High School Common Measures
Self-Advocacy
Identify Need: Remembering
“What are my personal preferences?”
What are my academic preferences?
For example, “I like to be taught in a small group,” or “I learn best with visuals.”
 ________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________
What are my interpersonal preferences?
For example, “I like to spend time with friends in a small group,” or “I value honesty in my relationships.”
 ________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________
What are my preferences for free time, hobbies and/or interests?
For example, “I prefer to be physically active,” or “I care about spending time on my art work.”
 ________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________
High School Common Measures
Self-Advocacy
Identify Need: Understanding
“What are my influences?” (page 1 of 2)
Use the worksheet “What are my personal preferences?” to complete this activity. For each identified
preference, decide whether this has been influenced by your personal history (e.g., “Having free time to
practice my piano playing is important to me because I am proud of the years I have spent building my skills”),
your family/culture (e.g. “I like math class most because my mother is a math teacher who has always
encouraged me”) or your personal beliefs (“I prefer my friends to be completely honest with me, because I
believe true friends have no secrets”).
Example:
Family/Culture
*my mother is a math
teacher—I prefer math class
*piano lessons for 10 years—I value
playing in my free time
*friends shouldn’t have secrets—I
need honesty in relationships
Personal Beliefs
Personal History
High School Common Measures
Self-Advocacy
Identify Need: Understanding
“What are my influences?” (page 2 of 2)
My Influences:
Family/Culture
Personal History
Personal Beliefs
Using your completed diagram of influences, complete the following statement about one of
your personal needs:
When it comes to ____________________________________(relationships, school, my
personal time, etc.), I need _____________________________________________ because
__________________________________________________________________________.
High School Common Measures
Self-Advocacy
Identify Need: Applying
“What influences this situation?”
What is a problem or area of difficulty I am facing in my life? (examples: “I am having trouble in math class,” “I
am deciding what colleges to apply to,” “I am arguing with my romantic partner”).
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What is one strength I have in this situation?
_____________________________________________________________________________
_____________________________________________________________________________
What is a weakness I have in this situation?
_____________________________________________________________________________
_____________________________________________________________________________
How is this situation influenced by my personal history?
_____________________________________________________________________________
_____________________________________________________________________________
How is this situation influenced by my personal beliefs?
_____________________________________________________________________________
_____________________________________________________________________________
How is this situation influenced by my family/culture?
_____________________________________________________________________________
_____________________________________________________________________________
High School Common Measures
Self-Advocacy
Identify Need: Creating/Evaluating/Analyzing
“Personal Needs Assessment”
What is a problem or area of difficulty I am facing in my life? (examples: “I am having trouble in math class,” “I
am deciding what colleges to apply to,” “I am arguing with my romantic partner”).
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Complete the following statement, or write your own statement that includes the same six components:
When it comes to ______________________________________________________________, I need
The situation (math class, my relationship, looking for a job, etc.)
_______________________________________________________________________ because I value
What is most important/necessary to you in this situation?
________________________________________________________________. In this situation, my strengths
Why is this your most important need?
are: _________________________________________________________________________
_____________________________________________________________________________.
What strengths do you have that can help you in this situation?
In this situation, I need to work on: _________________________________________________
_____________________________________________________________________________. Other people
What personal weaknesses will you need to be aware of and plan for in this situation?
involved can help me with this by _______________________________________________________
_____________________________________________________________________________.
What support can you ask for from other people involved in this situation to best get your needs met?
High School Common Measures
Self-Advocacy
Identify Resources: Remembering
“Supports Checklist”
During a small group or individual counseling session, the counselor initiates discussion with the following
prompt:
“Tell me about people in your life who can support you. What kind of support does each person offer?”
The counselor should also offer prompts such as “tell me about some other people who can support you?” or
“tell me more about what kind of support that person offers?” as needed to encourage student(s) to
continue discussion.
1) The counselor checks off one box below for every individual reasonably identified as a possible source of
support by the student:
1
2
3
4
5(+)
To be considered “reasonable,” the person must be accessible to the student.
Acceptable: mother, father, sister, minister, friend, counselor, teacher, school resource officer, etc.
2) The counselor checks off one box each time the student is able to identify what potential support/area of
expertise each identified individual offers:
1
2
3
4
5(+)
The counselor should check off a box only if the student is able to be specific about why an individual can offer
a certain area of support. For example, check a box if the student can say, “my sister and I are close, so she
offers me emotional support and comfort when I am upset” or “my guidance counselor knows about applying
to colleges, so he’s a good person to ask about my college applications.” The student would not receive credit
for “my mom helps me because she loves me.”
High School Common Measures
Self-Advocacy
Identify Resources: Understanding
“Rights Checklist”
During a small group or individual counseling session, the counselor initiates discussion with the following
prompt:
“Explain rights you have as an individual and how these can help you access needed resources.”
The counselor should also offer prompts such as “tell me about some other rights you have?” or “tell me
more about how that can help you access resources?” as needed to encourage student(s) to continue
discussion.
1) The counselor checks off one box below for every right the student can accurately identify:
1
2
3
4
5(+)
To be acceptable, the student’s explanation of their rights should be generally accurate and not reflect a lack
of consideration for the rights of others.
Acceptable: the right to free speech, as long as it is non-disruptive and non-harmful; the right to be free from
discrimination based on race, gender, religion or sexual orientation; the right to be free from sexual
harassment; student on IEP has the right to be part of educational TEAM; right to a free and appropriate
education, etc.
2) The counselor checks off one box each time the student is able to identify how an identified right helps
them access resources or guarantees support:
1
2
3
4
5(+)
For example: “I have the right to an education appropriate for my reading disability, so I have an IEP that
ensures the school provides me with access to resources such as special instruction”; “I have the right to be free
from harassment, so the school administration has to listen to and investigate any harassment complaint I
make.”
High School Common Measures
Self-Advocacy
Identify Resources: Applying
“Accessing Resources”
What is the problem that I need to access resources to address?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What potentially useful and appropriate resource(s) are available to me to address this problem/area of need?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What is my plan to access the resources I need? What steps will I need to take, and what factors do I need to
consider?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
When will I carry out my plan?
_____________________________________________________________________________
_____________________________________________________________________________
How will I know if I was successful?
_____________________________________________________________________________
_____________________________________________________________________________
High School Common Measures
Self-Advocacy
Identify Resources: Creating/Evaluating/Analyzing
“Evaluating Access of Resources”



Prior to this activity, the student has been able to complete the graphic organizer “Accessing
Resources” and has been given time outside of counseling sessions to attempt the plan created.
During a small group or individual counseling session, the counselor will ask the student to reflect on
effectively they were able to use their plan to access needed resources and address the previously
identified area of need. The counselor will ask a series of four questions:
o #1: “When we met before, you came up with a plan to access resources you needed to help
you with _____________ (reference the problem area identified on the “Accessing
Resources” graphic organizer). Were you able to try that plan?”
 If the student reports that they attempted the plan, mark question #1 complete and ask
the following questions. If the student reports that they did not attempt the plan, do not
continue asking the following questions.
o #2 “Great! Tell me what you tried, and what the results were.”
 Mark question #2 complete if the student can describe both what they tried, and what
occurred as a result, and continue to question #3. Do not continue to question #3 if the
student cannot answer question #2.
o #3 “Do you feel like your plan was successful? Did it help you get the support you needed to
address your problem? Why or why not?”
 Mark question #3 complete if the student is able to explain how their plan either did or
did not help them access the support they needed and/or address their problem, and
then continue to question #4. If the student cannot answer question #3, do not continue
to question #4.
o #4 If the student reported that they felt that the plan was successful, ask “How do you think
you can apply this to other problems or areas of need?” If they reported that they did not feel
the plan was successful, ask “What do you think you could try differently next time to make
your plan more successful?” Mark question #4 complete if the student is able to successfully
self-reflect about at least one way they can either improve their plan next time, or apply their
plan to another problem/area of need in their life.
The counselor should offer restatement or clarification of any of the above questions if the student
does not understand what is being asked. However, the student should be able to answer the above
questions without excessive counselor guidance.
High School Common Measures
Self-Advocacy
Communicate Need: Remembering
“’I Statement’ Checklist”
During a small group or individual counseling session, the counselor initiates discussion with the following
prompt:
“Think about some situations in your life or problems in which you need to communicate your needs to
another person. This includes both seeking help from another person, such as asking a teacher for help with
a tough assignment, or advocating for yourself in a situation when you feel it is important for your opinion
or needs to be heard by someone else. Try to come up with some “I statements” to express your needs in
these situations. For example, “I need help from my teacher studying for a test.” Finish the statement, “I
need…” for some of your own needs.
The counselor should also offer prompts such as “give me another ‘I statement’” or repeating the prompt “I
need…” as needed to encourage student(s) to continue discussion.
1) The counselor checks off one box below for every reasonably specific and accurate “I statement” made by
the student.
1
2
3
4
5(+)
To be considered reasonably specific and accurate, the statement must be truthful for the student (as far as
can be known) and not too general.
Not acceptable: “I need a billion dollars.” “I need help.”
High School Common Measures
Self-Advocacy
Communicate Need: Understanding
“Five Components of Self-Advocacy”
 Body Language
 Being prepared and knowledgeable
 Knowing your audience
 Prepare your “I statement”
 Identify an appropriate time and/or
location
High School Common Measures
Self-Advocacy
Communicate Need: Applying
“Communicating My Need” (page 1 of 2)
What need to I need to communicate? ____________________________
Who do I need to communicate this to? ___________________________
 Body Language: What do I want to communicate with my body language in this
situation? How can I show that?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
 Being prepared and knowledgeable: What do I need to know in advance, and what
should I have prepared?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
 Knowing your audience: What do I know about the person I am talking to that might
influence how I communicate with them?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
High School Common Measures
Self-Advocacy
Communicate Need: Applying
“Communicating My Need” (page 2 of 2)
 Prepare your “I statement”: What is the most important thing for me to communicate
to this person? How will I say that?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
 Identify an appropriate time and/or location: When and where would be best for me to
approach this person?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
High School Common Measures
Self-Advocacy
Communicate Need: Creating/Evaluating/Analyzing
“Evaluating Ability to Communicate Need”



Prior to this activity, the student has been able to complete the graphic organizer “Communicating
Need” and has been given time outside of counseling sessions to attempt the plan created.
During a small group or individual counseling session, the counselor will ask the student to reflect on
effectively they were able to use their plan to communicate their previously identified need. The
counselor will ask a series of four questions:
o #1: “When we met before, you came up with a plan to communicate this need:
_____________ to ___________(reference the problem area identified on the
“Communicating Need” graphic organizer). Were you able to try that plan?”
 If the student reports that they attempted the plan, mark question #1 complete and ask
the following questions. If the student reports that they did not attempt the plan, do not
continue asking the following questions.
o #2 “Great! Tell me what you tried, and what the results were.”
 Mark question #2 complete if the student can describe both what they tried, and what
occurred as a result, and continue to question #3. Do not continue to question #3 if the
student cannot answer question #2.
o #3 “Do you feel like your plan was successful? Did you feel you effectively communicated
with the other person? Why or why not?”
 Mark question #3 complete if the student is able to explain how their plan either did or
did not help them communicate their need to another person, and then continue to
question #4. If the student cannot answer question #3, do not continue to question #4.
o #4 If the student reported that they felt that the plan was successful, ask “How do you think
you can apply this to other people you need to communicate a need to?” If they reported that
they did not feel the plan was successful, ask “What do you think you could try differently next
time to make your plan more successful?” Mark question #4 complete if the student is able to
successfully self-reflect about at least one way they can either improve their plan next time, or
apply what they learned to another problem/area of need in their life.
The counselor should offer restatement or clarification of any of the above questions if the student
does not understand what is being asked. However, the student should be able to answer the above
questions without excessive counselor guidance.
High School Common Measures
Social Communication
Perspective Taking: Remembering
“Conflict Resolution Checklist”
Counselor will initiate the prompt “Tell me the 5 steps of conflict resolution”
and record student responses.
o Introduction
o Story Telling
o Identifying the issue
o Finding a solution
o Final agreement
High School Common Measures
Social Communication
Perspective Taking: Understanding
“Conflict Resolution Checklist”
This worksheet contains 6 conflicts with different points of view, students will use this worksheet to be able to see the
different points of view and work towards a solution.
1. A group of students eats lunch together everyday. One day, a student new to the school, who dresses very differently
from the group, attempts to join them for lunch. The students in the group intentionally turn their backs on the new
student. What would be some of the different points of view of this situation from: the new student; a student in the
group; the principal who sees what happens; another student sitting nearby.
2. Three students are assigned a group project: John, Pete and Mark. The students split up the work evenly and plan to
bring their assigned pieces together in a week. When they meet again, John hasn’t done the work but still wants to get
credit for the project. Pete agrees, but Mark doesn’t. Talk about the points of view of: John; Pete; Mark; the teacher.
3. Sally and Meg have been best friends for many years. When the new school year starts, Meg begins spending a lot of
time with a popular new student, Jennifer. Soon after, Sally learns that Meg is telling hurtful stories about her that are
not true. Talk about the different points of view of: Sally; Meg; Jennifer.
4. You become friends with a new student Pat. After a few weeks, Pat cheats on a test by copying your paper. The
teacher finds out and gives both of you a failing grade. Imagine the viewpoints of: Pat; yourself; the teacher; Pat’s
younger sister; your parents.
5. Everyday at lunchtime, you see a large, tough student picking on a younger, smaller student. Others see this as well,
but no one intervenes. What are some of the different perspectives on this situation from: the bully; the student being
picked on; yourself; a teacher on lunch duty; another student sitting near the smaller student; a friend of the bully.
6. At the science fair, Hannah and Kevin, who are good friends, share a table for their projects. A mutual friend, Morgan,
has a table space across from Hannah and Kevin. The science teacher walks up and down the aisles inspecting the
projects. Hannah notices Kevin drinking a bottle of water, and she decides to leave her project for a few minutes to get
one for herself. When she returns, she finds some water spilled on her side of the table. Talk about the different points
of view of this situation from: Hannah; Kevin; Morgan; the science teacher.
High School Common Measures
Social Communication
Perspective Taking: Applying
“Conflict Resolution Chart”
Perspective #1:
Perspective #2:
Supporting Evidence:
Supporting Evidence:
Explain how such conflict hurts the other party involved:
High School Common Measures
Social Communication
Perspective Taking: Creating/Evaluating/Analyzing
“Peer Mediation Contract Form”
Date: _______ Disputant: ____________ Disputant: ___________ Mediator: ______________
Type of Conflict:
o
Fighting
o
Rumor
o
Threat
o
Name-calling
o
Property
o
Teasing
o
Friendship
o
Pushing
o
Other:_________________
We have participated in mediation and have agreed to the following: I,______________,
agree to: _______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________.
I,__________________________, agree to: ___________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________________________________________________.
_____________________________ (Signature, disputant)
_____________________________ (Signature, disputant)
____________________________(Signature, mediator)
High School Common Measures
Social Communication
Understanding Norms: Remembering
“Expected vs Unexpected Behaviors”
Expected behaviors are defined as…
o The rules of behavior that reflect the expectations of the group/setting.
o The actions that are appropriate for the group/setting.
Unexpected behaviors are defined as…
o The behaviors that are against the expectations of the group/setting.
o The actions that are inappropriate for the group/setting.
High School Common Measures
Social Communication
Understanding Norms: Understanding
“Behavior Matching Worksheet”
Student will match each behavior listed to either the Expected or Unexpected Labels.
Johnny was raising his hand in class.
Sue was running down the halls.
Joseph is eating his food in the cafeteria.
EXPECTED
Linda is eating her food in the library.
Julie is reading quietly in the library.
Wesley was jumping around in class.
Jarrett brought his turtle to school.
Billy is bringing his dog for a walk.
Veronica completes all of her homework.
Ciera does not complete her homework.
Kristen sets the table for her mother.
UNEXPECTED
High School Common Measures
Social Communication
Understanding Norms: Applying
“Expected & Unexpected Venn Diagram”
Student will identify two different settings, (example: Home & School), the student will then
list the expected behaviors in each setting including ones which may be the same across
settings in the middle of the two circles.
High School Common Measures
Social Communication
Understanding Norms: Creating/Evaluating/Applying
“Expected & Unexpected Graphic Organizer”
Student will use their Venn Diagram to complete the graphic organizer, outlining the social
responses of others based on the behavior.
Setting
Behavior
Thoughts
Actions
Feelings
High School Common Measures
Social Communication
Social Pragmatics: Remembering, Understanding, Applying, Creating/Evaluating/Analyzing
“Conversation Checklist”
The important components of a reciprocal conversation.
When people play a game of catch, they toss a ball back and forth to each other several times. Having a reciprocal
conversation is a lot like playing a game of catch, throwing and catching words and thoughts to each other.
o Face the person talking or talking to
o Quiet hands and feet
o Eye contact
o Listening
o Add information
o Stay on topic
o Ask questions
o Answer questions
Feedback provided to student:
High School Common Measures
Self-Regulation
Self-Awareness: Remembering
“CBT Triangle”
Instructions: Draw and label a CBT triangle in the space below
High School Common Measures
Self-Regulation
Self-Awareness: Understanding
“If/Then Statements”
If __________________________________ happens then I feel happy.
If __________________________________ happens then I feel happy.
If __________________________________ happens then I feel happy.
If __________________________________ happens then I feel angry.
If __________________________________ happens then I feel angry.
If __________________________________ happens then I feel angry.
If __________________________________ happens then I feel nervous.
If __________________________________ happens then I feel nervous.
If __________________________________ happens then I feel nervous.
If __________________________________ happens then I feel sad.
If __________________________________ happens then I feel sad.
If __________________________________ happens then I feel sad.
If __________________________________ happens then I feel annoyed.
If __________________________________ happens then I feel annoyed.
If __________________________________ happens then I feel annoyed.
If __________________________________ happens then I feel excited.
If __________________________________ happens then I feel excited.
If __________________________________ happens then I feel excited.
If __________________________________ happens then I feel frustrated.
If __________________________________ happens then I feel frustrated.
If __________________________________ happens then I feel frustrated.
If __________________________________ happens then I feel depressed.
If __________________________________ happens then I feel depressed.
If __________________________________ happens then I feel depressed.
If __________________________________ happens then I feel motivated.
If __________________________________ happens then I feel motivated.
If __________________________________ happens then I feel motivated.
If __________________________________ happens then I feel defeated.
If __________________________________ happens then I feel defeated.
If __________________________________ happens then I feel defeated.
High School Common Measures
Self-Regulation
Self-Awareness: Applying
“How I respond to feelings” (page 1 of 2)
Complete the prompt “When I am feeling (emotion), I react by (behavior)”
When I am feeling ______________________________ ,
I react by _________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________.
When I am feeling ______________________________ ,
When I am feeling ______________________________ ,
I react by _________________________________________________________________
I react by _________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________.
__________________________________________________________________________.
High School Common Measures
Self-Regulation
Self-Awareness: Applying
“How I respond to feelings” (page 2 of 2)
Complete the prompt “When I am feeling (emotion), I react by (behavior)”
When I am feeling ______________________________ ,
I react by _________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________.
When I am feeling ______________________________ ,
When I am feeling ______________________________ ,
I react by _________________________________________________________________
I react by _________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________.
__________________________________________________________________________.
High School Common Measures
Self-Regulation
Self-Awareness: Creating/Evaluating/Analyzing
“How my past experiences impact my emotional reactions”
Past Experience:
How I reacted:
Long Term Effects:
Example: “Friend”
posted a secret I shared
with them on facebook.
Example: Shut down,
felt embarrassed, felt
angry
Example: Cautious in trusting
people, different group of
friends
1.
2.
3.
4.
5.
6.
Prediction for how I’d respond to a
situation now:
Example: Wouldn’t share personal
information with someone as
quickly.
High School Common Measures
Self-Regulation
Self-Management: Remembering
“Is ____ a coping strategy?”
Counselor asks “Is __________ a coping strategy?” and records responses in table below.
Strategy
1. Deep Breathing
Yes
Response
No
2. Talking to an adult
Yes
No
3. Counting forwards/
backwards
Yes
No
4. Listening to Music
Yes
No
5. Exercising
Yes
No
6. Meditating
Yes
No
7. Positive Thinking
Yes
No
8. Journal/ Write
Yes
No
9.
10.
Yes
Yes
No
No
Notes
High School Common Measures
Self-Regulation
Self-Management: Understanding
“Define Coping Strategy”
Counselor asks student to define “coping strategy” and checks off if they include the following targets:
Way to deal with stress
Positive / Negative reaction
Impacts Functioning
Different for each person
Yes
Yes
Yes
Yes
No
No
No
No
High School Common Measures
Self-Regulation
Self-Management: Applying
“10 Coping Strategies”
Strategy
1. Deep Breathing
2. Talking to an adult
3. Counting forwards/
backwards
4. Listening to Music
5. Exercising
6. Meditating
7. Positive Thinking
8. Journal/ Write
9.
10.
High School Common Measures
Self-Regulation
Self-Management: Creating/Evaluating/Analyzing
“Coping strategies in life situations”
Situation
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
What strategy would you use?
High School Common Measures
Self-Regulation
Problem-Solving: Remembering
“Strategies to respond to conflict” (page 1 of 2)
Generate a list of strategies utilized in response to past conflicts.
Strategies I have used in the past when faced with a conflict:
Reflection question: Were these strategies positive or negative?
High School Common Measures
Self-Regulation
Problem-Solving: Understanding
“Strategies to respond to conflict” (page 2 of 2)
Using the strategies on the first page, identify whether or not they helped solve the conflict.
Strategies I have used in the past when faced with
a conflict:
Was this strategy helpful?
(Answer yes/no with an explanation)
Reflection question: How might these strategies have impacted other people involved?
High School Common Measures
Self-Regulation
Problem-Solving: Applying, Creating/Evaluating/Analyzing
“Problem Solving Process”
1. Identify the Problem
Key Facts:
What?
Where?
When?
Who?
Desired Outcome:
2. Alternative Solutions
Action Steps:
3. Choose the Solution
What is my solution?
4. Evaluate the Outcome
Did I achieve my desired outcome?
What could I have done differently?
5. Prevention
What steps can I take to prevent the same problem from happening again?