Table 2.

Evaluating Risk for Self-Injury: STOPS FIRE Assessment Guide

What to Assess	How to Assess It	High-Risk Indicators Warranting Referral for Behavioral Health Services
Suicidal ideations	“[Specific behavior] might be different than trying to kill yourself, but for some people they’re related. Do you ever think about killing yourself when you [specific behavior]? Do you think about killing yourself when you don’t [specific behavior]?”	Intense thoughts about suicide while self-injuring Thoughts about suicide before or after self-injuring
Types	“What have you used to [specific behavior]?” “In what ways do you injure yourself?”	Multiple types ≥3 methods
Onset	“When did you first [specific behavior]?”	Early/childhood onset Extended duration or history ≥6 months
Place/location	“What parts of your body have you [specific behavior]?”	Genitals or breasts Face
Severity of damage	“Has [specific behavior] ever caused any bleeding/bruising/scarring?” “Have you ever had to go to the hospital after you [specific behavior]?” “How do you handle the wound after you [specific behavior]?	Hospitalization or suturing required Neglect of wounds Reopening of wounds
Functions	“What does [specific behavior] do for you?” “How do you usually feel before [specific behavior]?” “How do you usually feel after [specific behavior]?” “Would it help you in any way if you stopped [specific behavior]?”	Any relationship to suicide (eg, compromise between living and dying; reduces suicidal thoughts or urges)
Intensity of self-injury urges	“How strongly would you rate your urges to [specific behavior] in a typical day from 0 to 100?”	70 or higher
Repetition	“About how many times would you say you [specific behavior] since you started?”	11–50 (moderate risk) ≥50 (high risk)
Episodic frequency	“How often do you [specific behavior] in a typical day? What about a typical week?”	Multiple times per week ≥5 wounds per episode