This checklist is designed to complement the guidance offered in Comprehensive School Suicide Prevention in a Time of Distance Learning and to stimulate thinking about preparing to provide school suicide intervention via telehealth. It should not supplant, nor is it a substitute for, approved school district protocols.

☐ 1. Review existing school suicide intervention policies, procedures, and protocols; as indicated modify them to include the use of telehealth (e.g., how to connect with students virtually, secure student safety remotely, secure supervision, contact and consult with caregivers).
☐ 2. Develop a resource directory of currently available local agencies that would respond to the student’s location if needed.
Law enforcement ____________________________________________________________________________
Mobile crisis response team ___________________________________________________________________
Children and family services ___________________________________________________________________
Other resources _____________________________________________________________________________
☐ 3. Review with school staff members risk factors and warning signs associated with suicide (and emphasize how the current pandemic can affect suicide risk).
☐ 4. Review with school staff members procedures to follow when a suicidal behavior is judged to be imminent (e.g., call 911 and request a wellness check).
☐ 5. Review with all school staff members suicide risk assessment referral procedures and any modifications to such made necessary by distance learning. School staff understand how to quickly access support for, and refer, at risk students when providing distance learning activities.
☐ 6. Develop telehealth skills and resources.
Telehealth skill development activities: ___________________________________________________________
District technical assistance resources: ___________________________________________________________
☐ 7. Develop telehealth communication options.
Considerations for the use of service providers’ personal devices: ______________________________________
Communication options for students without internet access: __________________________________________
Communication options for homeless students: _____________________________________________________
☐ 8. Identify telehealth communication platforms.
List primary telehealth platforms: ________________________________________________________________
List other telehealth platforms: __________________________________________________________________
Communication options when telehealth is not practical: ______________________________________________
☐ 9. Individuals identified as responsible for conducting suicide intervention have access to updated and current student demographic data (name, address, phone number, primary caregiver contact information, email). _____________________________________________________________________________________________
☐ 10. Individuals identified as responsible for conducting suicide intervention have access to school and community crisis resources for immediate consultation (name, address, 24/7 phone number, email). _____________________________________________________________________________________________
☐ 11. Develop caregiver telehealth consent procedures .
☐ Describes telehealth service delivery and specifies technical considerations
☐ Explains how service providers operate and telehealth limits
☐ Delineates student expectations and responsibilities of all parties involved
☐ Identifies emergency contacts and specifies multiple communication options
☐ Obtains consent for specific service providers to offer telehealth
☐ Reviewed by district legal counsel to ensure compliance with state and federal regulations
☐ 12. Determine protocol for when caregiver consent for services cannot be obtained.
List protocol: ________________________________________________________________________________
☐ Reviewed by district legal counsel to ensure compliance with state and federal regulations