Compass and Support Plan – Assessment for Referrers (shared care independent pathway)

Client's Name and Surname(Required)

Please write the Name and Surname of the client exactly as it appeared in the email you received.

Review Occasion(Required)

Review Date(Required)

Key Performance Indicators

Employment Status

Employed full time (16+ hours)

Employed part time

Education

Training

Volunteering

Unemployed

Retired

Prefer not to say

Are you supporting this client to access employment?

Yes

Prefer not to say

Not applicable

Are you supporting this client to access training/volunteering?

Yes

Prefer not to day

Do you smoke?

Yes

Prefer not to say

Are you supporting this client to refer to a smoking cessation service?

Yes

Prefer not to say

Not applicable

Issues with illicit prescription drugs?

Yes

Prefer not to say

Issues with drinking?

Yes

Prefer not to say

Is this person linked in with Turning Point?

Yes

I am not sure

Not applicable

Summary of Assessment

Please copy and paste your reason for referral(Required)

Compass Scores

Please rate using the confidence scale:

1 = Very Low Confidence
2 = Low Confidence
3 = Some Confidence
4 = Confident
5 = Very Confident

Mental Wellbeing

Taking notice of the present moment

Please enter a number from 1 to 5.

How confident have you felt staying present and focused recently? E.g., noticing your surroundings, enjoying small moments, calming your thoughts.

Making healthy decisions problem-solving

Please enter a number from 1 to 5.

How confident have you felt in making everyday decisions or finding ways to deal with problems? Example: Choosing what to do in a tricky situation or figuring out how to handle a challenge.

Social Wellbeing

Connecting meaningfully with others

Please enter a number from 1 to 5.

How confident have you felt in spending time with others or staying in touch with people who matter to you? Example: Talking to a friend, joining a group, or just saying hello to someone.

Giving back to others

Please enter a number from 1 to 5.

How confident have you felt in doing something kind or helpful for someone else? Example: Giving your time, listening to someone, or helping out in small ways (not just money).

Physical Wellbeing

Building healthier habits

Please enter a number from 1 to 5.

How confident have you felt in taking care of your physical health? Example: Eating well, managing health conditions, or cutting down on things like smoking or alcohol

Being physically active

Please enter a number from 1 to 5.

How confident have you felt in moving your body in a way that feels good for you? Example: Walking, stretching, dancing, or any kind of movement you enjoy.

Everyday Wellbeing

Learning new skills

Please enter a number from 1 to 5.

How confident have you felt about learning new skills?

Creating purpose, meaning in your life

Please enter a number from 1 to 5.

How confident have you felt in doing things that feel meaningful or give you a sense of purpose? Example: Doing something that matters to you, helping others, or working toward a goal that feels important

Support Plan: Goal 1

Goal Input Note

Can be general goals you're already working on — doesn't have to be specific to WBN or your reason for accessing WBN.

Goal 1

Goal 1: Compass Area

Support Plan: Goal 2

Goal 2

Goal 2: Compass Area

Support Plan: Goal 3

Goal 3

Goal 3: Compass Area

Has there been any change to client risk?(Required)

Yes

Risk Summary

Details of Any Risk to Self or Others

Details of any suicide risk

Below are some statements about feelings and thoughts.

I have been feeling optimistic about the future(Required)

Please enter a number from 1 to 5.

1 – None of the time | 2 – Rarely | 3 – Some of the time | 4 – Often | 5 – All of the time

I have been feeling useful(Required)

Please enter a number from 1 to 5.

1 – None of the time | 2 – Rarely | 3 – Some of the time | 4 – Often | 5 – All of the time

I have been feeling relaxed(Required)

Please enter a number from 1 to 5.

1 – None of the time | 2 – Rarely | 3 – Some of the time | 4 – Often | 5 – All of the time

I've been dealing with problems well(Required)

Please enter a number from 1 to 5.

1 – None of the time | 2 – Rarely | 3 – Some of the time | 4 – Often | 5 – All of the time

I've been thinking clearly(Required)

Please enter a number from 1 to 5.

1 – None of the time | 2 – Rarely | 3 – Some of the time | 4 – Often | 5 – All of the time

I've been feeling close to other people(Required)

Please enter a number from 1 to 5.

1 – None of the time | 2 – Rarely | 3 – Some of the time | 4 – Often | 5 – All of the time

I've been able to make up my own mind about things(Required)

Please enter a number from 1 to 5.

1 – None of the time | 2 – Rarely | 3 – Some of the time | 4 – Often | 5 – All of the time

Over the last week, how often have you been bothered by any of the following problems?

Feeling nervous, anxious or on edge(Required)

0 - Not all all

1 - Several days

2 - More than half the days

3 - Nearly every day

Not being able to stop or control worrying(Required)

0 - Not all all

1 - Several days

2 - More than half the days

3 - Nearly every day

Feeling down, depressed, or hopeless(Required)

0 - Not at all

1 - Several days

2 - More than half the days

3 - Nearly every day

Little interest or pleasure in doing things(Required)

0 - Not at all

1 - Several days

2 - More than half the days

3 - Nearly every day