Appendices for Facilitators

Appendix B: Scenario Worksheet, The 5-Point Formula, Value-Based Decisions Worksheet, and Sample Worksheet

Follow a link below or scroll down for all Appendix B components:

Scenario Worksheet

  1. What is the goal?
     
  2. Discuss the Five Decision Making Steps:
     
    a) Notice the Event (At what point could you notice?)
     
    b) Interpret it as Problem/Emergency (What are the red flags?)
     
    c) Assume Personal Responsibility (What could you do?)
     
    d) Have the Skills to Intervene (What knowledge/skills are necessary?)
     
    e) Implement the Help — STEP UP! (What are direct and indirect ways to help?)
     
  3. What could you do to make the intervention Safe, Early and Effective?
     
  4. Costs/Rewards – What are the benefits of intervening? What are some costs? What are some costs of NOT intervening?
     
  5. Perspective Taking - How would you feel if you were the “victim”?
    What would you be thinking? What would you want others to do for you?
     

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The 5-Point Formula

Create a script using The 5 Point Formula (See sample script in Strategies for Effective Helping, Section C). Remember the Law of Delivery — audience, content, timing, reasons, location, tone.

I Care –

I See –

I Feel –

I Want –

I Will –

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Value-Based Decisions Worksheet

This technique is designed to help with making good decisions that are aligned with our stated values regarding impulsive behaviors such as drinking, using drugs, unhealthy eating, aggressive behavior, risky sexual behavior, etc.

If I choose to ___________________________________ (name the behavior)
List the Benefits
List the Costs
Value 0 (none - 10 (high)
In 5 minutes     Benefit value =
Cost value =
In 1 hour     Benefit value =
Cost value =
In 6 hours     Benefit value =
Cost value =
In 1 day     Benefit value =
Cost value =
In 1 week     Benefit value =
Cost value =
In 1 month     Benefit value =
Cost value =
In 1 year     Benefit value =
Cost value =

If I choose NOT to _______________________________ (name the behavior)
List the Benefits
List the Costs
Value 0 (none - 10 (high)
In 5 minutes     Benefit value =
Cost value =
In 1 hour     Benefit value =
Cost value =
In 6 hours     Benefit value =
Cost value =
In 1 day     Benefit value =
Cost value =
In 1 week     Benefit value =
Cost value =
In 1 month     Benefit value =
Cost value =
In 1 year     Benefit value =
Cost value =

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Sample Worksheet

If I choose to drink until I get drunk (name the behavior)
List the Benefits
List the Costs
Value 0 (none - 10 (high)
In 5 minutes Relaxed
Acceptance by peers
Taste		 None Benefit value = 8
Cost value = 0
In 1 hour Have a good time
Forget about problems		 Impaired decision making abilities Benefit value = 8
Cost value = 5
In 6 hours Little to none Could put self and others at risk
Nauseous/vomiting
Impaired sleep		 Benefit value = 1
Cost value = 8
In 1 day Brag about it to friends Hangover
Skipped class, bad practice
Prevents recovery from workout
Second-hand effect on others		 Benefit value = 1
Cost value = 8
In 1 week None Decrease physical and mental acuity
Decrease in performance in school and sport
Get out of routine and behind in things		 Benefit value = 0
Cost value = 9
In 1 month None Heal slower
Still making up for lost time		 Benefit value = 0
Cost value = 9
In 1 year None Possible DUI on record
Possible suspension / dismissal from team		 Benefit value = 0
Cost value = 10
Total
 Benefit = 18
Cost = 49

If I choose NOT to drink until I get drunk
List the Benefits
List the Costs
Value 0 (none - 10 (high)
In 5 minutes Pride
Self control		 Teased by peers
Insecure; more self-conscious		 Benefit value = 4
Cost value = 8
In 1 hour In control Not fitting in with group
Bored
Alienation or "attitude" from peers		 Benefit value = 5
Cost value = 8
In 6 hours Clear head
Sound mind
Able to drive		 Little; party is pretty much over Benefit value = 8
Cost value = 2
In 1 day Good night sleep, well-rested
Productive academically and athletically
More focus		 None Benefit value = 9
Cost value = 0
In 1 week Keep routine
Maintain training and study schedule		 None Benefit value = 9
Cost value = 0
In 1 month Don't have to play catch-up
Consistent optimal performance
More energy		 None Benefit value = 9
Cost value = 0
In 1 year No regrets None Benefit value = 9
Cost value = 0
Total
 Benefit = 53
Cost = 18

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