STARR 911: Understanding & Implementing the New Guidance at Your Site

Premier Research recently contributed to the STARR 911 initiative, a project of the STARR Coalition to provide actionable guidance for clinical researchers after identifying volunteers with suicidal leanings. This post provides more information on the process itself, which was presented earlier this year at the 2018 ASCP Annual Meeting in Miami.


The primary goal of clinical researchers is to improve the lives of the individuals who decide to participate in a clinical study. However, current guidelines disallow suicidal individuals from participating in clinical trials.

However, despite these prohibitions against suicidal or potentially suicidal individuals participating in clinical trials, research can still play a major role in preventing suicide. For example, clinical research call centers are capable of identifying individuals exhibiting suicidal ideation or behavior. These clinical research call centers can then refer these people to national suicide prevention experts.

Project STARR 911 seeks to bridge a gap between suicide prevention and clinical research. Here is some information about STARR 911 and how you can implement this concept at your site.

Core Components of the STARR 911 Process

The main gist of STARR 911 is to train operators to recognize callers who may be exhibiting suicidal ideation or behavior. Operators can have callers answer a simple questionnaire that can assess whether they may have suicidal thoughts. If a caller is potentially suicidal, the operator can provide them with educational information and a warm hand-off to suicide prevention specialists.

STARR 911 was also developed to emphasize the human factor. The creation of a concept like STARR 911 is long overdue. This project will provide suicide prevention resources to call centers, sites, and recruitment agencies and establish an industry standard that will help individuals suffering from suicidal ideation and behavior.

How to Implement STARR 911

Clinical research organizations can implement STARR 911 by training their operators to identify and appropriately handle callers who are exhibiting signs of suicidal ideation or behavior.

When an operator answers a call from a volunteer, the operator should confirm that the individual is interested in participating in a clinical study. One this has been confirmed, the individual should let the caller know that they will need to respond to a brief questionnaire before they can learn more about joining the clinical trial. The operator should attempt to be as supportive and friendly as possible.

Once the caller has consented to the questionnaire, the operator should ask, “In the past month, have you had thoughts about killing yourself or thoughts of suicide?” If the caller answers in the affirmative again, the operator should say something along the lines of, “It’s good to hear that you are working with your mental health professional about these thoughts. Because of your suicidal ideations, you are not currently eligible for this clinical trial. I would like to give you the number of the National Suicide Prevention Lifeline, 1-800-273-8255, in case you feel you are in a crisis and cannot reach your clinician. You can also text TALK to 741741 for help.”

However, if the caller answers “No,” the operator should say, “I would like to connect you with someone who can help you right now. First, write down this number in case we get disconnected, 1-800-273-TALK (8255), or text TALK to 741741. I’ll stay on the line with you until we get you connected to the National Suicide Prevention Hotline. This should just take a minute.” The operator would then follow the process they were trained on and directly connect the caller to the National Suicide Prevention Hotline.

Looking Ahead

If the caller says they are not currently having thoughts about suicide and/or have not made plans to commit suicide, the operator should say, “If you ever do have these thoughts, there are some really good people who can help you. Please write down this number for the National Suicide Prevention Hotline and call them right away if you need to talk to someone: 1-800-273-TALK (8255) or text TALK to 741741.” The operator should then provide the caller with information about becoming a participant in the research study.

While much work needs to be done to prevent suicides in the United States, STARR 911 is a step in the right direction.

Read more:

STARR 911 Provides Clinical Researchers With Actionable Guidance for At-Risk Volunteers