Adolescent Health Program
Nebraska Youth Suicide Prevention Early Identification and Referral Form: Please complete an Early Identification and Referral Form online each time you have contact with a youth you believe is at risk for suicide. This information helps us count and report the number of youth identified at risk and referred for services by suicide prevention trainees. To complete the online form, visit the Nebraska Youth Suicide Prevention web page (http://youthsuicideprevention.nebraska.edu/), and click on the Identification & Referral link under EIRF Form Links on the upper right side of the Home page. The form is estimated to take 5 minutes to complete.
Teri Perkins (firstname.lastname@example.org), Research Specialist
University of Nebraska Public Policy Center
Tel: (402) 472-5678, Fax: (402) 472-5679
For more information, contact:
Michaela Meismer, M.A.
Adolescent Health Program Manager
(402) 471-0538 (office); (402) 416-6746 (cell) or 1-800-801-1122
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Adolescent Health Homepage