SOS Data Reporting Form
Please use this form to report on SOS implementation with students. 

What information/data is being requested?
  • the date of implementation
  • the number of students who participated
  • the number of students who were followed up with after completing the BSAD screening and/or response slip
  • the number of students who required hospitalization after screening and follow up with school mental health staff
Why is Beacon Mental Health requesting this data?

The Beacon Mental Health Prevention Team and our services are entirely funded through local and state grants, and as such we are required to provide data to the Missouri Department of Mental Health (DMH) to acquire and maintain this funding. The data we collect helps us demonstrate the need for our services within the community, evaluate the effectiveness of those services, and identify where we can improve them to better serve our community. 

Then, MO DMH combines those numbers with data from the rest of the state to provide a bigger picture understanding of the state of youth mental health. That data is also provided to federal agencies for national datasets.

The names of students and other PHI are not included - all we need is the number - to maintain privacy and confidentiality. 

For questions about this form, contact Taylor Cline, Youth Suicide Prevention Specialist, at taylorc@beaconmh.org. You can find the SOS Request Form here
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Date of Implementation:  *
MM
/
DD
/
YYYY
School Name: *
# of students who participated in implementation: *
# of students who were followed up with after the BSAD screening/SOS response slip (N/A if you did not track this): *
# of students who were hospitalized after the BSAD screening/SOS response slip (N/A if you did not track this): *
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