Elementary Counselor Suicidal Behavior Screening

A. Getting Student’s Perspective on a referral(from teacher or parent) or an incident:
1)“It seems like something happened that really upset you. Can you tell me what happened?
2)“Your (teacher /parent shared with me that you …(said, did, wrote, drew a picture)…..
Do you want to tell me more about that?”______
3)Use the Wellness Scale to identify feelings?
  • I I’m am going to ask you about how you are feeling on a scale 1-5.
  • 5 is “I’m feeling horrible. I don’t even want to wake up or no point of living”
  • 2 is “I am fine.”
  • 0 is “ I feel great and happy.”
4)If the student’s answers to the wellness scale is 3 or above or indicate risk: (sad/despondent/distressed/hopeless/or considering hurting self )….continue through assessment.
  • Say: “We care about you and I have some questions that I’m going to ask you because I want to make sure you are safe.”
B. If NO PRESENT RISK came up in getting perspective, COUNSELOR’S GOAL IN ASSESSMENT IS TO LEARN:
  • “How are you feeling now?
  • “Are you thinking about hurting self or have you had these thoughts before?”
NOTE: If NO current thoughts or risk or significant history, use judgment about which questions you might still want to ask, considering knowledge and student’s history & current level of functioning.

SECTION I – ASSESSMENT OF FEELINGS: / YES / NO
  1. Do you ever feel really sad?
  • If Yes, what do you do with your sad feelings?

  1. Do you ever feel really mad?
  • If yes, what do you do with your mad feelings?

  1. Do you ever feel really bad about things? Like What?
  • Tell me what you do when you feel really bad about things?

  1. Do you worry a lot about anything?
  • If yes, what kinds of things?

  1. Do you sleep good at night?
  • If no, tell me what you are doing or thinking about?
  • Do you ever get really tired?

  1. Do you get enough to eat?
  • If no, tell me more.

SECTION II – ASSESSMENT OF SUPPORT FROM FAMILY OR FRIENDS:
  1. When you have the feelings we have talked about, is there anyone that you can talk to?
  • Who?

  1. Is there anyone in your family that helps you feel better? Who?
  • What do they do that makes you feel better?

  1. What else helps you feel better?

  1. Is there someone at school (teacher/student) that you like to be with?
  • What do you like to do with them?

  1. Is there anyone that you know that has been hurt really bad?
  • What happened?

  1. Is there anyone you know that has died?
  • What happened?
  • When was that?
  • What was that like?

SECTION III – SUICIDE ASSESSMENT QUESTIONS (INCLUDING CHILD’S CONCEPTION OF DEATH) / YES / NO
  1. Do you ever feel so bad that you feel like going to sleep and never waking up?
Tell me what that would look like?
  1. Do you ever think about hurting yourself?
Tell me about that?
  1. Do you ever think about hurting yourself so bad that you will not be alive anymore?
  • If yes, what would you do?
  • What would you use to not make yourself be alive anymore?

  1. Do you want to hurt self now?
  • Can you tell me what happened to make you have that feeling?
  • What do you want to happen if you hurt yourself now?
Make empathic statement: “I can tell you have really been upset.”
______
SECTION IV – If hasn’t already come up. (Suicide Intent with Specific Plan)
Thoughts of killing oneself with details of plan fully or partially worked out and student has some intent to carry it out. Examples: collected pills, obtained a gun, went to roof but didn’t jump, cut self, tried to hang self, plan to run out in front of car.
  1. Do you ever think about wanting to die?
If Yes, tell me more.
  1. Would you ever do anything to make yourself die?
  • If yes, what would you do?
  • Where would you do it?
  • When would you do it?

  1. Have you ever done anything in the past to make yourself die?
What?
When?
How?
What happened?
What did you want to happen?
  1. What does being dead mean to you?

  1. What do you think happens to people when they die?

  1. Do you think people can come back to live on earth after they die?

FOR OLDER CHILDREN 8 AND UP:
  1. How do you think other people might fell if you died?
(Do not add any statements that may make them feel guilty…i.e. (your parents would be very upset) NOTE: purpose of question is just to get child’s perspective.

If the answer to 3, 5, 6, 7, is YES, take action IMMEDIATELY!! Contact SRO and follow AISD Quick Reference Guide for Suicide Interventions.

DO NOT LEAVE STUDENT ALONE !