Survey of Experiences in Residential Treatment
 

1. Survey of Experiences in Residential Treatment

 
The purpose of this survey is to collect information directly from youth and adults who have experienced residential treatment as youth. We wish to understand more about how you view this experience and the impact it has had on your life so that we may both disseminate this information in our raising awareness campaigns and improve our local and national advocacy and educational efforts. This survey could take up to an hour to complete - if needed, you may take as many breaks as needed and return to the partially completed survey as long as you use the same computer and same browser. NOTE: Cookies must be enabled.

Near the end of the survey, we will provide you with the option of using your experience to take further action. You will be asked to reveal identifying information. The purpose of this disclosure will be used solely for us to contact you so that you may later decided if and how you would like to use your experience to advance the rights of youth. Under no circumstance will any of the identifying information submitted be tied to your response without you giving your written permission consenting to such disclosure for advocacy purposes.

POSSIBLE RISKS: For those who have had traumatic experiences while in residential placement, this survey may cause some distress as you recount your experiences. You are not alone. Please contact CAFETY to talk to a peer support volunteer at kat@cafety.org. If your symptoms persist and are disruptive to your life, please contact a mental health professional specializing in trauma. If you experience any desire to harm yourself or others please contact 911.

For more information on trauma and its effects please visit:

Factsheet:
http://www.trauma-pages.com/s/t-facts.php

Recovery from a Traumatic Event:
http://www.apa.org/helpcenter/recovering-disasters.aspx

General
http://www.trauma-pages.com/trauma.php

1. At completion of this survey you will become eligible for a CAFETY membership. You must provide us with your contact information, including your address and phone number either at the end of the survey or by completing CAFETY's volunteer form upon your completion of our survey http://www.cafety.org/volunteer

2. Please enter the number of residential programs you have attended:

3. Please enter the name of the residential programs you have attended from past to present:

4. Type of Program: (Check all that apply)

5. Dates attended, from past to present: (Example: May 1995-June 1996, Dec 2000 - June 2000)

6. Age Admitted, from past to present:

*
7. Please enter the name of the ONE program you will focus on for the purpose of the survey.

(From this point on, if you attended multiple programs, please choose only one to focus on and list the name below. If you would like to fill out a second survey about another program, you must log in from a different IP address. Please contact kat@cafety.org for more information.)

8. The City, State and Country in which the residential program was located:

9. The The City, State and Country in which you lived prior to placement, from past to present:

10. Who did you live with prior to placement? (Example: both parents, mother, father, foster care, with relatives, in another treatment program, group home, etc.)

11. Was the residential program regulated or licensed by the state?

12. Was the residential program a member of a trade organization such as National Association of Therapeutic and Programs (NATSAP) or American Association of Children's Residential Centers (AACRC)?

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