Neftaly Therapeutic Psychosocial Support Programme

Client Evaluation File

This file measures client progress, therapeutic outcomes, programme effectiveness, and impact, and is suitable for:

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NEFTALY THERAPEUTIC PSYCHOSOCIAL SUPPORT PROGRAMME

CLIENT EVALUATION FILE

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SECTION 1: CLIENT DETAILS

Item	Information
Client Name & Surname
Client File Number
ID Number
Gender
Age
Programme Site
Practitioner
Case Manager
Referral Source
Date Admitted
Evaluation Period

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SECTION 2: BASELINE CLIENT ASSESSMENT (ENTRY EVALUATION)

Psychosocial Functioning at Intake

Indicator	Severe Concern	Moderate Concern	Stable
Emotional Wellbeing	☐	☐	☐
Anxiety Level	☐	☐	☐
Depression Symptoms	☐	☐	☐
Behaviour Control	☐	☐	☐
Social Interaction	☐	☐	☐
Family Support	☐	☐	☐
Coping Skills	☐	☐	☐

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Presenting Problems

☐ Trauma
☐ Gender-Based Violence
☐ Grief & Loss
☐ Family Conflict
☐ Substance Abuse
☐ Stress & Anxiety
☐ Depression
☐ Child Protection Concerns
☐ Other: ___________________

Practitioner Observations:

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SECTION 3: SERVICE INTERVENTIONS RECEIVED

Intervention	Frequency	Duration	Practitioner
Individual Counselling
Group Therapy
Crisis Intervention
Family Therapy
Psychoeducation
Referrals

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SECTION 4: MID-TERM PROGRESS EVALUATION

Indicator	Improved	No Change	Worsened
Emotional Stability	☐	☐	☐
Stress Management	☐	☐	☐
Self-Confidence	☐	☐	☐
Behaviour Management	☐	☐	☐
Social Relationships	☐	☐	☐

Progress Notes:

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SECTION 5: CLIENT SELF-ASSESSMENT

Client Feedback Rating

Statement	Strongly Disagree	Disagree	Agree	Strongly Agree
I feel emotionally stronger	☐	☐	☐	☐
I can cope better with stress	☐	☐	☐	☐
My relationships improved	☐	☐	☐	☐
Counselling helped me	☐	☐	☐	☐
I feel supported	☐	☐	☐	☐

Client Comments:

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Client Signature: ___________________

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SECTION 6: FINAL OUTCOME EVALUATION

Outcome Area	Achieved	Partially Achieved	Not Achieved
Emotional Recovery	☐	☐	☐
Trauma Stabilization	☐	☐	☐
Improved Coping Skills	☐	☐	☐
Family Functioning	☐	☐	☐
Social Reintegration	☐	☐	☐

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SECTION 7: COMPARATIVE PROGRESS ANALYSIS

Psychosocial Area	Intake Status	Exit Status
Emotional Health
Behaviour
Mental Wellness
Social Participation
Risk Level

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SECTION 8: PRACTITIONER EVALUATION REPORT

Summary of Client Progress

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Remaining Risks / Challenges

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Professional Recommendation

☐ Case Closure
☐ Continued Support
☐ Referral Required
☐ Follow-Up Monitoring

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SECTION 9: CLIENT SATISFACTION SURVEY

Service Quality Area	Excellent	Good	Fair	Poor
Counselling Services	☐	☐	☐	☐
Staff Professionalism	☐	☐	☐	☐
Confidentiality	☐	☐	☐	☐
Accessibility	☐	☐	☐	☐

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SECTION 10: FOLLOW-UP PLAN

Follow-Up Date	Method	Responsible Practitioner	Outcome

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SECTION 11: CASE OUTCOME CLASSIFICATION

☐ Successfully Completed
☐ Significant Improvement
☐ Partial Improvement
☐ Referred to Specialized Service
☐ Client Withdrawn
☐ Ongoing Case

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SECTION 12: EXIT APPROVAL

Practitioner Name: _________________________

Signature: _________________________________

Supervisor Name: __________________________

Signature: _________________________________

Date Closed: _______________________________

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SECTION 13: CONFIDENTIALITY & POPIA DECLARATION

All information contained in this evaluation file is confidential and protected under:

• Protection of Personal Information Act (POPIA)
• Social Service Ethical Codes
• Mental Health Care Standards

Access restricted to authorised personnel only.

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✅ Evaluation Timeline (Recommended)

Evaluation Stage	Timeframe
Baseline	Intake
Mid-Term Review	6–8 Weeks
Final Evaluation	Exit
Follow-Up	3–6 Months

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✅ Client Evaluation File Divider Structure

Client Evaluation File
│
├── Client Details
├── Baseline Assessment
├── Intervention Record
├── Mid-Term Evaluation
├── Client Feedback
├── Final Outcome
├── Practitioner Report
├── Follow-Up Plan
└── Exit Approval

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