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Student Response/ Follow up to SOS Curriculum
SOS Signs of Suicide Student Screening Form using the Brief Screen for Adolescent Depression (BSAD)*
* Indicates required question
Email
*
Your email
Student First Name
*
Your answer
Student Last Name
*
Your answer
After watching the video clips, do you want to talk to someone?
*
I Would like to talk to someone about myself or a friend
I DO NOT want to talk to someone about myself or a friend
In the last four weeks have you.......
Please answer "yes" or "no"
....felt like nothing is fun for you and you just aren't interested in anything?
*
Yes
No
.... had less energy than you usually do?
*
Yes
No
.... felt you couldn't do anything well or that you weren't as good-looking or as smart as most other people?
*
Yes
No
.... thought seriously about killing yourself?
*
Yes
No
Have you EVER, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt?
*
Yes
No
.... has doing even little things made you feel really tired?
*
Yes
No
.... has it seemed like you couldn't think as clearly or as fast as usual?
*
Yes
No
Are you currently being treated for depression?
*
Yes
No
Identifying Trusted Adults
In this section, identify a trusted adult you could turn to if you need help for yourself or a friend (example: "My English Teacher", "My School Counselor", "My Mom", "My Coach"
Name a trusted adult that you could turn to at School
*
Your answer
Name a trusted adult that you could turn to Outside of school
*
Your answer
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