Student Mental Health Screening OPT OUT Form

Complete one form for each child in your family ONLY IF YOU WISH TO OPT OUT of mental health screening.

If you have questions, please contact the MPUSD Multi-Tiered Systems of Support Department at (831) 645-1261.

Mental Health Screening Information

A child’s positive mental health and well-being contribute to their ability to achieve their educational and social-emotional potential. Recognizing the importance of student mental health, Monterey Peninsula Unified School District (MPUSD) may administer mental health screening tools to support the early identification of students who may benefit from additional support.

Mental health screening is a process used to identify students who may be experiencing or be at risk for mental health or behavioral concerns. The purpose of screening is to gather information that may help school staff better understand a student’s needs and provide appropriate interventions, supports, or referrals that promote well-being and resiliency.

Screening tools are not diagnostic and are not intended to provide a mental health diagnosis. Participation in mental health screening is voluntary, and information obtained through the screening process will be handled confidentially in accordance with applicable laws and District policies.

If screening results indicate a potential concern, appropriate school personnel may communicate with the student and/or parent/guardian to discuss the concern and determine appropriate next steps. Follow-up may include additional school-based supports, monitoring, assessment, or connection to community-based resources, as appropriate.

MPUSD may utilize the following screening tools and processes:

• Patient Health Questionnaire-9 (PHQ-9A): The PHQ-9A may be used as a self-report screening tool to identify symptoms associated with depression and to help determine whether a student may benefit from additional support.

Opt-Out Information

Parents/guardians are not required to have their student participate in District mental health screening.

Parents/guardians who DO NOT want their student to participate in MPUSD mental health screening must complete this form and return it to their child’s school office by August 30, 2026.

An opt-out request will apply for the 2026 - 2027 school year, or until the District issues a subsequent opt-out form, whichever occurs later.

Please return this form ONLY if you DO NOT want your child to participate in District mental health screening.

If this form is not completed and returned, your student may participate in the District’s mental health screening activities.

Opt-Out Selection

Please complete the form to OPT OUT.

Parent/Guardian Acknowledgment

Stop! Do not sign below unless you have read and understand the selection made above.

By signing below, I confirm that I have reviewed the information above and understand the mental health screening opt-out option I have selected.