HOTLINE TO SET UP A 3-WAY CALL: 1-800-448-3000.
IF YOU CANNOT GET THROUGH USING THE BOYS TOWN NATIONAL HOTLINE, CALL THE LIFELINE
HELPLINE: 1-800-273-8255
IF IN PERSON: CALL BOYS TOWN NATIONAL HOTLINE: 1-800-448-3000.
IF YOU CANNOT GET THROUGH USING THE BOYS TOWN NATIONAL HOTLINE, CALL THE LIFELINE
HELPLINE: 1-800-273-8255

5. ONCE YOU REACH THE HELPLINE, INTERVIEWER READS: I work for RTI International, a research company
in North Carolina, and we are conducting a research study. During a telephone interview, a respondent
told me that (he/she) is thinking about hurting (himself/herself). I have asked the respondent to wait here
with me while I contacted you. I can give you additional information about the research study, if you
would like. I can also provide you with the respondent’s contact information.
IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use and Health
sponsored by the Substance Abuse and Mental Health Services Administration, is designed to assess
new and revised measures for marijuana, vaping, synthetic drugs, substance use and mental health
treatment, distress and impairment, youth suicide, self-harm, needle use, and criminal justice. Please
note that this information was obtained through the respondent’s participation in a research study.
We went through appropriate informed consent procedures, during which I told the respondent that
if (he/she) told me something that caused me to be concerned about (his/her) well-being, I would

6

report that to someone else who could help or intervene. Do you have any questions about the study?
ANSWER QUESTIONS.
6. INTERVIEWER ACTION: CONNECT CHILD RESPONDENT WITH THE HELPLINE COUNSELOR. STAY IN THE
ROOM WHILE THE CHILD RESPONDENT TALKS WITH THE HELPLINE COUNSELOR. IF THE CHILD
RESPONDENT REFUSES TO SPEAK WITH THE HELPLINE COUNSELOR, PROVIDE THE COUNSELOR WITH
THE CHILD RESPONDENT’S NAME, TELEPHONE NUMBER, AND ADDRESS.
7. INTERVIEWER ACTION: DOCUMENT THE CALL WITH AN INCIDENT REPORT. NOTE YOUR ACTION TAKEN:
REPORTED TO PARENT, LEFT MESSAGE FOR PARENT, CONNECTED TO HELPLINE (note whether the Boys
Town or Lifeline number was used).
8. INTERVIEWER ACTION: Contact Ms. Croteau-Johnson and notify her of the situation.
9. INTERVIEWER ACTION: Call Scott Payne and leave a message on his answering machine indicating that
you have a distressed respondent and be sure to leave the Case ID number. Do not leave the
respondent’s name or telephone number on this message.

7

Scenario Number
1c—Suicidal Child Respondent

Script for:
CHILD RESPONDENT IS ALARMED AND ABSOLUTELY REFUSES
PARENT CONTACT

STEPS
1. INTERVIEWER READS: I understand that you do not want me to contact your parent. But, I must make
sure that you are safe and I would like for you to be able to talk to another adult about how you are
feeling. So, I would like to connect you with a helpline where counselors are available to speak with you.
Please stay in the room/on the line while I call.
2. INTERVIEWER ACTION: CALL THE BOYS TOWN NATIONAL HOTLINE: 1-800-448-3000.
IF YOU CANNOT GET THROUGH USING THE BOYS TOWN HOTLINE, CALL THE LIFELINE HELPLINE: 1-800273-8255
3. ONCE YOU REACH THE HELPLINE, INTERVIEWER READS: I work for RTI International, a research company
in North Carolina, and we are conducting a research study. During a telephone interview, a respondent
told me that (he/she) is thinking about hurting (himself/herself). I have asked the respondent to wait in
the room/stay on the line [if during phone screening] while I contacted you. I can give you additional
information about the research study, if you would like. I can also provide you with the respondent’s
contact information (or conference them into the call [if during phone screening]).
IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use and

Health sponsored by the Substance Abuse and Mental Health Services Administration, is
designed to assess new and revised measures for marijuana, vaping, synthetic drugs,
substance use and mental health treatment, distress and impairment, youth suicide, selfharm, needle use, and criminal justice. Please note that this information was obtained
through the respondent’s participation in a research study. We went through appropriate
informed consent procedures, during which I told the respondent that if (he/she) told me
something that caused me to be concerned about (his/her) well-being, I would report
that to someone else who could help or intervene. Do you have any questions about the
study? ANSWER QUESTIONS.
4. INTERVIEWER ACTION: CONNECT CHILD RESPONDENT TO THE HELPLINE COUNSELOR. STAY IN THE
ROOM WHILE THE CHILD RESPONDENT TALKS WITH THE HELPLINE COUNSELOR. IF ON THE PHONE,
INITIATE A 3-WAY CALL WITH THE HOTLINE. PROVIDE COUNSELOR WITH THE RESPONDENT’S NAME,
TELEPHONE NUMBER, AND ADDRESS IN CASE OF ACCIDENTAL DISCONNECT, THEN RECONNECT WITH
RESPONDENT. AFTER ENSURING CONNECTION, HANG UP. THE LINE WILL REMAIN ACTIVE UNTIL THE
8

REMAINING PARTIES HANG UP. IF R REFUSES TO SPEAK TO COUNSELOR, PROVIDE COUNSELOR WITH
THE CHILD RESPONDENT’S NAME, TELEPHONE NUMBER, AND ADDRESS.
5. INTERVIEWER ACTION: COMPLETE AN INCIDENT REPORT. NOTE YOUR ACTION TAKEN: REPORTED TO
PARENT, LEFT MESSAGE FOR PARENT, CONNECTED TO HELPLINE (note whether the Boys Town or
Lifeline number was used).
6. INTERVIEWER ACTION: Contact Ms. Croteau-Johnson and notify her of the situation.
7. INTERVIEWER ACTION: Call Scott Payne and leave a message on his answering machine

indicating that you have a distressed respondent and be sure to leave the Case ID number. Do
not leave the respondent’s name or telephone number on this message.

9

Scenario Number
2-- Upset child

Script for:
ADOLESCENT RESPONDENT SEEMS UPSET BY THE INTERVIEW. DOES
NOT EXPRESS A SPECIFIC SUICIDAL PLAN

STEPS
1. INTERVIEWER READS: Some of these questions are hard to talk about, and it seems to be upsetting you.
Maybe you can talk to someone, like an adult who you trust when you get done with the interview, so
that she or he can help you talk about how you are feeling. Also, I have a telephone number where
counselors are available 24-hours a day to talk to you about how you are feeling.
•

If on phone: Do you have a pen or pencil? (WAIT ON RESPONDENT) To contact the national
helpline, call 1-800-448-3000. Could you repeat that number back to me? (IF RESPONDENT
CANNOT REPEAT, READ THE TELEPHONE NUMBER AGAIN).

•

If in person: Provide number

2. INTERVIEWER ACTION: CONTINUE WITH INTERVIEW, IF POSSIBLE.
3. INTERVIEWER ACTION: DOCUMENT THE CALL WITH AN INCIDENT REPORT.
4. INTERVIEWER ACTION: Contact Ms. Croteau-Johnson and notify her of the situation.
5. INTERVIEWER ACTION: Call Scott Payne and leave a message on his answering machine indicating that
you have a distressed respondent and be sure to leave the Case ID number. Do not leave the
respondent’s name or telephone number on this message.

10

Scenario Number
3—Suspected child abuse or neglect

Script for:
NO SCRIPT, ONLY INTERVIEWER ACTIONS POST-INTERVIEW

STEPS
During the course of the interview the child respondent shares information that leads you to believe that he or
she has been abused or neglected.
1. INTERVIEWER ACTION: Continue with interview and do not break off. Do not ask specifically for
additional details about the suspected child abuse or neglect and do not ask for details beyond what is
shared naturally during the course of the interview. Once the interview has been completed, put concise
notes in an Incident Report. Write down specifically what the respondent told you that led you to suspect
child abuse or neglect.
2. Call Scott Payne and leave a message on his answering machine indicating that you have a case of
suspected child abuse or neglect. Be sure to leave the Case ID number. Do not leave the respondent’s
name or telephone number on this message.

11

Adult Participant Overview
Due to the nature of the sample targeted for the NSDUH Main Study Pretest and the nature of the questions
asked during cognitive interviews, it is possible that a respondent will indicate during their interactions with the
study recruiter or the cognitive interviewers that he or she poses a likely threat to his or her own safety or the
safety of others. It is essential that NSDUH project staff members be prepared to handle these situations
appropriately.
The cognitive interview recruiter and all cognitive interviewers will be instructed to be alert to signs of distress
or agitation, or indication of imminent danger of harm to oneself or another based on indirect and direct
statements made by respondents. In all such circumstances with adult respondents showing signs of distress,
the study recruiter or cognitive interviewer will follow the protocol outlined in this document. (For
respondents under the age of 18, see the study’s Distressed Respondent Protocol for Adolescent
Respondents.)
There are essentially two situations that would constitute imminent danger of harm:

1. A respondent tells the interviewer that he/she is thinking about killing or harming himself
or herself, has a plan, and has a means to carry out that plan.
2. A respondent tells the interviewer that he/she intends to hurt or kill someone else (not
necessarily someone living in the household) has a plan and has a means to carry out that
plan.
In cases where imminent danger is or may be involved, the cognitive interview recruiter or cognitive
interviewer will contact Ms. Nicole Croteau-Johnson (919-316-3581), when appropriate based on the
instructions in the tables below. Ms. Croteau-Johnson is a licensed Master Psychological Associate with 17
years of clinical experience. Ms. Croteau-Johnson will act primarily as a sounding board for the
recruiter/cognitive interviewer. If there is a question about what action to take in response to the
recruiter’s/cognitive interviewer’s interactions with a respondent, Ms. Croteau-Johnson and the
recruiter/cognitive interviewer will discuss the situation and Ms. Croteau-Johnson will make the final decision
as to what action, if any beyond documenting the situation in an incident form, should be taken. If emergency
psychiatric services, including 911, has been or might need to be called (imminent danger, Scenarios 2 or 4),
and Ms. Croteau-Johnson is unavailable within 15 minutes of the recruiter/cognitive interviewer attempting to
contact her, attempt will be made to contact Dr. Mark Edlund, a licensed psychiatrist (919-597-5132). Any
questions about whether to contact emergency psychiatric services or 911 will be made by Ms. CroteauJohnson or Dr. Edlund. The following table will be printed on the inside cover of the cognitive interviewer
handbook and in the instructions for handling distressed respondents:

Call:

Cell Phone Numbers:

Nicole Croteau-Johnson

919-316-3581

Dr. Mark Edlund

919-641-5460

12

The addresses of individuals calling to indicate interest in participation in a cognitive interview will be
unknown. The recruiter will ask the respondent for the address of his/her current location if appropriate based
on these guidelines. Even if the respondent refuses, we believe that having at least the respondent’s phone
number adequately minimizes respondent risk to themselves or others because the screening questions are
short and fairly innocuous. Furthermore, we do not anticipate any cognitive interview recruitment respondents
to become distressed or agitated, or to indicate imminent danger of harm to oneself or another. Nevertheless,
the recruiter will be provided this protocol and instructed to follow the guidelines herein.
All cognitive interviewers hired to work on this study will confirm that these guidelines are consistent with all
legal and ethical guidelines by which they must abide. They will report that they are under no obligation to,
nor will they, convey any information about this study or about respondents to anyone not involved with this
study. They also will also confirm that they are under no legal or ethical obligation to provide mental health
services or counseling to a respondent beyond referring individuals to other resources or contacting authorities
as specified in this document. Moreover, RTI legal counsel Chris Buchholz confirmed via e-mail to David Hunter
(then Cunningham) on April 25, 2007 that in his judgment the guidelines are consistent with all pertinent “duty
to warn” laws in the states in which the certification recruiter, cognitive interviewers, and respondents reside
because the individuals working on the project, even the cognitive interviewers clinically trained in mental
health issues, will not be participating in a medical or psychological professional capacity.
Although some situations may require consultation with IRB representatives, we believe these procedures will
provide comprehensive guidelines to protect the safety of our human subjects.

13

Specific Guidelines
If respondents report any of the issues listed below during any interactions with the study recruiter or
cognitive interviewer, including before, during, or after a cognitive interview, the staff member will
immediately refer to the scenario chart below and follow the instructions provided. Details of all incidents will
be documented in an incident report and reported to project management staff immediately.
•

If a respondent answers questions that indicate thoughts of harming him or herself, ask the respondent this
series of questions: “Have you thought about what you might do? Are you going to do this? Have you done
anything to prepare for killing yourself?” As indicated in training, a suicidal plan is present if one of the
following criteria is met in the past 3 months:
•

a specific plan (e.g., I would overdose on Tylenol, I could get sleeping pills), considered, over which
no action was taken [SCENARIO 1], OR

•

a specific plan, considered with preparatory action taken, for example storing up pills [SCENARIO 2].

IF A SUICIDAL PLAN IS PRESENT IN THE PAST 3 MONTHS, STOP THE INTERVIEW AND FOLLOW THE APPROPRIATE SCRIPT
BELOW. Note that you only need to read the script to the respondent when he or she reports a suicidal plan in the past 3
months and not before.
• If a respondent has had any homicidal thoughts in the past two weeks, including
– passive homicidal thoughts (i.e. thoughts or wishes about seriously harming someone else in
the absence of thoughts about specific ways in which s/he could seriously harm another
person, plans for how s/he could seriously harm another person, intentions of seriously harming
another person) [SCENARIO 3] or
– active homicidal thoughts (i.e. thoughts or wishes about seriously harming someone else
combined with thoughts about specific ways s/he could seriously harm another person, plans
for how s/he could seriously harm another person, the intention of seriously harming another
person, and the means to carry out that plan) [SCENARIO 4]
Scenario Chart
Scenario Number

Individual at Risk of Harm

Imminent Danger?

1

Self

No

2

Self

Possible / Yes

3

Other(s)

No

4

Other(s)

Possible / Yes

5

No risk of harm; respondent is
agitated or upset

No

14

Scenario Number

Individual at Risk of Harm

Imminent Danger?

1

Self

No

STEPS
A. COMPLETE SCREENING/INTERVIEW AND THEN READ TO R: When you agreed to
participate in this interview, I promised that I would not tell anyone what you have told me
unless it was necessary to protect you or other people. You told me earlier that you have recently
had thoughts or wishes about your death or dying. Do you have a doctor, counselor, or someone
you can talk to about how you are feeling now?
IF YES: I strongly suggest that you contact this person immediately so you can talk to him
or her about how you have been feeling, especially about the thoughts you’ve been having
about death and dying. Would you be willing to do that?
IF YES: Okay. There is also a national Lifeline hotline you can call where
counselors are available to talk at any time of the day or night. Their toll-free
number is 1-800-273-8255. THANK R FOR THEIR PARTICIPATION IN THE
STUDY AND END SCREENING/INTERVIEW.
IF NO: I strongly suggest that you contact the national Lifeline hotline at 1-800-273-8255.
Lifeline has counselors available 24-hours a day to talk to you about how you are feeling.
They may also help you locate (additional) mental health services in your area. If you feel
that this is an emergency now or later, you should go to a hospital emergency room right
away. If you are not able to get to an emergency room immediately, you should call 911 for
assistance. THANK R FOR THEIR PARTICIPATION IN THE STUDY AND END
SCREENING/INTERVIEW.
B. WHEN SCREENING/INTERVIEW IS COMPLETED, CALL MS. NICOLE CROTEAUJOHNSON TO DEBRIEF. FILL OUT AN INCIDENT REPORT.
C. CALL SCOTT PAYNE AND LEAVE A MESSAGE ON HIS ANSWERING MACHINE
INDICATING THAT YOU HAVE A DISTRESSED RESPONDENT AND BE SURE TO LEAVE
THE CASE ID NUMBER. DO NOT LEAVE THE RESPONDENT’S NAME OR TELEPHONE
NUMBER ON THIS MESSAGE.

15

Scenario Number

Individual at Risk of Harm

Imminent Danger?

2

Self

Possible / Yes

STEPS
A. END SCREENING/INTERVIEW AND THEN READ TO R: When you agreed to participate
in this interview, I promised that I would not tell anyone what you have told me unless it was
necessary to protect you or other people. You told me earlier that you are thinking about
harming yourself. I will need to call the emergency services provider to see if they can send
someone to you who can provide the care you need in order to keep you safe. I’ll let you know
what I find out.
B. FIND THE NEAREST EMERGENCY PSYCHIATRIC SERVICES USING THE SAMHSA
WEBSITE (http://mentalhealth.samhsa.gov/databases/). SEARCH FOR INPATIENT MH
TREATMENT USING THE R’S CURRENT ZIP CODE.
C. CALL THEIR LOCAL INPATIENT PSYCHIATRIC CARE FACILITY OR CRISIS CENTER
AND READ THIS STATEMENT: I work for RTI International, a research company in North
Carolina, and we are conducting a research study. During an interview with a respondent, the
respondent told me that (he/she) is thinking about killing or harming (himself/herself)) and I am
concerned about (his/her) safety. I can give you additional information about the research study,
if you would like. I can also provide you with the respondent’s contact information.
IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use
and Health sponsored by the Substance Abuse and Mental Health Services Administration, is
designed to assess new and revised measures for marijuana, vaping, synthetic drugs,
substance use and mental health treatment, distress and impairment, youth suicide, selfharm, needle use, and criminal justice. Please note that this information was obtained
through the respondent’s participation in a research study. We went through appropriate
informed consent procedures, during which I told the respondent that if (he/she) told me
something that caused me to be concerned about (his/her) well-being, I would report that to
someone else who could help or intervene. Do you have any questions about the study?
ANSWER QUESTIONS.
D. GIVE R FIRST NAME, TELEPHONE NUMBER, AND ADDRESS (IF KNOWN) TO LOCAL
EMERGENCY CARE REPRESENTATIVE. IF THEY ARE UNABLE TO PROVIDE SERVICES
THAT ENSURE THE R’S SAFETY, SEARCH FOR THE R’S LOCAL EMERGENCY NUMBER
USING THE NATIONAL 911 DATABASE.
E. CALL EMERGENCY CARE REPRESENTATIVE OR LOCAL 911 DISPATCHER AND READ
SCRIPT FROM STEP C.
F. END CALL WITH THE EMERGENCY CARE PROVIDER OR LOCAL 911 DISPATCHER
AND ATTEMPT TO CONTACT R AGAIN WITH AN UPDATE.
G. WHEN SCREENING/INTERVIEW IS COMPLETED, CALL MS. CROTEAU-JOHNSON TO
DEBRIEF. IF SHE DOES NOT RETURN CALL WITHIN 15 MINUTES, CONTACT DR.
EDLUND. FILL OUT AN INCIDENT REPORT.
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H. CALL SCOTT PAYNE AND LEAVE A MESSAGE ON HIS ANSWERING MACHINE
INDICATING THAT YOU HAVE A DISTRESSED RESPONDENT AND BE SURE TO LEAVE
THE CASE ID NUMBER. DO NOT LEAVE THE RESPONDENT’S NAME OR TELEPHONE
NUMBER ON THIS MESSAGE.
Scenario Number

Individual at Risk of Harm

Imminent Danger?

3

Other(s)

No

STEPS
A. COMPLETE SCREENING/INTERVIEW AND THEN READ TO R: When you agreed to
participate in this interview, I promised that I would not tell anyone what you have told me
unless it was necessary to protect you or other people. You told me earlier that you have recently
had thoughts or wishes about seriously harming someone else. Do you have a doctor, counselor,
or someone you can talk to about how you are feeling now?
IF YES: I strongly suggest that you contact this person immediately so you can talk to him
or her about how you have been feeling, especially about the thoughts you’ve been having
about seriously harming someone else. Would you be willing to do that?
IF YES: Okay. There is also a national Lifeline hotline you can call where
counselors are available to talk at any time of the day or night. Their toll-free
number is 1-800-273-8255. THANK R FOR THEIR PARTICIPATION IN THE
STUDY AND END SCREENING/INTERVIEW.
IF NO: I strongly suggest that you contact the national Lifeline hotline at 1-800-273-8255.
Lifeline has counselors available 24-hours a day to talk to you about how you are feeling.
They may also help you locate (additional) mental health services in your area. If you feel
that this is an emergency now or later, you should go to a hospital emergency room right
away. If you are not able to get to an emergency room immediately, you should call 911 for
assistance. THANK R FOR THEIR PARTICIPATION IN THE STUDY AND END
SCREENING/INTERVIEW.
B. WHEN SCREENING/INTERVIEW IS COMPLETED, CALL MS. CROTEAU-JOHNSON TO
DEBRIEF. IF DIRECTED BY HER, FOLLOW SCENARIO 4 FOR POSSIBLE IMMINENT
DANGER TO OTHERS. FILL OUT AN INCIDENT REPORT.
C. CALL SCOTT PAYNE AND LEAVE A MESSAGE ON HIS ANSWERING MACHINE
INDICATING THAT YOU HAVE A DISTRESSED RESPONDENT AND BE SURE TO LEAVE
THE CASE ID NUMBER. DO NOT LEAVE THE RESPONDENT’S NAME OR TELEPHONE
NUMBER ON THIS MESSAGE.

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Scenario Number

Individual at Risk of Harm

Imminent Danger?

4

Other(s)

Possible / Yes

STEPS
A. END SCREENING/INTERVIEW.
B. SEARCH FOR THE R’S LOCAL EMERGENCY NUMBER USING THE NATIONAL 911 DATABASE.
C. CALL THEIR LOCAL 911 AND READ THIS STATEMENT: I work for RTI International, a research
company in North Carolina, and we are conducting a research study. During an interview with a respondent,
the respondent told me that (he/she) is thinking about killing or harming another individual. I am concerned
about this individual’s safety. I can give you additional information about the research study, if you would like.
I can also provide you with the respondent’s contact information.
IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use and Health
sponsored by the Substance Abuse and Mental Health Services Administration, is designed to assess new
and revised measures for marijuana, vaping, synthetic drugs, substance use and mental health treatment,
distress and impairment, youth suicide, self-harm, needle use, and criminal justice. Please note that this
information was obtained through the respondent’s participation in a research study. We went through
appropriate informed consent procedures, during which I told the respondent that if (he/she) told me
something that caused me to be concerned about (his/her) well-being, I would report that to someone
else who could help or intervene. Do you have any questions about the study? ANSWER QUESTIONS.
D. GIVE R FIRST NAME, TELEPHONE NUMBER, ADDRESS (IF KNOWN), AND VICTIM’S
IDENTIFYING INFORMATION TO LOCAL 911 DISPATCHER. END CALL.
E. WHEN SCREENING/INTERVIEW IS COMPLETED, CALL MS. CROTEAU-JOHNSON TO DEBRIEF.
IF SHE DOES NOT RETURN CALL WITHIN 15 MINUTES, CONTACT DR EDLUND TO NOTIFY HIM
ABOUT THE INCIDENT. FILL OUT AN INCIDENT REPORT.
F. CALL SCOTT PAYNE AND LEAVE A MESSAGE ON HIS ANSWERING MACHINE INDICATING THAT
YOU HAVE A DISTRESSED RESPONDENT AND BE SURE TO LEAVE THE CASE ID NUMBER. DO NOT
LEAVE THE RESPONDENT’S NAME OR TELEPHONE NUMBER ON THIS MESSAGE.

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Scenario Number

Individual at Risk of Harm

Imminent Danger?

5

No risk of harm; respondent is
agitated or upset

No

STEPS
A. END SCREENING/INTERVIEW AND THEN READ TO R: I know these questions are very
personal, and they seem to be upsetting you. Do you have a doctor or someone you can talk to
about how you are feeling?
IF YES: I suggest that you call that individual immediately so that she or he can help you
talk about and work through how you are feeling. There is also a national Lifeline hotline you
can call where counselors are available to talk at any time of the day or night. Their toll-free
number is 1-800-273-8255. THANK R FOR THEIR PARTICIPATION IN THE STUDY AND
END SCREENING/INTERVIEW.
IF NO: I suggest that you contact the national Lifeline hotline at 1-800-273-8255. Lifeline is a
24-hour hotline that you could call to discuss this with a counselor. They may also help you
locate (additional) mental health services in your area. If you feel that this is an emergency
now or later, you should go to a hospital emergency room right away or call 911 for
assistance. THANK R FOR THEIR PARTICIPATION IN THE STUDY AND END
SCREENING/INTERVIEW.
B. WHEN SCREENING/INTERVIEW IS COMPLETED, CALL MS. CROTEAU-JOHNSON TO
DEBRIEF. FILL OUT AN INCIDENT REPORT.
C. CALL SCOTT PAYNE AND LEAVE A MESSAGE ON HIS ANSWERING MACHINE
INDICATING THAT YOU HAVE A DISTRESSED RESPONDENT AND BE SURE TO LEAVE
THE CASE ID NUMBER. DO NOT LEAVE THE RESPONDENT’S NAME OR TELEPHONE
NUMBER ON THIS MESSAGE.

19