Client Outcome Measure-Caregiver

(COM-P)

Name*

First Last

Today's Date*

Date of Final Session*

Caregiver*

Instructions:

Please help us understand what has changed since you counseling began. Some of the questions are about you, some are about your child, and some are about your family. Please use this scale to answer the questions below.

5 – Very much better

Most all of the things you, your child, or your family tried to change were successful. Things are very much better.

4 – A lot better

Many but not all of the things you, your child, or your family tried to change were successful. Things are a lot better

3 – Some better

Some of the things you, your child, or your family tried to change were successful. Things are somewhat better.

2 – Little better

Few of the things you, your child, or your family tried to change were successful. Things are a little better.

1 – No Change

The things you, your child, or your family tried to change are no different.

0 – Things are worse

The things you, your child, or your family tried to change are worse.

N/A Not Applicable

This was not an issue when counseling began and is not an issue now.

Please answer the following questions using the number from the scale above. Remember – answer according to how much has changed since you began counseling.

1. In general, how much has the family changed since beginning counseling?*

5 – Very much better
4 – A lot better
3 – Some better
2 – Little better
1 – No Change
0 – Things are worse

2. How much has the family changed its communication skills?*

5 – Very much better
4 – Aot better
3 – Some better
2 – Little better
1 – No Change
0 – Things are worse
N/A Not Applicable

3. How much has your child's behavior changed?*

5 – Very much better
4 – A lot better
3 – Some better
2 – Little better
1 – No Change
0 – Things are worse

4. How much have you changed your parenting skills?*

5 – Very much better
4 – A lot better
3 – Some better
2 – Little better
1 – No Change
0 – Things are worse
N/a Not Applicable

5. How much have you changed your ability to supervise your child ?*

5 – Very much better
4 – A lot better
3 – Some better
2 – Little better
1 – No Change
0 – Things are worse
N/A Not Applicable

6. How much change has occurred in the family conflict level?*

5 – Very much better
4 – A lot better
3 – Some better
2 – Little better
1 – No Change
0 – Things are worse
N/A Not Applicable

Please answer the following questions about change in your child’s behavior SINCE counseling began.

If the behavior was not a reason why you were referred to counseling, it is ok to use non-applicable. Use the same scale as above.

7. How much did your child’s illegal behavior improve?*

5- Very much better
4- A lot better
3- Some better
2- Little better
1- No Change
0- Things are worse
N/A Not Applicable

8. How much did your child’s runaway behavior improve?*

5- Very much better
4- A lot better
3- Some better
2- Little better
1- No Change
0- Things are worse
N/A Not Applicable

9. How much did your child’s school attendance improve?*

5- Very much better
4- A lot better
3- Some better
2- Little better
1- No Change
0- Things are worse
N/A Not Applicable

10. How much did your child’s school performance (e.g. grades, behavior) improve?*

5- Very much better
4- A lot better
3- Some better
2- Little better
1- No Change
0- Things are worse
N/A Not Applicable

11. How much did your child’s alcohol use improve?*

5- Very much better
4- A lot better
3- Some better
2- Little better
1- No Change
0- Things are worse
N/A Not Applicable

12. How much did your child’s drug use improve?*

5- Very much better
4- A lot better
3- Some better
2- Little better
1- No Change
0- Things are worse
N/A Not Applicable