II. Scoring

  1. Score 0: No Action Needed
  2. Score 1: Needs Action, but not immediately
  3. Score 2: Needs Immediate Action

III. Criteria: Assign 0-2 points for each item using scoring system above

  1. Home
    1. How does family get along?
    2. Child protection?
    3. Violence?
  2. Education
    1. School Grades?
    2. School Absences?
  3. Activities and Peers
    1. How are friend relationships?
    2. What do you enjoy doing?
    3. Bullying?
  4. Drugs and Alcohol
    1. How often do you use drugs or Alcohol?
  5. Suicidality
    1. Do you have thoughts of killing yourself?
    2. How would you kill yourself?
    3. Have your thoughts of Suicide or plan changed?
  6. Emotions and Behaviors
    1. How have you been feeling recently?
    2. Are there any bad thoughts you cannot stop thinking about?
    3. Do you get into trouble at home, school or with the police?
  7. Discharge Resources
    1. Are you seeing a counselor or getting other help?

IV. Interpretation

  1. Total Score >=8 and Suicidality score 2
    1. Predicts inpatient admission

V. Resources

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