Parent Verification Survey: Part C of IDEA
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1
. Your Child's Age
Your Child's Age
*
2
. County Where You Live
Alameda
Alpine
Amador
Butte
Calaveras
Colusa
Contra Costa
Del Norte
El Dorado
Fresno
Glenn
Humboldt
Imperial
Inyo
Kern
Kings
Lake
Lassen
Los Angeles
Madera
Marin
Mariposa
Mendocino
Merced
Modoc
Mono
Monterey
Napa
Nevada
Orange
Placer
Plumas
Riverside
Sacramento
San Benito
San Bernardino
San Diego
San Francisco
San Joaquin
San Luis Obispo
San Mateo
Santa Barbara
Santa Clara
Santa Cruz
Shasta
Sierra
Siskiyou
Solano
Sonoma
Stanislaus
Sutter
Tehama
Trinity
Tulare
Tuolumne
Ventura
Yolo
Yuba
County Where You Live
3
. Ethnicity
African-American
American Indian
Asian-American
Caucasian
Hispanic
Mexican-American
Multiracial
Other (please specify)
Ethnicity
4
. I know how to get information about the early intervention services in my State (child find and referral, timely services, natural environments, transition, Individual Family Service Plan development, etc.).
I know how to get information about the early intervention services in my State (child find and referral, timely services, natural environments, transition, Individual Family Service Plan development, etc.).
Yes
No
5
. If yes, I can obtain the information from: (Please select all that apply)
If yes, I can obtain the information from: (Please select all that apply)
Website
State Agency or Local Early Intervention Program Staff Agency Staff
Parent Training Information center (e.g., Rowell Family Empowerment Center or Support For Families with Children with Disabilities)
Advocacy Group
Other (please specify)
6
. Within the last year, I received a copy of my rights under the Early Intervention Program for Infants and Toddlers with Disabilities for Part C of the Individuals with Disabilities Education Act (IDEA), the Federal special education law for providing early intervention services to infants and toddlers with disabilities and their families.
Within the last year, I received a copy of my rights under the Early Intervention Program for Infants and Toddlers with Disabilities for Part C of the Individuals with Disabilities Education Act (IDEA), the Federal special education law for providing early intervention services to infants and toddlers with disabilities and their families.
Yes
No
7
. If yes, who gave you this information? (Please select all that apply.)
If yes, who gave you this information? (Please select all that apply.)
Service Coordinator
Service Provider
Parent Center
Lead Agency
Other (please specify)
8
. If yes, was an explanation of your rights provided, if needed?
If yes, was an explanation of your rights provided, if needed?
Yes
No
NA
9
. Within the past year, I have asked for: (Please select all that apply.)
Within the past year, I have asked for: (Please select all that apply.)
Mediation
State Complaint
Resolution Session
Due Process Hearing
Other Dispute Resolution, including facilitated Individualized Family Service Plans
10
. Each of the concerns that I have raised in the State Complaint was addressed in the decision letter/letter of finding.
Each of the concerns that I have raised in the State Complaint was addressed in the decision letter/letter of finding.
Yes
No
11
. I have experienced or observed special education practices that I believe were not in compliance with Part C of IDEA.
I have experienced or observed special education practices that I believe were not in compliance with Part C of IDEA.
No
Don't know
Yes (Please Explain)
12
. Based on my experiences with the early intervention services in my State, I feel the areas that are most effective are: (Please select the top three.)
Based on my experiences with the early intervention services in my State, I feel the areas that are most effective are: (Please select the top three.)
Child Find and Referral (the process for finding children who qualify for services)
Evaluation/Assessment
Individualized Family Service Plans
Timely Early Intervention Services
Qualified Service Providers
Services in the Natural Environment
Other Community Based Services
Transition from Part C to Part B (transition from the infant/toddler program to preschool or other community-based settings)
Materials in Native Language
No Improvement Needed
Don't Know
Other (please specify)
13
. Please explain briefly:
Please explain briefly:
14
. Based on my experiences with the early intervention services in my State, I feel the areas that need most improvement are: (Select the top three.)
Based on my experiences with the early intervention services in my State, I feel the areas that need most improvement are: (Select the top three.)
Child Find and Referral (the process for finding children who qualify for services)
Evaluation/Assessment
Individualized Family Service Plans
Timely Early Intervention Services
Qualified Service Providers
Services in the Natural Environment
Other Community Based Services
Transition from Part C to Part B (transition from the infant/toddler program to preschool or other community-based settings)
Materials in Native Language
No Improvement Needed
Don't Know
Other (please specify)
15
. Please explain briefly
Please explain briefly
16
. My child receives services in his/her natural environments (i.e., home, child care, and other community-based settings).
My child receives services in his/her natural environments (i.e., home, child care, and other community-based settings).
Yes
No
Sometimes (Please explain)
17
. I know how to get the results of the U.S. Department of Education’s evaluation of my State’s performance under the federal early intervention laws and regulations (i.e., State’s Determination).
I know how to get the results of the U.S. Department of Education’s evaluation of my State’s performance under the federal early intervention laws and regulations (i.e., State’s Determination).
Yes
No
18
. My family is receiving the frequency and intensity of services as outlined in my infant’s or toddler’s Individualized Family Service Plan?
My family is receiving the frequency and intensity of services as outlined in my infant’s or toddler’s Individualized Family Service Plan?
Yes
No (Please explain)
19
. I think that the early intervention system in my State is providing the services and family supports that my child and family need.
I think that the early intervention system in my State is providing the services and family supports that my child and family need.
Yes
No (Please explain)
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