MICS-Distressed Respondent Protocol

Clinician Distressed Respondent Protocol
Overview
The Mental Illness Calibration Study (MICS) focuses on the collection of specific mental health
data. The aim of the study is to calibrate national mental disorder prevalence estimates to DSM5 for the National Survey on Drug Use and Health.
MICS data collection will involve interviewing selected adults via video conference or telephone
in their home or another private location.
During the MICS interview, a clinical interviewer may directly learn through responses to the
interview questions that a respondent poses a serious threat to his or her own safety or the
safety of others. The MICS interview poses detailed questions about suicidal ideation, intent,
plans and immediate risk of harm. Consequently, it is essential that MICS clinical interviewers
be prepared to handle these situations appropriately.
All MICS interviewers will be instructed to be alert to signs of distress or agitation, or indications
of imminent danger of harm to oneself or another based on indirect and direct statements made
by respondents. In all such circumstances, the interviewers will follow the appropriate distressed
respondent protocol. The distressed respondent protocol for clinical interviewers is outlined in
the following sections.

Important Contact Information for Reporting Adverse Events
Leyla Stambaugh, PhD

(919) 599-3890

lstambaugh@rti.org

Lauren Scroggs, PhD

(919) 448-8222

lscroggs@rti.org

Paul Geiger, PhD

(804) 840-9742

pgeiger@rti.org

Mark Edlund, MD, PhD

medlund@rti.org

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Clinician Distressed Respondent Protocol
Due to the nature of the clinical interview questions asked during the MICS data collection, it is
possible that a respondent will indicate during the course of their interactions with you that they
pose a likely threat to their own safety or the safety of others. It is essential that NSMH project
staff members be prepared to handle these situations appropriately.
As a clinical interviewer, you must be alert to signs of respondent distress or agitation, or
indication of imminent danger of harm to oneself or another based on indirect and direct
statements made by respondents.
There are 4 situations in which you might need to use the Distressed Respondent Protocol
(DRP):

1. A suicidal respondent
2. A respondent with thoughts of serious physical harm to others
3. A distressed or upset (but not suicidal) respondent
4. A case of current suspected abuse or neglect
In all such circumstances, you must follow the protocol outlined in this document. Each scenario
has specific steps to follow.
Situation 1: Suicidal Respondent
If respondents report any of the issues listed below during any interactions with you, including
before, during, or after an interview, you must follow the instructions in the box provided. Details
of all incidents must be reported to your clinical supervisor immediately.

•

Respondent has had any suicidal thoughts IN THE PAST WEEK, including:
–

current and serious passive suicidal thoughts (i.e., thoughts or wishes about their
death in the absence of intention of attempting suicide) [SCENARIO 1a] or

–

current and serious active suicidal thoughts with intention of dying or
attempting suicide (i.e., thoughts or wishes about their death combined with
thoughts about specific ways they could die or attempt suicide, plans for how they
could die or attempt suicide, the intention of dying or attempting suicide, or the
means to carry out that plan [SCENARIO 1b]

Follow the steps for Scenarios 1a (passive suicidal) and 1b (active suicidal) for each
scenario laid out in the box on the next page.

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Clinician Distressed Respondent Protocol (Cont’d)
Scenario Number
1a—Suicidal Respondent

Script for:
Current and Serious Passive Suicidal Thoughts (PAST
WEEK)

STEPS

1. COMPLETE 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.
2. 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 them
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 hotline number you can call where
counselors are available to talk at any time of the day or night. The number is
988. This was also provided in the email with your appointment information.
THANK R FOR THEIR PARTICIPATION IN THE STUDY AND END CALL.
IF NO: I strongly suggest that you contact the national hotline number, 988. Counselors are
available 24 hours a day to talk to you about how you are feeling. They may also help you
locate 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 CALL.
3. WHEN CALL IS COMPLETED, CALL YOUR CLINICAL SUPERVISOR IF YOU

HAVE QUESTIONS OR WOULD LIKE TO DEBRIEF. IF YOUR CLINICAL
SUPERVISOR IS NOT AVAILABLE, CONTACT DR. STAMBAUGH OR DR.
SCROGGS AT RTI. IMMEDIATELY FILL OUT A DISTRESSED RESPONDENT
REPORT AND E-MAIL YOUR CLINICAL SUPERVISOR. EXCLUDE PERSONALLY
IDENTIFYING INFORMATION (PII).

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Scenario Number
1b—Suicidal Respondent

Script for:
Current and Serious Active Suicidal Thoughts (PAST
WEEK)

STEPS

END 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. So, I would like to connect you with a helpline where
counselors are available to speak with you. What number should I use?
INTERVIEWER: REMAIN CONNECTED TO ZOOM VIDEO/AUDIO AND CALL
RESPONDENT WITH YOUR CELL PHONE OR LANDLINE. ONCE CONNECTED
TO RESPONDNET ASK RESPONDENT TO DISCONNECT FROM ZOOM AND
READ: Please stay on the line while I call the helpline. Will you do that? If we get
disconnected, I will call you back.
PUT RESPONDENT ON HOLD AND CALL National Suicide Prevention Lifeline services TO
SET UP A 3-WAY CALL: 988
•

IF SOMETHING HAPPENS AND YOU ARE UNABLE TO CONNECT TO 988:
KEEP THE RESPONDENT ON THE PHONE (ON HOLD) AND CALL DR
SCROGGS, DR GEIGER, OR DR EDLUND SO THEY CAN PROVIDE A RISK
ASSESSMENT.

1. ONCE YOU REACH 988, READ: I work for RTI International, a research
organization in North Carolina, and we are conducting a research study. During a
telephone interview, a respondent told me that they are seriously thinking about
hurting themselves. Even though I’m calling you from [FILL STATE], the respondent
lives in [INSERT SUBJECT’S STATE]. I have asked the respondent to wait on the
line 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. Remember that they should still be waiting on the other line.
DO NOT SHARE ANY INTERVIEW DATA. BUT GIVE ALL THE INFORMATION THAT IS
CENTRAL TO YOUR CONCERNS.

•

IF ASKED FOR MICS OVERVIEW: This study is sponsored by the U.S Department
of Health and Human Services. Knowledge gained from the study will improve our
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ability to describe and understand mental health issues in the United States.
Questions ask about a variety of mental health issues that people face, such as
depression or sadness, anxiety and fears, and other health related issues, such as
treatment and healthcare experiences. 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
they told me something that caused me to be concerned about their well-being, I
would report that to someone else who could help or intervene. Do you have any
questions about the study? ANSWER QUESTIONS. DO NOT SHARE ANY
INTERVIEW DATA.
2. INTERVIEWER ACTION: CONNECT RESPONDENT AND INTRODUCE TO THE
988 COUNSELOR. STAY ON THE LINE WHILE THE RESPONDENT TALKS WITH
THE COUNSELOR; IF YOU HANG-UP, THEIR CONNECTION WILL ALSO END. IF
THE RESPONDENT GETS DISCONNECTED AND YOU CANNOT REACH THEM
ON THE PHONE AGAIN IMMEDIATELY, CALL THE HELPLINE AND PROVIDE
INFORMATION -- GIVE RESPONDENT NAME, TELEPHONE NUMBER, AND
ADDRESS.
3. INTERVIEWER ACTION: WHEN CALL IS COMPLETED, CALL CLINICAL
SUPERVISOR. IF THEY DO NOT RETURN CALL WITHIN 15 MINUTES, CALL DR.
STAMBAUGH OR DR. SCROGGS TO DEBRIEF. IMMEDIATELY FILL OUT A
DISTRESSED RESPONDENT REPORT FORM AND E-MAIL YOUR CLINICAL
SUPERVISOR. EXCLUDE PERSONALLY IDENTIFIABLE INFORMATION.
•

IF SOMETHING HAPPENS AND YOU ARE UNABLE TO CONNECT TO 988 OR R
HANGS UP BEFORE YOU CONNECT R WITH LIFELINE AND YOU CANNOT
REACH R AGAIN.
CALL CLINICAL SUPERVISOR. IF THEY ARE NOT AVAILABLE, CALL
DR. STAMBAUGH OR DR. SCROGGS. THEY WILL SEARCH FOR THE
LOCAL 911 NUMBER FOR THAT RESPONDENT’S PART OF THE
COUNTRY. THEY WILL CALL 911 AND GIVE THE RESPONDENT’S
CONTACT INFORMATION. IMMEDIATELY FILL OUT A DISTRESSED
RESPONDENT REPORT FORM AND E-MAIL YOUR CLINICAL
SUPERVISOR. EXCLUDE PERSONALLY IDENTIFIABLE INFORMATION.

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Clinician Distressed Respondent Protocol (Cont’d)
Situation 2: Respondent with Thoughts of Serious Harm
If respondents report any of the issues listed below during any interactions with you, including
before, during, or after an interview, you must follow the instructions in the box provided.
Details of all incidents must be documented in the case management system and reported to
your clinical supervisor immediately.

In the past week, respondent has had any thoughts of causing serious harm,
including

•

–

current and serious passive thoughts about causing serious harm to someone
else or attempting homicide in the absence of thoughts about specific victims or
means, plans for how they could cause serious harm or attempt homicide, or
intention of causing serious harm or attempting homicide [SCENARIO 2a] or

–

current and serious active thoughts with intention about causing serious harm to
someone else or attempting homicide combined with thoughts about specific
victims or means, or plans for how they could cause serious harm or attempt
homicide, or the means to carry out that plan [SCENARIO 2b]

Follow the steps for Scenarios 2a (passive thoughts of serious harm) and 2b (active
thoughts of serious harm) for each scenario laid out in the box below.
Scenario Number
2a—Respondent with
Thoughts of Serious Harm

Script for:
Current and Serious Passive Thoughts of Serious Harm

STEPS

COMPLETE INTERVIEW AND THEN READ TO RESPONDENT: You told me earlier
that you have recently had thoughts or wishes about someone you know dying or
wishing they were dead.
1. 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 them
about how you have been feeling, especially about the thoughts you’ve been having about
physical harm towards other people. Would you be willing to do that?
 IF YES: Okay. There is also a national hotline number you can call where
counselors are available to talk at any time of the day or night. The number is
988. This was also provided in the email with your appointment information.

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THANK RESPONDENT FOR THEIR PARTICIPATION IN THE STUDY AND
END THE INTERVIEW.
IF NO: I strongly suggest that you contact 988. Counselors are available 24 hours a day to
talk to you about how you are feeling. They may also help you locate 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 RESPONDENT FOR THEIR PARTICIPATION IN
THE STUDY AND END CALL.
2. WHEN INTERVIEW IS COMPLETED, CALL YOUR CLINICAL SUPERVISOR IF

YOU HAVE QUESTIONS OR WOULD LIKE TO DEBRIEF. IF YOUR CLINICAL
SUPERVISOR IS NOT AVAILABLE, CONTACT DR. STAMBAUGH OR DR.
SCROGGS. FILL OUT A DISTRESSED RESPONDENT REPORT AND E-MAIL
YOUR CLINICAL SUPERVISOR. EXCLUDE PERSONALLY IDENTIFIABLE
INFORMATION.

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Scenario Number
2b—Respondent with
Thoughts of Serious Harm

Script for:
Current and Serious Active Thoughts of Serious Harm

STEPS

1. END INTERVIEW AND READ TO RESPONDENT: I am going to end the interview
now. You will receive your electronic giftcard in the next few days. Could you tell me
where you are right now?
If RESPONDENT refuses to give his or her location:
2. 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 physical harm to other people. Would you be willing to do that?
 IF YES: Okay. There is also a national hotline number you can call where
counselors are available to talk at any time of the day or night. The number is
988. This was also provided in email with your appointment information.
THANK RESPONDENT FOR THEIR PARTICIPATION IN THE STUDY AND
END CALL.
IF NO: I strongly suggest that you contact 988. Counselors are available 24 hours a day to
talk to you about how you are feeling. They may also help you locate 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 RESPONDENT FOR THEIR PARTICIPATION IN
THE STUDY AND END CALL.

Disconnect and immediately call your Clinical Supervisor. If they are
unavailable, call Dr. Stambaugh or Dr. Scroggs to de-brief. Fill out a
Distressed Respondent Report and e-mail your Clinical Supervisor. Exclude
PERSONALLY IDENTIFIABLE INFORMATION.

If RESPONDENT gives his or her location:

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3. Write down the address, and thank them for participating. Disconnect the call.
4. INTERVIEWER ACTION: WHEN CALL IS COMPLETED, IMMEDIATELY CALL

CLINICAL SUPERVISOR. IF THEY DO NOT RETURN CALL WITHIN 15
MINUTES, CALL DR. STAMBAUGH OR DR. SCROGGS TO DEBRIEF. HAVE
THE RESPONDENT’S LOCATION ON HAND SO THAT YOUR SUPERVISOR CAN
CONTACT 911. FILL OUT A DISTRESSED RESPONDENT REPORT AND E-MAIL
YOUR CLINICAL SUPERVISOR. EXCLUDE PERSONALLY IDENTIFIABLE
INFORMATION.

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Situation 3: A distressed or upset (but not suicidal) respondent
If a respondent becomes distressed or upset (but not suicidal or having thoughts of serious
harm) during any interactions with the clinical interviewer, including before, during, or after an
interview, the staff member will follow the instructions in the box provided below.
Scenario Number
3—Upset respondent

Script for:
RESPONDENT SEEMS UPSET BY THE INTERVIEW

STEPS

1. INTERVIEWER READS: Some of these questions are hard to talk about, and it seems
to be upsetting you.
INTERVIEWER ACTION: Offer the respondent a short break by saying:
“I realize these questions can be difficult to answer. Would you like to take a break and get a
drink of water?”
Depending on how the respondent answers you may do the following:

A. YES - CONTINUE WITH SENSITIVITY
INTERVIEWER ACTION: At the end of the interview, give R the National Lifeline
number 988 and encourage them to call if they feel like they need to talk to
someone about any of the issues discussed today. DO NOT file a report with
your CS.
B. YES, AND WOULD LIKE TO STOP INTERVIEW - Suspend and schedule another
interview time. State the following:
Maybe you can call someone when we are done so that they 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. The number is 988. Could
you repeat that number back to me? (IF RESPONDENT CANNOT REPEAT, READ
THE TELEPHONE NUMBER AGAIN)
INTERVIEWER ACTION: COMPLETE AND FILE A DISTRESSED RESPONDENT
REPORT WITH YOUR CLINICAL SUPERVISOR INFORMING THEM A 988
REFERRAL WAS GIVEN, RESPONDENT’S CASE ID, INTERVIEWER’S ID, DATE,
TIME, DETAILED DESCRIPTION OF THE INTERACTION BETWEEN THE

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INTERVIEWER AND THE RESPONDENT, AND IF THE APPROPRIATE
PROTOCOLS WERE FOLLOWED.
C. NO, DON’T WANT TO CONTINUE EVER – Terminate the interview and state the
following:
Maybe you can call someone so that they 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. The number is 988. Could you repeat
that number back to me? (IF RESPONDENT CANNOT REPEAT, READ THE
TELEPHONE NUMBER AGAIN)
Thank the respondent and end the call.
COMPLETE AND FILE A DISTRESSED RESPONDENT REPORT WITH YOUR
CLINICAL SUPERVISOR INFORMING THEM A 988 REFERRAL WAS GIVEN,
RESPONDENT’S CASE ID, INTERVIEWER’S ID, DATE, TIME, DETAILED
DESCRIPTION OF THE INTERACTION BETWEEN THE INTERVIEWER AND THE
RESPONDENT, AND IF THE APPROPRIATE PROTOCOLS WERE FOLLOWED.

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Clinician Distressed Respondent Protocol (Cont’d)
Situation 4: A case of present/current suspected abuse or neglect
There is no information in the roster or screening instruments that will lead to the direct
disclosure of current child/elder abuse or neglect. During the interview, though, there is a
chance that you may witness or hear something that leads you to believe that a child or elder
adult is being abused or neglected.
If during the interview the respondent shares information or you witness something that leads
you to believe that the respondent or a child is being abused or neglected, follow the
instructions in the box provided below.
Scenario Number
4—Suspected abuse or neglect

Script for:
NO SCRIPT, ONLY INTERVIEWER ACTIONS POSTINTERVIEW

STEPS
IF DURING THE COURSE OF THE INTERVIEW THE RESPONDENT SHARES INFORMATION OR
YOU WITNESS SOMETHING THAT LEADS YOU TO BELIEVE THAT THE RESPONDENT IS
CURRENTLY BEING ABUSED OR NEGLECTED, OR THAT A CHILD OR ELDER ADULT IS
CURRENTLY BEING ABUSED OR NEGLECTED.

1. INTERVIEWER ACTION: CONTINUE WITH INTERVIEW AND DO NOT BREAK OFF.
DO NOT ASK FOR ADDITIONAL DETAILS ABOUT THE SUSPECTED ABUSE OR
NEGLECT OR FOR ANY DETAILS BEYOND WHAT IS SHARED NATURALLY
DURING THE COURSE OF THE INTERVIEW. ONCE THE INTERVIEW HAS BEEN
COMPLETED, COMPLETE AND E-MAIL A DISTRESSED RESPONDENT REPORT
FORM WITH YOUR CLINICAL SUPERVISOR. WRITE DOWN SPECIFICALLY WHAT
THE RESPONDENT TOLD YOU OR WHAT YOU WITNESSED THAT LED YOU TO
SUSPECT ABUSE OR NEGLECT. EXCLUDE PII.
2. CALL YOUR CLINICAL SUPERVISOR TO DEBRIEF. IF YOUR CLINICAL
SUPERVISOR IS NOT AVAILABLE, CONTACT DR. STAMBAUGH OR DR.
SCROGGS. THE RTI TEAM WILL MANAGE THE PROCESS OF MAKING A
REPORT TO CHILD OR ADULT PROTECTIVE SERVICES IN THE STATE WHERE
THE RESPONDENT RESIDES, IF NEEDED.

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MICS Distressed Respondent Report Template
Instructions: Complete this report anytime you use the Distressed Respondent Protocol and
email it to your Clinical Supervisor , Dr. Scroggs (lscroggs@rti.org), and Dr. Stambaugh
(lstambaugh@rti.org) ASAP but no later than by midnight the day of the event. This form can
be downloaded directly from the Case Management System.
RTI IRB ID Number: STUDY00022143
RTI Project Number: 0218596
Date of Event:
Case ID Number:
Staff Involved with this Event:
Study Contact Person if there are further questions about this event:

*Description of Event Including Time of Event:

Description of Actions Taken by Staff (in response to event) Including Time of Actions:

Description of Reporting of this Event by Staff (including dates and time of each report and to
whom the reports were made):

Description of Any Deviations from Approved Data Collection Procedures:

Status of Situation (as of the date of this report):

Recommendations for Further Action (if any):

*For situations of abuse and neglect, only this section is applicable.

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