Middle Level Depression/Suicide Screener Checklist

Middle Level Depression/Suicide Screener Checklist

September is National Suicide Prevention month. October is National Depression Awareness month.

Items to do BEFORE:

  • Inform parent/guardian via newsletter or email about the MPS screener 2 weeks prior. Use the enclosed newsletter inserts that include the counselor's contact information (see appendix).

  • Make copies of the screener questionnaire. One copy per student.

  • Set up the schedule for each grade level’s presentation.

  • Communicate dates/time with the staff.

  • Distribute “Teacher Handout.”

  • Review/update presentation.

  • Determine which video will be shown to each group/level.

Items to do DURING:

  • Administer Depression/Suicide Screener presentation to students.

  • Collect the screener questionnaires.

  • Distribute “Break the Code of Silence” hotline cards and parent letter.

  • Gather names of absent students from teachers.

Items to do AFTER:

  • Based on screener results follow-up with students.

  • After determining the level of risk, you may…

    • Contact parent/guardian.

    • Complete Suicide Intervention Report and/or CARE Plan on IC following procedures, as outlined by the District.

  • Document all student &/or parent contact in Infinite Campus.

  • Schedule make-up days for students who were absent.

  • Complete data sheet for Student Services and enter data using this link https://goo.gl/forms/FaYOZKPEVpEizDDq2 **

When collecting data for the Depression/Suicide screeners, use the following guidelines:

Class Size: Total number of students registered in each grade level.

Number Screened: Total number of students screened after make-up sessions for those absent.

Number at No Risk: A student who was not interviewed OR a student who was interviewed and no further follow-up was needed; had a concern for a friend or misread a question.

Number at Medium Risk: A student who answered yes on question 2. A student who is interviewed and exhibiting signs of depression but  may or may not be thinking of suicide or hurting him/herself, has not tried to commit suicide in the past and does not have a plan.  Parent contact is required.

Number at High Risk: A student who answered yes on question 1 OR question 1 and 2. A student who is interviewed and  having thoughts of suicide or self-harm.  A Suicide Intervention Report and/or CARE Plan is completed on IC using procedures, as outlined by the District..