Escambia County Public Schools

Mental Health Referrals

Parent Consent form English (use for mental health referral to Tier III, signed forms are uploaded Focus)

Parent Consent for Group Counseling

CHS Consent for Assessment or Treatment (send home with Parent Consent for students being referred to CHS only)

Parent Consent form Spanish(use for mental health referral to Tier III, signed forms are uploaded into Focus)

Optiflow Form (use for sending the mental health referral to contracted counselors)

OptiFlow Workqueues

Suicide and Self-Injury Assessments (Upload to Self-Harm Risk tab)

What to do for a Suicidal/Self-Injurious Student

Columbia-Suicide Severity Rating Scale (use to Screen for Suicide)

Suicide Risk Assessment (use to identify underlying issues, must ask the last two questions)

Parent Acknowledgment Form (use when the parent comes to the school and you explain the need for further assessment)

Safety Plans

Safety Plan (Use upon return to school from a Baker Act)

Stress Reduction and Re-entry Plan (Use upon return to school from a Baker Act)

Success and Safety Plan Review (Use to review Stress Reduction Plan, 1 month out)

Threat Assessment Reporting

How to Initiate a Concern Referral (use when reporting a threat of violence)

How to Initiate a Threat Assessment Event (Administrator/Lead)

How to Work a Threat Assessment Event (Threat Assessment Team)

Mental Health Staff Use Only 

Informed Consent Form

Medicaid Parent Consent

Certificate of Professional Initiating Involuntary Examination (Baker Act)

Decline/Rescind School-Based Mental Health Services

Miscellaneous Resources

Mobile Response Team Information

Self Harm Protocol

After a Suicide: A Toolkit for Schools

Bullying Assessment Flowchart