JJRconsulting

Massachusetts Department of Public Health

Coaching, Training and Crisis Support

One short form for three needs: support for yourself, support for someone you supervise, or support for a team, unit or program. Answer one question to begin, then complete only the part that fits you.

Justice the Aim. Equity the Core. Belonging the Outcome.
Service Request Form  |  Document Owner: Jenna Roberts, JJRconsulting
Prepared for the Massachusetts Department of Public Health  |  Date prepared: June 23, 2026
Status: Draft for Vienna Rothberg review and approval  |  Foundation: Operationalizes Decision Memo 1, Equity-Grounded Intake Principles

How Your Request Moves

This request is step one of five. Complete only the sections that match your request, then return the form.

  1. Submit this request form.You are here
  2. The request is matched to providers who fit the specific need and sent back to you for review.
  3. You review the matched options and provider bios and reply to email with selection or request for call(s).
  4. A 15-minute chemistry call, if desired, to check the fit before anything is finalized.
  5. Scope developed, start date is finalized and support begins, shaped around your (of staff) needs.
Your privacy. What you write about yourself is private and only used for the purposes of matching your need with the right provider partner(s). Supervisors do not see what staff members write about themselves and provider partners see only what you choose to share.
Start here

Who Is This Request For?

Choose one. The form will show you only the sections you need.

Section 2

About You

The person submitting this request. Everyone on this path completes this section.

About these details. Your name and contact go to the matching system so the right support can reach you. Your matched coach or trainer receives your name and contact only after you have selected them.

Optional.

Time of day and/or day of week.

How soon do you hope support can begin?
Section 3

Your Request for Yourself

Tell us what you are working toward. There are no wrong answers here.

What is happening, or what would you like to work on?

What do you want to be able to do, feel or handle differently?

What kind of support are you drawn to?

Check all that apply, or leave blank and we will suggest.

How would you like the support structured?

Check all that apply.

Format preference

For example interpretation, captioning or materials in a specific format.

Next, Section 6 lets you note any personal preferences for who you are matched with. It is voluntary and in your control.
Section 4

Your Request for Someone You Supervise

Complete this if you are a supervisor requesting support for a staff member.

Before you begin. The staff member you are requesting support for will receive a copy of what you write here and will be invited to complete their own portion, Sections 5 and 6. Name the outcome you are hoping for and the strengths this person brings, so the request supports their growth.

So they can be invited to complete their portion.

Describe the situation and what you hope support will help this person move toward.

Is this staff member in a bargaining unit?

For bargaining unit staff, some engagements are framed and billed as training or facilitation rather than coaching, in keeping with DPH contracts. The system applies the correct framing automatically.

Have you spoken with this staff member about requesting support?
What happens next. Once you submit, your staff member receives their own short portion to complete, Sections 5 and 6. Their answers shape the match and stay private to the matching system. You do not see what they write about themselves.
Section 5

Your Portion of the Request

Your supervisor has requested support for you. This section is yours. Your answers are private to the matching system and shape the options that are surfaced. You choose among the options that result.

How would you prefer the support be structured?

Check all that apply.

Format preference
Next, Section 6 lets you note any personal preferences for who you are matched with. It is voluntary and never visible to your supervisor.
Section 6

Personal Preferences for Your Match

Completed by the person who will receive the support. Everything here is voluntary, private to the matching system and never visible to your supervisor. You decide what to share and how much it should matter. Identity here is what you say it is. Use whatever words fit you.

Are there qualities you would value in the person who supports you?

Check all that apply.

Would you like shared identity or lived experience considered in your match?

The questions below are open for you to use. Answer only what matters to you and skip anything you would rather not share.

Tell us in your own words

For each area that matters to you, describe yourself however you choose and tell us whether you would like a coach or trainer who shares that identity. Leave blank anything you would rather not answer.

In your own words, and as specific as you like.

Would you like a coach or trainer who shares this?
Would you like a coach or trainer who shares this?
Would you like a coach or trainer who shares this?

In whatever words fit you.

Would you like a coach or trainer who shares this?

We can prioritize a coach who is fluent in this language.

Would you like a coach or trainer who shares this?

For example caregiving, immigrant or refugee experience, first-generation professional, veteran or military connected, a faith community that matters to you, or navigating the workplace as a member of an underrepresented group. In your own words.

Would you like a coach or trainer who shares this?
Section 7

Your Request for a Team, Unit or Program

Complete this if you are requesting support for a group working together.

Describe the situation and the kind of support that would help.

What kind of support are you thinking of?

Check all that apply, or leave blank and we will suggest.

Does this team include bargaining unit staff?

Where bargaining unit staff are involved, the engagement is framed as training or facilitation rather than coaching, in keeping with DPH contracts.

For example interpretation, captioning, materials in a specific format or physical space.

How team support is designed: the listening session. Before the scope of work is finalized, the team being served is invited to a brief, voluntary 30-minute listening session. The team is asked what support would feel useful and what would not, whether there are any concerns about how the request is set up, and what preferences the team has about format, pace and who facilitates. What the team says shapes the final design. This is how we make sure support is built with the people it is for, not only for them.

Before You Send

A quick check so your request moves smoothly.

Where to send this form. Return your completed form to Erica Briggs, Senior Project Manager at JJRconsulting. If you have questions before you submit, reach out to Erica and someone will walk you through it.

Thank you. Asking for support, for yourself, for someone you supervise or for a team, is a strength. This system exists to make that ask easy and the match a good one.

© 2025 to 2026 Jenna Roberts, JJRconsulting. All rights reserved.