When it matters most, your employees need more than a hotline.

Refill Health's crisis protocol combines six identification pathways, validated risk stratification and defined response windows. Crisis is not an event — it's a managed clinical condition.

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A case cannot self-close. Closure requires clinical leadership sign-off.

The protocol at a glance

Lifecycle - not event.

Identification and risk stratification surface the case. The protocol takes over from there. The lifecycle has six steps - and it doesn't end when the acute moment does.

Immediate Navigator engagement

A clinically trained Care Navigator takes ownership of the case, initiates contact within the tier's response window, and completes a safety assessment.

Clinical supervisor review

All crisis cases are escalated to a senior clinical supervisor for review, ensuring oversight and adherence to evidence-based protocols.

Outreach and safety planning

Collaborative development of a documented safety plan — identifying triggers, coping strategies and support networks.

Emergency referral if needed

Where acute risk is determined, the Navigator coordinates with local emergency services or specialised higher-level care facilities.

Anonymised HR notification

Aggregated, de-identified reporting maintains workforce risk visibility without compromising individual privacy.

Four-week follow-through

Post-acute check-ins are scheduled and tracked for four weeks. The case closes only when clinical leadership verifies sustained stability.

Immediate Navigator engagement

A clinically trained Care Navigator takes ownership of the case, initiates contact within the tier's response window, and completes a safety assessment.

Clinical supervisor review

All crisis cases are escalated to a senior clinical supervisor for review, ensuring oversight and adherence to evidence-based protocols.

Outreach and safety planning

Collaborative development of a documented safety plan — identifying triggers, coping strategies and support networks.

Emergency referral if needed

Where acute risk is determined, the Navigator coordinates with local emergency services or specialised higher-level care facilities.

Anonymised HR notification

Aggregated, de-identified reporting maintains workforce risk visibility without compromising individual privacy.

Four-week follow-through

Post-acute check-ins are scheduled and tracked for four weeks. The case closes only when clinical leadership verifies sustained stability.

Immediate Navigator engagement

A clinically trained Care Navigator takes ownership of the case, initiates contact within the tier's response window, and completes a safety assessment.

Clinical supervisor review

All crisis cases are escalated to a senior clinical supervisor for review, ensuring oversight and adherence to evidence-based protocols.

Outreach and safety planning

Collaborative development of a documented safety plan — identifying triggers, coping strategies and support networks.

Emergency referral if needed

Where acute risk is determined, the Navigator coordinates with local emergency services or specialised higher-level care facilities.

Anonymised HR notification

Aggregated, de-identified reporting maintains workforce risk visibility without compromising individual privacy.

Four-week follow-through

Post-acute check-ins are scheduled and tracked for four weeks. The case closes only when clinical leadership verifies sustained stability.

A crisis case cannot be closed because the acute moment passed.

Closure is a gated step, not a default. A case is actively managed through the structured post-acute phase, and the system does not permit a crisis tag to be cleared without clinical leadership sign-off on resolution.

A crisis line answers. A clinical protocol stays.

Hotlines exist because crisis support has historically been treated as a single moment. Three differences make the distinction operational.

The hotline event

Standard EAP reactive support

Moment 1

Waits for the employee to dial in. Crisis only enters the system when the employee self-identifies and reaches out.

Moment 2

A counsellor talks with the employee for the duration of the call. The call ends. The employee continues alone.

Moment 3

No structured follow-up. The employee may be referred to a service. The thread typically ends there.

The Refill protocol

Proactive clinical governance

Moment 1

Identifies crisis through six pathways.The system finds the employee - it doesn't wait for the employee to find the system.

Moment 2

A clinically trained Care Navigator takes ownership of the case, which stays inside the protocol rather than ending with a call.

Moment 3

Structured post-acute follow-up across four weeks, with closure gated on clinical leadership review.

Why this matters at workforce scale.

A hotline is not wrong. It's incomplete. The protections that matter most - a case that cannot self-close, a defined response window, and follow-through that outlasts the acute moment - are structural. They are not achievable on a hotline model.

How crisis is identified

Six pathways. One outcome - no employee enters crisis alone.

Most platforms identify crisis when an employee picks up the phone. Refill Health identifies it through six distinct pathways, ensuring multiple layers of visibility even when an individual isn't ready to reach out.

What makes the identification net comprehensive.

Five of the six pathways work without the employee initiating contact — so no one falls through the gaps of silence.

Onboarding screening

At enrolment

Validated instruments are administered at onboarding - including PHQ-9 and C-SSRS - establishing a clinical baseline before care begins.

Practitioner-detected, in session

During clinical or coaching sessions

Therapists and coaches alike follow a documented protocol for identifying acute risk within session, triggering immediate escalation.

Direct message to Navigator

Any time

Employees reach their Care Navigator or practitioner via secure messaging - bypassing automated flows for direct human connection.

AI-detected distress signals

Continuous

Refill Foresight™ monitors clinical risk indicators across the platform. The employee does not need to articulate the crisis for the system to find it.

Between-session detection

In the member app

Refill Companion™ surfaces crisis-relevant responses between appointments, routing them into the same protocol as any clinical trigger.

HR or manager-reported concern

Workplace observation

Managers trained through the Refill Health Manager Guide can surface concern without being involved in clinical assessment.

Coaching never substitutes for crisis care.

ICF-certified coaches are trained to recognise clinical presentation and required to escalate rather than continue. A coach who identifies acute risk hands over to the clinical track immediately - the same protocol, the same response window, no difference in urgency. Crisis-protocol training is mandatory for every practitioner on the network, coaches included.

Crisis is not binary. The response shouldn't be either.

Once a signal is identified, it is graded against validated instruments - PHQ-9 item 9 combined with C-SSRS gating - and matched to a defined response tier. Higher risk means a shorter window, not a longer queue.

Tier 1

Passive ideation

Same-day outreach

Indicator

Thoughts of being better off dead or of self-harm reported on several days or more in the past fortnight, with no suicidal intent endorsed on C-SSRS.

Protocol Action

Structured outreach encouraging engagement in care, with direct access to the 24/7 crisis team. The case is flagged for monitoring.

Tier 2

Frequent ideation

Call within 24 hours

Indicator

The same thoughts reported nearly every day, with suicidal intent still denied on C-SSRS. Intent is absent, but frequency alone warrants direct contact.

Protocol Action

A Care Navigator calls within 24 hours to assess safety and support engagement, alongside written resources and crisis-team access.

Tier 3

Immediate risk

Outreach within 2 hours

Indicator

Ideation reported and suicidal intent endorsed on C-SSRS, with at least one indicator of intent, specific plan, preparatory behaviour or prior attempt.

Protocol Action

The employee sees an in-app notice confirming contact is coming. A Navigator conducts a safety assessment within two hours and determines next steps, with further outreach where indicated.

A 24/7 crisis team, staffed by Care Navigators.

Every outreach is conducted by a clinically trained human, and every interaction is documented in the member's clinical record. Response windows are commitments built into the protocol — not best-effort targets.

Crisis reporting

Crisis activity flows into Refill Insights™ so an organisation can meet its duty of care without ever seeing an individual in distress. This is what leadership sees - and what it never sees.

Crisis volume

By period, aggregated at cohort level

Response performance

Against protocol defined windows

Resolution status

Across open and closed cases

Pattern signals

Where risk is concentrating by site

The privacy firewall. What never appears: a name, a record, an individual score, or any detail that could identify an employee in crisis. Reporting thresholds prevent small-cohort re-identification.

De-identifiedAggregated cohortsNo individual recordsNo namesThreshold protected

Crisis reporting and analytics dashboard

Crisis support is one part of the clinical model.

Care Navigation

The dedicated human guiding every employee across every layer of care.

EAP+

Therapy, ICF-certified coaching, self-care and work-life support in one model.

Clinical Model

The instruments, decision logic and governance behind every care decision.

Outcomes & ROI

How improvement is measured and converted into business impact.

Care Navigation

The dedicated human guiding every employee across every layer of care.

EAP+

Therapy, ICF-certified coaching, self-care and work-life support in one model.

Clinical Model

The instruments, decision logic and governance behind every care decision.

Outcomes & ROI

How improvement is measured and converted into business impact.

Care Navigation

The dedicated human guiding every employee across every layer of care.

EAP+

Therapy, ICF-certified coaching, self-care and work-life support in one model.

Clinical Model

The instruments, decision logic and governance behind every care decision.

Outcomes & ROI

How improvement is measured and converted into business impact.

Common questions

Understanding the protocol.

Everything you need to know about our crisis intervention framework and response windows.

Yes. A 24/7 crisis team staffed by Care Navigators handles outreach, and automated detection runs continuously across the platform. Response windows are defined by risk tier — two hours for immediate risk, 24 hours for frequent ideation — and every outreach is conducted by a clinically trained human, not an automated message.

Immediate support when it matters most.

Connect your workforce with crisis support protocols, certified professionals, and clear pathways to safety — 24/7 care, zero wait times.

Schedule a demo Learn more about our approach

Six pathways. One outcome - no employee enters crisis alone.

What makes the identification net comprehensive.

Five of the six pathways work without the employee initiating contact — so no one falls through the gaps of silence.

Coaching never substitutes for crisis care.