Escambia County Public Schools

Mental Health Referrals

Mental Health Referral Flowchart

Parent Consent form English (use for mental health referral to Tier III, signed forms are uploaded Focus)

Parent Consent form Spanish(use for mental health referral to Tier III, signed forms are uploaded into Focus)

Parent Consent for Group Counseling

ECPS Mental Health Referral Process Video

Suicide and Self-Injury Assessments (Upload to Self-Harm Risk tab)

What to do for a Suicidal/Self-Injurious Student

Columbia-Suicide Severity Rating Scale (use to Screen for Suicide)

Video: How to Use the Columbia-Suicide Severity Rating Scale

Suicide Risk Assessment (use to identify underlying issues, must ask the last two questions)

Parent Acknowledgment Form (use when the parent comes to the school and you explain the need for further assessment)

Safety Plans

Safety Plan (Use upon return to school from a Baker Act)

Stress Reduction and Re-entry Plan (Use upon return to school from a Baker Act)

Success and Safety Plan Review (Use to review Stress Reduction Plan, 1 month out)

Threat Assessment Reporting Questions or Concerns

Contact Natalie Brault, District Threat Management Coordinator

NBrault@ecsdfl.us

Mental Health Staff Use Only 

Informed Consent Form

Medicaid Parent Consent

Certificate of Professional Initiating Involuntary Examination (Baker Act)

Termination of Services

Decline/Rescind Counseling

Coordination with Outside Providers Form

Miscellaneous Resources

Mobile Response Team Information

Self Harm Protocol

After a Suicide: A Toolkit for Schools

Bullying Assessment Flowchart