OTC Service Coordination Consumer Survey

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1. Are you a parent or guardian of a child with a disability?

Are you a parent or guardian of a child with a disability?   Yes No (If you answered no to this question, please exit survey now.)

2. Does your child with a disability receive services from the school and at least one agency outside the school? (Example: County social services, mental health agency, voc rehab, probation, foster care, chemical dependency, etc.)

Does your child with a disability receive services from the school and at least one agency outside the school? (Example: County social services, mental health agency, voc rehab, probation, foster care, chemical dependency, etc.)   Yes, my child receives services from more than one agency. No, my child only received services from the school district. If you answered no, please exit the survey now.

3. Please select all the terms below that you are familiar with:

Please select all the terms below that you are familiar with:   Service Coordination Interagency Coordination IIIP IEP

4. Has a casemanager offered the use of the IIIP document to your family?

Has a casemanager offered the use of the IIIP document to your family?   Yes No I am not familiar with the term IIIP.

5. Do you feel the agencies that provide services to your child work together to make things easier for you/your child?

Do you feel the agencies that provide services to your child work together to make things easier for you/your child?   Yes No Sometimes

6. If you answered "no" to question 5, please indicate all the reasons why you feel this does not happen.

If you answered "no" to question 5, please indicate all the reasons why you feel this does not happen.   My child's case manager has never offered to work together with other agencies. I do not want to share information about services my families receives from other agencies. Agencies seem unwilling/unable to work together.

Other (please specify):

7. How could agencies work together to better help families? (Check all that apply)

How could agencies work together to better help families? (Check all that apply)   Host and arrange meetings with other agencies at the same table. Develop a combined written plan with other agencies (IIIP). Make contacts with other agencies that are working with my family.

Other: (please be specific)

8. What services does your family currently receive? (check all that apply.)

What services does your family currently receive? (check all that apply.)   Special education County Social Services Probation Mental Health Public Health Chemical Dependency Vocational Rehabilitation Occupational Therapy or Physical Therapy

Other (please specify)

9. If classes where held to provide more information about how coordinated services might help my family I would attend.

If classes where held to provide more information about how coordinated services might help my family I would attend.   Yes No Maybe