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The screening identifies students who need additional mental health supports and lessens the stigma around suicide.

Lake Oswego is the first school district in the county to pilot a new risk assessment tool to aid in suicide prevention.

So why Lake Oswego, and why now?

Galli Murray, the suicide prevention coordinator at Clackamas County Health, Housing and Human Services, is in regular contact with the mental health teams at all 10 districts in the county. She said a conversation with Jim Sanders, a clinical psychologist and the LOSD assistant director of student services, sparked the request to the state for the funds for the assessment.

The screening tool, The Columbia Protocol, was created in 2007 and also is known as the Columbia-Suicide Rating Severity Scale. By 2011, the Centers for Disease Control adopted the protocol's definition for suicidal behavior and recommended the protocol for data collection. A year later, the Food and Drug Administration declared the Columbia Protocol as the standard for measuring suicidal ideation and behavior in clinical trials.

The screening itself can be done on the computer and takes most students about three minutes. Based on the students' answers, they might be flagged for a follow-up.

This involves talking to a screener — an actual human who asks clarifying questions. From there, the student's risk is determined. Students at a low risk are offered resources while students at a medium risk are referred to their school counselor or social worker. Students with a high risk are those who have identified enough of an intent or plan that they warrant an immediate safety plan. Sanders said safety planning involves reducing the triggers for that type of thinking.

"The good news is we were able to identify some students who benefited from getting a greater level of care," Sanders said.

In February, a Lakeridge High School student died by suicide. Murray said after his death, it came to the district's attention that a handful of other students had made suicide attempts around the same time.

"And that, of course, caused them deep concern," Murray said. "The recommendation was made by both the state and by the county that Lake Oswego provide universal screenings for suicide for all of their high school students."

The first round of screening in LOSD started with Lakeridge High School seniors. Sanders said the goal is to screen all district high schoolers by the end of May.

And though the recent death and attempts do not indicate a rise in suicide cases compared to last year, they were concerning for two reasons.

One, suicide remains the leading cause of death for people age 10-24 in Clackamas County and in the nation.

And Murray said research indicates that if someone you know dies by suicide, your risk of suicide goes up — even if you were not close to the person who died.

"So we knew that a significant amount of the Lake Oswego and Lakeridge (students) were at increased risk because of this death," she said.

Sanders said the screening not only identifies students who need additional mental health support, it also works to reduce the stigma around suicidal ideation.

According to Sanders, there's a common but false thinking that talking about suicide gives people the idea to follow through. In reality, a trusted adult talking to students about suicide shows students who might have suicidal ideations that it's OK to talk about what they're feeling.

Murray likened it to the awkward scoliosis screening that's often done in middle school.

"The scoliosis screening was really weird. I remember being nervous about it as a kid but yet, asking kids about suicide and asking kids about if they have the support that they need and want feels trickier to adults than doing a scoliosis screening or a hearing screening or eye screening," she said. "This is no different than any other screening. It just happens to involve the word suicide and ... we, as human beings, don't really know what to do with that."

Conducting a screening where students are asked explicitly if they've ever thought about killing themselves signals that these thoughts happen and that they're OK to talk about, Murray said.

Although it remains the first leading cause of death for 10- to 24-year-olds in Clackamas County, this screening isn't offered in every district. Not yet, anyway.

"I can say pretty confidently that at some point soon, as a county suicide prevention coordinator, that I will be recommending that all of our districts do a prevention-oriented universal screening for suicide of high school students annually, just like they do other health screenings," Murray said.

In fact, the piloted screening in LOSD will inform the future universal screening at other districts. Sanders said the Oregon Health Authority has asked them to put together the work they've done to create a "toolkit" for other districts.

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