APPENDIX B: NEEDS & RESOURCES ASSESSMENT PROFILE

Needs and Resources Assessment Profile - Sample One

Name:

Date of Birth:

Institutional Parole Officer:

Warrant Expiry Date:

Destination on Release:

1. Identification:

Do you have a valid driver's licence?

Birth Certificate?

Other forms of identification?

2. Living Arrangements:

Upon release, do you have a place to live?

Are you able to live on your own?

Can you cook?

Are you comfortable doing your own shopping?

Are you comfortable doing your own laundry?

Will you have adequate clothing (for the climate)?

3. Transportation:

Will you have your own transportation on release?

Will you be able to insure your vehicle?

Are you able to use public transportation at your destination?

4. Employment:

Upon release will you have a job to go to?

What work have you done in the past?

What would you enjoy doing?

Can you manage your own money?

Will you need social assistance?

Are planning to apply for a disability pension of any sort?

5. Education:

What education do you have?

Do you intend to pursue further studies?

Do you need to apply for a Student Loan?

6. Medical concerns:

Do you have Provincial Health Insurance coverage, or do you need to apply?

Do you have any specific (diagnosed) medical conditions?

Are you on medication (including methadone treatment)?

Do you have a family doctor?

7. Counselling Concerns:

Do you intend to seek counselling?

Do you need a referral?

Are depression, anger, grief, suicide relationships and/or sex matters of concern for you?

8. Do you have any outstanding legal concerns?

If there was a retraining order sought (e.g. S.810 CCC), what conditions would you be willing to live with?

What conditions would be most troublesome for you?

9. Free time:

How will you manage your free (leisure) time?

How have you managed this time in the past?

Do you have hobbies or recreational (including sports) interests?

10. Relationships:

What are your relationships with the following people like?

• Family
• Friends
• Neighbours
• Church and/or cultural groups
• Police
• Media

If you plan on living with or being in touch with family or friends you may find it helpful for us to contact them. They may even be interested in being part of your COSA.

Whose telephone numbers may we have?

11. Victim Concerns:

Will you have contact with any of your victims?

Will there be restrictions on your movements?

What were your offences?

Who were they against:

• Women?
• Men?
• Children?
• Male, female, both?
• Strangers?
• Family?
• Friends?

12. Relapse prevention plans:

What have you learned about relapse prevention for yourself?

What are the risk areas for you?

• Alcohol
• Drugs (preferred type)
• Both alcohol and drugs
• Solvents
• Limit setting
• Sexual behaviour
• Pornography
• Isolation
• Other

13. Resources:

What skills/gifts/interests do you bring to your release which you can share with friends in the COSA?

What are you able to contribute to the community upon your release?

Needs and Resources Assessment Profile - Sample Two

Name:

Date of Birth:

Institutional Parole Officer:

Warrant Expiry Date:

Destination on Release: