The Salvation Army in Central Ohio Hanbury House Program Plan


Appendix A: Prochaska & DiClemente’s Stages of Change Model



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Appendix A: Prochaska & DiClemente’s Stages of Change Model


Stage of Change

Characteristics

Techniques

Pre-contemplation

Not currently considering change: "Ignorance is bliss"

Validate lack of readiness

Clarify: decision is theirs

Encourage re-evaluation of current behavior

Encourage self-exploration, not action

Explain and personalize the risk


Contemplation

Ambivalent about change: "Sitting on the fence"

Not considering change within the next month



Validate lack of readiness

Clarify: decision is theirs

Encourage evaluation of pros and cons of behavior change

Identify and promote new, positive outcome expectations



Preparation

Some experience with change and are trying to change: "Testing the waters"

Planning to act within 1month



Identify and assist in problem solving re: obstacles

Help patient identify social support

Verify that patient has underlying skills for behavior change

Encourage small initial steps



Action

Practicing new behavior for

3-6 months



Focus on restructuring cues and social support

Bolster self-efficacy for dealing with obstacles

Combat feelings of loss and reiterate long-term benefits


Maintenance

Continued commitment to sustaining new behavior

Post-6 months to 5 years



Plan for follow-up support

Reinforce internal rewards

Discuss coping with relapse


Relapse

Resumption of old behaviors: "Fall from grace"

Evaluate trigger for relapse

Reassess motivation and barriers

Plan stronger coping strategies




Appendix B: SOQIC

SOQIC Standardized Microsoft Word Forms



Important Note: The SOQIC forms will be removed from the ODMH web site on December 31, 2010. For further information about the SOQIC initiative please read this numbered advisory.

The SOQIC forms were revised in 2008 by a committee consisting of agency personnel, ADAMH Board staff and other stakeholders. The criteria used to decide what revisions to make to the forms was based on ensuring continued compliance with certification/licensure and accreditation standards, increasing the efficiency of the forms and supporting the clinical quality of the form set. When viewing this information, please note that these standardized forms are only tools for documentation processes. While designed to effectively aid clinical staff in data collection and client assessment and treatment processes, use of these forms alone cannot ensure compliance or effective care.



Instructions about how to complete each of the SOQIC forms can be found in Section 4 of the Forms User Manual.

The forms cannot be changed until you unprotect the document. To unprotect the forms complete the following steps:



  • Click on Tools

  • Click on Unprotect Document

  • Enter password: soqic (lower case) and click OK

To protect the forms with a password complete the following steps:

  • Click on Tools

  • Click on Protect Document (forms)

  • Enter password and click OK

  • Reenter the password

  • Click on File and Save

Note: Forms were updated 11/2008.

Form Title

Form No.

Demographic Information

SQ-08-010

Health History Questionnaire

SQ-08-020

Crisis Intervention and Assessment Plan

SQ-08-030

Adult Diagnostic Assessment

SQ-08-040

Adult Diagnostic Assessment Update

SQ-08-045

Child/Adolescent Diagnostic Assessment

SQ-08-050

Child/Adolescent Diagnostic Assessment Update

SQ-08-055

Mental Status Exam (MSE)

SQ-08-060

Lethality Assessment

SQ-08-070

Initial Psychiatric Evaluation

SQ-08-080

Individualized Service Plan

SQ-08-090

Individualized Service Plan Review

SQ-08-095

Psychiatric/Pharmacological Management Plan

SQ-08-100

Pharmacologic Management/Psychiatric Progress Note

SQ-08-110

Pharmacologic Management/Nursing Progress Note Long

SQ-08-120

Pharmacologic Management/Nursing Progress Note Short

SQ-08-125

Individual Progress Note

SQ-08-130

Community Psychiatric Supportive Treatment Progress Note Long

SQ-08-140

Community Psychiatric Supportive Treatment Progress Note Short

SQ-08-145

Group Progress Note

SQ-08-150

Partial Hospital Progress Note

SQ-08-160

Transfer/Discharge Summary

SQ-08-170

ODADAS Level of Care Worksheets




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