Nb Conducted by phone [] or face to face []. Completed by ............ [insert name] |
As a follow up to the recent family meeting we are interested in finding out how things are for you at the moment. Before the family meeting |
You nominated: |
................................................................................................................................................................. |
as the main problem to be discussed at the family meeting, and |
................................................................................................................................................................. |
as your second greatest problem. |
How upset/worried are you about this problem (or these problems) at the present time? (Place a cross on the line)
|
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(1) Not at all |
As worried as I could possibly be (10) |
How often do these problems happen? (Place a cross on the line)
|
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(1) Not at all |
All the time (10) |
How much is the problem (or problems) interfering in your life? (Place a cross on the line)
|
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(1) Not at all |
Dominating my life completely (10) |
In what ways?........................................................................................................................................... |
How confident do you feel in dealing with the problem(s)? (Place a cross on the line)
|
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(1) Not at all |
Extremely (10) |
You nominated the following questions as those you would like addressed in the family meeting: |
................................................................................................................................................................. |
To what extent do you feel these questions were addressed? |
................................................................................................................................................................. |
Office use only: |
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|
|
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Pre-session |
Post-session |
Difference |
How upset/worried: |
........................ |
........................ |
........................ |
Problem frequency: |
........................ |
........................ |
........................ |
Life interference: |
........................ |
........................ |
........................ |
Confidence: |
........................ |
........................ |
........................ |