Recovery Plan
Page 1 of 4
Form Num 79
Template Last Modified 18/11/2013
Version 01.1
District Mental Health Services
Collaborative Recovery Plan
WaitemataDHB
Date of review
Care Co-ordinator:
Aims: To summarise my main needs and goals
To outline means and time frame to achieve these
My vision for wellness for myself is:
My goals - what I want to do
Contact People
These are the key contact people to notify of any change in circumstances and/or plan (e.g. crisis)
Name
Contact details/Phone number/s
Care Co-ordinator
Crisis team contact
GP
Family/whanau/friends
People I live with
Key community staff
Other services involved
Cultural/spiritual support
people
Explanation if Care Co-ordinator, consumer or family is not involved in the plan:
under the Offical Information Act 1982
Plan
Diagnosis:
Has the diagnosis been clearly explained or have diagnostic possibilities been explained?:
Are more tests or information needed to clarify the diagnosis?
Released
Have my family/whanau and I had written information about the diagnosis?
Are my family and I aware of relevant support groups?
What follow up do I need?
By whom
By when
Done:
Safety:
Is there a current risk assessment/plan?
Are there any safety issues now? if so what are they?
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/CollaborativeRecovery_Plan1.htm
04/12/2023
Recovery Plan
Page 2 of 4
How can we work to minimise risk (consider need for Inpatient treatment/MHA)
Who needs to be informed
By whom
By when
Done
Medication:
Do I understand why I am taking my medication?
Do I have written information about my medication?
Are there any problematic side effects? if so what are we doing about them?
Am I on too many medications?
Do I have any issues about taking my medication and if so what can we do about that?
By whom
By when
Done
Physical health issues:
Do I have a medical condition that needs to be considered, and what is the plan to manage it?
Is liaison with my GP needed?
By whom
By when
Done
Psychological issues:
Need for personal therapy?
Need for family therapy?
By whom
By when
Done:
Drug or alcohol use and gambling:
Is this a problem, and if so what help is needed?
By whom
By when
Done
under the Offical Information Act 1982
Children:
Do I need help with my children if I have any?
Are Child and Family (CYFS) involved and is liaison needed if they are?
By whom
By when
Done
Released
Social/Occupational issues:
Is my benefit or work income sorted out?
Do I have any debts? Is my accommodation OK?
Do I need help with self care? Do I need help with my leisure activities
Do I need help with getting back to work or school or organising my days
By whom
By when
Done:
C lt
l/S i it
l i
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/CollaborativeRecovery_Plan1.htm
04/12/2023
Recovery Plan
Page 3 of 4
Is there a need for cultural support or referral
Is there a need for spiritual support
Is an interpreter needed?
By whom
By when
Done:
Legal/Mental Health Act:
Are there any legal issues I need help with?
Do I know my rights under the Mental Health Act
Is the Mental Health Act needed or being used, and if so what is the plan to manage this?
By whom
By when
Done:
Relapse prevention (this is what has been found to help me most if I am developing a relapse of
symptoms)
Potential stressors
Early warning signs
Intervention Strategies
Client will
Caregivers/support person will
Key worker's/Dr's will
Crisis Plan
What I want from my supporters when I am in Crisis (why)
under the Offical Information Act 1982
What I do not want from my supporters when I am experiencing these symptoms (why)
Preferred medication (why)
Acceptable medication (why)
Released
Contra-indicated medication (why)
Preferred treatment/s
Least preferred treatments (why)
Preferred treatment facilities (why)
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/CollaborativeRecovery_Plan1.htm
04/12/2023
Recovery Plan
Page 4 of 4
Least preferred treatment facilities (why)
Things I need others to do for me and who I would prefer to do it (include pets, children, homecare)
Things I can do for myself
I have developed this document with the help and support of:
Completed with consumer
Completed with family/support people
Consumer signature
Date
Co-ordinator signature
Date
Agreement
Agreement: I, with my family/whanau feel that I/we understand and have been given, sufficient information
regarding the diagnosis and treatment options other choices and expected outcomes. I/we agree to the
proposed plan, and will take responsibility for doing the things I/we have agreed to
Signed
Date:
Copy to:
Consumer
Family/whanau
Other support
under the Offical Information Act 1982
Released
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/CollaborativeRecovery_Plan1.htm
04/12/2023
Clinical Review Form (MDT) Inpatient 621
Page 1 of 3
Form Num 621
Template Last Modified 11/05/2018
Version 1.0
WDHB Mental Health Services
Clinical Review Form (MDT) Inpatient 621
Waitemata DHB
KEY
Date Fields
Pre-populated locked fields
Free text fields
Drop down boxes
Date Admission
Length of stay
Community Care
Coordinator
Community Team(s)
Responsible Clinician
Primary Nurse
MHA Status
Date of review
Present at Review
under the Offical Information Act 1982
Overview
Backgroud Reason for
Circumstrances in lead up and during admission.
Admission
Note if Out of Area (OOA)
Mental State Examination Describe MSE changes over the last week
Released
Purpose and Goals of
As set by Community team/referrer.
admission
Treatment aims & expected length of stay (LOS).
What needs to be achieved for discharge e.g. support, accommodation
Diagnoses
Diagnoses Other
Family Involvement
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Clinical%20Review%20Form%20(...
04/12/2023
Clinical Review Form (MDT) Inpatient 621
Page 2 of 3
Next of Kin
Primary Caregiver
Current Risk and Safety
Brief summary in bullet point list.
Issues This section must Refer to Client History Regional Form for Risk Hisotry,
be completed and
Risk Formulation and Safety Strategies
updated. State if none
Community Supports
Activity, Interests, Social Contacts
Sensory Preferences
Record detail here
AOD Issues
Summary of use and CADS involvement
Family Violence/Child
Only complete if specific issues / involvement
Protection
Cultural & Spiritual
Document if present or if assessment needed
Connections
Medication Plan
Plan for meds - things stopping and starting, any monitoring needed
Assessments Completed
Short summary of any OT/Psychology/SW assessments
Groups/Recommendations Groups attending, groups ought to attend, output from group discussions
Barrier to Discharge
Please Choose Barrier
Collaborative Recovery
Update Date
Plan
Smoking Status
Top of form
Plan
under the Offical Information Act 1982
Care Status:
Please Choose Acuity
Estimated Discharge Date:
AWOL Status:
Please choose AWOL Status
Leave Transition Status:
Short summary of ET/UET/EL/UEL/ONL - time allows and any conditions
Released
Sensory preferences
Recorded ? Summary
Location
Date
recorded
yes
Top 5 preferences
Where is the detail?
no
NOTE: all * fields must contain info before saving, when completed Click Add Plan
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Clinical%20Review%20Form%20(...
04/12/2023
Clinical Review Form (MDT) Inpatient 621
Page 3 of 3
* Date
* Problem / Issue
* Due Date
Achieved Date
Add Plan
Date
Problem / Issue
Due Date
Achieve Date
Manage
Click Here To send any forms issues to HCC
under the Offical Information Act 1982
Released
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Clinical%20Review%20Form%20(...
04/12/2023
Popao - (Journey To Wellness - Folau ki he Mo'ui Lelei ) Care Plan
Page 1 of 4
Form Num 397
Template Last Modified 24/01/2012
Version 1.0
Mental Health Services
Popao - (Journey To Wellness - Folau ki he Mo'ui Lelei ) Care Plan
WaitemataDHB
Legal Status
Date
Assessor
LANGIMALIE
(fine day with sunshine and blue sky)
Wellness Snapshot
Describes how you would be if you were to be likened to the following metaphors, (usually good versus bad.)
Wellness:
‘AHO (day) / LA’A (sun)
Good day / fineday
Calm day
Warm day
Unwellness
PO’ULI (night) /MAHINA (moon) /FETU’U (stars) /‘UHA (rain) / HAVILI (wind)/
Dark night
Moonlight & stars
Windy & cold &
rainy night
POPAO Structure
under the Offical Information Act 1982
Support Networks
KATEA Main body of canoe - Cultural context that the person lives within
Culture Traditions
Released
Family structures
(genogram)
Beliefs Values
HAMA (Outrigger) - Health - names and contacts of the clinicians (GPs) and other health professionals.
Physical Health
Traditional healers
Psychological &
Mental Health -
Counsellors Family
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Popao%20-%20Journey%20to...
08/12/2023
Popao - (Journey To Wellness - Folau ki he Mo'ui Lelei ) Care Plan
Page 2 of 4
Therapists
Spiritual Healers
Religion
FOHE/TOKO (Paddle/ oar/ pole) - Knowledge/insights/common sense/motivators:
Knowledge Insights/
Common Sense -
Special profession
– Pride – resilience
– energy level –
strength
Motivators - strong
reason in life
Experience -Your
life experiences
what you strive for.
KIATO Connectors between outrigger and main body of canoe. Other services/outside supports
Support Services, Community groups, Family group, etc
KAHOKI Connector levellers
Trusting friends
advisors
KAFA
Rope/ ties - communication between all
Communication -
Understanding -
Beliefs Values -
Relationship -
Connection -
under the Offical Information Act 1982
Rapport
POPAO JOURNEY
The popao is launched out into the lagoon and will encounter the marine life. You need to row the popao with
great care.
Released
TUKIA’ANGA (obstacles). Marine life can be obstacles if you do not know how to work around them.
We have chosen four of the Tukia’anga. Think about those events/ situations which may prevent you from
staying well.
PEAU (waves ) Waves are of various sizes and strengths and can arrive without warning. These are sudden,
unexpected events or situations
Restless -surf
Waves Breaking
Rough Dangerous
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Popao%20-%20Journey%20to...
08/12/2023
Popao - (Journey To Wellness - Folau ki he Mo'ui Lelei ) Care Plan
Page 3 of 4
PUNGA (coral) Coral is rigid and always present. These are predictable events and situations.
Rocks - Sand
dunes -Damaging
LIMU (seaweed) Seaweed slows down progress. These will slow down any progress to wellness e.g. Lack of
Motivation and confidence
GroupTogether
Entangle
Frightening
Scattered
PA (fish trap fence) Fish trap fences will stop the popao. An action is required to begin to progress again.
Trap
Fenced
Stop
FAKA’UTO’UTA
(to navigate)
As captain you need to navigate and plan a safe Journey so that you can reach your destination.
Plan to prevent or remedy obstacles to progress to wellness
Obstacle/ Trigger
Action when encountered
By whom/ when
FANGA
(Beach – represent your destination or where you want to be)
Goals - Destination - Taumu’a /Hanganaki kiai e folau:
under the Offical Information Act 1982
Health
Activities – job,
social, education,
Relationships –
family, friends Released
Living
circumstances
Legal issues
Finances
HALANGAVAKA
(Safe Pathway)
Goal Plan
Short Term
Date
Goals
Action
By Whom
By When
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Popao%20-%20Journey%20to...
08/12/2023
Popao - (Journey To Wellness - Folau ki he Mo'ui Lelei ) Care Plan
Page 4 of 4
Review / Done
Long Term
Date
Goals
Action
By Whom
By When
Review / Done
Signed
Date
under the Offical Information Act 1982
Released
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Popao%20-%20Journey%20to...
08/12/2023
Treatment Review Regional 564
Page 1 of 2
Form Num 564
Template Last Modified FEB 22
Version 1.2
WDHB Mental Health Services
Treatment Review Regional 564
Waitemata DHB
Date:
Assessor
Case Manager/ Care Co-ordinator
Responsible Clinician
Ngo / Other agency involvement
Staff present
Date of admission to Service
Current legal status (MHA CJA)
For all Maori justify the rationale for the MHA; barriers to coming off; and specify actions to address these
barriers.
Next event due
under the Offical Information Act 1982
Brief Summary: include a&d, medication, details of POC/Res Rehab/Respite/therapy
Diagnosis, including Axis 1-5 (include GAF
Released
Previous Management Plan:
Summary of progress since last review
Measures (CLICK HERE for HoNOS scores):
( Vascular Screening, tools etc):
Current Issues
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/treatment_review_regional_56... 01/12/2023
Treatment Review Regional 564
Page 2 of 2
Service User’s current recovery goals:
Current Risk Formulation:
MDT Discussion (include family/whanau involvement & barriers):
Management plan, Treatment goals and interventions until the next review:
Next Treatment Review date
Click Here To send any forms issues to HCC
under the Offical Information Act 1982
Released
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/treatment_review_regional_56... 01/12/2023
Treatment Review Regional 564
Page 1 of 2
Form Num 564
Template Last Modified FEB 22
Version 1.2
WDHB Mental Health Services
Treatment Review Regional 564
Waitemata DHB
Date:
Assessor
Case Manager/ Care Co-ordinator
Responsible Clinician
Ngo / Other agency involvement
Staff present
Date of admission to Service
Current legal status (MHA CJA)
For all Maori justify the rationale for the MHA; barriers to coming off; and specify actions to address these
barriers.
Next event due
under the Offical Information Act 1982
Brief Summary: include a&d, medication, details of POC/Res Rehab/Respite/therapy
Diagnosis, including Axis 1-5 (include GAF
Released
Previous Management Plan:
Summary of progress since last review
Measures (CLICK HERE for HoNOS scores):
( Vascular Screening, tools etc):
Current Issues
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/treatment_review_regional_56... 01/12/2023
Treatment Review Regional 564
Page 2 of 2
Service User’s current recovery goals:
Current Risk Formulation:
MDT Discussion (include family/whanau involvement & barriers):
Management plan, Treatment goals and interventions until the next review:
Next Treatment Review date
Click Here To send any forms issues to HCC
under the Offical Information Act 1982
Released
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/treatment_review_regional_56... 01/12/2023
Integrated Health Care & Recovery Plan (HCRP) 605
Page 1 of 8
Form Num 605
Template Last Modified May 22 2016
Version 02
WDHB Mental Health Services
Integrated Health Care & Recovery Plan (HCRP) 605
Div id=intro
Form Guidelines
Sources of Information: Selected goal from Comprehensive Clinical Summary
Completion
By: Multi-Disciplinary
1st Completed:
Within 6 weeks of
Team
Received
admission, 6 Monthly
Using the information:
Individual disciplines tasks and specific plans aligned with HCRP Goals
Date
Assessor
Accommodation
Legal Status
Health care plan Overview:
(Describe consumer's current mental state and functioning and how it relates to His/Her Pillar and risk
formulation. State which overall goals need to be addressed in the upcoming treatment cycle/period, and give
a rationale for the plan)
Further studies or testing to be completed:
Type
Staff Responsible
Date initiated
How do I rate the Dundrum pillars
under the Offical Information Act 1982
1. Click the blue CODE Pillar link
2. The Rating descriptions display
3. Click the description that best rates your client
4. The score for the rating is displayed in the text box below the pillar heading
01 Click Here to show all rated plans and Show plan
02 Click Here to show all rated plans and Hide plan
Released
buttons
buttons
03 Click Here to hide all Plans and buttons
04 Click Here to show all buttons
Pillar 1– Physical Health
Code Pillar 1
Show Plan P1
Hide Plan P1
(Treatment / Rehabilitative) Goal (as per Comprehensive Clinical Summary)
Comment on why this Pillar (treatment/rehabilitative) goal is to be addressed in the upcoming review period.
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/IntegratedPlanHCRP605.h... 07/12/2023
Integrated Health Care & Recovery Plan (HCRP) 605
Page 2 of 8
Staff Responsible
Type of Intervention
Plan 01
Staff Responsible
Type of Intervention
Plan 02
Staff Responsible
Type of Intervention
Plan 03
Staff Responsible
Type of Intervention
Plan 04
Pillar 1 (Treatment/Rehabilitative) goal Review
Outcomes:
Achieved:
Ongoing::
Other: (Describe)
under the Offical Information Act 1982
Pillar 2 – Mental Health
Code Pillar 2
Show Plan P2
Hide Plan P2
Released
(Treatment / Rehabilitative) Goal (as per Comprehensive Clinical Summary)
Comment on why this Pillar (treatment/rehabilitative) goal is to be addressed in the upcoming review period.
Staff Responsible
Type of Intervention
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/IntegratedPlanHCRP605.h... 07/12/2023
Integrated Health Care & Recovery Plan (HCRP) 605
Page 3 of 8
Plan 01
Staff Responsible
Type of Intervention
Plan 02
Staff Responsible
Type of Intervention
Plan 03
Staff Responsible
Type of Intervention
Plan 04
Pillar 2 (Treatment/Rehabilitative) goal Review
Outcomes:
Achieved:
Ongoing::
Other: (Describe)
Pillar 3 – Drugs and Alcohol
Code Pillar 3
Show Plan P3
Hide Plan P3
under the Offical Information Act 1982
(Treatment / Rehabilitative) Goal (as per Comprehensive Clinical Summary)
Comment on why this Pillar (treatment/rehabilitative) goal is to be addressed in the upcoming review period.
Released
Staff Responsible
Type of Intervention
Plan 01
Staff Responsible
Type of Intervention
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/IntegratedPlanHCRP605.h... 07/12/2023
Integrated Health Care & Recovery Plan (HCRP) 605
Page 4 of 8
Plan 02
Staff Responsible
Type of Intervention
Plan 03
Staff Responsible
Type of Intervention
Plan 04
Pillar 3 (Treatment/Rehabilitative)Goal(as per Comprehensive Clinical Summary)
Outcomes:
Achieved:
Ongoing::
Other: (Describe)
Pillar 4 – Problem Behaviours
Code Pillar 4
Show Plan P4
Hide Plan P4
(Treatment / Rehabilitative) Goal (as per Comprehensive Clinical Summary)
Comment on why this Pillar (treatment/rehabilitative) goal is to be addressed in the upcoming review period.
Staff Responsible
under the Offical Information Act 1982
Type of Intervention
Plan 01
Released
Staff Responsible
Type of Intervention
Plan 02
Staff Responsible
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/IntegratedPlanHCRP605.h... 07/12/2023
Integrated Health Care & Recovery Plan (HCRP) 605
Page 5 of 8
Type of Intervention
Plan 03
Staff Responsible
Type of Intervention
Plan 04
Pillar 4(Treatment/Rehabilitative) goal Review
Outcomes:
Achieved:
Ongoing::
Other: (Describe)
Pillar 5 - Self-Care and Activities of Daily Living
Code Pillar 5
Show Plan P5
Hide Plan P5
(Treatment / Rehabilitative) Goal (as per Comprehensive Clinical Summary)
Comment on why this Pillar (treatment/rehabilitative) goal is to be addressed in the upcoming review period.
Staff Responsible
Type of Intervention
Plan 01
under the Offical Information Act 1982
Staff Responsible
Type of Intervention
Plan 02
Released
Staff Responsible
Type of Intervention
Plan 03
Staff Responsible
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/IntegratedPlanHCRP605.h... 07/12/2023
Integrated Health Care & Recovery Plan (HCRP) 605
Page 6 of 8
Type of Intervention
Plan 04
Pillar 5 (Treatment/Rehabilitative) goal Review
Outcomes:
Achieved:
Ongoing::
Other: (Describe)
Pillar 6 - Pillar 6 – Education, Occupation, Creativity
Code Pillar 6
Show Plan P6
Hide Plan P6
Plan2
(Treatment / Rehabilitative) Goal (as per Comprehensive Clinical Summary)
Comment on why this Pillar (treatment/rehabilitative) goal is to be addressed in the upcoming review period.
Staff Responsible
Type of Intervention
Plan 01
Staff Responsible
Type of Intervention
Plan 02
under the Offical Information Act 1982
Staff Responsible
Type of Intervention
Released
Plan 03
Staff Responsible
Type of Intervention
Plan 04
Pillar 6 (Treatment/Rehabilitative) goal Review
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/IntegratedPlanHCRP605.h... 07/12/2023
Integrated Health Care & Recovery Plan (HCRP) 605
Page 7 of 8
Outcomes:
Achieved:
Ongoing::
Other: (Describe)
Pillar 7 - Family and Social Networks, Friendship and Intimacy
Code Pillar 7
Show Plan P7
Hide Plan P7
(Treatment / Rehabilitative) Goal (as per Comprehensive Clinical Summary)
Comment on why this Pillar (treatment/rehabilitative) goal is to be addressed in the upcoming review period.
Staff Responsible
Type of Intervention
Plan 01
Staff Responsible
Type of Intervention
Plan 02
Staff Responsible
Type of Intervention
Plan 03
under the Offical Information Act 1982
Staff Responsible
Type of Intervention
Released
Plan 04
Pillar 7 (Treatment/Rehabilitative) goal Review
Outcomes:
Achieved:
Ongoing::
Other: (Describe)
R1 - Stability
Code R1
R2 - Insight
Code R2
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/IntegratedPlanHCRP605.h... 07/12/2023
Integrated Health Care & Recovery Plan (HCRP) 605
Page 8 of 8
R3 - Therapeutic Rapport
Code R3
R4 - Leave
Code R4
R5 - Dynamic Risk Items
Code R5
R6 - Victim Sensitivity Items
Code R6
R7 - Hope
Code R7
under the Offical Information Act 1982
Released
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/IntegratedPlanHCRP605.h... 07/12/2023
Inpatient Care Plan
Page 1 of 2
Form Num 372
Template Last Modified 09/08/2011
Version 1.0
District Mental Health Services
Inpatient Care Plan
WaitemataDHB
Date Assessed
Assessor
The areas of concern should come from the Admission HoNOS. All areas assessed as 2 or higher should form
the basis of the care plan. However other measures and areas of concern identified requiring intervention
during admission, should also be included.
The plan must be discussed with the service user and their views recorded (see below). A copy of the plan
should be provided to the service user at all times.
Interventions should be specific and concise and updated on a regular basis as client needs change.
The care plan should be updated on discharge to highlight any outstanding interventions/concerns. Community
teams can then access plan for follow up.
Select the number of plans to use Select Plans
Plan 1
Area of concern
Service User Perspective
Intervention
By Whom / By When
under the Offical Information Act 1982
Plan 2
Area of concern
Service User Perspective
Intervention
By Whom / By When
Released
Plan 3
Area of concern
Service User Perspective
Intervention
By Whom / By When
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Inpatient%20Careplan.htm
12/12/2023
Inpatient Care Plan
Page 2 of 2
Copy Provided to Service User No
under the Offical Information Act 1982
Released
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Inpatient%20Careplan.htm
12/12/2023
Early Warning Signs and Relapse Prevention
Page 1 of 1
Form Num 187
Template Last Modified 18/11/2013
Version 01.1
District Mental Health Services
Early Warning Signs and Relapse Prevention
WaitemataDHB
Date assessed
Assessor
Completed with client
Completed with family/support people
Potential stressors
Early warning signs
Please liaise with the following people (include names and phone numbers)
Intervention strategies
Clients strategies
Caregivers/support persons roles/ strategies
Key workers/Dr's/role strategies under the Offical Information Act 1982
Interventions that don't help
Released
Clients signature
Key workers
signature
Form signed by client
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Early%20Warning%20Signs%20... 12/12/2023
Parent - Infant Wellbeing Plan
Page 1 of 1
Form Num 597
Template Last Modified 14/07/2016
Version 1.0
WDHB Mental Health Services
Parent - Infant Wellbeing Plan
Waitemata DHB
Date:
Assessor
Caregiver(s):
What makes things difficult? (Triggers)
What do I (or others) notice about my child and myself when we are struggling? (Signs)
What can I do to help myself and my child? (Strengths and strategies)
Who else can help and what can they do? (Supports)
Copy given to caregiver(s):
Click Here To send any forms issues to HCC
under the Offical Information Act 1982
Released
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Parent-Infant%20Wellbeing%2... 08/12/2023
Regional Template
Page 1 of 2
Form Num 569
Template Last Modified 15/09/2014
Version 1.0
WDHB Mental Health Services
Transition Plan
Waitemata DHB
Date:
People that helped me with this plan
The partnership goals I have been working on
Things I can do to help me keep well
Things I am good at and enjoy doing
People I can talk to to help me keep well
My plans for follow-up after I finish here
Who
What They Do
Key Contact Person
Phone Number
What I need from these people
under the Offical Information Act 1982
How will I know if things are getting difficult again
What will I do if things get difficult again
Released
If I need support I can contact
Right Away
Soon
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Transition%20Planning.htm
08/12/2023
Regional Template
Page 2 of 2
My Medications
Medication Name
Dose
When to take it
Who I will share this plan with
Copy Given to Client
under the Offical Information Act 1982
Released
http://ha-webdev01/mentalhealth/HCCNew2/file_FormDet/Transition%20Planning.htm
08/12/2023
Document Outline
