Table 2.

Evaluating Risk for Self-Injury: STOPS FIRE Assessment Guide

What to AssessHow to Assess ItHigh-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

  • “What have you used to [specific behavior]?”

  • “In what ways do you injure yourself?”

  • Multiple types

  • ≥3 methods

  • “When did you first [specific behavior]?”

  • Early/childhood onset

  • Extended duration or history ≥6 months

  • “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

  • “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

  • “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