Self-Help Plan This template was developed to accompany

Completed as Needed Youth to Complete Staff to Complete Self-Help Plan This form is designed to be completed in collaboration with the youth, for the youth, and can be updated as often as the youth desires and needs. [...] Ultimately the plan should support youth by helping trusted people in their life to understand what they can do to support youth in their actions. [...] TRIGGERS - Things That Set Me Off ☐ Not being listened to ☐ Darkness ☐ Feeling isolated from ☐ Feeling bothered by noise ☐ Contact with Family community/family/friends/support ☐ Feeling lonely ☐ Particular time of day: network: ____________________ ☐ Being stared at _________ ☐ Feeling ignored ☐ Particular person: ☐ Being teased ☐ Violent TV shows/movies/news ____________ ☐ Feeling angry at people. [...] family, friends, peer support) ☐ Playing cards/board game ☐ Nutritional comfort food ☐ Taking a time out ☐ Praying/spiritual activity ☐ Ripping paper ☐ Male staff support ☐ Bouncing a ball ☐ Female staff support Substance Use ☐ Punching a pillow ☐ Being around others/staff ☐ Smoking a cigarette ☐ Snapping bubble wrap ☐ Speaking with my therapist ☐ Using marijuana ☐ Screaming into a pillow ☐ Using. [...] ☐ Ask if there is anything they can do to help ☐ Ask if they should contact anyone for me ☐ Call emergency services or crisis line ☐ Other: _________________________ OTHER INTERVENTION – Things Others Should Avoid Doing ☐ Be disrespectful ☐ Ignore me ☐ Tell me to relax ☐ Remind me of the rules ☐ Not listen to me ☐ Tell me it’s going to be OK ☐ Use loud tone of voice ☐ Make jokes ☐ Minimize the pro.