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Pilot Unpaid Carers Counselling Service

Feedback & Evaluation Form

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We’d really value your thoughts.

If you’ve used one of our services, please take a moment to share your feedback with us.

Your experience helps us learn what’s working well and where we can improve, so we can continue to provide the best possible support.

As a pilot service, the purpose of gathering this information is to provide evidence of the value of the unpaid carers counselling project.

 

Thank you for helping shape our service.

Counselling Service Evaluation Form

It is important to us to know what you thought about the service you received.  This feedback will help us make sure we keep delivering a service which meets the needs of people we work with.   



Please select the box which is closest to your answer

How satisfied were you with your Counsellor?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied were you with the service provided by the counsellor
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied are you that the confidentiality contract was fully explained and kept?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satified were you with the flexiblity of the counselling? (appointment times, days)
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied are you that you were listened to?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied are you that your needs were understood?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied are you that your needs were met?
Very Satisfied
Satisfied
Neutral
A bit
Not at all Satisfied
How satisfied were you with the number of sessions you had?
Very Satisfied
Some what
not really
Not at all
I felt that i could be myself
Strongly Agree
Agree
Disagree
Strongly Disagree
I felt like i understood myself better at the end
Strongly Agree
Agree
Disagree
Strongly Disagree
*I would recommend this service to others
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Please complete this section if you are exiting from ASSTBM Services
I have successfully dealt with the problems I wanted to
I need a break from services – I was finding it too hard right now
I don’t feel comfortable with the member of staff
I am no longer being forced to go
I feel I can deal with the problems myself
I don’t feel I was getting anywhere
I am now receiving support from a specialist service

Thank you for taking the time to complete this form. Your response is anonymous and confidential, however if you have raised any issues which you would like followed up, please insert your details below: 

Further Information

We recognise the current pressures on primary care in relation to all aspects of the work they do, not just in relation to ADHD.

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The intention of this service is not to create additional workload for GPs or other practitioners, but rather to reduce pressure arising from the increasing number of patients presenting with ADHD-related difficulties.

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The ADHD Support While Waiting Programme, early intervention service is designed specifically for adults who are awaiting ADHD assessment, awaiting follow-up from assessment, or attempting to access support. It is a non-clinical, psychoeducational and practical support programme, delivered by qualified practitioners, and aligned with NICE guidance.

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The core aim of the programme is to:

  • Support individuals experiencing functional difficulties (e.g. executive dysfunction, emotional regulation challenges)

  • Reduce distress, overwhelm, and burnout

  • Improve day-to-day functioning and engagement with services

  • Prevent escalation into crisis or higher-tier services

  • Provide psychotherapeutic education

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Importantly, this is not a diagnostic or assessment service, and participation does not require formal confirmation from primary care if the patient has the requested information.

 

Referral Process - 

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To ensure minimal impact on time, we have built in multiple alternative verification pathways, including:

  • Self-referral via QR code & evidence

  • Self-declaration supported through our triage process

  • Signposting by GP practice staff

  • HSC confirmation where available

  • GP letter - A template of which we provide

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This means that patients can access the service without any GP involvement if preferred.

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The funding requires that the patient/service user MUST have verifiable information of having been referred and or waiting on follow up for ADHD related support.

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This initiative to work alongside primary care and secondary care in a supportive capacity, rather than adding to existing pressures.

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We genuinely value the role of GPs and other medical practitioners.

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Downloadable Poster

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If you would like any further information, please feel free to get in touch via -

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info@asafespacetobeme.co.uk

02896 208284

Clinic Poster
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