Personal Engagement Plan - Country & Outback Health

Personal
Engagement Plan

Please complete all information required in the form fields below

Port Augusta
Port Lincoln
Whyalla

Date

Young Person Details

Young Person Name *

Date of Birth *

How would you describe your overall wellbeing?
(i.e. general health, mental health, energy levels, sleep, appetite, daily routine, life satisfaction, stressors)

What’s been challenging for you lately?
(i.e. poor mental health, struggling with relationships, financial/work responsibilities, household duties, self-care)

Who in your life do you feel comfortable to talk to when things get hard?
(i.e., friends, family, cultural and community connections)

What is working well for you?
(i.e. healthy habits, positive relationships, activities, learnt skills/strategies)

What kind of support do you think would help you the most right now?
(i.e. mental health support, work & study support, sexual and/or physical health support, AOD support)

What changes do you want to make, and how do you hope working with headspace can help you achieve those goals?
(i.e. dealing with stress and anxiety, managing emotions and negative thoughts, setting boundaries, being more productive, building resilience)

Plans moving forward

Extra information/client & family voice

(i.e. preferences of communication, triggers, areas of strengths, family observations of behaviour)

Professional supports

My GP or Medical Practice

Other Supports
(i.e. friends/family, support groups, community centres, health professionals, self-care resources)

Support Numbers:

eheadspace online support: 1800 650 890 or headspace.org.au

Kids Helpline: 1800 55 1800

Lifeline: 13 11 14

QLife: 1800 184 527

13YARN: 13 92 76

Mental Health Triage Service: 13 14 65 (16 & over)

Regional Access: 1300 032 186 (15 & over)

Present to local hospital

Emergency: 000

Signed (Young Person)

Clear Signature

Date

Signed (Support Person)

Clear Signature

Date

Signed (Worker)

Clear Signature

Date

Email