‘It’s OK to not be OK’: How one high school saved lives with a 34-question survey

It was 10:30 a.m. on a Monday in April. Nine counselors, psychologists, and therapists sat around a table in a conference room at Cañon City High School in southern Colorado.

In classrooms around the building, the school’s ninth-graders whizzed through an online mental health survey that would soon deliver real-time data to the group in the conference room. They were a triage team of sorts — particularly interested in the answers to question 24, which asked how often students had had thoughts of hurting themselves within the past week.

By 10:35 a.m., most of the results were in. Over the next few hours, team members pulled students who had responded “very often” or “often” out of class for private one-on-one conversations.

The overarching message to students, said Jamie Murray, a district psychologist who helped coordinate the effort, was “It’s OK to not be OK.”

While many Colorado school districts have beefed up mental health supports in recent years, Cañon City’s decision to administer a mental health screening to high school students is rare. Many district leaders are wary of soliciting such sensitive information, fearing they won’t have the tools to help students in crisis or that they’ll be liable if tragedy strikes and they weren’t able to intervene.

“When they let me know they had been working on rolling out this universal screener in the high school, that was amazing to me,” said Brian Turner, CEO of Solvista Health, a community mental health center that embeds some staff members in Cañon City schools.

“We were hearing that no district would touch it because it felt so risky,” he said. “To hear that they weren’t fazed by that … was really refreshing.”

Colorado has one of the highest suicide rates in the country for both youth and adults. In Fremont County, which houses 13 prisons and where Cañon City is the county seat, suicide rates are well above the state average.

Leaders in the Cañon City district say instead of getting caught up in liability worries over the mental health screening, they focus on their responsibility to students.

“We were totally well aware when we started the [screening] process that we would open a can of worms,” said Brian VanIwarden, the district’s wellness coordinator. “Our job is to help these kids.”

A statewide student health survey given every two years reveals just how prevalent thoughts of suicide are among Colorado youth. The 2017 version found that 17% of Colorado middle and high school students reported considering suicide and 7% reported making one or more attempts.

In the 3,500-student Cañon City district, the new mental health screening is part of a broader effort to better address students’ social-emotional and mental health needs. Over the last two years, the district has also adopted new curriculum, partnered more closely with local mental health centers, and conducted teacher training on mental health topics.

Soon after VanIwarden took the wellness coordinator job in the fall of 2017, Murray proposed the idea of a universal mental health screening. He and other district officials learned more at a school mental health conference that October and spent subsequent months planning for a local roll-out.

The district chose a 34-question screening survey called the BIMAS-2. It was co-created by a University of Northern Colorado psychology professor and has been used in Boston Public Schools since 2012-13.

Cañon City high-schoolers took the survey for the first time last October. In April, it was administered again — in one grade each day for four consecutive days. Both times, more than 800 of the school’s 1,000 students opted to take the voluntary survey.

The two BIMAS screenings last year cost the district about $2,000. Next year, district leaders plan to use the tool with seventh- and eighth-graders as well.

The screening survey asks students a range of questions about their thoughts and behavior during the previous week — for instance, whether they felt angry, maintained friendships, had trouble paying attention, or missed school.

And, of course, whether they had thoughts of hurting themselves.

“Research indicates that self-injury is often viewed as a coping mechanism and can be an indicator of depression and anxiety,” Murray said.

Self-harm can take many forms, including cutting skin with a blade, intentionally causing bruises, or not eating. Thinking about self-harm doesn’t always mean teens will act on it or that they’re considering suicide.

“We don’t want to just immediately leap to a place of, ‘Oh my gosh you’re self-injuring or you’re having suicidal ideation,’” she said.

That’s where the triage team comes in. Their job is to probe more deeply after kids report thoughts of self-harm on the survey — reaching out the same day in the most urgent cases.

At Cañon City High School last year, the team learned that some students had misunderstood the directions and weren’t in dire need of help. Staff members talked to others about counseling services and helped them make phone calls to their parents.

In about a dozen cases — over the course of the fall and spring screenings — district staff identified students as high-risk and immediately referred them to community-based mental health crisis teams for formal evaluations. Some of those students, Murray said, had concrete plans to kill themselves.

“Without a doubt,” she said, the screener saved lives.

Although being pulled out of class in the middle of a school day might make some students uncomfortable or defensive, Murray said the teens were more often relieved.

Some of the students said, “I was waiting for this. I was waiting for someone to know,” she recalled.

Murray said when the district launched the screening, there were 29 secondary students receiving counseling in their schools through providers like Solvista. Now, because of the BIMAS screening and the district’s growing partnership with community mental health organizations, there are 150 elementary and secondary students getting school-based counseling from those providers.

In addition, other Colorado districts have begun introducing the BIMAS after hearing about the work in Cañon City schools. The 2,400-student Woodland Park district administered the screening to middle school students earlier this spring and the 700-student Park County RE-2 district will begin using it in grades seven through 12 next school year.

VanIwarden said while the BIMAS screener helps identify students with urgent problems, it also serves as a barometer for overall student well-being and helps break down the stigma associated with mental health problems.

One of the biggest takeaways from the screening data was that many teens need more help coping with school and life. And not just kids who have obvious problems with grades, attendance, or behavior. The survey turned up plenty of high-achieving students with solid friendships and a raft of extracurricular activities who reported being unhappy.

“We weren’t really 100% aware of the internal stress and anxiety they were feeling,” Murray said.

Such findings point to the need to help students across all grade levels develop healthy ways to work through stress. And if the district can do that, its leaders hope they’ll see the pay-off not just in future BIMAS data, but in student achievement results, too.

“We‘ve got BIMAS giving us a moment-in-time study and we also have curriculum in place to address these issues,” said VanIwarden, who has three school-age children.

“I’m very grateful that stuff like this exists,” he said. “It’s as important as learning how to read.”


Colorado Crisis Line: 1-844-493-8255, coloradocrisisservices.org. You can chat online or text TALK to 38255.

Crisis Text Line: crisistextline.org. Text 741741 from anywhere in the nation to reach a counselor.

Mental health resources: From the Colorado Department of Human Services, including a list of community mental health centers and a searchable directory of mental health providers statewide.

Mental Health First Aid Colorado: http://www.mhfaco.org/. Classes teach participants the signs and symptoms of mental health challenges or crisis, what to do in an emergency, and where to turn for help.

Mental Health Coloradohttps://www.mentalhealthcolorado.org/ This statewide advocacy organization offers a free mental health toolkit for schools.

Suicide Prevention Coalition of Colorado: www.suicidepreventioncolorado.org. The coalition works to reduce suicide through education and advocacy.