Neftaly Therapeutic Psychosocial Support Programme
Client Evaluation File
This file measures client progress, therapeutic outcomes, programme effectiveness, and impact, and is suitable for:
NEFTALY THERAPEUTIC PSYCHOSOCIAL SUPPORT PROGRAMME
CLIENT EVALUATION FILE
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 |
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 | ☐ | ☐ | ☐ |
Presenting Problems
☐ Trauma
☐ Gender-Based Violence
☐ Grief & Loss
☐ Family Conflict
☐ Substance Abuse
☐ Stress & Anxiety
☐ Depression
☐ Child Protection Concerns
☐ Other: ___________________
Practitioner Observations:
SECTION 3: SERVICE INTERVENTIONS RECEIVED
| Intervention | Frequency | Duration | Practitioner |
|---|---|---|---|
| Individual Counselling | |||
| Group Therapy | |||
| Crisis Intervention | |||
| Family Therapy | |||
| Psychoeducation | |||
| Referrals |
SECTION 4: MID-TERM PROGRESS EVALUATION
| Indicator | Improved | No Change | Worsened |
|---|---|---|---|
| Emotional Stability | ☐ | ☐ | ☐ |
| Stress Management | ☐ | ☐ | ☐ |
| Self-Confidence | ☐ | ☐ | ☐ |
| Behaviour Management | ☐ | ☐ | ☐ |
| Social Relationships | ☐ | ☐ | ☐ |
Progress Notes:
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:
Client Signature: ___________________
SECTION 6: FINAL OUTCOME EVALUATION
| Outcome Area | Achieved | Partially Achieved | Not Achieved |
|---|---|---|---|
| Emotional Recovery | ☐ | ☐ | ☐ |
| Trauma Stabilization | ☐ | ☐ | ☐ |
| Improved Coping Skills | ☐ | ☐ | ☐ |
| Family Functioning | ☐ | ☐ | ☐ |
| Social Reintegration | ☐ | ☐ | ☐ |
SECTION 7: COMPARATIVE PROGRESS ANALYSIS
| Psychosocial Area | Intake Status | Exit Status |
|---|---|---|
| Emotional Health | ||
| Behaviour | ||
| Mental Wellness | ||
| Social Participation | ||
| Risk Level |
SECTION 8: PRACTITIONER EVALUATION REPORT
Summary of Client Progress
Remaining Risks / Challenges
Professional Recommendation
☐ Case Closure
☐ Continued Support
☐ Referral Required
☐ Follow-Up Monitoring
SECTION 9: CLIENT SATISFACTION SURVEY
| Service Quality Area | Excellent | Good | Fair | Poor |
|---|---|---|---|---|
| Counselling Services | ☐ | ☐ | ☐ | ☐ |
| Staff Professionalism | ☐ | ☐ | ☐ | ☐ |
| Confidentiality | ☐ | ☐ | ☐ | ☐ |
| Accessibility | ☐ | ☐ | ☐ | ☐ |
SECTION 10: FOLLOW-UP PLAN
| Follow-Up Date | Method | Responsible Practitioner | Outcome |
|---|
SECTION 11: CASE OUTCOME CLASSIFICATION
☐ Successfully Completed
☐ Significant Improvement
☐ Partial Improvement
☐ Referred to Specialized Service
☐ Client Withdrawn
☐ Ongoing Case
SECTION 12: EXIT APPROVAL
Practitioner Name: _________________________
Signature: _________________________________
Supervisor Name: __________________________
Signature: _________________________________
Date Closed: _______________________________
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.
✅ Evaluation Timeline (Recommended)
| Evaluation Stage | Timeframe |
|---|---|
| Baseline | Intake |
| Mid-Term Review | 6–8 Weeks |
| Final Evaluation | Exit |
| Follow-Up | 3–6 Months |
✅ 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
