TRP Referral Form

Pre-Screen

Please check the box by each of the Skill-Based Interventions that you would like help with. Please check all that apply. This list is not exhaustive, but it gives us a good idea of what is needed. Thank you!

Recognizing signs/symptoms related to my diagnosis

Coping with they symptoms related to my diagnosis

Improving daily skills such as hygiene, meal preparation, nutrition, routines for bedtime/morning, etc.

Understanding how to handle a crisis situation and implementing/practicing skills for when/if a crisis occurs

Understanding finances to include budgeting and shopping

Emotional Regulation Skills - understanding and coping with emotions such as anger, anxiety, sadness, etc.

Implementing calming techniques - e.g. meditation, guided imagery, deep breathing, etc.

Developing and practicing interpersonal and social skills

Learning triggers and understanding how to cope with each of them

Understanding how exercise and nutrition can improve mental health symptoms and lead to being healthier mentally and physically

Understanding, accessing, and using community resources effectively to get needs met

Job-seeking skills

Improving communication skills to be better able to get needs met, advocate for yourself, be assertive vs aggressive and self-report household cleanliness

Understanding signs/symptoms of relapse from a mental health and/or substance use disorder

Modeling effective use of conflict resolution skills