Popular Searches:  Newsletter  •  Careers  •  Referrals  •  New Client Forms

Find a




Make a


Call Now


Samaritan Wellness Screen

WeLLNess Screen Forms

Opt-Out Forms:

If you have additional questions or are unable to access the forms above, reach out to Amy D’Addario, Program Manager.

Si tiene preguntas adicionales o no puede acceder a los formularios anteriores, comuníquese con Amy D’Addario, administradora del program.

Yog tias koj muaj cov lus nug ntxiv los sis tsis tuaj yeem nkag mus muab tau daim foos saum toj no, tiv tauj mus rau Amy D’Addario, Tus Thawj Tswj Hwm Qhov Txheej Txheem Pab Cuam.

*Mental wellness screening is available for students K-5th grade using a separate tool and process.

What is The Wellness Screen Program?

The Wellness Screen Program provides mental wellness screening for students in their school environment. Students voluntarily answer questions about their thoughts, feelings, and behaviors. Answers are confidential and only seen by Wellness Screen staff.

Mental wellness screening allows for early identification of highly treatable mental health needs, including those that may be associated with increased suicide risk. If mental health needs are identified, results will be verbally shared with the student and their parent/ legal guardian. Wellness Screen staff will provide resources and offer support to find appropriate mental health services.

Samaritan Wellness Screen

Importance & Impact

Psychosocial (psychological and social) problems are relatively common. Such problems often go unnoticed by pediatricians, teachers and even parents and can lead to more serious problems in later life. Research shows that earlier detection and treatment can lead to better outcomes. As such, professional organizations like the American Academy of Pediatrics (AAP) recommend psychosocial screening as a part of the annual physical for all children and adolescents. -Massachusetts General Hospital, Psychiatry Department

Additional Information

The Wellness Screen Program uses the Pediatric Symptom Checklist- Youth PLUS to screen students in 6th-12thgrade*. This tool is based on a well-researched, valid, and reliable tool, the Pediatric Symptom Checklist. The PLUS portion of the tool includes questions related to non-suicidal self-injury, suicidal ideation, risk factors related to depression, anxiety, and suicidal ideation, as well as substance use from the CRAFFT.

The tool, as well as the Wellness Screen process, is analyzed annually by the Child and Adolescent Research in Emotion (CARE) lab at Lawrence University.

The Wellness Screen Program is VOLUNTARY. If you do not want your student to participate in the program, complete the form below. Please note, students can refuse participation at the time of the screen.