chapter  4
Power Plans
Pages 14

These are some of the best things that happened for me and my family:

Age What Happened, Who Was with Me

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These are some times I felt safe:

Age What Happened, Who Was with Me

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I think school is:

_____________________________________________________

School makes me feel:

_____________________________________________________

My favorite class or subject is:

_____________________________________________________

My worst class or subject is:

_____________________________________________________

It helps me learn when teachers:

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These are some things that have made me feel stressed or unsafe or remind me of bad times:

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I also think some of these things2 (below) get me feeling stressed:

Feeling no one listens to me Feeling pressured

Being touched Lack of privacy

People yelling Loud noises

Feeling lonely Arguments

Not having control Being alone

Darkness Being stared at

Being teased Feeling tired

Feeling hungry Being criticized

Being reminded of a very Being told ‘no’ about bad time in my life something I want

Particular people: ______________________________________

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Particular time of day: __________________________________

Particular time of year: __________________________________

Other things that get me stressed [please describe]:

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These are some things I do, show, or feel when I am starting to lose self-control [warning signs]:

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I also find some of these things (below) happen when I am getting stressed:

Stomach hurts Breathing hard

Racing heart Clenching teeth

Clenching fists Sweating

Wringing hands Using loud voice

Sleeping a lot Trouble sleeping

Acting hyper Swearing

Jittery legs Rocking

Can’t sit still Being rude

Pacing Crying

Staring at something Hurting things

Eating more Eating less

Avoiding people or isolating Laughing loudly

Singing inappropriately

Other [please describe]:

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These are some of the things I have done when I was stressed that led to problems for me or other people:

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I have done some of these things (below) when I was stressed:

Losing control Leaving without permission

Running away Threatening others

Hurting people Hurting myself

Attempting suicide Using alcohol

Using drugs Getting into fights

Other [please describe]:

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These are some things that help me calm down and help me and other people feel safe in ‘tough times’:

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These are some of the other things that help me calm down:

Talking with family members [who?]:

_____________________________________________________

Talking with adults [who?]:

_____________________________________________________

Talking with friends [who?]:

_____________________________________________________

Time alone in my room Listening to music

Reading a book Playing an instrument

Walking A quiet place

Drawing/art Molding clay

Jokes/humor Writing in a journal

Hugging a stuffed animal Exercising

Cold washcloth on face Drinking hot tea

Drinking cold water Deep breathing

Taking a shower Playing cards

Video games Lying down

Meditating Getting a hug

Holding ice in hands Using the gym

Rocking chair Praying

Being around others Being read a story

Wrapping myself in something Making a collage warm or soft

Crying Running

Shooting baskets Doing chores/jobs

Yoga Dancing

Swimming

Other [please specify]:

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Draw a picture of how other people can help you calm down.