Type: Individual
| Tools & Equipment | Materials |
|---|---|
| Similar chairs | Counselling forms: Termination summary form, Referral form, Consent form |
| Small-sized table | Assessment tools: Gottman Emotional Abuse Questionnaire, Cerretto Relationship Status Inventory |
| Box of tissues/serviettes | |
| Drinking water dispenser | |
| Cups | |
| Wall clock | |
| Wastepaper basket | |
| Stationery |
| S/N | Item | Quantity |
|---|---|---|
| 1 | Similar chairs | 3 chairs per candidate |
| 2 | Small-sized table | 1 table per candidate |
| 3 | Box of tissues/serviettes | 1 box per candidate |
| 4 | Drinking water dispenser | 1 dispenser per room |
| 5 | Cups | 3 cups per candidate |
| 6 | Wall clock | 1 clock per room |
| 7 | Wastepaper basket | 1 basket per candidate |
| 8 | Counselling forms: Termination summary form, Referral form, Consent form | 1 set per candidate |
| 9 | Assessment tools: Gottman Emotional Abuse Questionnaire, Cerretto Relationship Status Inventory | 1 set per candidate |
| 10 | Stationery: Pens and notebook | 2 pens and 1 notebook per candidate |
| Items to be Evaluated | Marks Available | Marks Obtained | Comments |
|---|---|---|---|
| TASK 1: Prepare Counselling Environment and Client Orientation | |||
| Set up counselling room with 3 similar chairs arranged 2 feet apart and small table appropriately placed (Award 2 marks if room arranged correctly; 0 if not) | 2 | ||
| Provide box of tissues, drinking water with 3 cups, wall clock, and wastepaper basket in the counselling room (Award 2 marks if at least 3 items provided; 0 if less) | 2 | ||
| Greet client appropriately, allow client to choose seat, invite self-introduction, use appropriate body language and tone (Award 3 marks if all steps done; 0 if partially done) | 3 | ||
| Sub-Total | 7 | ||
| TASK 2: Identification and Use of Assessment Tools and Counselling Forms | |||
| Identify and correctly fill Termination summary form, Referral form, and Consent form (Award 2 marks if all forms correctly identified and filled; 0 if not) | 2 | ||
| Identify and administer at least two assessment tools: Gottman Emotional Abuse Questionnaire and Cerretto Relationship Status Inventory (Award 2 marks if two tools identified and administered; 0 if less) | 2 | ||
| Sub-Total | 4 | ||
| TASK 3: Conduct Termination Interview | |||
| Explain purpose of termination session and counselling standards to client (Award 2 marks if clearly explained; 0 if not) | 2 | ||
| Highlight key issues discussed during counselling (Award 2 marks if key issues clearly summarized; 0 if not) | 2 | ||
| Negotiate next steps: referral or booking next session based on client needs (Award 2 marks if appropriate referral or next session booked and referral form presented if applicable; 0 if not) | 2 | ||
| Use appropriate counselling skills during interview: active listening, paraphrasing, summarizing (Award 2 marks if all skills used effectively; 0 if partially or not used) | 2 | ||
| Sub-Total | 8 | ||
| TASK 4: Evaluate Counselling and Obtain Client Feedback | |||
| Obtain client feedback on counselling relationship, support, and willingness to continue (Award 1 mark if client feedback obtained; 0 if not) | 1 | ||
| Identify and document two areas of strength in counselling process (Award 1 mark each for 2 areas identified; 0 if less) | 2 | ||
| Identify and document two areas needing improvement (Award 1 mark each for 2 areas identified; 0 if less) | 2 | ||
| Sub-Total | 5 | ||
| PRODUCT CHECKLIST | |||
| Termination summary form correctly filled with key issues, client feedback, and next steps documented (Award 2 marks if form fully completed and accurate; 0 if incomplete) | 2 | ||
| Referral form correctly filled and signed if referral was made (Award 1 mark if referral form correctly completed and presented; 0 if not) | 1 | ||
| Sub-Total | 3 | ||
| GRAND TOTAL | 27 | ||
Type: Individual
| Tools & Equipment | Materials |
|---|---|
| Blue ballpoint pens | Couples' Intake Form |
| A4 ruled notebook | Consent Form |
| Computer with word processing software | Referral Form |
| Gottman Emotional Abuse Questionnaire | |
| Cerretto Relationship Status Inventory | |
| Sample client counselling case notes |
| S/N | Item | Quantity |
|---|---|---|
| 1 | Counselling Forms: Couples' Intake Form, Consent Form, Referral Form | 1 set per Candidate |
| 2 | Assessment Tools: Gottman Emotional Abuse Questionnaire, Cerretto Relationship Status Inventory | 1 set per Candidate |
| 3 | Writing materials: 2 blue ballpoint pens, 1 A4 ruled notebook | 1 set per Candidate |
| 4 | Sample client counselling case notes and session summaries | 1 set per Candidate |
| 5 | Computer with word processing software or typewriter | 1 per Candidate |
| Items to be Evaluated | Marks Available | Marks Obtained | Comments |
|---|---|---|---|
| TASK 1: Prepare Termination Summary Report | |||
| Reviewed all client case notes and counselling forms for accuracy and completeness (Award 3 marks if reviewed all required documents or 0 if incomplete) | 3 | ||
| Summarized presenting issues, counselling goals, and interventions applied (Award 4 marks if summary is clear, concise, and comprehensive or 0 if incomplete) | 4 | ||
| Documented client progress and outcomes achieved during counselling (Award 4 marks if progress and outcomes are well documented or 0 if missing) | 4 | ||
| Included evaluation feedback from client and counsellor reflections (Award 3 marks if feedback and reflections are included or 0 if missing) | 3 | ||
| Outlined termination process including referrals or follow-up plans (Award 3 marks if termination and referral details are clearly stated or 0 if missing) | 3 | ||
| Prepared report in a professional format with correct grammar and spelling (Award 3 marks if report is professionally presented or 0 if poorly presented) | 3 | ||
| Sub-Total | 20 | ||
| PRODUCT CHECKLIST | |||
| Termination summary report is complete, clear, and meets the 1500-word requirement (Award 5 marks if report is complete and meets length or 0 if incomplete or too short) | 5 | ||
| Report accurately reflects client issues, counselling process, outcomes, and termination (Award 5 marks if report reflects all key elements accurately or 0 if missing elements) | 5 | ||
| Sub-Total | 10 | ||
| GRAND TOTAL | 30 | ||