Forms for IDD Community Members
Explore the forms below for practical resources, guidance, and information to help support adults with IDD in a health care setting.
About My Health (Surrey Place)
A form for people with IDD and/or family/support persons to share communication strategies, likes and dislikes, and support needs with clinicians. Note: This document contains a few references to Ontario, Canada.
My Health Care Visit
This form is for people with IDD to prepare for seeing a clinician and completing it with the clinician to better understand the purpose and outcome of the health care visit. This could ideally serve as documentation of the appointment for the person’s record, if needed.
My Hospital Form
This form is designed for family or other support persons of adults with IDD to communicate vital information in the event of a hospital stay. It can provide hospital staff with key medical information, substitute decision-makers’ contacts, and information about the person’s support needs. It is recommended that this form be prepared in advance of an emergency.
My Coping Tool
A form that helps people with IDD identify coping strategies and supports to use when feeling stressed, upset, or in crisis. My Coping Tool helps the individual and other people know what to do when the person doesn’t feel like their usual self.
SHARE Transition Checklist (Surrey Place)
This form helps families and youth (age 14-25) talk about skills and supports for successful transition into adult life. SHARE includes: Supports for communication and capability; Health care transition; Activities and engagement; Relationships and wellbeing; Exploring services and supports. Note: This document contains Canadian resources.
Epilepsy
These tools and information sheets have been created and compiled for families/support persons of adults with IDD who have concerns about seizures.
Monitoring Charts
Families/support persons can use these forms to track various health issues commonly experienced by people with IDD. These charts can be shared with the primary care clinician during a health assessment or when a concern arises. Monitoring charts can also help to see whether a medication or treatment is helping.
HELP with Emotional and Behavioral Concerns
This form can help primary care clinicians to understand contributing factors when adults with IDD present with emotional distress or behavioral concerns. It provides a systematic exploration of four areas that might underlie or be contributing to emotional distress and behaviors of concern, including aggression or self-injury: Health, Environment, Lived Experiences, and Psychiatric Disorders (HELP). While this form is for the clinician, it may be helpful for families/support persons to read through.
Crisis Prevention and Management Plan
This form addresses serious behavior concerns and helps prevent or prepare
for a crisis. It describes how to recognize a pattern of escalating behaviors. It identifies responses that are usually effective for the person to prevent (if possible) a behavioral crisis, or to manage it when it occurs. The Crisis Prevention and Management Plan is best developed by an interdisciplinary team.
Antecedent-Behavior-Consequence (ABC) Chart
This form helps identify factors that can trigger or reinforce acute behavioral incidents. This information provides a basis for developing a plan to help the person with IDD and distressing behaviors. A completed example is included.