Special Needs Parent SurveySpecial Needs Parent Survey

Broward County Survey: The 2-1-1 Broward Special Needs Hotline provides FREE comprehensive information and referrals to over 500 social service programs for children and youth with Special Needs. Please take a moment to complete this brief questionnaire in order to share your thoughts and help identify specific programs and services in Broward County that you've found to be most helpful in accommodating children with physical and/or developmental disabilities.

Call a Special Needs Counselor at 2-1-1 or 954-537-0211 for assistance or referrals.
For more info visit: www.211-broward.org/specialneeds.htm

Thank you for your time and consideration.

1. Have you contacted the 2-1-1 Broward Special Needs Hotline in the past 12 months?

Have you contacted the 2-1-1 Broward Special Needs Hotline in the past 12 months? Yes

Comment (Optional)

2. What is the primary disability of your child or young adult (age 0-22)?

What is the primary disability of your child or young adult (age 0-22)?

Other or Additional Disability

3. What do you feel is the one (1) major obstacle to providing effective care to children and young adults with special needs?

What do you feel is the one (1) major obstacle to providing effective care to children and young adults with special needs? A need for Before / After Care / Summer Camp / Out-of-School Services

School Issues (Such as problems in school system related to services, educators, accommodations, etc.)

Need for Medical Care (Such as health insurance issues, therapies, finding doctors and other health / dental services).

Need for transportation for my child.

Lack of Training and Knowledge by Service Providers and Professionals

Discrimination (Such as being treated unfairly because of disability)

Need for Respite Care

Jobs / Vocational and Transitional Supports for young adults

Social / Recreational Needs

Education, training or finding a tutor

Financial Issues (Such as difficulty paying mortgage /rent /utility bills /providing food)

Other, please specify.

Comments (Optional)

4. Do you find your child or young adult's physician and / or medical professional knowledgeable about their disability?

Do you find your child or young adult's physician and / or medical professional knowledgeable about their disability? Yes

5. Can you identify a Medical Professional, Physician, or Dental Provider that you feel is most helpful in serving individuals with special needs? Please share their contact info. Also, are there any additional programs or services that you found helpful? Please include their contact information if available.

Can you identify a Medical Professional, Physician, or Dental Provider that you feel is most helpful in serving individuals with special needs? Please share their contact info. Also, are there any additional programs or services that you found helpful? Please include their contact information if available.

6. Select One: How would you rate the quality of the following services for you and your child in Broward County?
[Excellent]-My needs are completely met in this area. || [Moderate]-Some improvement is needed || [Poor]-Help and improvement are needed in this area. || [N/A]-Does not apply.

	Excellent	Moderate	Poor	N/A
Maintaining Basic Needs (Food, Utilities, Housing)	*Select One: How would you rate the quality of the following services for you and your child in Broward County? [Excellent]-My needs are completely met in this area. \|\| [Moderate]-Some improvement is needed \|\| [Poor]-Help and improvement are needed in this area. \|\| [N/A]-Does not apply. Maintaining Basic Needs (Food, Utilities, Housing) Excellent	Maintaining Basic Needs (Food, Utilities, Housing) Moderate	Maintaining Basic Needs (Food, Utilities, Housing) Poor	Maintaining Basic Needs (Food, Utilities, Housing) N/A
Receiving Medical Care / Receiving Medical Equipment	Receiving Medical Care / Receiving Medical Equipment Excellent	Receiving Medical Care / Receiving Medical Equipment Moderate	Receiving Medical Care / Receiving Medical Equipment Poor	Receiving Medical Care / Receiving Medical Equipment N/A
Therapy / Health Insurance Needs / Medicaid Needs	Therapy / Health Insurance Needs / Medicaid Needs Excellent	Therapy / Health Insurance Needs / Medicaid Needs Moderate	Therapy / Health Insurance Needs / Medicaid Needs Poor	Therapy / Health Insurance Needs / Medicaid Needs N/A
Respite Care	Respite Care Excellent	Respite Care Moderate	Respite Care Poor	Respite Care N/A
Out of School Time / Day and After Care / Summer School	Out of School Time / Day and After Care / Summer School Excellent	Out of School Time / Day and After Care / Summer School Moderate	Out of School Time / Day and After Care / Summer School Poor	Out of School Time / Day and After Care / Summer School N/A
Parent Supports	Parent Supports Excellent	Parent Supports Moderate	Parent Supports Poor	Parent Supports N/A
Advocacy Services	Advocacy Services Excellent	Advocacy Services Moderate	Advocacy Services Poor	Advocacy Services N/A
Jobs / Transitional Supports	Jobs / Transitional Supports Excellent	Jobs / Transitional Supports Moderate	Jobs / Transitional Supports Poor	Jobs / Transitional Supports N/A
Education / Training / School Tutoring	Education / Training / School Tutoring Excellent	Education / Training / School Tutoring Moderate	Education / Training / School Tutoring Poor	Education / Training / School Tutoring N/A
Social / Recreational Needs	Social / Recreational Needs Excellent	Social / Recreational Needs Moderate	Social / Recreational Needs Poor	Social / Recreational Needs N/A

Comments

7. Compared to three years ago, my child has more opportunities and access to services.

Compared to three years ago, my child has more opportunities and access to services. Agree

Disagree

About the Same

8. Compared to three years ago, our community has become more accepting and accomodating to individuals with disabilities.

Compared to three years ago, our community has become more accepting and accomodating to individuals with disabilities. Agree

Disagree

About the Same

9. Thank you! Your opinion is important to us. May we contact you to follow-up on your answers to this survey or to help you find Special Needs resources? (*Local Broward numbers only) If yes, please leave your contact information below and a Special Needs Counselor will call you shortly. [Also, dial 2-1-1 (Monday-Friday) and ask to speak to the Special Needs Counselor for immediate assistance.]

Thank you! Your opinion is important to us. May we contact you to follow-up on your answers to this survey or to help you find Special Needs resources? (*Local Broward numbers only) If yes, please leave your contact information below and a Special Needs Counselor will call you shortly. [Also, dial 2-1-1 (Monday-Friday) and ask to speak to the Special Needs Counselor for immediate assistance.] Name:
Address:
Address 2:
City/Town:
ZIP/Postal Code:
Email Address:
Phone Number:

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