Miners/Panther Valley School Health Index Module 6 School Counseling, Psychological, and Social Services Question Title * 1. Thank you for taking the time to participate in the Panther Valley Healthy Schools survey. Please select the answer that best describes you. Student Parent/Guardian/Grandparent of a school aged child Faculty/Staff/Administration Community Member Other Question Title * 2. Does your school have access to a full-time counselor, social worker, and psychologist for providing counseling, psychological, and social services? Is an adequate number of these staff members provided based on the following recommended ratios?* one counselor for every 250 students* one social worker for every 400 students* one psychologist for every 1000 students Yes, we have a full-time counselor, social worker, and psychologist, and the recommended ratios are present We have a full-time counselor. social worker, and psychologist, but fewer than the recommended ratios We have a full0time counselor, social worker, or psychologist, but not all three No, we do not have even one full-time counselor, social worker, or psychologist Question Title * 3. Does the counseling, psychological, or social services provider promote the emotional, behavioral, and mental health or and provide treatment to students and families in the following ways?* 1-on-1 counseling/sessions* Small group counseling/sessions* Classroom-based health promotion and prevention* School-wide health promotion and prevention Yes, it is provided in all four ways It is provided in 1-on-1 and small group sessions, and classroom-based or school-wide activities It is provided only via 1-on-1 and small group sessions No, our counseling, psychological, or social services provider does not promote emotional, behavioral, and mental health or provide treatment in any of these ways or we do not have such a provider Question Title * 4. Does the school's counseling, psychological, or social services provider collaborate with other school staff members to promote student health and safety in at least six of the following ways?Examples of ways to collaborate include:* developing plans to address student health problems (e.g., individual health care plans, individual education plans, 504 plans, school team plans)* providing professional development on managing student health and safety concerns, a component of which educates staff on the impact of Adverse Childhood Experiences (ACEs) and the principles of a trauma-informed school* developing policy* identifying, revising or developing curricula or units/lessons* developing and implementing school-wide and classroom activities* developing school improvement plans* establishing communication systems with other school staff Yes, there is collaboration in at least six of these ways There is collaboration in three to five of these ways There is collaboration in one or two of these ways No, there is no collaboration, or the school does not have a counseling, psychological, or social services provider Question Title * 5. Does the counseling, psychological, or social services provider have a system for identifying and tracking students with emotional, behavioral, and mental health needs? Yes, there is a system to identify and track students with emotional, behavior, and mental health needs Students are systematically identified, but not systematically tracked Students are identified only when an urgent need arises at school No, there is no system for identifying or tracking students with emotional, behavioral, and mental health needs, or the school does not have a counseling, psychological, or social services provider Question Title * 6. Does your school implement a systematic approach (including the following components) for referring students, as needed, to appropriate school-or community-based counseling, psychological, and social services?* Case management, including assessment, referral, education, support, and monitoring, is offered* Referral information is distributed widely (e.g., through flyers, brochures, website, student handbook, health education class) so that students, staff, and families can learn about school and community services without having to contact school staff* Staff members are given clear guidance on referring students to school counseling, psychological, and social services* Referral forms are easy for staff members to access, complete, and submit confidentially* A designated staff person (e.g., school counselor, social worker, or psychologist) regularly reviews and sorts referral forms and conducts initial screening* With written parental permission, additional information (e.g., questionnaires, relevant records, brief testing) is gathered as necessary and in compliance with FERPA* Written consent is obtained, in compliance with HIPAA, to gather relevant records from other professionals or agencies, if applicable* A list is kept and regularly updated of youth-friendly referral providers along with basic information about each (e.g., cost, location, language, program features, previous client feedback, types of insurance accepted)* Meetings are held with all relevant parties to discuss referral alternatives* Potential barrier (e.g., cost, location, transportation, stigma), and how to overcome them, are discussed* Follow-up (e.g., via telephone, text messaging, email, personal contact) is conducted to evaluate the referral and gather feedback about the service* A status report is provided to the person who identified the problem, if applicable and in compliance with FERPA and/or HIPAA* Professional development is provide to all staff members about the referral process Yes, our school has a referral system that includes all of these components Our school has a referral system that includes some of these components Our school has a referral system that includes a few of these components Our school's referral system does not include any of these components, or our school does not have a referral system Question Title * 7. Does your school aid students during school and life transitions (such as changing schools or changes in family structure) in the following ways?* Matching new students with another student or buddy* Opportunities for students to check-in with a trusted adult* Orientation programs that focus on adapting to transitions Yes, our school aids students during school and life transition in all three of these ways Our school aids students during school and life transitions in two of these ways Our school aids students during school and life transitions in one of these ways No, our school does not aid students during school and life transitions in these ways Question Title * 8. Does the school's counseling, psychological, or social services provider have a system for identifying students who have been involved (as a bystander, victim, perpetrator, or some combination of these) in any type of violence (e.g., child abuse, dating violence, sexual assault, bullying or harassment, fighting, suicide and self-harm behaviors) and, if necessary, refer them to the most appropriate school-based or community-based services? Yes, identifies and refers students to the most appropriate services Identifies and refers students, but does not always refer them to the most appropriate services Identifies students, but sometimes does not refer them to appropriate services Does not identify students with these problems, or the school does not have a counseling, psychological, or social services provider Question Title * 9. Thanks again for participating. Please provide any comments or feedback regarding any of the survey questions and/or suggestions on how to improve the health and wellness of Panther Valley. Done