Leader Resources –
Take Charge Programs
How to use this page:
Resources are listed by document title. Some materials are available in mulitple languages—select the appropriate language link when provided. These materials are intended for trained Take Charge program leaders.
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These resources include workshop materials for the following programs:
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Take Charge of Your Health (CDSMP)
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Take Charge of Your Diabetes (DSMP)
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Take Charge of Your Pain
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Cancer: Thriving and Surviving
For Spanish-language workshops, please refer to the Tomando resources page.
Leader Materials
ILPTH Program Quick Reference: Guidance on facilitating Take Charge, including participant limits, session cutoffs, workshop lengths, and session times.
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Data Collection Checklist: Instructions for collecting data from registration through to the final session.
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Attendance Sheet: For tracking participant attendance and received forms.
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Participant Sign-In Sheet: An optional sign-in sheet for participants (not required).
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Session 1 Data Collection Script: A script to read aloud to participants during Session 1 to explaining which forms are collected and why [English] | [Spanish]
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Session 1 Virtual Data Collection Script: A virtual version of the Session 1 data collection script [English] | [Spanish]
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Photo Media Release: Optional; use this form if collecting testimonials or taking pictures. Feel free to customize it for your organization [English] | [Spanish]
Participant Materials
Session 1 Participant Registration Forms & Pre-Survey
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Participant Registration Packet: Includes the participant registration form, privacy policy acknowledgment & liability waiver [English] | [Spanish]
Participant Pre-Survey: [English] | [Arabic] | [Gujarati] | [Hindi] | [Korean] | [Mandarin] | [Urdu]
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Session 1 Handouts for Participants
(One form per participant)
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Welcome Letter: Intro to the program and form instructions for online workshops [CDSMP] | [DSMP] | [PAIN] | [CANCER]
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Workshop Overview and Homework by Session: [CDSMP] | [DSMP] | [PAIN] | [CANCER]
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Menu Planning 1: For Take Charge of Your Diabetes only
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Menu Planning 2: For Take Charge of Your Diabetes only
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Menu Planning DSMP Charts 9 & 10: For Take Charge of Your Diabetes only
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Last Session Forms
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Participant Post-Survey: [English] | [Arabic] | [Gujarati] | [Hindi] | [Korean] | [Mandarin] | [Urdu]
Links & Other Materials
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SMRC Leader Certification Guidelines
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Pre-workshop Checklist and Recruitment Plan
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Email Templates: For leaders running online workshops
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Zoom Instructions: For online workshops [English] | [Spanish]
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Certificate of Completion Template
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Crisis Intervention Plan: General crisis guidance
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Host Site Survey: Email template for conclusion of workshop
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Take Charge of Your Pain Digital MEP: https://www.bullpub.com/mep.html
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Brief Body Scan: Contact us for CD purchase or find a free version online or on YouTube.
Marketing Materials
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ILPTH Evidence Based Program Flyer
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Take Charge Series Program Flyer
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ILPTH Outreach Toolkit Template: This Toolkit includes templates for flyers, posters, social media posts, etc. You will need a Canva account to access the template and create a COPY to make edits (DO NOT EDIT THE TEMPLATE). If you need help, refer to the ILPTH Outreach Toolkit User Guide.