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

Note: If you are a CCDPH partner, use the participant pre and post surveys that are specifically for CCDPH.


Course Materials for Leaders

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

Attendance SheetExcel Document

Attendance Sheet- Printable Form

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
  • Receive a link for a 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 and 2:

Printable/Fillable Participant Registration Packet- Includes registration form, privacy policy, and liability waiver)

Printable/Fillable Participant Pre-Survey

Option 3:

Link to Electronic Participant Registration Packet and Pre-Survey- https://forms.office.com/r/Axne6YXuWt 

CCDPH Partners Only- Link to CCDPH Electronic Participant Registration Packet and Pre-Survey- https://forms.office.com/r/HBy9BDRHYb

Option 4:

Participant Guide for ILPTH Portal- Instructions that can be sent to participants for completing electronic forms on the ILPTH participant portal

Session 1 Handouts for Participants 

(One form per participant)

Welcome Letter- CDSMP - DSMP - PAIN - CANCER   Coming Soon!

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

Last Session Forms

Option 1 and 2:

Printable/Fillable Participant Post-Survey 

Option 3:

Link to Electronic Participant Post Survey- https://forms.office.com/r/NzjsJLMabr

CCDPH Partners Only- Link to CCDPH Electronic Participant Post Survey- https://forms.office.com/r/k9s5M5qxaT

Option 4:

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

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

Receipt Template for Books/CD's

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

 


Marketing Materials

IL Pathways to Health Logo

ILPTH Evidence Based Program Flyer