Post-Session Report Form

Note: This form is a modified version of the forms from the Formative Program Evaluation Procedure
that appears in Peterson and Stumbo (2000) on pages 304-306.
Students Name: __Rachel Sitek_____________ Date of Implementation: _11-19-14_____________
Program Title: ___Word Game and Bucket List __________________________________________
Initials of Clients Present: _S.D., H.R., S.S., J.R., A.H., M.J., N.W. __________________________
Initials of Clients Absent: ___________________________________________________________
Was the session implemented as planned? If not describe changes and related rationale for them.
Yes, the session was implemented as planned. The participants were more engaged in it than I was
expecting though.
Were these changes effective? Explain.
No changes.
How effective were the activities used in enabling the clients to meet the predetermined goals and
objectives? Address each goal individually.
1. To increase communication skills
a. By the end of the session, each participant will have shared at least 2 stories with the
group, as judged by staff.
i. Each participant shared two stories with the group and each student shared one.
Everybody was willing to participate and nobody gave me a hard time about it.
b. Throughout the session, participants will practice turn-taking during conversations, as
judged by staff.
i. Throughout the first section of the program, the word game, not only did each
participant share stories when it was their turn, but they asked questions and
made comments at the appropriate time as well. People were quiet while others
were talking and were very encouraging of one another.
2. To increase executive functioning.
a. Throughout the session, participants will use their shot-term and long-term memory to
reflect on the past in order to share past experiences, as judged by staff.
i. Each participant was able to reflect back and tell two stories from their past.
Some of these stories were pretty recent and others were from a long time ago.
The participants were able to recall many details for their stories.
3. To increase self-awareness.
a. By the end of the session, each participant will become aware of how their past
experiences have influenced the person they are today, as judged by staff.
i. Each participant reflected on their past and talked about it, but Im not so sure
that they became aware of how these experiences have influenced the person they
are today. I think that this was my fault though because I forgot to ask how this
has had an effect.
b. By the end of the session, each participant will become aware of at least 2 goals they
have for the future, as judged by staff.

i. Most participants wrote down and discussed at least 2 goals that they have for
themselves and their future. However, H.R. stated that she has done everything
she wants to do and just wants to live in peace and didnt come up with any goals
for herself. There were a variety of goals. Some participants had career goals,
some had medical goals, and some had leisure goals.

How appropriate were staff interactions or intervention strategies? Explain.

For the majority of the intervention staff interaction was appropriate. Student therapists helped out when
needed and even shared stories with the group as well. At one point though, N.W. began crying. Because I
was standing behind him and couldnt see his face, I thought he was done speaking at one point and was
going to move on before other staff members let me know that he wasnt done and he just needed a
minute. I thought this was very helpful because I did not mean to cut him off but from my perspective I
thought he was done speaking.
Did the sequence of activities appear to be logical and appropriate? If not, what changes would you
make?
Yes. The first activity reflected on the past. Next, I talked about the importance of goal setting and
followed with the bucket list activity. I thought it was good to first reflect on the past and then move onto
the future.
Was the amount of time allowed sufficient for client achievement of program goals and objectives? Please
explain.
Yes, the amount of time ended up working out. I ended the session about 5 minutes early, but I thought
that this was acceptable.

Were planned resources available? Explain.

Yes, I was bringing all the resources I needed.
Describe any unanticipated events or outcomes.
I wasnt really sure how the participants would respond to this activity, but they responded pretty well.
Everybody was willing to share with the group and I thought it was really good that we were able to do
this activity in a large group rather than in smaller groups. I also did not anticipate anybody getting very
emotional. I thought that because I purposely came up with positive words that all of the stories would be
good and make everybody smile.
Additional comments: