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Exit Assessment (Final Session)

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Mental Wellbeing & Symptoms

Q2. I’ve been feeling optimistic about the future (single choice)

Question Settings ▼ ▲

Hide this question

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q3. I’ve been feeling cheerful (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q4. I’ve been feeling relaxed (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q5. I’ve been dealing with problems well (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q6. I've been thinking clearly (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q7. I’ve been feeling close to other people (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q8. I’ve been able to make up my own mind about things (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q9. I have felt tense, anxious or nervous (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q10. I have felt I have someone to turn to for support when needed (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q11. I have felt able to cope when things go wrong (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q12. Talking to people has felt too much for me (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q13. I have felt panic or terror (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q14. I have made plans to end my life (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q15. I have had difficulty getting to sleep or staying asleep (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q16. I have felt despairing or hopeless (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q17. I have felt unhappy (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q18. Unwanted images or memories have been distressing me (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Coping & Self-Management

Q20. Coping Skills Confidence (single choice)

Question Settings ▼ ▲

How confident are you using coping strategies when you're struggling?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q21. Can Identify Triggers (single choice)

Question Settings ▼ ▲

How well can you identify what triggers your difficult feelings or thoughts?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q22. Can Ask for Help (single choice)

Question Settings ▼ ▲

How comfortable are you asking for help when you need it?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q23. Has Self-Care Routine (single choice)

Question Settings ▼ ▲

How consistently do you practice self-care activities that help your wellbeing?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Hope & Recovery

Q25. Hope for Recovery (single choice)

Question Settings ▼ ▲

How hopeful do you feel about your recovery and future?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q26. Belief in Ability to Cope (single choice)

Question Settings ▼ ▲

How much do you believe you can cope with challenges in your life?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q27. Sense of Control (single choice)

Question Settings ▼ ▲

How much control do you feel you have over your mental health?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Social Connection

Q29. Social Connection (single choice)

Question Settings ▼ ▲

How connected do you feel to other people (friends, family, community)?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q30. Reduced Loneliness (single choice)

Question Settings ▼ ▲

How often do you feel lonely?

1 2 3 4 5 6 7 8 9 10
Always Never

Dropdown List used: Knows Neighbors

Q31. Has Support Network (single choice)

Question Settings ▼ ▲

Do you have people you can turn to for support when needed?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Medium-term Outcomes

Q33. Confidence in Self-Management (single choice)

Question Settings ▼ ▲

How confident do you feel managing your mental health day-to-day?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q34. Knows When to Seek Help (single choice)

Question Settings ▼ ▲

How confident are you recognizing when you need professional help?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q35. Relapse Prevention

Question Settings ▼ ▲

Do you have a plan for what to do if your mental health deteriorates?

Yes No

Q36. Engaging in Hobbies/Interests (single choice)

Question Settings ▼ ▲

Are you regularly doing activities or hobbies that you enjoy?

Yes regularly Yes occasionally No

Dropdown List used: Engaging in Hobbies/Interests

Q37. Has Sense of Purpose (single choice)

Question Settings ▼ ▲

How much do you feel your life has purpose and meaning?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Ongoing Wellbeing Plan

Q39. Using Community Resources (single choice)

Question Settings ▼ ▲

What are you using to support your wellbeing now?

Peer support group Self-help resources Exercise/physical activity Creative activities Volunteering Faith community Social groups Nothing specific Other

Dropdown List used: Using Community Resources

Q40. What support, if any, will you access going forward? (single choice)

Question Settings ▼ ▲

What support, if any, will you access going forward?

GP NHS mental health services Another voluntary service Peer support Self-managing Other

Dropdown List used: What support, if any, will you access going forward?

Q41. Please specify (Text)
This question will appear once within your story or survey response. Hidden Unless Other is selected in Q40 What support, if any, will you access going forward?

Experience Feedback

Q43. Overall, how would you rate your experience with our service? (single choice)

Question Settings ▼ ▲

Overall, how would you rate your experience with our service?

1 2 3 4 5

Dropdown List used: Overall, how would you rate your experience with our service?

Q44. How much has this support helped you? (single choice)

Question Settings ▼ ▲

How much has this support helped you?

1 2 3 4 5 6 7 8 9 10
Not at all Life-changing

Dropdown List used: Knows Neighbors

Q45. What was most helpful about the support you received? (Text)
This question will appear once within your story or survey response.

Q46. What could we improve? (Text)
This question will appear once within your story or survey response.

Q47. Would you recommend this service to others? (single choice)

Question Settings ▼ ▲

Would you recommend this service to others?

Yes Maybe No

Dropdown List used: Would you recommend this service to others?

Exit Status (Staff-recorded)

Q49. Reason for exit (single choice)

Question Settings ▼ ▲

Reason for exit

Completed planned support Stepped down (ready to end early) Stepped up (referred to more intensive service) Disengaged/dropped out Moved away Other

Dropdown List used: Reason for exit

Q50. Please specify (Text)
This question will appear once within your story or survey response. Hidden Unless Other is selected in Q49 Reason for exit

Q51. Total sessions attended

Question Settings ▼ ▲

Total sessions attended



Q52. Program completion rate (% of planned sessions attended)

Question Settings ▼ ▲

Program completion rate (% of planned sessions attended)



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