The Quality Of Care Provided By The Abc Community Health Center

Section 5: Creating a Step-by-Step Action Plan – 27 Points
Action Step
Strengths/
Resources
Barriers/
Challenges
How will you overcome barriers?
Instructions for completing the table:
Action Steps (2 points each x 3 = 6 points)
Goals are achieved by breaking them down into smaller, more manageable steps that bring you closer to your goal. Write 3 Action Steps that relate to your goal.
Strengths/Resources (2 points each x 3 = 6 points)
For each Action Step, describe strengths or resources you possess that can help you complete that Action Step. Strengths and resources can be internal things, like knowledge or skills that you have already, or can be concrete things like access to what you need to complete the step.
Barriers/Challenges (2 points each x 3 = 6 points)
For each Action Step, describe barriers or challenges you might come across in trying to complete this step. Barriers and challenges can be internal things, like lack of motivation or competing demands on time, or can be external things.
How Will You Overcome Barriers? (2 points each x 3 = 6 points)
For each Action Step, describe how you might overcome the barriers you identified. Don’t forget you can use your resources to help.
Date (1 point each x 3 = 3 points)
Finally, as with your overall goal, put a realistic date on each Action Step. That way you can concretely document progress toward your goal!
Section 6: Support – Who Can Support You and How? – 7 Points
Identify at least 2 people who support you as you go through your behavior change process. These should be people who can help keep you on track to succeed.
List the person (you don’t have to provide names, but list their relationship to you – for example, sister, dad, coach, friend, etc.) and describe what you will ask the person to do to support you – be specific in your requests.
(a) Person 1: ___________________________. I will ask this person to support me by: ___________________________________ (3 points)
(b) Person 2: ___________________________. I will ask this person to support me by: ___________________________________ (3 points)
(c) What other groups or individuals could you reach out to for support that you are not already connected with? Name at least 1. (1 point)
Section 7: Rewarding Yourself for Positive Changes – 4 Points
(a) How will you reward yourself for making progress toward positive change? (Be specific and make sure rewards mean something to you!) (2 points)
(b) When will you reward yourself? (2 points)
Section 8: Lapse/Relapse Prevention Plan – 6 Points
(a) What are the cues (triggers, situations, reminders, feelings, etc.) that could increase the chances that you will go back to an old negative behavior? (2 points)
(b) Describe how you plan to change these cues – this may include a description of how you will avoid the cue (if possible), separate the behavior from the cue, or change your environment. (2 points)
(c) What healthy or neutral behaviors could you substitute for the negative behavior that you want to change? (1 point)
(d) If you do slip and go back to old behavior, what are some specific things you can do to get back on track? (1 point)
Section 9: Campus and Community Advocacy – 5 Points
(a) What changes would you like to see on campus or in your neighborhood/community that would help you and others work toward this type of health goal? (3 points)
(b) What steps could you take to get involved in efforts to make these changes on campus or in your neighborhood/community? (2 points)