Client Exit Evaluation Form Name Date of Birth Gender Date of Evaluation Evaluator's Name Section 1: Review of Initial Assessment Initial Level of Socialization Skills: Response to Name Eye Contact Initiating Interaction Responding to Interaction Playing/Working in Groups Turn-Taking in Conversations Understanding Social Cues Primary Goals at Program Start Section 2: Current Social Interaction Skills Eye Contact Eye Contact Improved Same Declined Initiating Interaction Initiating Interaction Improved Same Declined Responding to Interaction Responding to Interaction Improved Same Declined Playing/Working in Groups Playing/Working in Groups Improved Same Declined Understanding Social Cues (e.g., body language, facial expressions) Understanding Social Cues (e.g., body language, facial expressions) Improved Same Declined Turn-Taking in Conversations Turn-Taking in Conversations Improved Same Declined Section 3: Current Communication Skills Expressing Needs and Want Expressing Needs and Want Improved Same Declined Using Appropriate Volume and Tone Using Appropriate Volume and Tone Improved Same Declined Understanding Instructions Understanding Instructions Improved Same Declined Engaging in Back-and-Forth Conversation Engaging in Back-and-Forth Conversation Improved Same Declined Using and Understanding Gestures Using and Understanding Gestures Improved Same Declined Section 4: Behavioral Observations Repetitive Behaviors Repetitive Behaviors Reduced Same Increased Anxiety in Social Situations Anxiety in Social Situations Reduced Same Increased Avoidance of Social Situations or Activities Avoidance of Social Situations or Activities Reduced Same Increased Specific Triggers or Challenges Noted During Social Interactions Section 4: Behavioral Observations New Skills Acquired During the Program Progress Toward Initial Goals Client's Strengths Areas for Continued Improvement Section 6: Client and Family Feedback Feedback From Client: What did you enjoy most about the program? What was the most challenging part of the program? What skills do you feel you have improved the most? Feedback From Client: How do you perceive the client's progress in socialization skills? What changes have you noticed at home or in social settings? Are there any additional comments or suggestions? Section 7: Future Recommendations Recommended Next Steps Suggestions for Further Support or Programs 12 + 13 = Submit
