Clemens Health | Person and family learning brief
Updated 2026-10-05 | (651) 354-1196

Prepare this with the person before the planning conversation. The filled entries are one illustrative routine, not a recommended goal for everyone.

Chosen routine
What does the person want to do more comfortably?
Illustrative entry: Prepare what they need for a weekly art group.
Your notes: ________________________________________

Existing strength
Which part already works?
Illustrative entry: Chooses art materials independently.
Your notes: ________________________________________

Person's learning
What specific step would they like to practice?
Illustrative entry: Check the activity list and decide what to pack.
Your notes: ________________________________________

Family learning
What support approach needs instruction?
Illustrative entry: Use one agreed reminder instead of several competing prompts.
Your notes: ________________________________________

Session question
What would you like the provider to demonstrate?
Illustrative entry: Show how to introduce the checklist and observe one attempt.
Your notes: ________________________________________

Feedback
How will the person say whether the approach helps?
Illustrative entry: Choose a spoken or written comment after practice.
Your notes: ________________________________________

Review
When and with whom will difficulties be discussed?
Illustrative entry: Bring observations to the next agreed provider conversation.
Your notes: ________________________________________

Illustrative example
A person wants to prepare for art group without several relatives calling out reminders. Their learning goal concerns checking the activity list and choosing what to pack. Their family's learning concerns using an agreed reminder and allowing time for the person to respond. The provider conversation can now address both roles. If packing goes well only because a relative quietly completes it, the team has not observed the intended practice. They record what each person actually did and discuss how to adjust the next attempt.

Next step
Bring one routine and the separate learning roles to your case manager and potential family-training provider.

This is an optional discussion worksheet, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.