Model 2 - Opt-Out Process
Model 2 reflects an Opt-Out approach to universal screening in schools. Opt-out means that all students will be screened for suicide risk. Those who indicate risk for suicide are offered a safety planning process and offered resources. model 2 reflects universal screening for all grade levels across a school.
The objective of this opt-out screening process was to provide students and families with suicide risk screening and subsequent resources/support. Suicide risk screenings cannot predict future risk; their purpose is to assess current risk at a specific point in time. Throughout the process, Google Forms and Google Sheets were extensively utilized.
Initial Steps
a. Conduct discussions with the Superintendent and obtain consent to administer the screening.
b. Present to and seek approval from the School Board.
c. Engage in discussions with principals and building stakeholders to determine suitable dates for each grade level, considering factors such as AP Testing, SATs, and school events.
Development
a. Establish the workflow, including when the screening will be delivered and how students will progress through the process.
b. Create necessary forms, including the Abbreviated Columbia Suicide Severity Rating Scale (C-SSRS), data collection, screener feedback, and non-responsive student forms.
c. Prepare emails to introduce the screening process to parents, staff, and students.
d. Develop presentation materials for staff.
e. Prepare presentation materials for parents.
f. Establish communication channels and determine the level of support/involvement with Lines for Life and County or Community Mental Health.
Staffing Considerations
a. Determine Level 2 screeners and schedule them for specific dates and shifts (this task requires early attention).
b. Assign roles to department staff, clearly defining where their responsibilities end and building staff's roles begin.
c. Arrange for building staff (Counselors, Social Workers, Psychologists, Level 2 Screeners) to be available on screening days, ensuring their regular duties are covered to fully dedicate their time to the screening process.
d. Assess staff members' experience with suicide screens and identify leaders within the team.
Required Roles
a. District Administrator: Serves as a liaison between the Superintendent, School Board, Building Administrators, Counselors, Social Workers, Psychologists, Lines for Life, OHA, and County Mental Health. Ensures compliance with legal requirements, follows up with building staff regarding high-risk students, and ensures proper care and follow-through. Handles staffing considerations as outlined above.
b. Principal: Communicates with parents, collects Opt Out data, provides introduction scripts to teachers, sends out the screening, coordinates meetings, training, and parent sessions with the District Administrator, and may conduct home visits if necessary on the screening day.
c. Staff (1 or 2): Monitors all aspects of the screening day, proficient in Google Forms, Google Docs, Google Sheets, online texting, Gmail, and Synergy (student database program). Monitors the distribution of surveys, tracks responses on Google Sheets, schedules students with positive screen answers for Level 2 screeners, escorts students to screeners' breakout rooms, collects feedback forms, escalates students with high or medium risk to Level 3 intervention, and compiles packets for building counselors, psychologists, and social workers. Ensures the confidentiality of student data, tracks no-shows, reschedules appointments, manages lunch breaks, and addresses Level 2 screeners' questions.
d. Level 2 Screeners: Five screeners worked effectively, but three or four could have sufficed. Late scheduling poses challenges for contacting students who do not show up on the same day.
e. Counselors, Social Workers, and Psychologists: Assist Level 2 screeners in facilitating student appointments, provide Level 2 support to students who are unwilling to meet with external screeners, and offer Level 3 support to students classified as having medium or high risk.
Information Sharing
a. Employee presentation for Building Administrators, Counselors, Social Workers, and Psychologists: Discuss logistics, approach, workflow, responsibilities, and review the Columbia Screening tool.
b. Parent presentations: Conduct one during the day and another in the evening to address suicide myths, explain the purpose of the screening and the Columbia Screening tool, and answer questions. Principals send out parent emails and provide an opt-out option.
Preparations the Week Before
a. Train Level 2 Screeners on workflow, data tracking expectations, and feedback tools. Provide greeting scripts, comprehensive Columbia Screen materials, Harvard Partners Flow Chart, closing scripts, and criteria for advancing to Level 3.
b. Review forms packet with screeners and collect Confidentiality Agreements before the screening day.
c. Brief staff on the screening day's schedule and collect their contact numbers.
d. Prepare forms for each grade level and school, ensuring a plan for distributing forms prior to the first screening day.
e. Principals maintain a list of opt-out students and remove their emails from the master list to prevent them from receiving the screening on the screening day.
f. Set up a non-personal texting number to communicate with students (e.g., Text Free).
Day of the Screening
a. Principal sends out the screening to students at the designated time.
b. Teachers read an introduction statement to students and allow time for completing the screening.
c. Students complete the screening, with most finishing within 15-20 minutes, but some may take longer.
d. Staff monitor data as students fill out the suicide screens.
e. Students with positive answers are scheduled with Level 2 screeners.
f. Students receive an email with the Level 2 screening time, usually containing a virtual meeting link.
g. A text message is sent to the student via Text Free, instructing them to check their email for our message.
h. Students are welcomed in a virtual room and then directed to breakout rooms with screeners.
i. Students who do not respond or attend their scheduled time are logged in a No Show document, which counselors monitor for rescheduling.
j. Screeners send each student a resources list and complete a feedback form after the meeting, ranking the student's risk level as Low, Medium, or High, and taking notes on their discussions.
k. High-risk students are contacted by their counselor, social worker, or school psychologist. Their parents are notified, and permission for further support is sought.
l. The option to refer high-risk students to Clackamas County Mental Health for immediate intervention is available.
m. Staff are prepared for home visits if necessary.
n. All students with positive screenings are contacted by a staff member or seen by a Level 2 screener by the end of the day.
o. Feedback forms from Level 2 screeners are compiled into summary packets and shared with the students' counselors, school psychologists, and social workers for awareness and future connection.
After the Screening Day
a. Counselors follow up with students in the Low and Medium risk categories.
b. Staff members gather to provide feedback and address concerns.
c. Check-in on staff members' mental health due to potential exposure to difficult topics.
d. Review data for trends.
e. Review data for students who identify other struggles or concerns.
Considerations
a. Student reactions: Some students may exhibit resentment, dismissiveness, withdrawal, or concerns about confidentiality.
b. Building administrators and staff comfort: Spend time ensuring that everyone understands their roles and responsibilities. Some individuals may feel anxious about causing harm by saying or doing something wrong.
c. Timing: Consider spreading out each grade level's screening over the course of the year instead of conducting them consecutively. Managing the screening for a whole week can be demanding for staff members.
d. Day-of timing: Allow students a minimum of 30 minutes between receiving an appointment with a Level 2 Screener and the actual appointment time.