You can recognize the upsetting emotions that may lead to your SI.
_____ 2. You can control/manage the upsetting emotions that lead to your SI.
_____ 3. You can find replacement/alternative activities when you feel like engaging in SI.
_____ 4. You can change the thoughts that trigger your SI.
_____ 5. You can develop a healthier lifestyle.
_____ 6. You can form a network of friends, including adults you can turn to for help.
_____ 7. You can develop an emergency plan to use when you are in a crisis.
_____ 8. You can develop a better relationship with your parents, based on open communication.
_____ 9. You can be happier and find more pleasure in your life every day. 10. You are in therapy with a counselor/therapist? ( Y ) or ( N )
Please Specify the Number of times per week you are currently engaging in self-injury. _______
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Members may feel pressure to answer a certain way for fear that the results may be shared with their parents or caregivers. However, confidentiality will be discussed and agreed upon by participants and parents during the intake process. Only “life altering” information/disclosures will be reported to parents or caregivers. The members would benefit from this evaluation in terms of the RWFRC being able to put out a better product. This evaluation is being designed to shed light on the new program that was designed and to ensure that it is meeting the goals of the