For 4 years, Fairfield Middle School and Fairfield High School have given a mental health screener to all students in grades 6-12 up to three times per year. This screener provides information about individual students and whether they are exhibiting warning signs of depression, anxiety, and suicidal ideation. The data from this screener provides our counselors with valuable information that our students may not otherwise share and allow counseling staff to intervene and/or refer students and families to needed services and resources.

The survey will be conducted in the last half of January and again in the spring. The survey asks students about warning signs related to depression, anxiety, and suicidal ideation over the past seven days and is nine questions long. The survey is given via Google Form at the same time to each student and takes approximately 5-10 minutes. The only people with access to the responses are counselors and administrators. We may also share responses with partners that support our efforts in this work if parents/guardians were to opt in to other outside resources/services. Birthdates, student numbers, and other private information are not collected. 

Participating in this survey will cause little or no risk to your student. The only potential risk is that some students might find certain questions to be uncomfortable to answer. Students who choose not to do the survey will do another activity during the survey time. There is no penalty for anyone who decides not to participate, but we would love to have all students participate so we are able to intervene and refer to needed resources and services.

If you have questions about the survey, please contact the building administrators or counselors. The questions on the screener are below:

Instructions: How often have you been bothered by each of the following symptoms during the past 7 days? For each symptom select the answer below that best describes how you have been feeling.

Not At All = 0

Several Days = 1

More Than Half The Days = 2

Nearly Every Day = 3

What grade are you in?

In the last 7 days have you felt down, depressed, irritable, or hopeless? 

In the last 7 days have you experienced little interest or pleasure in doing things?

In the last 7 days have you had trouble falling asleep, staying asleep, or sleeping too much?

In the last 7 days have you experienced a poor appetite, weight loss, or overeating?

In the last 7 days have you felt tired, or had little energy?

In the last 7 days have you felt bad about yourself - or felt that you are a failure, or that you have let yourself or your family down?

In the last 7 days have you had trouble concentrating on things like school work, reading, or watching TV?

In the last 7 days have you felt that you were moving or speaking so slowly that other people could have noticed?   Or the opposite - being so fidgety or restless that you were moving around a lot more than usual?

In the last 7 days have you had thoughts that you would be better off dead, or of hurting yourself in some way?

Please complete the form below and return to your student’s Trojan Time teacher indicating whether or not you would like your student(s) to participate in the Mental Health Screener. This form has also been sent home in a hard copy. Only one version of the response is required.

We appreciate your support in our efforts to connect students with the resources they need.

Sincerely,

FMS and FHS Administrators and Counseling Department