PHB Outcome measure

PHB Outcome measure
Recovery goals/PHB Outcome
Referrer name*

First NameLast Name
Email address*
example@example.com
Review date*

DayMonthYear
Date
PHB holder name*

First NameLast Name
PHB package number*
NHS number*
Please tell us how much you agree or disagree with this statement:
"The Personal Health Budget has supported me to work towards my mental health recovery goal"**
Please tell us a little more about why you have selected the answer above**
Do you have further recovery goals you would like to be supported with*
Please detail*
Additional information
Is there anything else you wish to share about your Personal Health Budget experience?*
What if anything, would have made your PHB experience better or improved?*
Please select an outcome measure*
1 – Totally dissatisfied

2 – Very dissatisfied

3 – Fairly dissatisfied

4 – In the middle

5 – Fairly satisfied

6 – Very satisfied

7 – Totally satisfied
DIALOG+ monitoring
How satisfied are you with your mental health?*
How satisfied are you with your physical health?*
How satisfied are you with your job situation?*
How satisfied are you with your accommodation?*
How satisfied are you with your leisure activities?*
How satisfied are you with your relationship with your partner/family?*
How satisfied are you with your friendships?*
How satisfied are you with your personal safety?*
How satisfied are you with your medication?*
How satisfied are you with the practical help you receive?*
How satisfied are you with your meetings with mental health professionals?*
ReQoL/10 monitoring
Answer the questions in relation to last week.

1 – None of the time

2 – Only occasionally

3 – Sometimes

4 – Most of the time

5 – Most or all of the time
I found it difficult to get started with everyday tasks*
I felt able to trust others*
I felt unable to cope*
I could do the things I wanted to do*
I felt happy*
I thought my life was not worth living*
I enjoyed what I did*
I felt hopeful about my future*
I felt lonely*
I felt confident in myself*
Experience of the Personal Health Budget (optional)
Please tell us how much you agree or disagree with the following statements:
"I would recommend this service"*
"I was able to get what I needed to support my mental health recovery goal"*
"I felt I had choice and control over my recovery plan"*
"I benefited from what my personal health budget enabled me to do"*
Should be Empty:

PHB Outcome measure

Recovery goals/PHB Outcome

Additional information

DIALOG+ monitoring

ReQoL/10 monitoring

Experience of the Personal Health Budget (optional)