Recovery Coaching Support Tool
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- Cuthbert Harrison
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1 Recovery Coaching Support Tool Date / / We appreciate that recovery coaching is a collaborative process between two people who are committed to recovery. We hope that both participants will be willing to take the time required to collect this information at the beginning of, during, and at the end of the Recovery Coaching process. We believe that considering the elements below will help with the process of developing a recovery plan and working at living in recovery. If this is the first time you are answering these questions, please answer for the month before beginning of the recovery coach/recoveree relationship. Collecting this information will help us all consider the progress people make through the process of recovery coaching. We are committed to protecting identities & anonymity. Initials / / Gender: male [ ] female [ ] Year of Birth 1. Who referred recoveree to Recovery Coaching? (Circle all that apply) A = Friend or Person in Recovery (sponsor) B = Substance abuse agency/clinic/provider C = Mental health agency/clinic/provider D = Detoxification program E = Emergency Room F = Hospital G = Doctor - Primary Care Provider H = Department of Corrections I = Court J = PATH K = Department of Labor L = Housing services M = Educational Institution N = Boss or Employee Assistance O = Self P = Family Member Q = Recovery Home R = Community center S = Church T = Faith ministry 4. Duration of Recovery Coaching meetings: starting out 1 month 2 months 3 months 2. Has recoveree participated in the following? Before Recovery Coaching? After starting Recovery Coaching? Yes No Yes No Ongoing (still attending) A = Peer Recovery Support (12 step or other) B = Substance abuse treatment / counseling C = Mental Health treatment / counseling D = Detoxification program E = Emergency Room F = Hospital G = Doctor - Primary Care Provider H = Department of Corrections I = Court J = PATH K = Dept. of Children and Families L = Department of Labor M = Housing service providers N = Education O = Faith Based Ministry / Faith Based Provider 3. How many minutes a week do you spend working with your recoveree? 4 months 5 months 6 months 9 months 12 months over 12 months Page 1 of 6
2 5. Regularity of use during the last month? Not at all 1-3 times per month 1 time per week 2-5 times per week Daily In the table below please circle the number that indicates how motivated you are not to use each substance in the corresponding row. 6. Motivation to avoid use: (scale of 1 to 10) 1 = not at all motivated 10 = very motivated A. Alcohol B. Marijuana C. Prescription Drugs D. Other Drugs How long clean from alcohol and drugs right now? days (1 month = 30 days) 8. Legal involvement A. How many times had contact with the police during the past 90 days? B. How many times arrested during the past 90 days? C. How many times convicted of a crime during the past 90 days? 9. Correctional involvement A. During life time - how many days spent on probation? B. During the last 90 days - how many days spent on probation? C. During life time - how many days spent in jail/prison? D. During the last 90 days - how many days spent in jail/prison?!0. Crisis Services A. How many times in crisis during the last 90 days? B. Which domain(s) on SSM Chart were the cause(s) of the crisis? 11. Medication Compliance During the past 90 days have you been able to follow medical advice when taking the following types of prescribed medications? Physical Health medications (yes or no) - Addiction medications (yes or no) - Mental Health medications (yes or no) - Pain medications (yes or no) Page 2 of 6
3 Domains Access to Services Health Insurance Housing Basic Needs Food, Heat, Mail Clothing, Phone Transportation Self- Sufficient Score: 1 Is receiving a full range of services to meet needs Has full coverage to meet needs Housing is sufficient and meets needs Basic needs are being met Has reliable transportation; meets needs Physical Health No problems or health needs are being met Social Family (Primary partner relationships) Spirituality/ Optimism Recovery supports Social network is more than sufficient (more than 3-5 friends who care) Family & relationships are stable; no help is needed Maintenance of Spirituality and Optimism Pursuing recovery in multiple ways helping others Stable/Safe Score: 2 Recovery Coaching Participant Self-Sufficiency Matrix At Risk Score: 3 Receiving services; may limit choices Has limited coverage, meets needs Housing adequate; meets most needs Resources are adequate; meets most needs. Has adequate transportation; meets most needs Treatment of health problems is adequate; meets most needs Social network is sufficient (has at least 3 friends who care) Family & relationships are somewhat stable; adequate resources/help Action - Actively pursuing spirituality & developing optimism Actively pursuing recovery in multiple ways Knows what is needed; options are limited Has coverage; financial barriers; doesn t meet needs Insufficient/ at risk; help Lacks resources to meet basic needs; help Lacks reliable transportation; help is Health problems treated inadequately Social network is insufficient ( less than 2-3 friends who care) Family & relationships are unstable; inadequate resources/help Preparation Considering belief in Spirituality & better future Meeting peer supporters and professionals Unstable Score: 4 Assistance required to access services on their own. At risk of losing coverage; limited resources/requires help in accessing services. At risk of losing housing; limited access to help Basic needs not met; has limited access to help Lacks transportation; and has limited options Has health problems; treatment inadequate; limited access to help; Social network is very limited (has 1 friend who cares); and has no one to add Family & relationships are very unstable; have limited resources Contemplation Questioning Spirituality - Considering others who have optimism for future Disconnected but aware of possible benefits from recovery support In Crisis/Not Self- Sufficient Score: 5 Doesn t know needs; ; Needs help No coverage; ; No housing; barriers to access; Basic needs not met; ; Lacks transportation; ; Has health problems, Has no social network; barriers to increase; Family is in crisis; Pre-contemplation In Crisis No belief in Spirituality No optimism for future In Crisis - No belief that things can get better flight risk Page 3 of 6
4 Domains Continued Alcohol & Drug Treatment Mental Health Legal issues & Involvement with Dept. of Corrections Education Employment Parenting Skills Safety Self- Sufficient Score: 1 Responsible use or active intervention and/or no help needed No problems and/ or No legal problems; Sufficient education; Working full time or part time; no help needed Possesses positive approach/skills to parenting; access to ample resources; no help needed emotionally supportive/nurturing and free of violence; Stable/Safe Score: 2 Alcohol/Drug problems are adequately treated Mental health problems are adequately treated Few legal problems and receiving help Insufficient education; is in school/training Working full or part time but may need help Possesses adequate approach/skills to parenting; meets most needs Relationship (s) are supportive; meets most needs At Risk Score: 3 Alcohol/Drug problems inadequately treated; help Mental health problems are inadequately treated; help Legal problems; help Insufficient education; help is Unstable job; help is Parenting approach/skills and resources inadequate; help chaotic; help Unstable Score: 4 Alcohol/ Drug problems are not treated; limited resources Mental health problems are not treated; limited resources Legal problems; limited help/resources Insufficient education; limited resources Unstable job; limited resources Parenting approach/skills potentially put children at risk; limited resources verbally abusive, controlling, coercive; limited resources In Crisis/Not Self- Sufficient Score: 5 Severe problems; ; Mental health problems not treated, ; Legal problems not being addressed, Insufficient education; barriers to access help; needs help Unemployed; Parenting insufficient and children at risk; verbally and physically abusive; Please discuss the participant s levels of self-sufficiency as reflected by elements in chart and enter their perceived scores below. Coaches help by sharing their experiences in developing an understanding of denial and their personal difficulty in seeing how their lives were affected by addictions. Support participant in beginning to develop & pick priorities, What do you want to work on 1 st? 2 nd? 3 rd? etc. Page 4 of 6
5 Planning Participant s Recovery Priorities Domains # Priority Action Steps Score # (1 = sufficient, 2 = stable, 3 = at risk, 4 = unstable, 5 = In crisis) - Priority ratings for evolving recovery priorities Access to Services Health Insurance Housing Basic Needs Food, Heat, Clothing, Transportation Physical Health Primary Healthcare provider? Diet? Exercise? Social Family & (Primary partner relationships) Spirituality/ Optimism Recovery supports # Phone numbers recoveree has, number of support meeting attended a week, new meetings explored Alcohol & Drug Treatment Mental Health Legal issues & Involvement w/ DOC Education Note training on financial management and progress in that area. Employment Parenting Skills Safety Page 5 of 6
6 NOTES: Page 6 of 6
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