Child Development Services - Part C Indicator - Parent SurveyChild Development Services - Part C Indicator

1. Please indicate the name of the CDS site that you deal with.

	CDS SITE DROP DOWN MENU
CDS Site Drop Down Menu Selection	Please indicate the name of the CDS site that you deal with. CDS Site Drop Down Menu Selection CDS SITE DROP DOWN MENU

2. Over the past year; early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
participate in typical activities for children and families in my community	*Over the past year; early intervention has helped me and/or my family: participate in typical activities for children and families in my community Never	participate in typical activities for children and families in my community Rarely	participate in typical activities for children and families in my community Often	participate in typical activities for children and families in my community Always

3. Over the past year; early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
know about services in the community	*Over the past year; early intervention has helped me and/or my family: know about services in the community Never	know about services in the community Rarely	know about services in the community Often	know about services in the community Always

4. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
improve my family's quality of life	*Over the past year, early intervention has helped me and/or my family: improve my family's quality of life Never	improve my family's quality of life Rarely	improve my family's quality of life Often	improve my family's quality of life Always

5. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
know where to go for support to meet my child's needs	*Over the past year, early intervention has helped me and/or my family: know where to go for support to meet my child's needs Never	know where to go for support to meet my child's needs Rarely	know where to go for support to meet my child's needs Often	know where to go for support to meet my child's needs Always

6. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
know where to go for support to meet my family's needs	*Over the past year, early intervention has helped me and/or my family: know where to go for support to meet my family's needs Never	know where to go for support to meet my family's needs Rarely	know where to go for support to meet my family's needs Often	know where to go for support to meet my family's needs Always

7. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
get the services my child and family need	*Over the past year, early intervention has helped me and/or my family: get the services my child and family need Never	get the services my child and family need Rarely	get the services my child and family need Often	get the services my child and family need Always

8. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
feel more confident in my skills as a parent	*Over the past year, early intervention has helped me and/or my family: feel more confident in my skills as a parent Never	feel more confident in my skills as a parent Rarely	feel more confident in my skills as a parent Often	feel more confident in my skills as a parent Always

9. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
keep up friendships for my child and family	*Over the past year, early intervention has helped me and/or my family: keep up friendships for my child and family Never	keep up friendships for my child and family Rarely	keep up friendships for my child and family Often	keep up friendships for my child and family Always

10. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
make changes in our routines that benefit my child with special needs	*Over the past year, early intervention has helped me and/or my family: make changes in our routines that benefit my child with special needs Never	make changes in our routines that benefit my child with special needs Rarely	make changes in our routines that benefit my child with special needs Often	make changes in our routines that benefit my child with special needs Always

11. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
be more effective in managing my child's behavior	*Over the past year, early intervention has helped me and/or my family: be more effective in managing my child's behavior Never	be more effective in managing my child's behavior Rarely	be more effective in managing my child's behavior Often	be more effective in managing my child's behavior Always

12. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Ofrten	Always
do activities that are good for my child even in times of stress	*Over the past year, early intervention has helped me and/or my family: do activities that are good for my child even in times of stress Never	do activities that are good for my child even in times of stress Rarely	do activities that are good for my child even in times of stress Ofrten	do activities that are good for my child even in times of stress Always

13. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
understand how the early intervention system works	*Over the past year, early intervention has helped me and/or my family: understand how the early intervention system works Never	understand how the early intervention system works Rarely	understand how the early intervention system works Often	understand how the early intervention system works Always

14. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
feel I can get the services and support my child and family need	*Over the past year, early intervention has helped me and/or my family: feel I can get the services and support my child and family need Never	feel I can get the services and support my child and family need Rarely	feel I can get the services and support my child and family need Often	feel I can get the services and support my child and family need Always

15. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
be able to evaluate how much progress my child is making	*Over the past year, early intervention has helped me and/or my family: be able to evaluate how much progress my child is making Never	be able to evaluate how much progress my child is making Rarely	be able to evaluate how much progress my child is making Often	be able to evaluate how much progress my child is making Always

16. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
feel that my child will be accepted and welcomed in the community	*Over the past year, early intervention has helped me and/or my family: feel that my child will be accepted and welcomed in the community Never	feel that my child will be accepted and welcomed in the community Rarely	feel that my child will be accepted and welcomed in the community Often	feel that my child will be accepted and welcomed in the community Always

17. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
feel that my family will be accepted and welcomed in the community	*Over the past year, early intervention has helped me and/or my family: feel that my family will be accepted and welcomed in the community Never	feel that my family will be accepted and welcomed in the community Rarely	feel that my family will be accepted and welcomed in the community Often	feel that my family will be accepted and welcomed in the community Always

18. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
communicate better with the people who work with my child and family	*Over the past year, early intervention has helped me and/or my family: communicate better with the people who work with my child and family Never	communicate better with the people who work with my child and family Rarely	communicate better with the people who work with my child and family Often	communicate better with the people who work with my child and family Always

19. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
understand the roles of the people who work with my child and family	*Over the past year, early intervention has helped me and/or my family: understand the roles of the people who work with my child and family Never	understand the roles of the people who work with my child and family Rarely	understand the roles of the people who work with my child and family Often	understand the roles of the people who work with my child and family Always

20. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
do things with and for my child that are good for their development	*Over the past year, early intervention has helped me and/or my family: do things with and for my child that are good for their development Never	do things with and for my child that are good for their development Rarely	do things with and for my child that are good for their development Often	do things with and for my child that are good for their development Always

21. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
understand my child's special needs	*Over the past year, early intervention has helped me and/or my family: understand my child's special needs Never	understand my child's special needs Rarely	understand my child's special needs Often	understand my child's special needs Always

22. Over the past year, early intervention has helped me and/or my family:

	Never	Rarely	Often	Always
feel that my efforts are helping my child	*Over the past year, early intervention has helped me and/or my family: feel that my efforts are helping my child Never	feel that my efforts are helping my child Rarely	feel that my efforts are helping my child Often	feel that my efforts are helping my child Always

23. What is your current involvement with CDS

What is your current involvement with CDS My child has only been referred to CDS

My child is eligible for services

We are waiting for services to begin

We are receiving services

24. How old was your infant/toddler at the time you completed this survey?

How old was your infant/toddler at the time you completed this survey? Birth to 1 year

1-2 years

2-3 years

Over 3 years

25. old was your child when he or she was first referred to CDS?

old was your child when he or she was first referred to CDS? Birth to 6 months

6 months to 12 months

12 months to 18 months

18 months to 24 months

24 months to 30 months

26. Is your child a male or a female?

Is your child a male or a female? Male

Female

27. What is your child’s race / ethnicity?

What is your child’s race / ethnicity? White

African-American

Hispanic

Asian or Pacific Islander

American Indian/Alaskan Native

28. What is your relationship to the child?

What is your relationship to the child? Mother

Father

Guardian

Surrogate Parent

Foster Parent

Grandparent

29. Which statement best describes how well you understand your child’s development?

Which statement best describes how well you understand your child’s development? We are just starting to understand our child’s development.

We understand our child’s development a little, but still have a lot to learn.

We have a pretty good understanding of our child’s development.

We understand our child’s development very well.

30. How well do you know your rights and what to do if you are not satisfied?

How well do you know your rights and what to do if you are not satisfied? We aren’t sure about our rights or what to do if we aren’t satisfied.

We understand our rights but aren’t sure about options if we are not satisfied.

We think we know of our rights and what to do if we are not satisfied.

We know our rights well and know exactly what to do if we are not satisfied.

31. How much has early intervention helped you know and understand your rights?

How much has early intervention helped you know and understand your rights? It has not helped us know about our family’s rights.

It has done a few things to help us know about our rights.

It has provided good help so that we know our family’s rights.

It has done an excellent job of helping us know our family’s rights.

32. How would you describe your ability to help your child develop and learn?

How would you describe your ability to help your child develop and learn? We need to know a lot more about how to help our child develop and learn.

We know the basics of helping our child, but still have many questions.

We feel pretty sure that we know how to help our child develop and learn.

We are very sure that we know how to help our child develop and learn.

33. How much has early intervention helped your family be able to help your child develop and learn?

How much has early intervention helped your family be able to help your child develop and learn? It has not helped us help our child develop and learn.

b. It has done a few things to help us help our child develop and learn.

It has done a good job of helping us help our child develop and learn.

It has done an excellent job of helping us help our child develop and learn.