Fillable Ryan - SNAP Form

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Ryan - SNAP Form

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The Ryan - SNAP Form form is 2 pages long and contains:

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  • 53 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Oakland

BROWSE CITY OF OAKLAND (CA) FORMS

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Page 1 of 2
Client’s Strengths, Needs, Abilities, Preferences
(SNAP)
Date: __________________ PH Service Site: __________________________
Client Name: ______________________ Client ID: _____________________________
STRENGTHS
NEEDS
What are some things that will help you in
treatment?
Check all that apply and list others you think will
help.
1. Support from family (parents, children, others)
2. Support from spouse or significant other
3. Connection to self-help group (AA, NA, etc.)
4. A positive and supportive sponsor
5. Connection to a church group or minister
6. Counselor of case manager who helped you
get into treatment
7. Judge or probation officer who helped you get
into treatment
8. Financial assistance or benefits
9. Permanent residence
10. Connection to a mental health facility and/or
psychiatric care; provisions for obtaining
medications
11. Supportive friends
12. Others:
___________________________________________
___________________________________________
___________________________________________
What do you want to learn in treatment?
Check all that apply and list other things you
can think of that are not shown.
1. Education about substance abuse
2. An explanation of my diagnosis
3. Improvement in my communication skills
4. Improvement in my interpersonal skills
5. Contact with supportive others
6. Emotion-management skills
7. Anger-management skills
8. Personal safety plan
9. Parenting skills
10. Getting and keeping a job
11. Education about improving my health
12. Relapse prevention
13. Others:
_________________________________________
_________________________________________
_________________________________________
Save Form
The Clinical Site
02/13/2015
1 Clinical
1069946
Page 2 of 2
PREFERENCES
What do you hope to get out of treatment?
Check all that apply and list other things you
can think of that are not shown.
1. I will learn the skills to stay clean and sober
2. I will learn the skills to stay mentally stable
3. I will have a better understanding of my
diagnosis
4. I will be able to communicate more
effectively
5. My interpersonal skills/relationships will
improve
6. I will develop a system of support in
recovery
7. I will be able to better manage my emotions
8. I will be able to better manage my anger
9. My health will improve
10. I will have a better understanding of
relapse prevention
11. I will learn how to reunite with my children
12. I will learn to get a job
13. Religious Preference
14. Others:
________________________________________
________________________________________
________________________________________
Signature of Client Signature of Staff
____________________ _______________________
Date ________________ Date___________________
I want to work on going back to college but not right now
Right now I just want to concentrate on my recovery.
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Ryan - SNAP Form

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Completed 10 June 2020

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