4 Depression, Anxiety, & Colombia Screeners / SI Protocol

What are the three levels of consent in school-based therapy?

Permission to engage, permission to collaborate, permission for who is present.

Why should therapists adjust language for elementary students?

To match developmental comprehension.

Why should pacing be slower with younger children?

They need more time to understand questions.

What does PHQ-9 stand for?

Patient Health Questionnaire-9.

What age group is PHQ-9 generally used for in this training?

Ages 12+.

What timeframe does the PHQ-9 assess?

The last two weeks.

How many total questions are on the PHQ-9?

Nine.

What PHQ-9 score range reflects minimal symptoms?

0–4.

What should be done if PHQ-9 score is 5 or higher?

Repeat every 3–4 visits.

What should be done if Question 9 is flagged?

Administer PHQ every visit and immediately complete Columbia assessment.

Why convert '2 weeks' into days for youth?

It improves understanding (14 days).

Why use calendars or visuals during screening?

To support low literacy or memory.

Why avoid sounding robotic during assessments?

Relational connection still matters.

What is PHQ-9A?

Adolescent version of the PHQ-9.

Are all bottom questions on PHQ-9A scored?

No, bottom context questions are optional.

What does GAD-7 stand for?

Generalized Anxiety Disorder-7.

What timeframe does GAD-7 assess?

Last two weeks.

How many questions are on GAD-7?

Seven.

What GAD-7 score range is mild anxiety?

1–5.

What score range is moderate anxiety?

6–10.

What score range is moderately severe anxiety?

11–15.

What score range is severe anxiety?

16–21.

Why might a high GAD-7 score not equal anxiety disorder?

It may reflect trauma responses.

What diagnosis was said to have high treatment success rates?

Anxiety disorders.

What does SCARED assess?

Child anxiety symptoms.

What age group is SCARED most useful for?

Under age 12.

How many questions are on SCARED?

41.

What is the SCARED rating scale?

0 = not true, 1 = somewhat true, 2 = very true.

Why break SCARED into sections?

To reduce fatigue and improve engagement.

Name one creative way to administer SCARED.

Trash cans, stoplights, faces, trucks, coloring breaks.

If one anxiety category is highly flagged, what should happen?

Target interventions to that category.

When should SCARED be repeated if globally elevated?

In 2–3 months.

Is there a parent version of SCARED?

Yes.

When must Columbia be administered?

Immediately after any PHQ-9 with Question 9 flagged.

Is there a pediatric Columbia version?

Yes, for under age 11.

What four major suicide domains does Columbia assess?

Thoughts, intent, plan, past attempts.

Why should therapists use exact Columbia wording?

To preserve validity.

For children under 11, who should be present?

Another adult (school counselor preferred) or supervisor support.

For ages 12+, can Columbia be done alone?

Yes, then contact supervisor after.

Should therapists apologize for suicide questions?

No—normalize them.

What should your emotional tone be if a student discloses SI?

Calm and steady.

What should you say after disclosure?

Thank them for sharing.

Who should be contacted immediately after SI concerns?

Jake, Rachel, or Angela.

What key facts do supervisors need?

Plan, intent, PHQ score, Columbia results, context.

Should supervisors be contacted even if no plan is present?

Yes, if Question 9 was flagged.

Name one part of a child safety plan.

Triggers, distractions, safe people, coping tools, means safety, crisis resources.

How many safe people should be identified?

Three.

What national crisis number should be included?

988.

Should safety plans be given only to the student?

No—student, parent, and school copies.

Why do schools appreciate safety plans?

They improve coordination and risk management.

How long is a standard therapy session?

20 minutes.

What situations justify extended time?

Columbia or suicide-related concerns.

Who is the main school contact during SI concerns?

School counselor.

What may parents need to do after SI disclosure?

Pick up the child.

Why does a student need a pass back to class?

To explain their absence appropriately.

What bullying can schools directly intervene in most easily?

On-campus bullying.

Name one intervention for bullying concerns.

Classroom changes or lunch schedule changes.

What should be done with complex bullying/social media cases?

Consult supervisors.

How are asthma and anxiety connected?

Breathing difficulty can trigger anxiety and anxiety can worsen symptoms.

People with asthma may misperceive airway restriction by up to what percent?

60%.

Name one environmental asthma trigger.

Pollen, smoke, dust, pesticides, illness, cold air.

Why ask about secondhand smoke?

It can worsen asthma symptoms.

Why might a student seem behaviorally dysregulated when it’s medical?

Breathing distress may drive behavior.

Where should PHQ/GAD scores go in a SOAP note?

Objective section.

How should scores be documented?

Include last date given and score.

Why add context to high screener scores?

Scores may reflect situational stressors.

Why document when last assessments were given?

Shows monitoring and continuity of care.

Why partner with parents after screenings?

To compare home vs school symptoms.

Why might parent reports differ from child reports?

Parents may under-report symptoms.

Is self-harm always suicidal intent?

No.

What function can self-harm serve?

Emotional regulation or pain management.

Example from training: why did one student bite himself?

Anxiety and impulse control, not SI.

Should student therapists worry about contacting supervisors too much?

No.

What was emphasized more than independence?

Ethics and safety.

What else do supervisors monitor during hard cases?

Student clinicians’ emotional well-being.