Wautoma Area School District
Approved 02/11/1988
Revised 01/29/2004
Crisis Intervention Team
The team shall be comprised of the Building Principal, Building Assistant Principal (where applicable), School Guidance Counselor, District Psychologist, District Nurse, and School Liaison Officer.
I. IN-SCHOOL PROCEDURES FOR CRISIS INTERVENTION TEAM
A. Referred/Rumored Threat or Exhibited Symptoms of Suicide Threat
1. Interview witnesses, referral source, or rumor source and record all pertinent data.
2. Interview potential suicide risk and complete the referral for emergency suicide assessment.
3. Complete an informal assessment of situation.
4. Make determination based upon facts of the situation to refer or not to refer student for formal intervention.
5. If formal intervention is not indicated, complete documentation of situation.
6. If formal intervention is indicated, proceed to implement procedures listed under II-A or II-B.
B. Witnessed Suicide Threat
1. Student repeats threat in presence of designated interventionist.
2. Implement procedures under A, 2-6.
C. Suicide Attempt on District Premises
1. Implement procedures under II A and any other emergency medical techniques available.
2. Implement additional procedures under II B as may be appropriate.
3. Contact the Crisis Intervention Team to discuss the advisability of school intervention procedures.
D. Suicide Attempt Off District Premises
1. When a staff member learns of a suicide attempt, successful or not, the staff member shall contact the building administrator to initiate appropriate intervention actions.
II. INTER-AGENCY AGREEMENT BETWEEN THE DISTRICT AND THE 51.42
AGENCY-WAUSHARA COUNTY HUMAN SERVICES GUIDANCE CENTER
The agencies agree to implement the following procedures upon determination by the
Crisis Intervention Team that formal intervention by Human Services is necessary.
A. Imminent Danger
1. Do not leave student alone.
2. Based on immediate assessment of the situation call 911.
3. Contact the building administrator or designee.
a) Contact District Nurse and Crisis Intervention Team.
4. Provide immediate first aid as needed and remain with student until medical assistance is obtained.
5. Notify parent/legal guardian.
B. No Imminent Danger
1. Contact building administrator or designee.
2. Contact parent/legal guardian and request they report to the school.
a) If parent/legal guardian refuse to acknowledge seriousness of situation and report as requested, contact 51.42 Agency (787.6550).
3. Contact 51.42 Agency (787.6550) to arrange the emergency suicide assessment.
4. Obtain all pertinent information related to the suicide threat.
5. Obtain all demographic data and basic background regarding the student.
6. The building administrator or designee will transport the student to the
51.42 agency for the emergency assessment provided the student consents.
7. School interventionists and/or the building administrator will participate in the emergency assessment, along with 51.42 staff, the parent/legal guardian and law enforcement personnel, if required.
C. Assessment Results
1. If immediate hospitalization is not indicated, the parent/legal guardian or
District employee will provide transportation for the student to either home or school as appropriate.
2. A member of the Crisis Intervention Team or other District staff who witnessed acts or threats shall be available to testify in the event of involuntary court proceedings.
3. Request two-way release of information from the student and parent/legal guardian in order to:
a) Continue comprehensive evaluation of the student beyond the emergency assessment.
b) Develop a coordinated service and treatment plan
c) Monitor the student’s progress following the suicide crisis.
d) Hold inter-agency staffing if continued planning and intervention is indicated.
Legal Reference: Wisconsin State Statute §118.13
Wisconsin Administrative Code PI 9.03(1)
Cross Reference: Policy 411-Equal Educational Opportunities
