At-Risk in the ED


(For resources, this is the publication date. For programs, this is the date posted.)



The cost of At-Risk in the ED depends on the size of the population to which the purchasing institution plans to make the training available, and the amount of time they would like those licenses to be active (e.g., one year). Price ranges from approximately $35 to $75 per user, depending on the number and length of the licenses. More information, including a program demo, is available at


Kognito At-Risk in the ED is a one-hour, online, interactive training simulation that teaches Emergency Department (ED) staff how to (1) recognize patients who exhibit warning signs of suicide and substance abuse risk, (2) screen patients for suicide and substance abuse risk, and (3) respond to patients who screen positive for suicide and substance abuse risk. In the training, users engage in simulated conversations with three emotionally responsive avatars representing patients who may be at risk for suicide and/or substance abuse. In these virtual role-plays, users learn how to effectively interview patients in order to recognize warning signs and gain patients’ trust. If users suspect that patient avatars are at-risk, they engage in further simulated conversations and screen the patient avatars using evidence-based suicide and substance abuse toolkits (including SAD PERSONS, the RAPS4-QF, and the CRAFFT). Physicians are eligible to receive 1.5 CME AMA PRA Category 1 Credits™ upon course completion. Nursing and other staff may receive CEUs depending on local requirements.

The program was developed by Kognito Interactive with input from a group of mental and behavioral health experts and ED clinicians including face-to-face and phone-based focus groups with ED personnel during program development and as part of beta testing.

Program Objectives

After completing the training, Emergency Department personnel will have increased knowledge of:

  1. Warning signs for suicide and substance abuse risk, including verbal, behavioral, and situational clues.
  2. Evidence-based tools that can be used to screen patients for suicide and substance abuse risk.
  3. Communication techniques to use with at-risk patients in order to gain their trust, motivating them to respond truthfully during conversations.
  4. Next steps when patients screen positive for suicide and substance abuse risk.
  5. Best practices for effective risk management documentation of patient interviews related to suicide and substance abuse risk.
  6. Protective factors and means restriction when patients are identified as at risk.

Implementation Essentials

  • Emergency departments should have protocols in place to manage those who are found to be at risk for suicide.

2012 NSSP Objectives Addressed: 

Objective 7.2: Provide training to mental health and substance abuse providers on the recognition, assessment, and management of at-risk behavior, and the delivery of effective clinical care for people with suicide risk.