Role Play Check Sheet

Role Play Check Sheet - Name of Teacher _ DISCUSSION,...

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Name of Teacher _______________________________________ DISCUSSION, ASSESSING RISK, AND REFERRAL PROTOCOL Establish Rapport Present Absent N/A Select an appropriate place and time to talk Use student’s name Use appropriate eye contact *Orient student to purpose of conversation *Remember confidentiality limits Comments_____________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ __ Discussion Present Absent N/A Start with general questions based on observations *Listen *Ask about and affirm feelings Use “I” statements to reflect understanding *Move to specific questions (e.g. about physical and behavioral indicators, parent/guardian responses, medical attention, stressors, coping strategies, resources) Assure student you can handle discussion,
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Role Play Check Sheet - Name of Teacher _ DISCUSSION,...

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