Thinking Ahead to Implement – Part Four

An Emerging Best Practice – Universal Mental Health Screening (Part 4)

By Shelley Seslar, Managing Director, Behavioral Health Services, NCESD
Published December 12, 2022

We’re arriving at the main event in our series describing Universal Mental Health Screening (UMHS) implementation at school. I hope you’ve become intrigued by UMHS and have started to envision how it could be done and how it would benefit your students, your school, and your community. In this fourth post, we will describe some of the logistics necessary to ensure successful implementation of a UMHS event and provide three critical resources to support UMHS implementation.

In the previous three installments, we introduced Universal Mental Health Screening (UMHS), how to get support for UMHS at your school, and details for setting the foundation with partners.

You have assembled your team, and together, you have developed an understanding of UMHS. Now, you are ready to put the pieces together and hear from your students! Keep reading to learn how.

Screening Tool

• Choose a screening tool in collaboration with partners
  • The SHAPE System – Once you have created a free account and logged in, go to “Resource Library,” and search the “Screening and Assessment Library”
  • Recommended UMHS tools to consider:
    • PHQ-9
    • GAD-7
    • BTS
    • RCADS
    • SDQ
• Establish scoring guidance for next steps after screener, scoring rubric, additional screening tree
  • Example for PHQ-9/GAD-7/UCLA Brief Trauma Screen (BTS)
  • Example for RCADS/BTS/SDQ

Partners

• Invite and collect contacts for local providers that will be on-campus for the day of the event, including Designated Crisis Responders, for immediate follow-up safety assessment and safety planning, as needed.
• Request that mental health organization partners clear some time for intakes and new clients on clinicians’ schedules in the days following the event.
• School personnel ready and prepared at the event to make immediate parent calls to students at-risk.

Messaging

• Establish consistent messages that emphasize the purpose and importance of screening for mental health.
• Ask for administrative decision on consent process
  • Recommended approach: Passive Consent with an Opt-Out Process
• Parent notification process in multiple formats and timeline
  • Script a parent robo-call, letters, and email messaging. This FAQ could help.
  • Create opt-out instructions, alternate activity, and opt-out tracking process.
  • Student voluntary opt-out process
• Create an informed consent message to be read to students prior to administration of screener. Here’s a FAQ that could help with your drafting.

Timing

• Provide the screening to all students to be screened at the same time to avoid negative messaging possibly spread by the early group.
• Schedule the event early in the school day so there’s time to score screeners and triage response to high need students
  • Reach parents before at-risk students leave campus that day.
• Pick a day early in the week (e.g. Mon-Tues) to give time for follow-up with students at high-risk.

Aftercare

• Script for parent calls (again, the FAQ could help), assign and prepare school staff for parent liaison role, get support resources ready to share with parents
• Create a menu of school-based interventions at all levels of risk (mild, moderate, high, immediate)
  • Recommended: TRAILS to Wellness groups and material (free registration required)
• Develop appropriate local pathways to community support at each of the moderate, high, and immediate risk levels
  • Moderate-risk examples: Provide educational resources and optional phone consultation to parents and students; Referral to local mental health providers and other community services where self-help, peer-help, and other positive prosocial activities can be found; Make sure students and parents have crisis contacts.
  • High-risk examples: All the above, plus, provide a referral to a pre-scheduled appointment in the next few days at a local mental health provider.
  • Imminent-risk examples: All the above, plus, recommend parents/students go to local emergency dept or contact Designated Crisis Responder for immediate safety assessment and crisis assistance.

Click graphic to enlarge

Key Implementation Resources

• Center for School Mental Health (2018). School Mental Health Screening Playbook: Best Practices and Tips from the Field.
• Massachusetts School Mental Health Center: School-Mental-Health-Screening-Playbook.pdf
  • UMHS Implementation Guide – This is a broad checklist of implementation steps
  • UMHS Resource Guide – This is a collection of relevant templates, sample timelines, and other resources

• The SHAPE System – Once you have created a free account and logged in, go to “Resource Library” at the top of the page, and select the “Screening and Assessment Library” to access. Use the search features to identify measures that match with the presenting concern you want to screen for, the age of the screening population, etc. Most of the tools in this library are free.

Watch for our next article on UMHS that is intended to be our last in this series. It will focus on outcomes and lessons learned by schools that have implemented UMHS, including experience gained at Wenatchee High School’s on-going UMHS practice. For assistance in planning your school’s UMHS, contact Shelley Seslar at NCESD via email.