Profound Autism Information Gathering - Caregiver Question Title * 1. Are you the caregiver of a person with profound autism? Yes No If so, please provide the current age(s) of your loved ones with profound autism. Question Title * 2. Has your loved one with profound autism ever (select all that apply) Been denied access to services such as ABA, healthcare, respite, school, etc. because of their level of disability Been asked to leave a program because of their behavior Been denied the opportunity to participate in community programs (church, recreational activities, etc.) because of their level of disability Been detained, arrested, or incarcerated by law enforcement because of their behavior Been the subject/victim of an abuse, neglect, or exploitation (ANE) investigation Been a victim of or subjected to a traumatic event (unrelated to ANE) Other (please specify) Question Title * 3. Do you currently have any of the below services for your loved one with profound autism? Select all that apply. Applied Behavior Analysis Respite Day Program/Day Hab Residential/Group Home Crisis Services/Support Educational Other therapies (OT, ST, PT) Volunteer Opportunities in the Community Social Recreation (e.g trips to the movies, gym, theme parks, restaurants, sporting events, theatre, etc.) Employment Services Medical/Psychiatric Services Mental Health Services None Other (please specify) Question Title * 4. What services is your loved one missing or would you like for them to have more of? Select all that apply. Applied Behavior Analysis Respite Day Program/Day Hab Residential/Group Home Crisis Services/Support Educational Other therapies (OT, ST, PT) Volunteer Opportunities in the Community Social Recreation (e.g. movies, gym, theme parks, restaurants, sporting events, theatre, etc.) Employment Services Medical/Psychiatric Services Mental Health Services None Other (please specify) Question Title * 5. For services that your loved one is missing or that you would like for them to get more of, what is preventing them from accessing these services? Select all that apply. Private insurance will not cover Medicaid will not cover Transportation issues including parking costs, reliable vehicle, dependable driver, etc. There are no providers in my area Services do not accept individuals with profound autism Scheduling conflicts Other personal barriers for caregiver (medical or mental health concerns, negative past experience, cultural or religious reason, childcare for other children/dependents) I am fearful of the involvement of other agencies that could remove my loved one from my care such as Adult and/or Child and Family Protective Services or US Immigration and Customs Enforcement, ICE. My loved one with profound autism does not want to participate due to a negative past experience or other reason. I cannot afford to pay for the services out of pocket. My loved one's social security is not enough to pay for the service as well as their other needs. Other (please specify) Question Title * 6. At this time, on a scale of 1 – 10 (1 = extremely poor 10 = excellent), how would you rank your quality of life? 1 10 Clear i We adjusted the number you entered based on the slider’s scale. Thank you so much! Done