fix(clinical): red flags, one crisis rule, callback after a crisis, one table of numbers

Clinical review of the questionnaires (ADR-013):
- Red-flag block first in stage 1 (config/instruments/red_flags.yaml); any «Да» stops the
  questionnaire with an acute alert and the help screen of its category.
- One crisis rule: the crisis screen opens at a HIGH C-SSRS risk only; moderate stops and goes
  to a psychiatrist (24 h as a guide), low is a flag with the safety plan. PHQ-9 item 9 with a
  negative screener is a discrepancy flag; without a completed screener it asks the C-SSRS at once.
  config/questionnaire.yaml: cssrs_positive_policy graded (C01).
- Every crisis leaves a callback task for the doctor on duty (post_crisis_call, one per patient)
  and the app asks how the person is the next day, the safety plan one tap away.
- Routing: risk and flags first, scales second; PCL-5 >= 50 no longer means a priority
  appointment (pcl5_severe is moderate on the dashboard too).
- Crisis numbers live only in config/texts/crisis.yaml; texts and the agent prompt refer to them
  via {phone:<key>}. Fixes the children's helpline offered to adults by the chat agent.

Refs #92

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
This commit is contained in:
2026-10-04 16:21:16 +03:00
co-authored by Claude Opus 5.5
parent bde6ec6855
commit 44814b7293
29 changed files with 365 additions and 56 deletions
+6 -5
View File
@@ -50,7 +50,6 @@ class IntakePolicy(BaseModel):
phq9_specialist_at: int = Field(ge=0, le=27, strict=True)
phq9_priority_at: int = Field(ge=0, le=27, strict=True)
pcl5_specialist_at: int = Field(ge=0, le=80, strict=True)
pcl5_priority_at: int = Field(ge=0, le=80, strict=True)
pcl5_behavior_flag_at: int = Field(ge=0, le=4, strict=True)
@model_validator(mode="after")
@@ -65,8 +64,6 @@ class IntakePolicy(BaseModel):
raise ValueError("choose a total threshold OR a zone for alcohol expansion")
if not self.phq9_psychologist_at < self.phq9_specialist_at < self.phq9_priority_at:
raise ValueError("PHQ-9 thresholds must be ordered")
if self.pcl5_specialist_at >= self.pcl5_priority_at:
raise ValueError("PCL-5 thresholds must be ordered")
return self
@@ -276,7 +273,9 @@ def evaluate_intake(
if c.positive:
flags.append("cssrs_positive")
flags.extend(c.conflicts)
if item9_positive or c.risk_lower_bound == "high":
# One crisis rule (ADR-013): a high C-SSRS risk. Item 9 alone is a crisis only while the screener is not complete;
# with a negative / low screener it is the «discrepancy» flag of the routing table, not the crisis screen.
if c.risk_lower_bound == "high" or (item9_positive and not c.complete):
return IntakeDecision(policy.version, "crisis", "crisis", (), tuple(flags), c.missing)
if c.positive and policy.approval and policy.cssrs_positive_policy == "stop_any":
return IntakeDecision(policy.version, "crisis", "crisis", (), tuple(flags), c.missing)
@@ -327,9 +326,11 @@ def evaluate_intake(
# PHQ-2-negative does not invent a PHQ-9 total; it simply does not trigger expansion.
phq_total = phq.total if phq.complete else 0
pcl_total = pcl.total if pcl.complete else 0
# Risk and flags first, scales second (clinical review 2026-10-04). A high PCL-5 alone is not a reason for a
# priority appointment: it goes to the planned specialist route.
if c.risk == "moderate":
primary = "urgent_psychiatrist"
elif phq_total >= policy.phq9_priority_at or pcl_total >= policy.pcl5_priority_at:
elif phq_total >= policy.phq9_priority_at:
primary = "priority_psychiatrist"
elif phq_total >= policy.phq9_specialist_at or pcl_total >= policy.pcl5_specialist_at:
primary = "psychiatrist_or_psychotherapist"