Peer Recovery Specialist ECHO (Wellness Wheel)

SAMHSA’s Four Dimensions of Recovery Wellness Wheel

To submit a case, fill out the form below.

Prefer to complete it in your own time? Download this form and email it to the contact listed on the form.

If you have any questions about this case form, please contact cward-freeman@spthb.org or lseabolt@spthb.org.

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Wellness Wheel

Health can be overcoming or managing one’s disease(s) or symptoms, and making informed, healthy choices that support physical and emotion well being. HOW IS HEALTH BEING IMPACTED?
Home is having a stable place to live. WHAT DOES HOME LOOK LIKE?
Purpose can be cultural, spiritual, ceremonial or religious practices, meaningful daily activities (job, school, volunteerism, family caretaking, creativity), independence (income/resources to participate in society). WHAT IS INFLUENCING PURPOSE?
Part of community is having relationships and social networks that provide support, friendship, love, and hope. WHAT DOES COMMUNITY LOOK LIKE RIGHT NOW?

Case Form adapted from the Indian Country ECHO UCLA Tribal MAT Clinic

By submitting this form, you have acknowledged that Project ECHO case consultations do not create or otherwise establish a provider-patient relationship between an ECHO clinician and any patient whose case is being presented in a teleECHO session. Always use Patient ID# when presenting a patient in clinic. Sharing patient name, initials or other identifying information violates HIPAA privacy laws.