QIPPartIITemplate.docx
MHW 512 FAMILY DYNAMICS WORKSHEET#3
April 8, 2022MHW-512.R.T3Worksheet3ScoringGuide.docx
April 8, 2022Page 2 of 2
Use this Template for the Quality Improvement Project (QIP) PART II
See the QIP Presentation Module and Resources to complete the template
Recap from QIP Part I;
1. My Readiness for Change Score was: ________
2. My Topic from the Wheel of Life was: ________
3. My short-term goal is to: ________
4. My long-term goal is to: __________
Download your Clifton strengths reports and read them. Describe how your strengths helped you work on your project.
· Strength
· Strength:
· Strength:
· Strength:
· Strength:
5. How does at least one of the strengths listed above relate to your personal characteristics and how you implemented this behavior change project?
6. Insert an excel graph that is fully completed for all four weeks that measures your outcome and aligns with your short-term SMART goal. Add a note if needed to explain the graph.
7. On a scale of 1-10, how would you say you achieved your goal? Why did you choose that number? How did evidence from the article inform your behavior change? Cite reference for the article in APA format.
8. Self-care journal for the short-term goal reflects on the weekly Plan Do Study Act cycle. Full and complete sentences showing demonstration of thought expected on each response.
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Week 1 |
Response |
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What was your SMART short-term goal? |
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What steps did you take towards your goal? What did you achieve? |
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Describe barriers or negative triggers you encountered. |
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Based on barriers, what actions can you take? What adjustments can you try to be successful? |
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How could this change be realistically implemented and maintained into your routine? |
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Any other comments: Were there any unexpected positive or negative consequences to your activities this week? |
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Week 2 |
Response |
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What steps did you take towards your goal? What did you achieve? |
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|
Describe barriers or negative triggers you encountered. |
|
|
Based on barriers, what actions can you take? What adjustments can you try to be successful? |
|
|
How could this change be realistically implemented and maintained into your routine? |
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Any other comments: Were there any unexpected positive or negative consequences to your activities this week? |
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Week 3 |
Response |
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What steps did you take towards your goal? What did you achieve? |
|
|
Describe barriers or negative triggers you encountered. |
|
|
Based on barriers, what actions can you take? What adjustments can you try to be successful? |
|
|
How could this change be realistically implemented and maintained into your routine? |
|
|
Any other comments: Were there any unexpected positive or negative consequences to your activities this week? |
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|
Week 4 |
Response |
|
What steps did you take towards your goal? What did you achieve? |
|
|
Describe barriers or negative triggers you encountered. |
|
|
Based on barriers, what actions can you take? What adjustments can you try to be successful? |
|
|
How could this change be realistically implemented and maintained into your routine? |
|
|
Any other comments: Were there any unexpected positive or negative consequences to your activities this week? |
