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Recovery High Follow-Up Evaluation Form

 

 Recovery High

A Cooperative Substance Abuse Intervention Program of BASES,
Charlevoix Probate Court & Boyne City Alternative Education



If you have a referral and would like additional information, please contact:
Danni Sherwood                                      Scott Kelly
       email                                                                    email
231-549-7760 x-22                                                231-547-1144

Recovery High Follow-Up Evaluation Form

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Person Filling out 
Form's Name: 		   Person Filling out Form's  Relationship to Teen: 
Person Filling out 
Form's Email: 		   Phone: 
Teen's Name:    Address: 
D.O.B.:    City: 
Age:    State: 
Dates in Phase One:    Zip: 
Completion Status:       
         
SCHOOL
1. I am attending school or have graduated. YES NO
2. My grades improved following Recovery High. YES NO
3. My attitude toward school improved following Recovery High. YES NO
       
LEGAL
4. I have had no legal charges or probation violations since completing Recovery High. YES NO
5. I have successfully completed probation. YES NO
6. My attitude toward the legal system improved following recovery high. YES NO
       
FAMILY
7. I returned to my home following Recovery High. YES NO
8. My relationships with family improved after Recovery High. YES NO
9. My attitude toward my family improved after Recovery High. YES NO
       
COMMUNITY
10. I participated in after care services or 12 step activities following Recovery High. YES NO
11. I have sober and drug free friends in my community. YES NO
12. My attitude toward my community has improved following Recovery High. YES NO
       
SUBSTANCE ABUSE
13. I have not used alcohol or drugs since leaving Recovery High. YES NO
14. I now know that I need to remain drug and alcohol free. YES NO
15. My attitude toward staying clean and sober has improved since Recovery High. YES NO
       
GENERAL
16. I followed my aftercare plan when I left Recovery High. YES NO
17. I am currently involved in recovery related activities. YES NO
18. I would recommend the Recovery High program for others. YES NO
19. Phase One of the Recovery High program was effective for me. YES NO
20. Recovery High was effective for my family. YES NO
       

OPEN ENDED QUESTIONS FOR FURTHER IN-DEPTH INFORMATION

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What do you feel was most effective for you in the Recovery High program?
 
What was the least effective for you?
 

In 10 words or less, how would you describe your experience in Phase One
of the Recovery High program?
 
In the first 6 months after Recovery High, how many days out of 180 do
you think you used alcohol or drugs?
 
In the past 6 months, how many days out of 180 do you think you
used alcohol or drugs?