WRAP Training Pre and Post Survey

Filling out this survey is voluntary. You don’t have to fill it out if you don’t want to. Answer only those questions you want to answer. Skip over questions you do not feel comfortable answering. By choosing to complete this survey, you are helping to

  1. improve recovery programs and convince agencies and health care authorities to provide support for these programs.
I am beginning this program:
Yes Date
No
I finished this program:
Yes Date
No
Instructor(s) Name(s)


Your Age
Gender:
Female Male
Ethnic Background (ex. Spanish, Am. Indian, Indian, American)
1. Do you have hope that you can and will feel better and better? Yes No
2. Do you take personal responsibility for your own wellness? Yes No
3. Do you feel that it is important to educate yourself about the symptoms you experience? Yes No
4. Do you know how to advocate for yourself to get what it is you want, need and deserve for yourself? Yes No
5. Do you feel it is important to have several family members and friends to support you in difficult times? Yes No
6. Do you have several friends and family members to support you in difficult times? Yes No
7. If you don’t have as many supporters as you would like now, do you have some ideas about things you could do to develop some new friends or to strengthen your relationships with your current friends and family members? Yes No
8. Do you have any special things you do to insure that you get good health care for yourself? Yes No
9. If you take medications, do you feel that you manage them well? Yes No
10. Check the things you do to help yourself feel better and to keep yourself well:
support from friends peer counseling
focusing exercise
relaxation and stress reduction techniques exposure to outdoor light
food supplements supplements
daily plans counseling
alternative therapies (if so, please name them)



creative or diversionary activities (if so, please name them)



Please list other things you do to help yourself feel better and to keep yourself well.


11. Do you have a list of things you do every day to keep yourself well? Yes No
12. Do you know what your triggers are? Yes No
13. Do you have a plan or ideas of what you can do to keep yourself well or help relieve symptoms if you are triggered? Yes No
14. Do you know the early warning signs that your symptoms are worsening? Yes No
15. Do you have a plan or ideas of what you can do to keep yourself well or help relieve symptoms if you are experiencing early warning signs? Yes No
16. Do you know those symptoms that indicate you are feeling much worse? Yes No
17. Do you have a plan or ideas of what you can do to help relieve symptoms if you are feeling much worse? Yes No
18. Do you know what a crisis plan or advanced directive is? Yes No
19. If you know what it is, are you developing one for yourself, or are you thinking about developing one for yourself? Yes No
20. Do you like yourself? Yes No
21. Do you know how to change negative thoughts to positive ones? Yes No
22. Do you feel that your symptoms might be caused by bad things that have happened? Yes No
If so, do you know what to do to help yourself feel better? Yes No
23. Do you know things you can do and/or do to keep yourself from hurting yourself when you are feeling badly? Yes No
24. Do you think your lifestyle helps you to feel better and get well? Yes No
25. Do you think there are some things about your lifestyle that you could change to help yourself feel better? Yes No
26. Is it hard for you to do things that will help you recover? Yes No
What would make it easier for you to do things that will help you recover?

 

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