District-Wide Safe Schools and Crisis Plan - Blytheville Public Schools

H.8. SUICIDE ASSESSMENT
YES Answers increase the probability of a suicide attempt or completion.
1. Presently does the student demonstrate any signs of:
NO YES
a. Being high or intoxicated ___ ___
b. Increased trouble concentrating ___ ___
c. Confused thinking ___ ___
d. Seeing, hearing, feeling what is not there (hallucinations) ___ ___
e. Extreme misinterpretations of events and others' behavior ___ ___
f. A dramatic change in behavior ___ ___
g. Difficulty distinguishing fantasy from reality? ___ ___
2. Is the student showing signs of depression:
a. hopelessness, helplessness, sadness, or frequent fearfulness ___ ___
b. many physical complaints ___ ___
c. recent changes in sleeping patterns (too much/little, fitful, or early waking) ___ ___
d. significant change in overall activity level (hyper or slowed down) ___ ___
c. problems in concentration, memory, and/or judgment ___ ___
f. significant changes in weight/appetite ___ ___
g. social problems, including withdrawal or unusual hypersociability ___ ___
h. decreased motivation, apathy ___ ___
i. deterioration in personal habits/hygiene i.e. soiled clothing, unkept room ___ ___
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