End of course/quarterly group evaluation form
Name
Date
Course
This form aims to assist you in self-evaluating your progress and development whilst attending
peer support group work courses, support groups and activity groups. It is used to help provide
feedback, anonymously, to our funders about the outcomes and benefits of our work.
1.
How long have you been using peer support?
2.
Peer support has helped me to improve my mental health
Strongly Agree
Agree
Disagree
Strongly Disagree
In what ways?
3.
By attending peer support I am better able to manage emotional distress.
Strongly Agree
Agree
Disagree
Strongly Disagree
In what ways?
4.
Since using peer support I am more able to enjoy and achieve the things I want to
do
Strongly Agree
5.
Agree
Disagree
Strongly Disagree
Since using peer support my quality of life has:
Improved
Stayed the same
Got worse
Examples:
Copyright Leeds Mind
Version
Custodian
www.leedsmind.org.uk
2.01
Kathy Engler
Date
Status
Contact
11/7/16
Last agreed 5/7/16
0113 305 5803 [email protected]
6.
Peer support is a place where I feel safe and free from discrimination
Strongly Agree
7.
Strongly Disagree
Agree
Disagree
Strongly Disagree
Using peer support has helped me develop and maintain my dignity and respect
Strongly Agree
9.
Disagree
Since using peer support I feel I have more choice and control in my life
Strongly Agree
8.
Agree
Agree
Disagree
Strongly Disagree
Since using peer support group work, I have used other mental health services:
Less
About the same
more
10. Using peer support has helped me work towards returning to employment
(Only answer if you are looking for employment)
Strongly Agree
Agree
Disagree
Strongly Disagree
11.
Using peer support has helped me stay in employment
(Only answer if you are in paid employment)
Strongly Agree
Agree
Disagree
12.
Strongly Disagree
What will you do differently as a result of attending this peer support course?
13. Any other comments or feedback:
The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)
Name…………………………………..…………….. Date…………………………………….
Course ……………………………………………………………………..……………………...
This form aims to assist you in self-evaluating your progress and development whilst attending peer
support group work courses, and will be used to help provide feedback, anonymously, to our funders
about the outcomes and benefits of peer support group work.
Please tick the box that is closest to how you have felt over the last two weeks
Statement
None
of the
time
I’ve been feeling optimistic about
the future
I’ve been feeling useful
I’ve been feeling relaxed
I’ve been feeling interested in other
people
I’ve had energy to spare
I’ve been dealing with problems
well
I’ve been thinking clearly
I’ve been feeling good about myself
I’ve been feeling close to other
people
I’ve been feeling confident
I’ve been able to make up my own
mind about things
I’ve been feeling loved
I’ve been interested in new things
I’ve been feeling cheerful
End
Rarely
Some
of the
time
Often
Most of
the
time