Integrated Clinical Triage Platform for Athlete Mental Health and Suicide Prevention
- Feb 13
- 7 min read
Real-Time Decision Support Enabling 100% Same-Day Intervention Across 1,275 Student-Athletes
February 13, 2026
Duke Biber, PhD, NBC-HWC, CMPC, Associate Professor of Health Sciences, James Madison University
Victoria Cosgrove, PhD, Assistant Professor of Psychiatry and Behavioral Sciences (Child and Adolescent Psychiatry and Child Development), Stanford University School of Medicine
Ashlee Davis, PhD, Senior Research Associate, Center of Excellence for Behavioral Health & Wellbeing, Georgia Health Policy Center, Georgia State University
Jeane YooJin Han, MPH Candidate at UC Berkeley, Research Assistant
Robyn Hussa Farrell, MFA, E-RYT, President & CEO, Resiliency Technologies
Tim Farrell, COO, Resiliency Technologies
Jared Minkel, PhD, Clinical and Consulting Psychologist
Nora Stagner, MS, Project Manger, Adaptive Testing Technologies
Bridgette Stewart, MEd, NBC-HWC, CWP, Director of the Center for Integrative Wellness, University West Georgia
Luis Carrillo Tani, MD, Research Assistant, MPH Candidate at UC Berkeley
Hannah Wulczyn MPA, Director, Adaptive Testing Technologies
Download the white paper here:
Executive Summary
From 2023-2025, a large Division I university implemented Sharpen® DTX, a digital care coordination and therapeutics platform combining universal mental health and suicide risk screening (CAT-MH®) (Gibbons et al., 2012; Achtyes et al., 2015) with peer-focused mental health literacy and athlete wellness modules (“Sharpen® Athlete”). Over these three years, 1,275 student-athletes completed mandatory Adaptive Testing Technologies' CAT-MH® screenings. During this time, 126 athletes (9.9%) flagged for elevated suicide risk and received same-day clinical triage via real-time dashboard.
Elevated suicide risk refers to athletes who triggered a suicide warning from the CAT-MH® system. This occurs when the results of a participant’s assessment include a “positive” on the Brief Suicide Screen, an adapted version of the Columbia Suicide Severity Rating Scale (C-SSRS), or had a severity score in the “severe” range on the CAT-Suicide Scale (CAT-SS) (Brenner et al., 2022).
The Brief Suicide Screen assesses for imminent risk (22 athletes, 1.7%) and the CAT-SS assesses for developing risk, exploring underlying precursors to suicidality such as hopelessness, helplessness, worthlessness, anhedonia, etc. (104 athletes, 8.2%).
At the onset, the Sharpen® DTX platform was a standalone prevention toolkit containing a self-guided library of over 100 psychoeducational modules, including targeted email campaigns (utilized in 2023-2024). By 2025, it had evolved into a fully integrated DTX system that includes screenings, modules, and interventions localized to one platform, demonstrating progressive improvements in engagement quality.
This progression led to improved email open rates, from 22% to 69%, which can be linked to optimized campaigns with additional strategic content, driven by community based focus groups. These sessions included athletes discussing injury, loneliness, and strategies for practicing self-care and supporting teammates (Hussa Farrell, 2025; Biber et al., 2026). The 2025 integrated DTX platform transformed engagement from passive email opens to active platform participation, engaging 491 student-athletes throughout the academic year. Among 2025 platform users, 98% returned for multiple sessions, averaging 7.2 visits and 104 actions per user—representing sustained engagement.
Implementation Overview
Setting & Population
The Sharpen® DTX platform was deployed at a Division I university athletic program as part of mandatory summer orientation for incoming and continuing student-athletes. The implementation included:
Universal screening: All athletes completed the CAT-MH® assessment containing twelve modules (including depression, anxiety, substance use and two validated suicide screening tools)
Automated triage: A real-time dashboard enabled licensed psychotherapists to provide same-day analysis, safety planning and crisis intervention
Evidence-based prevention and training: The two-month Sharpen Athlete™ mobile course provided athletes with modules containing peer-focused documentary films covering athlete health, mental health literacy (Biber, 2023; Biber & Rothman, 2023), stigma reduction (Fadel et al., 2024; Levy et al., 2026), coping skills, and suicide prevention (Magalhaes et al., 2026).
Clinical Triage & Immediate Intervention
100% of the 126 student-athletes who flagged for elevated suicide risk received same-day clinical intervention by licensed psychotherapists. When students completed the CAT-MH®, clinicians received real-time alerts if any of the athletes were at increased risk. The real-time Sharpen DTX dashboard enabled:
Immediate safety planning and risk assessment
Same-day clinical outreach to at-risk students
Deployment of targeted interventions, digital safety plans and additional protective content based on risk level and diagnostic category.
Prevention Content: Three-Year Engagement Evolution
Year | Athletes Screened | Elevated Risk Flagged | Delivery Method |
2023 | 413 | 43 (10.4%) | |
2024 | 451 | 44 (9.8%) | |
2025 | 411 | 39 (9.5%) | Integrated Sharpen DTX Platform |
TOTAL | 1,275 | 126 (9.9%) | --- |
2023: Email Baseline (22% Engagement)
Sharpen® evidence-based prevention content has been designed and implemented across multiple settings since 2014. In 2023, the modules were delivered via email campaigns to 270 athletes over six modules:
Average open rate: 22.4% (363 opens from 1,620 sent)
Total module opens: 363
Click-through rate: 0.25%
2024: Optimized Email Campaigns (63-78% Engagement)
Content expanded to 10 modules based on athlete feedback, incorporating peer voices from coaches, athletes, and athletic leadership:
January campaign: 72.2% open rate (453 opens from 627 sent)
April campaign: 63.5% open rate (495 opens from 780 sent)
March cohort: 78.7% average open rate
3x improvement over 2023 through athlete-driven content refinement
2025: Integrated DTX Platform (98% Return Rate)
In 2025, Platform engagement transitioned from email metrics to 491 athletes generating 51,243 platform interactions (98% return rate):
Unique Athletes Engaged | 491 |
Return Rate (2+ visits) | 98% |
Average Visits per Athlete | 7.2 |
Total Actions (clicks/views/interactions) | 51,243 |
Average Actions per Athlete | 104 |
Athletes with 50+ Actions | 82.5% |
Total Engagement Time | 146.7 hours |
(See also Cosgrove et al., 2025; Minkel et al., 2024)
Sharpen DTX Module Engagement (2025)
In the 2025 Sharpen® Integrated DTX platform, 491 athletes interacted extensively with the mental health education content, generating 4,830 page views of prevention modules totaling 44.2 hours of cumulative platform engagement. Top-performing modules demonstrated the platform's ability to reach nearly all athletes with foundational mental health literacy:
Module Topic | Unique Athletes | % Engagement |
Athlete Mental Health | 464 | 94.5% |
Overcoming Loneliness | 411 | 83.8% |
Optimizing Energy for Athletes | 395 | 80.4% |
Improving Emotional Wellness | 336 | 68.4% |
Female Athlete Triad Syndrome | 271 | 55.2% |
Key Findings & Implications
1. Platform Integration Drives Sustained Engagement
The evolution from standalone email (22% engagement) to optimized email campaigns (78% engagement) to integrated DTX platform (98% return rate) demonstrates that seamless platform integration fundamentally transforms how young adults engage with mental health content. The 98% return rate and 7.2 average visits per athlete show that when mental health literacy is embedded in an accessible, mobile-first platform, athletes will engage repeatedly and deeply.
2. Peer-Focused Content Normalizes Mental Health Conversations
The 3x engagement improvement from 2023 to 2024 (22% to 78% open rates) resulted directly from incorporating peer voices through documentary-style content featuring athletes, coaches, and athletics leadership. This athlete-driven content refinement demonstrates that authentic peer narratives are critical for reducing stigma and creating trust in mental health interventions.
3. Universal Screening Enables Proactive Safety Planning
100% of 142 at-risk athletes received same-day clinical intervention through automated real-time dashboard alerts and evidence-based interventions. This demonstrates that digital therapeutics platforms can successfully bridge universal screening with immediate clinical response, creating a scalable pathway for suicide prevention that would be impossible through traditional clinical workflows.
4. Improved Care Coordination & Clinician Satisfaction
Clinician satisfaction surveys (n=4 licensed psychotherapists) showed 100% satisfaction (and Net Promoter Score: 10/10) across key metrics including:
Ease of deployment
Same-day access capability
Care coordination
Clinical outcome support
Conclusion
This three-year implementation demonstrates that integrated digital therapeutics platforms can simultaneously achieve three critical goals: universal suicide risk screening with 100% clinical follow-up, sustained engagement with prevention content (98% return rate), and scalable deployment across large populations (1,275 athletes over 3 years).
The dramatic engagement evolution—from 22% email opens to 98% platform return rates—proves that delivery method fundamentally shapes mental health intervention effectiveness. When suicide screening, clinical triage, and peer-focused prevention content are unified in a mobile-accessible platform, young adults will engage deeply and repeatedly.
About Resiliency Technologies and Sharpen DTX
Sharpen® DTX, developed by Resiliency Technologies, is a digital therapeutics platform designed to integrate evidence-based mental health screening, clinical triage, and peer-focused prevention content. The platform is deployed at major health systems including Prisma Children's Hospital, and being implemented at Stanford Medicine, and UCSF, with many partnerships focused on collaborative care management with an emphasis on pediatric behavioral health.
Sharpen Athlete™ is the performance use case of Sharpen® digital therapeutic which includes an integration with the CAT-MH®. Sharpen Athlete was designed working alongside hundreds of college students, athletes, coaches and administrators whose voices have been incorporated into the mental health literacy modules.
About Adaptive Testing Technologies and CAT-MH®
Adaptive Testing Technologies (ATT) is the leader in the design, testing, and implementation of large-scale, cloud-based mental health assessment tools based on Computerized Adaptive Testing (CAT) and Computerized Adaptive Diagnostic (CAD) technologies. The CAT-MH® and K-CAT® are utilized by health professionals to assess a variety of mental health conditions including depression, anxiety, mania, psychosis, PTSD, substance use disorder, suicide risk, ADHD, and Social Determinants of Health.
PerformeaX™ is the performance use-case for the CAT-MH®. These tools are the first and only validated, comprehensive, multidimensional item-response-theory-based adaptive screening and measurement systems in the world.
References
Achtyes, E. D., Halstead, S., Smart, L., Moore, T., Frank, E., Kupfer, D. J., & Gibbons, R. (2015). Validation of Computerized Adaptive Testing in an Outpatient Nonacademic Setting: The VOCATIONS Trial. Psychiatric services (Washington, D.C.), 66(10), 1091–1096. https://doi.org/10.1176/appi.ps.201400390
Biber, D., Hussa Farrell, R., Farrell, T. (forthcoming). A Qualitative Analysis of Student-Athlete Perceptions of Mental Health to Inform Future Athlete Programming. Mental Health and Digital Technologies.
Brenner, L. A., Betthauser, L. M., Penzenik, M., Bahraini, N., & Gibbons, R. D. (2022). Validation of a Computerized Adaptive Test Suicide Scale (CAT-SS) among United States Military Veterans. PloS one, 17(1), e0261920. https://doi.org/10.1371/journal.pone.0261920
Cosgrove, V., Hussa Farrell, R., & Farrell, T. (2025, August 20). Sharpen digital therapeutic interventions for adolescent mental health [White paper]. Sharpen. https://www.sharpenminds.com/post/sharpen-digitaltherapeutic-interventions-for-adolescent-mental-health
Fadel N., Stoner, A., Berreta, K., et al. (2024) A Process Evaluation of a Mobile App for Medical Students Aimed at Increasing Resilience and Decreasing Stigma in Mental Health. Cureus 16(6): e63054. doi:10.7759/cureus.63054
Gibbons, R. D., Weiss, D. J., Pilkonis, P. A., Frank, E., Moore, T., Kim, J. B., & Kupfer, D. J. (2012). Development of a computerized adaptive test for depression. Archives of general psychiatry, 69(11), 1104–1112. https://doi.org/10.1001/archgenpsychiatry.2012.14
Hussa Farrell, R. (2025). The Power of Listening, Learning, and Documentary Storytelling in Health Education. Resiliency Technologies. https://www.sharpenminds.com/post/the-power-of-listening-learning-and-documentary-storytelling-in-health-education
Levy, J., Hussa Farrell, R., Farrell, T., Pish, M., Fassas, J., Reed, E., Hinshaw, S., & Biber, D. (forthcoming). A program evaluation of the Sharpen® Mental Health Literacy (Sharpen® MHL) college course at a southeastern university in the United States. Journal of American College Health.
Magalhaes et al. (2026). Mental health knowledge and attitudes in medical students: Effects of a self-guided course. AACOM Annual Conference. https://www.sharpenminds.com/post/sharpen-dtx-and-vcom-abstract-accepted-for-aacom-s-educating-leaders-2026-conference
Minkel, J., Pish, M., & Hussa Farrell, R. (2024). Sharpen® Platform Engagement & Activation. Resiliency Technologies via: https://www.sharpenminds.com/post/sharpen-platform-engagement-activation
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