Introduction

As part of our commitment to improve the health, lifestyles and overall well-being of our members and the communities we serve, Security Health Plan is pleased to invest $125,000 in school-based behavioral health screening and interventions, offering support to schools and children. Security Health Plan invites your organization to submit an application. If you have questions, please feel free to contact Lisa Borchardt, Community Health Coordinator at (715) 221-9106 or via email at borchardt.lisa@securityhealth.org.

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* 1. General Information

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* 2. Organization Primary Contact Information

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* 3. Application (b.e.s.t. Initiative) Primary Contact Information

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* 4. Please enter the number of elementary schools in your school district who plan to participate and use the b.e.s.t. universal screener.

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* 5. Please list the names of the schools in your school district who plan to participate and use the b.e.s.t. universal screener.

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* 6. Please list the total number of classrooms (4k - 6th grade) in the elementary schools you identified.

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* 7. Please list the total number of teachers (4k - 6th grade) in the elementary schools you identified.

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* 8. Please list the total number of students (4k - 6th grade) in the elementary schools you identified.

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* 9. Please explain why the b.e.s.t. universal screener and interventions will be helpful to your school district and provide applicable data to support your need.

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* 10. Please list any academic or behavior screening, early intervention or prevention initiatives utilized in your school district, e.g. Phonological Awareness Literacy Screening (PALS), Dynamic Indicators of Basic Early Literacy Skills (DIBELS), Positive Behavioral Interventions and Support (PBIS), Measures of Academic Progress (MAP), Aimsweb, Response to Intervention/Instruction (RTI)/Professional Learning Communities (PLCs).

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* 11. Does your school district have an Information Systems (IS) department to provide technical support?

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* 12. Please explain how your school district can sustain use of the b.e.s.t. universal screener in future years (Approximately $2 per student screened per year).

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* 13. We are considering adding middle school and high school "norms" to the b.e.s.t. program. Would your school district be willing to participate in a pilot review for these grade levels in fall 2019?

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* 14. If you answered 'yes' to the question above, please indicate what grade level you’d like to screen for the pilot program.

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* 15. Please share your thoughts or suggestions for improvement of the b.e.s.t. universal screening program.

If you'd like to provide supporting documentation that you feel will enrich your application, please email Lisa Borchardt, Community Health Coordinator at borchardt.lisa@securityhealth.org. Please list "b.e.s.t. application supporting documentation" and your school district in the email subject line.
If our school district is selected, we agree to the following:
  1. Utilize the Behavioral, Emotional, Social Traits (b.e.s.t.) universal screener and attend support sessions to understand behavioral interventions
  2. Identify at least 3 individuals in our school district (One champion and two additional project coordinators/leads) for integrating the b.e.s.t. screener and interventions into our school district
  3. Coordinate all press releases with Security Health Plan marketing

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* 16. I certify that all information contained in this application is true and accurate to the best of my knowledge.

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