Phone: Phone: My address:

MY CARE PLAN This is the Care Plan Section. There’s space to put important information about you, help on planning where to stay, things to remember t...
Author: Carol Mitchell
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MY CARE PLAN This is the Care Plan Section. There’s space to put important information about you, help on planning where to stay, things to remember to take with you, a calendar, some thoughts on money, space to list your medical details, and a section to sign off on your plan.

ABOUT ME

Phone:

When you and your family are stressed it can be easy to forget things. Sometimes you can be so worried about your family that you forget about you. This page is a space to list important details about you. It’s also so other people have a copy of your important details if they need them.

Phone: My address:

My name:

My other address (if you have one):

My age: My birth date: My favourite foods: Where I was born: Food I hate or I’m allergic to:

My brothers and sisters names and ages:

My hobbies & stuff I like do to relax and have fun:

My school: Year/Grade:

My cultural or religious customs (eg. Do you go to church? When and where?):

My phone: My mobile:

My favourite TV show and movie:

Parent’s phone:

My favourite book or magazine:

Parent’s phone:

My favourite music or band:

List other family member’s phone numbers below

My favourite sport or team:

(like sibling’s, grandparent’s, uncle’s, aunt’s or cousins).

My Hero (Do you have people you admire or who inspire you?):

Phone: Phone:

*Tip*

If you have pets and need be away from home while your parent is unwell, talk to your parents or worker about who will look after them. The Coloured KIt: My Care Plan

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www.youthcoalition.net www.health.act.gov.au

WHERE AM I GOING TO STAY? If your parent is unwell and needs to stay away from home to get treatment, you may need to stay somewhere else until they are well enough. This part is to help you plan where you are going to stay. Sometimes you can’t stay at home. Some places you might have to stay could include: • With another family member • A family friend *Tip* • Temporary family care / substitute care If you can’t think of anyone to stay • A youth refuge with, you need to discuss your options. Your key worker could help you and your family do this.

If my parent gets too sick to stay at home I want to stay with: Name/Address

Their relationship to me

Home phone

Work/Mobile Number

Eg: Joey Jeffries 123 Fake Street, Springfield

Uncle

6111-1111

0444-444444

Checklist: I’ve talked to these people about staying with them.

Yes

No

They’ve agreed its ok for me to stay.

Yes

No

My parent or carer has agreed that it is ok.

Yes

No

I’ve got a plan on how to get there in an emergency.

Bus



Taxi



Getting picked up



Key worker



Other

I’ve made a list of other people who need to know what’s happening? (Eg. Friends, relatives, school)

Yes

No

Yes

No

The person who will tell them is: My parent knows how to contact me.

The Coloured KIt: My Care Plan

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www.youthcoalition.net www.health.act.gov.au

THINGS TO REMEMBER IF I’M STAYING AWAY FROM HOME It’s a good idea to make a list of stuff to take with you so when you stay with other people you don’t forget anything.

Here are some ideas: • A photo of your family • Favourite clothes • Medication • School gear (books, bag, uniform) • Your own pillow & sleeping gear • Sports gear • Favourite music

Other:

*Tip* Here are some things you may want to talk about with the people you’re staying with, so they know what’s important to know about you. • Friends – Is it cool to have friends over, or to go and see them? How many and how often? • What rules are there about bedtimes or sleepovers? • Can I call and visit my parent?

Yes

• Can I call and visit my brothers or sisters?

No Yes

No

• Can I use the telephone? Are there any phone rules? • Can I use the computer/internet/email?

Yes

Yes

No

No

Other:

The Coloured KIt: My Care Plan

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www.youthcoalition.net www.health.act.gov.au

ORGANISING MY WEEK Here’s a calendar you can use to help you remember, plan, or let people know your routine. Things I need to remember (eg birthdays, sports comp, school camp, excursions, sleepovers):

MORNING

AFTERNOON

NIGHT

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY

The Coloured KIt: My Care Plan

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www.youthcoalition.net www.health.act.gov.au

MONEY Where will you get financial support from? Perhaps you get pocket money from your parents or perhaps you help manage the money for your family. Ask your key worker for help to see if you are eligible for financial assistance. You may be eligible for Youth Allowance, or other entitlements that a worker may be able to assist you to access. If you provide care to your parent or another family member you may be eligible for Carers Allowance or a Carers Payment.

What do you normally need money for? Sometimes it’s easy to forget stuff. This exercise helps you think about what you usually need money for. The little things can really make a big difference. Circle some of the normal weekly expenses you have and talk to your family and worker about how you’re going to plan for these:

Bus

Other

School expenses

Other

Lunch

Other

Clothing expenses

Other

Music expenses

Other

Recreation

Other

MY MEDICAL DETAILS My Doctor’s name: Phone: My Dentist’s name: Phone: My Medicare Number is: Current medicines I use are: I have allergies to: Illnesses or special conditions I suffer from:

The Coloured KIt: My Care Plan

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www.youthcoalition.net www.health.act.gov.au

SIGNING OFF This part is to get everyone who’s involved in your support and the support of your family to show that they’ve read the plan, and know what’s going on. If you want someone to have a copy of this kit or of particular pages, ask your worker to make one. They should have access to a photocopier and should be able to post copies to whoever needs one.

I have agreed to this plan being put into action by if my parent / carer becomes unwell. Signatures Child X Parent/Carer X Parent/Carer X Key Worker X

Signed on: (date)

/

/

Lets come back and look over our plan again on this date: /

/



Who else will have a copy of this plan?

The Coloured KIt: My Care Plan

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www.youthcoalition.net www.health.act.gov.au

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