Neftaly Therapeutic Psychosocial Support Programme

Client Evaluation File

This file is designed for:

✅ Department of Social Development (DSD)
✅ Psychosocial & Mental Health Programmes
✅ NGO/NPO Reporting & Funding Compliance
✅ Case Outcome Monitoring
✅ Evidence-Based Intervention Evaluation
✅ POPIA & Ethical Practice Compliance

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NEFTALY THERAPEUTIC PSYCHOSOCIAL SUPPORT PROGRAMME

CLIENT EVALUATION FILE

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SECTION 1: CLIENT EVALUATION COVER PAGE

Field	Information
Client Name
Client File Number
Programme Site
Practitioner
Case Manager
Evaluation Period
Date Evaluation Started
Date Evaluation Completed

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SECTION 2: BASELINE ASSESSMENT (ENTRY LEVEL)

Client Condition at Admission

Indicator	Poor	Moderate	Good
Emotional Stability	☐	☐	☐
Coping Ability	☐	☐	☐
Social Functioning	☐	☐	☐
Family Support	☐	☐	☐
Behaviour Control	☐	☐	☐
Mental Wellbeing	☐	☐	☐

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Presenting Challenges

☐ Trauma
☐ Anxiety
☐ Depression
☐ GBV
☐ Substance Abuse
☐ Grief & Loss
☐ Family Conflict
☐ Social Isolation
☐ Other: ___________

Practitioner Notes:

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SECTION 3: INTERVENTION TRACKING

Intervention Type	Frequency	Duration	Practitioner
Individual Counselling
Group Therapy
Crisis Intervention
Family Sessions
Referrals

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SECTION 4: MID-TERM CLIENT EVALUATION

Indicator	Improved	No Change	Declined
Emotional Regulation	☐	☐	☐
Stress Management	☐	☐	☐
Social Interaction	☐	☐	☐
Self-Esteem	☐	☐	☐
Behaviour Adjustment	☐	☐	☐

Comments:

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SECTION 5: CLIENT SELF-EVALUATION FORM

Client Feedback

Rate the following:

Statement	Poor	Fair	Good	Excellent
I feel emotionally supported	☐	☐	☐	☐
I can manage stress better	☐	☐	☐	☐
My relationships improved	☐	☐	☐	☐
I understand coping skills	☐	☐	☐	☐
Programme helped me	☐	☐	☐	☐

Client Comments:

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Client Signature: ___________________

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SECTION 6: FINAL OUTCOME EVALUATION

Outcome Indicator	Achieved	Partially	Not Achieved
Emotional Stability	☐	☐	☐
Trauma Recovery	☐	☐	☐
Improved Coping Skills	☐	☐	☐
Social Reintegration	☐	☐	☐
Reduced Risk Behaviour	☐	☐	☐

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SECTION 7: IMPACT ASSESSMENT

Measurable Changes Observed

Area	Before Programme	After Programme
Emotional Health
Behaviour
Family Relations
Community Participation
Mental Wellness

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SECTION 8: PRACTITIONER EVALUATION REPORT

Summary of Progress:

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Remaining Challenges:

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Recommendations:

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SECTION 9: CLIENT SATISFACTION SURVEY

Service Area	Very Satisfied	Satisfied	Neutral	Dissatisfied
Counselling Quality	☐	☐	☐	☐
Staff Professionalism	☐	☐	☐	☐
Confidentiality	☐	☐	☐	☐
Accessibility	☐	☐	☐	☐

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SECTION 10: CASE OUTCOME CLASSIFICATION

☐ Successfully Completed
☐ Improved Condition
☐ Referred for Specialized Care
☐ Ongoing Support Required
☐ Case Closed – Non Participation

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SECTION 11: FOLLOW-UP PLAN

Follow-Up Date	Method	Responsible Person	Notes

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SECTION 12: PROGRAMME EXIT APPROVAL

Practitioner Name: ______________________

Signature: ______________________________

Supervisor Name: _______________________

Signature: ______________________________

Date Closed: ____________________________

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SECTION 13: CONFIDENTIALITY DECLARATION

This evaluation file is confidential and protected under:

• Protection of Personal Information Act (POPIA)
• Social Service Ethical Guidelines
• Mental Health Confidentiality Standards

Authorized personnel access only.

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✅ Evaluation Timeline Recommended

Stage	Timing
Baseline Evaluation	Intake
Mid-Term Evaluation	3 Months
Final Evaluation	Programme Exit
Follow-Up Evaluation	3–6 Months After Exit

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✅ DSD & Funders Compliance Use

Supports:

• Outcome-Based Reporting
• Impact Measurement
• Psychosocial Programme Effectiveness
• Evidence for Funding Renewal
• Monitoring & Evaluation Audits

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✅ Recommended Filing Structure

Client Evaluation File
│
├── Baseline Assessment
├── Intervention Tracking
├── Mid-Term Evaluation
├── Client Feedback
├── Final Evaluation
├── Impact Assessment
├── Satisfaction Survey
└── Exit Approval

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