Social & Communication · SC-04
Assertive Communication Worksheet
Plan a clear message that reflects your goal, limits, preferred delivery, and backup choices.
Clinician-created · specialist review requiredFor clinician-facilitated use
This is a professional resource, not a child-facing online service. A licensed clinician or other qualified adult must determine suitability, explain and adapt the activity, and supervise its use. Do not direct a child to access this webpage independently or enter client information.
The full-resolution WebP includes print-safe margins and should be downloaded by an adult professional. Read the guidance below before using the page.
How to use it
- Describe the situation using as much or as little detail as you want.
- Choose your goal, feeling words, request, and boundary; there can be more than one workable message.
- Pick a delivery option and a backup plan that fit the context.
- You may revise, pass, or seek support before using the message.
Reflection prompts
- Which part of the message matters most to you?
- What would tell you to pause, change approach, or seek help?
Facilitator guidance
Treat passive, direct, indirect, and delayed responses as contextual strategies rather than moral categories. Help the participant distinguish a request from a limit and consider whether the recipient and setting are safe enough for direct communication.
Adaptations & accessibility
- Complete one section at a time or use sentence strips.
- Allow drawing, dictation, role-play, or AAC-supported composition.
- Use a fictional example before discussing a personal situation.
Professional-use review
Licensed-clinician review required before use; enhanced safeguarding review is required when the activity may involve coercion, abuse, or meaningful power imbalance.
