Individual Counseling Check In Sheet

This is the sheet I use to determine how counseling is progressing with students I see individually. I record the date and meeting number then I ask "On a scale of 0-10 with 10 being outstanding and ) the pits, what number would you give School since we met last...Friends...Home..." For my students who shift between mom's and dad's home I note which place they are rating (and sometimes get 2 ratings). I love this scale that I download from R. Sabella's site  http://schoolcounselor.com/ I really believe in positive psychology and that we solve problems using our strengths so I then ask for 5 good things that have happened since out last meeting. It is good for students to focus on the positive because the ones I see individually already have plenty of negative thoughts. I try to use the term challenges rather than problems to determine what we need to discuss. Usually the challenges relate directly to the area of their life that is rated with the lowest number, but not always. If not that is something else I explore. I always have a stated goal students are working on with me and we jointly determine if that is still something they are willing to work on between sessions or if it needs to be revised. I do not show the students this sheet (its on a clipboard) but I would if asked. I want to see how their numbers and challenges change over the course of counseling. If a student would say all 10s for 2 sessions in a row and have no significant challenges, I'd be moving to terminate our work together in individual counseling.