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Take Charge Programs Leader Resources

Includes workshop material for:

  • Take Charge of Your Health (CDSMP)
  • Take Charge of Your Diabetes (DSMP)
  • Take Charge of Your Pain
  • Cancer: Thriving and Surviving

Upon workshop completion, email attendance sheet to joan.fox@ageoptions.org

If you will NOT be entering class participant data, and participants are NOT using electronic forms, email the completed participant forms to joan.fox@ageotions.org

ILPTH Program Quick Reference- Program guidance for facilitating Take Charge. Details regarding max number of participants, cut off for new participants to join, workshop length and session time.

Course Materials for Leaders

Data Collection Checklist- For all Take Charge Programs. Instructions for data collection from registration to last session.

Attendance Sheet- The first page is designed for tracking attendance, while the second page is for recording participant forms

Participant Sign-In Sheet- Leaders can have participants use to sign-in. Not required. 

Session 1 Data Collection Script- To be read aloud to participants during Session 1

Session 1 Virtual Data Collection Script- To be read aloud to participants during Session 1

Photo Media Release- This form is optional; to be used if collecting testimonials or taking pictures. Feel free to edit to add your organization's information.

 

Forms for Participants

Participants can choose one of the following options when completing paperwork:

  • Complete a paper form or fillable PDF
  • Receive a link to complete an electronic form (through Microsoft Forms)
  • Register for a participant portal on the IL Pathways website and complete forms directly in the portal

Note: If you choose to you use Microsoft Forms, the surveys are submitted directly to AgeOptions. AgeOptions will complete the data entry. 

Session 1 Participant Registration Forms and Pre-Survey

Option 1:

Option 2:

  • Link to Electronic Participant Registration Packet and Pre-Survey- Email us at info@ilpathwaystohealth.org to request a survey link for your specific workshop

Option 3:

Session 1 Handouts for Participants 

(One form per participant)

Welcome Letter- The welcome letter provides an intro to the program and the forms that participants will receive. The letter can be mailed to participants with workshop forms for online workshops- CDSMP - DSMP - PAIN - CANCER

Workshop Overview and Homework by Session- CDSMP - DSMP - PAIN - CANCER 

Menu Planning 1- For Take Charge of Your Diabetes only

Menu Planning 2- For Take Charge of Your Diabetes only

Menu Planning DSMP Charts 9 & 10- For Take Charge of Your Diabetes only

Last Session Forms

Option 1:

Option 2:

  • Link to Electronic Participant Post Survey- Email us at info@ilpathwaystohealth.org to request a survey link for your specific workshop. 

Option 3:

  • Participant Guide for ILPTH Portal- Instructions that can be sent to participants for completing electronic forms on the ILPTH participant portal (These are the same instructions that are available above for completing Session 1 forms)

 

Links and Other Materials

Workshop 101

SMRC Leader Certification Guidelines

Pre-workshop Checklist and Participant Recruitment Plan

Email Templates- For leaders to send to participants for online workshops

Zoom Instructions- (Provided by Rush) For online workshops

Participant Certificate of Completion Template

Crisis Intervention Plan- Provides general guidance about what to do in crisis situations

Fidelity Visit Checklist

Host Site Survey- Email template to send to host sites at the conclusion of the workshop

Receipt Template for Books/CD's

Take Charge of Your Pain Digital MEP Audio- The Take Charge of Your Pain Digital MEP (Moving Easy Program) audio is available for free to play at the following link: https://www.bullpub.com/mep.html

Brief Body Scan- Contact us if you would like to purchase a CD. You may also Google or use YouTube to find a meditation.

Schedule a Fidelity Visit

 

Marketing Materials

IL Pathways to Health Logo

ILPTH Evidence Based Program Flyer

Take Charge Series Program Flyer

ILPTH Outreach Toolkit Template- This Toolkit includes templates for flyers, posters, social media posts, etc. You will need to have a Canva account to access the template and create a COPY to make edits (DO NOT EDIT THE TEMPLATE). If you need help doing so, please refer to our ILPTH Outreach Toolkit User Guide.