Resources

Multiple Self Management Behaviors

This section includes materials related to multiple self management behaviors. Because many self management behaviors are interrelated, one document may address multiple behaviors (e.g. nutrition and physical activity or goal setting and problem solving). Such materials are listed here and organized by the nature of their use.

Assessment Materials, Forms & Instruments

• Are You Ready? Brochure
• BCS Patient Questionnaire
  
• Behavioral Health Assessment Tool
  
• Behavioral Health Assessment Tool Spanish
• Behavior Worksheet
• Case Management Assessment and Follow Up Form
• Case Management Check-in Form
• Case Management Intake Form
  
• Diabetes Clinical Form
  
• Diabetes Group Visit Form
  
• Diabetes Provider Visit Form
  
• Lifestyle Survey
• Medical Assistant Diabetes Survey
  
• Patient Assessment Form
  
• Patient Assessment Form Spanish
  
• Patient Information Sheet English/Spanish
• Program Intake Form
• Program Intake Form
• Project Participant Assessment
• Project Participant Post-Test
• Project Participant Pre-Test
• Project Participant Questionnaire
• Questions for People with Diabetes
• Stages of Change Questions
  
• Type II Diabetes Standing Orders (MA Planned Visit)

Patient Education Material

• Live Your Life! Control Your Diabetes English/Spanish
• Key Health Messages
• Patient Education Material English/Spanish
• Patient Education Material English/Spanish
• Patient Health Record Book
• Self Assessment and Action Planning Guide: A1Cs, Sick Days, Feet, and Flu
• Self Management Goal Setting Tri Fold English
• Self Management Goal Setting Tri Fold Spanish
• TTM Patient Brochures on Checking Blood Sugar
• TTM Patient Brochures on Checking Blood Sugar Spanish
• TTM Patient Brochures on Taking Medicine
• TTM Patient Brochures on Taking Medicine Spanish
• Tribally-Tailored Diabetes Brochures 1 I 2 I 3
  

Program Management & Implementation

• 6-Session Diabetes Self Management Curriculum (text)
  
• 6-Session Diabetes Self Management Curriculum (slides, sessions 2-6)
• 6-Session Diabetes Self Management Curriculum Spanish (slides)
  
• Barriers to Diabetes Self Management
• Case Management Check-in Form
  
• Case Management Intake Form
• Certified Diabetes Educator Guidelines
• Diabetes and The Family Curriculum
  
• Diabetes Clinical Form
  
• Diabetes Provider Visit Form
  
• Goal Setting Form
• Program Intake Form
• Self Management Education Tracking Form
• Self Management Goal Tracking Form
  
• Self Management Goal Tracking Sheet
• Take Action: Managing Blood Sugar Lesson Plan, Student Material and Log
• Take Action: Managing Complications Lesson Plan and Student Material
• Take Action: Managing Medication Lesson Plan and Student Material (Insulin) and Student Material (Oral)
• Take Action: Sick Days Lesson Plan, Student Material, Workbook and Record Worksheet
• Take Action: What is Diabetes Lesson Plan, Student Material, Provider Questions, and Record Worksheet
  
• Type II Diabetes Standing Orders (MA Planned Visit)
• Weekly Diabetes Class Curriculum Session 1 and Session 2

Staff Training Materials & Methods

• Certified Diabetes Educator Guidelines
• Diabetes Self Management Education Manual
• Family Medicine Orientation
• General Diabetes and Self Management Information
• Medical Assistant Diabetes Survey
  
• Resident Training: Diabetes for the Primary Care Provider, Part I and Part II

Template Recruitment & Marketing Materials

• Class Brochure
• Diabetes Self Management Class Flyer English
• Diabetes Self Management Class Flyer Spanish
• Program Brochure
• Tribally-Tailored Diabetes Brochures 1 I 2 I 3